Initiative of the Minister

for Population Welfare

SAFE MOTHER HOMES

Introduction
Proposal
Rationale
Goal
Objectives
Scope of Work
Expected Outcomes
Institutional Management
Unit Cost

Introduction:

Pakistan is the sixth most populous country in the world with a very high Maternal Mortality Ratio (MMR), Infant Mortality Rate (IMR), Population Growth Rate (PGR) and a low Contraceptive Prevalence Rate (CPR). Obstetric health-care facilities are scattered (10-20 km) away from health-care services and have a dominant trend towards home deliveries (around 80%) conducted by Traditional Birth Assistants (TBAs/Dias) without caring for safe delivery practices. These unsafe deliveries lead to post-natal complications leading to high mortality and morbidity of mothers and children. Most of these women are not informed / motivated for adoption of Family Planning services and thereby increase the chances of repeated and un-wanted pregnancies. According to the UNFPA’s report, after every 20 minutes in Pakistan, a woman dies from pregnancy and pregnancy related complications.

Further, Pakistan is a signatory to the International Conference on Population and Development (ICPD) held in 1994 and Millennium Development Goals (MDGs) and therefore bound to provide quality health and Family Planning / Reproductive Health (FP/RH) care to reduce MMR, IMR and PGR, and to increase CPR. As per ICPD-plan of Action (PoA), couples have the right to seek high quality medical care for ensuring safe delivery services and obtain information and have access to quality FP/ RH care. The couples also have the right to a variety of contraceptive method mix.

Given that, there is a dire need for strengthening linkages between the community and health-care facilities for conducting safe deliveries followed by provision of quality FP / RH services at one stop.

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Proposal:

Family Welfare Centre (FWC) is the cornerstone of Pakistan’s Population Welfare Programme. It constitutes the most extensive institutional network in the country to promote and deliver family planning services in the urban and rural areas. FWC operates in a rented building or in a Public Private Sector Organization where two separate rooms are available. It serves as a static facility to about 7,000 people, whereas operating through its satellite clinics and outreach facilities it covers a population of around 12,000. The scope of work of FWC includes provision of Family Planning and Maternal and Child Health (MCH) services and related Reproductive Health issues.

To establish Two (02) Safe Mother Homes in the rural areas, one in Punjab/ Sialkot and the other in Sindh/ Tando Allah Yar on pilot basis. After its evaluation and successful experience it will be replicated across the country @ one SMH per district. A cluster of FWCs and other service delivery outlets of the programme in the municipal limits of the district will serve as the feeding units for the “Safe Mother Home” located in that area.

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Rationale:

To combat the challenges poised to Safe Motherhood that is high maternal, infant and child mortality, the Ministry of Population Welfare is striving to reduce the unmet need through scaling up of the requisite services through its network of service outlets.
Pakistan being signatory to the ICPD’s plan of action for Pakistan to implement the Reproductive Health Package comprising nine components which amongst other include safe motherhood and comprehensive family planning services. In addition to that, compliment the efforts of Health Sector in timely accomplishment of Millennium Development Goals, 4 & 5 in particular.
Accordingly a proposal to establish Safe Mother Homes has been formulated to ensure Safe Delivery Services for improving the maternal and neonatal outcomes at door steps in underserved areas, where no such services are available.
Under the scheme the burden of clients on tertiary level facilities would be lessened. In addition, the services would be provided at the door steps of the communities to avert the “Three Delays” and avoid wastage of resources spent in terms of time and mobilization.

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Objectives:

· To decrease Maternal Mortality Ratio (MMR), through extension of Reproductive Health and Comprehensive Family Planning Services.

· To offer safe delivery services at the door-steps of marginalized communities.

· To decrease neonatal and Infant Mortality Rate through prompt referral / transportation to appropriate Health facility.

· To increase Contraceptive Prevalence Rate (CPR), decrease Total Fertility Rate (TFR) and Population Growth Rate (PGR).

· To extend services for Pre and Post Abortion Care and thus avoid their complications.

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Scope of Work:

All the Service Delivery Outlets of Population Welfare Programme within the Municipal limits of the District/ Area will serve as the feeding units of “Safe Mother Home” for quality antenatal services, safe delivery and post natal care.
The complicated cases identified during routine antenatal care will be referred to an appropriate health facility.
Similarly high risk cases with anticipated problems during parturition will be referred to hospitals through a prompt and effective referral linkage with the Health Sector/ Department.
Neonatal problem identified after delivery would also be referred to Hospitals. However, routine infant health care like feeding advice and immunization services will be available at Safe Mother Homes.

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Expected Outcomes:

This initiative will supplement the efforts of Health Sector in improving :

• Maternal Mortality Ratio

• Infant Mortality Rate

• Antenatal, Peri-natal and Postnatal Care

• Post-abortion Care to avoid complications

• Meet the unmet need for FP / RH

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Institutional Management:

During the pilot phase, the project will be executed from the federal level, however, Provincial Population Welfare Departments (PPWDs) will implement the project. The funds will be transferred to PPWDs as grant from federal PSDP. PC-1 of the Project is being prepared by Directorate of FWC, MoPW, Islamabad.

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unit cost:

The anticipated cost of one Safe Mother Home (SMH) will be around Rs. 15.000 Million.

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