Jpma Journal of the Pakistan Medical Association, Mar 1, 2014
Despite being ranked 3rd among the countries having highest burden of stillbirths, it remains a n... more Despite being ranked 3rd among the countries having highest burden of stillbirths, it remains a neglected priority in Pakistan. We review the evidence regarding social and biomedical understanding of stillbirths by both communities and healthcare providers. The terminology used to define stillbirth worldwide remains inconsistent. Not only do the health professionals mis-classify and under-report stillbirths, but also the parents and families are unclear about the difference between miscarriage, stillbirth and early neonatal deaths. Stillbirths occur more in poor families and are not recognised by tradition and religion as a loss comparable to a newborn who was born alive. There is need to understand perspective of communities and healthcare providers to identify prevention and management strategies along with providing support for coping with the implications of stillbirths. Future government policies on stillbirths must be informed by the influence of culture on the attitudes, beliefs and practices of the communities and the healthcare providers.
Background
Pakistan’s Maternal, Newborn and Child Health (MNCH) Program is faced with multiple c... more Background
Pakistan’s Maternal, Newborn and Child Health (MNCH) Program is faced with multiple challenges in service delivery, financial and logistic management, training and deployment of human resources, and integration within the existing health system. There is a lack of evidence on managerial aspects of the MNCH program management and implementation.
Methods and Findings
This study used qualitative methods to explore the challenges national, provincial and district program managers have faced in implementing a community midwifery program in province of Punjab while also exploring future directions for the program under a devolved health system. While the program had been designed in earnest, the planning lacked critical elements of involving relevant stakeholders in design and implementation, socio-demographic context and capacity of the existing health system. Financial limitations, weak leadership and lack of a political commitment to the problem of maternal health have also had an impact on program implementation.
Conclusions
Our study results suggest that there is a need to re-structure the program while ensuring sustainability and collaboration within the health sector to increase uptake of skilled birth attendance and improve maternal health care in Pakistan.
Background: Maternal mortality ratio in Pakistan remains high at 276 per 100000 live births (175 ... more Background: Maternal mortality ratio in Pakistan remains high at 276 per 100000 live births (175 in the urban areas and 319 in rural) with a mother dying as a result of giving birth every 20 minutes. Despite the intervening years since the Safe Motherhood Initiative launch and the Millennium Development Goals (MDGs), there have been few improvements in MDGs 4 and 5 in Pakistan. A key underlying reason is that only 39% of the births are attended by skilled birth attendants. Pakistan, like many other developing countries has been struggling to make improvements in maternal and neonatal health, amongst other measures, which include a nationwide health infrastructure network. Recently, government of Pakistan revised its maternal and newborn health program and introduced a new cadre of community based birth attendants, called community midwives (CMW), trained to conduct home-based deliveries. There is limited research available on field experiences of community midwives as maternal health care providers. Formative research was designed and conducted in a rural district of Pakistan with the objective of exploring role of CMWs as home based skilled service providers and the challenges they face in provision of skilled maternal care. Methods: A qualitative research using content analysis was conducted in one rural district (Attock) of Pakistan. Focus group discussions were conducted with CMWs and other community based health workers as LHWs and LHSs, focusing on the role of CMWs in the existing primary health care infrastructure. Results: Results of this study reveal that the community midwives are struggling for survival in rural areas as maternal care providers as they are inadequately trained, lack sufficient resources to deliver services in their catchment areas and lack facilitation for integration in district health system. Conclusions: CMWs face many challenges in the field related to the communities' attitude and the health system. With adequate training and facilitation by health department, CMWs have potential to play a vital role in reducing burden of maternal morbidity and in achieving significant gains in improving maternal and child health.
Married young women's reproductive needs are a challenge in traditional Pakistani society. Th... more Married young women's reproductive needs are a challenge in traditional Pakistani society. The decisions regarding family planning and pregnancy are controlled by the family, often involving complex negotiations. The current study was undertaken to explore how young married women's involvement in the arrangements surrounding their marriage is associated with their ability to negotiate sexual and reproductive health decisions in marriage. The study explores the associations between young women's involvement in their marriage arrangements and their ability to negotiate for contraceptive use and fertility decisions. A subset of 1,803 married young women aged 15-24 years was drawn from a nationally representative adolescent and youth survey conducted in Pakistan in 2001-2002 by the Population Council. Regression models were fitted to outcomes: reported agreement with spouse on the number of children to have, current use of contraceptives, intention to use contraceptives in t...
Eastern Mediterranean health journal = La revue de santé de la Méditerranée orientale = al-Majallah al-ṣiḥḥīyah li-sharq al-mutawassiṭ, 2005
We used acute flaccid paralysis surveillance data collected between 1 January 2001 and 31 Decembe... more We used acute flaccid paralysis surveillance data collected between 1 January 2001 and 31 December 2003 from the Pakistan Polio Eradication Initiative to describe the epidemiological characteristics and disease burden of traumatic injection neuropathy among children aged under 15 years. Of the 5627 acute flaccid paralysis cases reported, 456 were identified as traumatic injection neuropathy by case review. The condition was more common in younger children who were also more likely to have persistent paralysis. We estimate that the annual incidence of traumatic injection neuropathy rate in Pakistan is 7.1 per 1 000 000 in children under 3 years old.
JPMA. The Journal of the Pakistan Medical Association, 2014
Despite being ranked 3rd among the countries having highest burden of stillbirths, it remains a n... more Despite being ranked 3rd among the countries having highest burden of stillbirths, it remains a neglected priority in Pakistan. We review the evidence regarding social and biomedical understanding of stillbirths by both communities and healthcare providers. The terminology used to define stillbirth worldwide remains inconsistent. Not only do the health professionals mis-classify and under-report stillbirths, but also the parents and families are unclear about the difference between miscarriage, stillbirth and early neonatal deaths. Stillbirths occur more in poor families and are not recognised by tradition and religion as a loss comparable to a newborn who was born alive. There is need to understand perspective of communities and healthcare providers to identify prevention and management strategies along with providing support for coping with the implications of stillbirths. Future government policies on stillbirths must be informed by the influence of culture on the attitudes, beli...
Many low and middle income countries lack the human resources needed to deliver essential health ... more Many low and middle income countries lack the human resources needed to deliver essential health interventions. A health care system with a limited number of nurses cannot function effectively. Although the recommended nurse to doctor ratio is 4:1, the ratio in Pakistan is reversed, with 2.7 doctors to one nurse. A qualitative study using narrative analysis was undertaken in public and private tertiary care hospitals in Pakistan to examine and compare job satisfaction among nurses and understand the factors affecting their work climate. Interactive interviews were conducted with nurses working with inpatients and outpatients. All of the respondents had joined the profession by choice and were supported by their families in their decision to pursue their career, but now indicated that they were dissatisfied with their jobs. Three types of narratives were identified, namely, "Working in the spirit of serving humanity", "Working against all odds", and "Working in a functional system and facing pressures of increased accountability". Nurses working in a public sector hospital are represented in the first two narrative types, whereas the third represents those working in a private sector hospital. The first narrative represents nurses who were new in the profession and despite hard working conditions were performing their duties. The second narrative represents nurses working in the public sector with limited resources, and the third narrative is a representation of nurses who were working hard and stressed out despite a well functioning system. The study shows that the presence of a well trained health workforce is vital, and that certain aspects of its organization are key, including numbers (available quantity), skill mix (health team balance), distribution (urban/rural), and working conditions (compensation, nonfinancial incentives, and workplace safety). This study has identified the need to reform policies for retaining the nursing workforce. Simple measures requiring better management practices could substantially improve the working environment and hence retention of nurses.
Jpma Journal of the Pakistan Medical Association, Mar 1, 2014
Despite being ranked 3rd among the countries having highest burden of stillbirths, it remains a n... more Despite being ranked 3rd among the countries having highest burden of stillbirths, it remains a neglected priority in Pakistan. We review the evidence regarding social and biomedical understanding of stillbirths by both communities and healthcare providers. The terminology used to define stillbirth worldwide remains inconsistent. Not only do the health professionals mis-classify and under-report stillbirths, but also the parents and families are unclear about the difference between miscarriage, stillbirth and early neonatal deaths. Stillbirths occur more in poor families and are not recognised by tradition and religion as a loss comparable to a newborn who was born alive. There is need to understand perspective of communities and healthcare providers to identify prevention and management strategies along with providing support for coping with the implications of stillbirths. Future government policies on stillbirths must be informed by the influence of culture on the attitudes, beliefs and practices of the communities and the healthcare providers.
Background
Pakistan’s Maternal, Newborn and Child Health (MNCH) Program is faced with multiple c... more Background
Pakistan’s Maternal, Newborn and Child Health (MNCH) Program is faced with multiple challenges in service delivery, financial and logistic management, training and deployment of human resources, and integration within the existing health system. There is a lack of evidence on managerial aspects of the MNCH program management and implementation.
Methods and Findings
This study used qualitative methods to explore the challenges national, provincial and district program managers have faced in implementing a community midwifery program in province of Punjab while also exploring future directions for the program under a devolved health system. While the program had been designed in earnest, the planning lacked critical elements of involving relevant stakeholders in design and implementation, socio-demographic context and capacity of the existing health system. Financial limitations, weak leadership and lack of a political commitment to the problem of maternal health have also had an impact on program implementation.
Conclusions
Our study results suggest that there is a need to re-structure the program while ensuring sustainability and collaboration within the health sector to increase uptake of skilled birth attendance and improve maternal health care in Pakistan.
Background: Maternal mortality ratio in Pakistan remains high at 276 per 100000 live births (175 ... more Background: Maternal mortality ratio in Pakistan remains high at 276 per 100000 live births (175 in the urban areas and 319 in rural) with a mother dying as a result of giving birth every 20 minutes. Despite the intervening years since the Safe Motherhood Initiative launch and the Millennium Development Goals (MDGs), there have been few improvements in MDGs 4 and 5 in Pakistan. A key underlying reason is that only 39% of the births are attended by skilled birth attendants. Pakistan, like many other developing countries has been struggling to make improvements in maternal and neonatal health, amongst other measures, which include a nationwide health infrastructure network. Recently, government of Pakistan revised its maternal and newborn health program and introduced a new cadre of community based birth attendants, called community midwives (CMW), trained to conduct home-based deliveries. There is limited research available on field experiences of community midwives as maternal health care providers. Formative research was designed and conducted in a rural district of Pakistan with the objective of exploring role of CMWs as home based skilled service providers and the challenges they face in provision of skilled maternal care. Methods: A qualitative research using content analysis was conducted in one rural district (Attock) of Pakistan. Focus group discussions were conducted with CMWs and other community based health workers as LHWs and LHSs, focusing on the role of CMWs in the existing primary health care infrastructure. Results: Results of this study reveal that the community midwives are struggling for survival in rural areas as maternal care providers as they are inadequately trained, lack sufficient resources to deliver services in their catchment areas and lack facilitation for integration in district health system. Conclusions: CMWs face many challenges in the field related to the communities' attitude and the health system. With adequate training and facilitation by health department, CMWs have potential to play a vital role in reducing burden of maternal morbidity and in achieving significant gains in improving maternal and child health.
Married young women's reproductive needs are a challenge in traditional Pakistani society. Th... more Married young women's reproductive needs are a challenge in traditional Pakistani society. The decisions regarding family planning and pregnancy are controlled by the family, often involving complex negotiations. The current study was undertaken to explore how young married women's involvement in the arrangements surrounding their marriage is associated with their ability to negotiate sexual and reproductive health decisions in marriage. The study explores the associations between young women's involvement in their marriage arrangements and their ability to negotiate for contraceptive use and fertility decisions. A subset of 1,803 married young women aged 15-24 years was drawn from a nationally representative adolescent and youth survey conducted in Pakistan in 2001-2002 by the Population Council. Regression models were fitted to outcomes: reported agreement with spouse on the number of children to have, current use of contraceptives, intention to use contraceptives in t...
Eastern Mediterranean health journal = La revue de santé de la Méditerranée orientale = al-Majallah al-ṣiḥḥīyah li-sharq al-mutawassiṭ, 2005
We used acute flaccid paralysis surveillance data collected between 1 January 2001 and 31 Decembe... more We used acute flaccid paralysis surveillance data collected between 1 January 2001 and 31 December 2003 from the Pakistan Polio Eradication Initiative to describe the epidemiological characteristics and disease burden of traumatic injection neuropathy among children aged under 15 years. Of the 5627 acute flaccid paralysis cases reported, 456 were identified as traumatic injection neuropathy by case review. The condition was more common in younger children who were also more likely to have persistent paralysis. We estimate that the annual incidence of traumatic injection neuropathy rate in Pakistan is 7.1 per 1 000 000 in children under 3 years old.
JPMA. The Journal of the Pakistan Medical Association, 2014
Despite being ranked 3rd among the countries having highest burden of stillbirths, it remains a n... more Despite being ranked 3rd among the countries having highest burden of stillbirths, it remains a neglected priority in Pakistan. We review the evidence regarding social and biomedical understanding of stillbirths by both communities and healthcare providers. The terminology used to define stillbirth worldwide remains inconsistent. Not only do the health professionals mis-classify and under-report stillbirths, but also the parents and families are unclear about the difference between miscarriage, stillbirth and early neonatal deaths. Stillbirths occur more in poor families and are not recognised by tradition and religion as a loss comparable to a newborn who was born alive. There is need to understand perspective of communities and healthcare providers to identify prevention and management strategies along with providing support for coping with the implications of stillbirths. Future government policies on stillbirths must be informed by the influence of culture on the attitudes, beli...
Many low and middle income countries lack the human resources needed to deliver essential health ... more Many low and middle income countries lack the human resources needed to deliver essential health interventions. A health care system with a limited number of nurses cannot function effectively. Although the recommended nurse to doctor ratio is 4:1, the ratio in Pakistan is reversed, with 2.7 doctors to one nurse. A qualitative study using narrative analysis was undertaken in public and private tertiary care hospitals in Pakistan to examine and compare job satisfaction among nurses and understand the factors affecting their work climate. Interactive interviews were conducted with nurses working with inpatients and outpatients. All of the respondents had joined the profession by choice and were supported by their families in their decision to pursue their career, but now indicated that they were dissatisfied with their jobs. Three types of narratives were identified, namely, "Working in the spirit of serving humanity", "Working against all odds", and "Working in a functional system and facing pressures of increased accountability". Nurses working in a public sector hospital are represented in the first two narrative types, whereas the third represents those working in a private sector hospital. The first narrative represents nurses who were new in the profession and despite hard working conditions were performing their duties. The second narrative represents nurses working in the public sector with limited resources, and the third narrative is a representation of nurses who were working hard and stressed out despite a well functioning system. The study shows that the presence of a well trained health workforce is vital, and that certain aspects of its organization are key, including numbers (available quantity), skill mix (health team balance), distribution (urban/rural), and working conditions (compensation, nonfinancial incentives, and workplace safety). This study has identified the need to reform policies for retaining the nursing workforce. Simple measures requiring better management practices could substantially improve the working environment and hence retention of nurses.
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Papers by Saima Hamid
Pakistan’s Maternal, Newborn and Child Health (MNCH) Program is faced with multiple challenges in service delivery, financial and logistic management, training and deployment of human resources, and integration within the existing health system. There is a lack of evidence on managerial aspects of the MNCH program management and implementation.
Methods and Findings
This study used qualitative methods to explore the challenges national, provincial and district program managers have faced in implementing a community midwifery program in province of Punjab while also exploring future directions for the program under a devolved health system. While the program had been designed in earnest, the planning lacked critical elements of involving relevant stakeholders in design and implementation, socio-demographic context and capacity of the existing health system. Financial limitations, weak leadership and lack of a political commitment to the problem of maternal health have also had an impact on program implementation.
Conclusions
Our study results suggest that there is a need to re-structure the program while ensuring sustainability and collaboration within the health sector to increase uptake of skilled birth attendance and improve maternal health care in Pakistan.
and 319 in rural) with a mother dying as a result of giving birth every 20 minutes. Despite the intervening years
since the Safe Motherhood Initiative launch and the Millennium Development Goals (MDGs), there have been few
improvements in MDGs 4 and 5 in Pakistan. A key underlying reason is that only 39% of the births are attended by
skilled birth attendants. Pakistan, like many other developing countries has been struggling to make improvements
in maternal and neonatal health, amongst other measures, which include a nationwide health infrastructure
network. Recently, government of Pakistan revised its maternal and newborn health program and introduced a new
cadre of community based birth attendants, called community midwives (CMW), trained to conduct home-based
deliveries. There is limited research available on field experiences of community midwives as maternal health care
providers. Formative research was designed and conducted in a rural district of Pakistan with the objective of
exploring role of CMWs as home based skilled service providers and the challenges they face in provision of skilled
maternal care.
Methods: A qualitative research using content analysis was conducted in one rural district (Attock) of Pakistan.
Focus group discussions were conducted with CMWs and other community based health workers as LHWs and
LHSs, focusing on the role of CMWs in the existing primary health care infrastructure.
Results: Results of this study reveal that the community midwives are struggling for survival in rural areas as
maternal care providers as they are inadequately trained, lack sufficient resources to deliver services in their
catchment areas and lack facilitation for integration in district health system.
Conclusions: CMWs face many challenges in the field related to the communities' attitude and the health system.
With adequate training and facilitation by health department, CMWs have potential to play a vital role in reducing
burden of maternal morbidity and in achieving significant gains in improving maternal and child health.
Pakistan’s Maternal, Newborn and Child Health (MNCH) Program is faced with multiple challenges in service delivery, financial and logistic management, training and deployment of human resources, and integration within the existing health system. There is a lack of evidence on managerial aspects of the MNCH program management and implementation.
Methods and Findings
This study used qualitative methods to explore the challenges national, provincial and district program managers have faced in implementing a community midwifery program in province of Punjab while also exploring future directions for the program under a devolved health system. While the program had been designed in earnest, the planning lacked critical elements of involving relevant stakeholders in design and implementation, socio-demographic context and capacity of the existing health system. Financial limitations, weak leadership and lack of a political commitment to the problem of maternal health have also had an impact on program implementation.
Conclusions
Our study results suggest that there is a need to re-structure the program while ensuring sustainability and collaboration within the health sector to increase uptake of skilled birth attendance and improve maternal health care in Pakistan.
and 319 in rural) with a mother dying as a result of giving birth every 20 minutes. Despite the intervening years
since the Safe Motherhood Initiative launch and the Millennium Development Goals (MDGs), there have been few
improvements in MDGs 4 and 5 in Pakistan. A key underlying reason is that only 39% of the births are attended by
skilled birth attendants. Pakistan, like many other developing countries has been struggling to make improvements
in maternal and neonatal health, amongst other measures, which include a nationwide health infrastructure
network. Recently, government of Pakistan revised its maternal and newborn health program and introduced a new
cadre of community based birth attendants, called community midwives (CMW), trained to conduct home-based
deliveries. There is limited research available on field experiences of community midwives as maternal health care
providers. Formative research was designed and conducted in a rural district of Pakistan with the objective of
exploring role of CMWs as home based skilled service providers and the challenges they face in provision of skilled
maternal care.
Methods: A qualitative research using content analysis was conducted in one rural district (Attock) of Pakistan.
Focus group discussions were conducted with CMWs and other community based health workers as LHWs and
LHSs, focusing on the role of CMWs in the existing primary health care infrastructure.
Results: Results of this study reveal that the community midwives are struggling for survival in rural areas as
maternal care providers as they are inadequately trained, lack sufficient resources to deliver services in their
catchment areas and lack facilitation for integration in district health system.
Conclusions: CMWs face many challenges in the field related to the communities' attitude and the health system.
With adequate training and facilitation by health department, CMWs have potential to play a vital role in reducing
burden of maternal morbidity and in achieving significant gains in improving maternal and child health.