Pakistan: Nowshera Health Centre

Nowshera Health Centre April-September 2015 Report

November 23, 2015

Shift from quarterly reporting to six-monthly reporting
The regular quarterly reporting mechanism was brought to a temporary halt after the 2nd quarter of 2015 came to a close in June 2015. Following the 10-day Monitoring and Evaluation exercise conducted in the first quarter of this year, a series of meetings were held with the field staff and the head office and conclusion was to introduce a new working order that will increase work output and streamline efficiency of reporting mechanism from the field office to the head office. The new order was developed over 3 weeks and brought into effect by 15th June 2015. Hence it was decided to withhold the release of the second morbidity report and merge it with the third morbidity report to be presented as a consolidated six monthly report
Morbidity Report from 1st April to 30th September 2015
In the six months from April to September 2015, a total of 5,265 women and children frequented our women-only MCH center during OPD hours. The percentage distribution between women and children is 62.4 % and 37.6% respectively.
MCH Statistics: Antenatal services were sought by 1,615 women while 254 women came for post-natal checkups. None of these women chose to deliver in our health setting instead a majority were home delivered by local traditional birth attendants. Family planning services, as usual, was the least sought for service and provided to only 79 women. On the same note, only 45 women sought advice and guidance for both primary and secondary infertility issues.

(chart) Distribution of Types of MCH Services Provided

The Gynecology/Obstetrics category covered the following pathologies which were provided to 1,429 women. They include

Gynecological Pathologies Presentation  
Amenorrhea 67
Dysmenorrhea 134
Leucorrhea 359
P/V Discharge 75
P/V Bleeding 89
Ovarian Cyst 34
Irregular Period 401
Polymenorrhagia 67
PID (pelvic Inflammatory Disease) 187
Fibroids 16
Total 1,429

Primary Health Statistics: The number of primary health cases presented at our center totaled to 2,908 women and children. Many women who sought MCH services often presented with other ailments that fell into this category. Over these six months of summer, the most common complaint was diarrhea (26.3%), followed by dyspepsia and vomiting in equal distribution (14.1%).  As usual anemia (13.3%) came as the third most common complaint, congruent with the poor diet of these IDPs but this time with respiratory ailments at the same rate.  Other ailments presented were:

Primary Health Presentation  
Anemia 388
Abdominal Pain 68
Respiratory Tract Infections 387
Enteric Fever (Typhoid) 80
Dyspepsia 411
Vomiting 410
Scabies 67
Food Poisoning 16
Urinary Tract Infections 125
Hypertension 108
Suspected Meningitis 0
Burns / Trauma / Injury 12
Acute Appendicitis 0
Jaundice 3
General body aches and weakness 66
Diarrhea 766
Total 2,908
Pathology Lab Statistics: The pathology lab conducted a total of 1,138 routine investigative tests over this six-month period.  The table below shows the breakdown

Lab Test Performed from 1st April to September 30th t  2015  
Pregnancy Urine Test 251
Urine Routine Examination 139
Blood Grouping 154
Blood Hb 315
Blood Glucose 79
Vidal Test 81
Blood Malarial Parasite (MP) 59
RA Factor 38
Toxoplasma 19
Total Test 1,138

Ultrasound Investigations: This is our first anniversary of our ultrasound services to our patients and the statistics have shown an increasing trend of utilization. We are the only not-for-profit primary health care facility, in the vicinity of this Union Council of Taru Jabba as well as the surrounding 5 Union Councils. Other NGO primary health centers refer their patients to us. What is interesting is that the government based health facilities also refer women to us because their ultrasound facilities, although present, are often broken down and repair takes a long bureaucratic route to materialize. Pregnant women referred to us usually choose to have an ante-natal checkup along with the ultrasound. A total of 590 women utilized the ultrasound services and the investigations conducted were as follows:

Ultrasound investigations 1st April to September 30th 2015  
Ultrasound for antenatal check up 868
Ultrasound abdomen only 64
Ultrasound pelvis only 212
Ultrasound abdomen and pelvis 98
Ultrasound for fatty liver 14
Total 1,256

Introduction of new protocols:
Our third-party evaluation conducted in the first quarter of this year highlighted several points that indicated that our standard operation protocols (SOPs) needed a revision as they were not capturing the complete picture of the operation of this health center. Also the internal quality checks systems and the internal M&E protocols were lacking. In addition, the evaluation report recommended that the fullest potential of the health center was not being utilized effectively and needed revisiting.
A one-day meeting was held in Islamabad with the RMF Nowshera field staff and the head office staff. All points made in the evaluation were discussed in detail and explanations sought. Then suggestions for upgrading or changing of protocols were taken up and brainstormed until a consensus was reached. The new SOPs were agreed upon and validated by the Country Director. They were put into operation with immediate effect.