Keeping with
its vision of a vibrant and healthy Karachi, the Aman Foundation has created a
three-pronged healthcare eco-system in the form of Aman Health Care Services
(AHCS). AHCS conducts outreach initiatives targeted toward essential healthcare
issues, with a focus on mother & child health. A grand ceremony was
recently held at a local hotel in Karachi to highlight the aims and objectives
of this initiative.
The core
components of this strategy are to bring care to the home of the most
vulnerable, to provide care during transfer and the establishment of accessible
healthcare facilities for mothers and children. The at-home component is
delivered by AmanTelehealth and Aman Community Health Program (ACHP), the
latter contributing to health promotion and disease prevention at home through
its cadre of community health workers (CHWs). The Aman Ambulance delivers the
en-route component through the provision of high quality and timely ambulance
services. A network of low-cost and high quality Mother& Child hospitals is
also planned for the near future.
‘Sukh ’, means
peace and tranquility, and it is a sign of a happy family. The goal of Sukh
Initiative is to increase modern contraceptive usage by 15 percentage points in
selected, underserved, 1 million peri-urban communities from 4 towns of Karachi,
namely Bin Qasim, Korangi, Landhi & Malir. The focus lies on young, newly
wedded and low-parity (1 to 2 children) couples. In the context to Pakistan,
this will translate in improving maternal and neonatal health by reducing
unintended pregnancies.
Pakistan has
one of the highest rates of maternal, peri-natal and child mortality recorded
internationally. Karachi, the largest urban centre of the country accommodates
a total of 18 million inhabitants, with 60 per cent of its population living in
katchi abadis (slums) often without proper water or sanitation systems.
AHCS has
structured the Program Management Unit (PMU) to ensure the success of the
program. PMU delivers its role by providing coordination mechanisms among all
project stakeholders and by developing and managing program monitoring systems.
It also works in liaison with advocacy partners to enable program
sustainability.
The Sukh
Initiative has emerged out of commitments made at the London Summit held in July
2012 and is a joint partnership between three Foundations, Aman Foundation,
Bill & Melinda Gates Foundation and The David and Lucile Packard
Foundation. Sukh Initiative is positioned to improve the health of mothers and
children by appropriate spacing of pregnancies and by expanding access and
quality of both information and services. The Initiative implements a menu of services
to address barriers to contraceptive use. This menu of interventions include:
door-to-door counseling for mobilization, provision of call center support for
referrals and follow-ups, and reaching out to young boys and girls through
family life education with an objective to make them responsible adults. The
strengthening of both public and private sector FP health facilities is to
improve quality of services. The activities are guided by program measurement
and assessment at various stages.
THE SUKH
BASELINE
The baseline
report summarises findings from the household survey and qualitative assessment
conducted within Sukh project area. For the Quantitative Survey component of
the report, a total of 5,340 married women in the reproductive age group of
15-49 years were interviewed, however data were analyzed for responses of 5,140
women. For Qualitative assessment, 60 focus group discussions were held, with
8-10 participants in each group. These included men, women, boys and girls. 17
key informant interviews were also conducted with stakeholders at program and
community level.
The median age
of the sampled women for Quantitative survey was 30 years (IQR 25-35year). The
majority of the women were in the age group of 20-34 years (67.4%). About 64%
women had formal education whereas 36% women had never attended a school.
The findings
of the survey identified the existence of teenage marriages and pregnancies
with 4% of married women of reproductive age (MWRAs) in the sample population
falling in the 15-19 age bracket. Of the women pregnant
at the time of interview, almost a quarter of them reported their current
pregnancy as unplanned. These women were found to be at increased risk due to
unsafe abortions.
The data
revealed that although knowledge of modern contraceptives is high, their usage
is low. The wide difference in proportion of ever users (69%) and current users
(42%) suggests high discontinuation rate for contraceptive use (27 percentage
points). Approximately 46% of all women who started family planning but
discontinued later were in the age group of 20-29 years. More than 60% of
discontinued users had no schooling or primary level education. 57.4% of all
discontinued users had parity between one to three children. 32% of the women
reported having had an abortion with only 31% going for post abortion family
planning counseling.
These results
suggest that there is a large gap in the family planning related demand, supply
and in provision of quality services. Women were generally using less effective
contraceptive methods, with contraceptive prevalence rate for modern methods being
low. The solution levers for Sukh Initiative aim to address many of these gaps
especially through door-to-door services, tele-health services and enhancing
availability and quality of FP services.
WAY FORWARD
Sukh
Initiative is now providing services in light of these findings and in conjunction
with its project partners. The project works in close coordination with the
Government of Sindh through their Population Welfare Department and the
Departments of Health and Education respectively. The cadre of Community Health Workers (CHWs)
for Sukh has been trained by the Lady Health Workers (LHW) Program, with a
potential for their induction by the LHW program upon project completion. Sukh
is also actively engaging in the uplift and upgradation of public health
facilities and services, with an eye on project impact sustainability. The Family Life Education (FLE) component of
the program, aimed at youth, is now also being inducted in school curricula by
the Sindh Government.
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