Pakistan

Agra Hospital Supporting Primary and Maternal/Child Health

July 17, 2013

Project Background:

The unprecedented monsoon rains of 2010 caused devastating floods that affected up to 20 million people in Pakistan in what is now officially recognized as one of the country’s worst natural disasters in scale. Continuous, relentless rains led to repeated surges of flood water along the Indus River and its tributaries from the mountains and valleys of the North to the agricultural plains of Central and South Pakistan affecting an estimated 70 districts in the provinces of Khyber Pakhtunkhwa (KPK), Punjab, Sindh, Baluchistan, Gilgit-Baltistan (GB), and Azad Jammu Kashmir (AJK).

The inundation caused devastation and damage to communities, homes (estimates of 1.2 million households), infrastructure (roads, bridges, railway networks, and dams), communications, health and education facilities, livestock, agricultural crops, shops and workplaces, and livelihoods in general. An estimated 8 million people were in need of assistance and around 800,000 became internally displaced persons (IDPs) as they shifted to higher plains to seek refuge in tent camps set up by the government. According to the United Nations the scale of Pakistan's flood disaster was worse than the 2004 Asian tsunami and the 2010 Haiti earthquake combined.

The province of KPK was the most severely affected in terms of destruction where massive damage to infrastructure and property was sustained. Against a backdrop of recurrent natural and man-made calamities in this province – including the protracted fighting and mass displacement witnessed in 2009 due to the Taliban invasion of Swat – the long term effects of the floods threaten to entrench food insecurity and poverty in KPK. Within KPK, District Charsadda is one of the worst affected because of its close proximity to the Kabul and Indus Rivers; some Union Councils remained inundated with water for several weeks after the rains stopped.

Post floods, the most pressing needs were clean water, food, shelter, healthcare and sanitation. Given that many healthcare services outlets have themselves been destroyed or affected by the floods, the need for medicines and health care was immense. The main causes of morbidity from the floods were outbreaks of water-borne diseases including acute diarrhea, gastroenteritis, skin infections, acute respiratory tract infections, typhoid fever, malaria, and viral conjunctivitis. Particularly vulnerable were children, pregnant women, elderly and other vulnerable populations whose immune systems are compromised.

On March 1st, 2012, Real Medicine Foundation joined hands with Pakistan Health Foundation UK to provide comprehensive primary healthcare to the people of Union Council Agra, District Charsadda of Province KPK.

Project Objectives:

Though the RMF Comprehensive Integrated Primary Health Care (CIPHC) Model, the project objectives are:

To provide basic, high quality, and free of cost MCH services inclusive of antenatal care, gynecological/ obstetric care and family planning to child-bearing women and to children.
To develop a strong referral system to secondary and tertiary care facilities for complicated cases
To provide a basic pathological laboratory for routine diagnostic investigations which will augment both primary healthcare and MCH services
To conduct outreach activities focused on preventive health/hygiene education & promotion and capacity training of community health workers
Create a sustainable and scalable model for other NGOs, private investors, and government to apply throughout remote regions of Pakistan.

Summary of RMF-sponsored activities carried out during the reporting period:

Background: Unprecedented monsoon rains of 2010 caused devastating floods that affected up to 20 million people in Pakistan in what is now officially recognized as one of the country’s worst natural disasters in scale. Continuous, relentless rain led to repeated surges of flooding along the Indus River and its tributaries from the mountains and valleys of the North to the agricultural plains of Central and South Pakistan, affecting an estimated 70 districts in the provinces of Khyber Pakhtunkhwa (KPK), Punjab, Sindh, Baluchistan, Gilgit-Baltistan (GB), and Azad Jammu Kashmir (AJK).

Interventions conducted by RMF

In the aftermath of the flood RMF Pakistan conducted 12 free medical camps across several union councils of District Charsadda from September to November 2010. These reached 20,304 men, women and children with free, high quality healthcare service.

RMF then established a primary health facility in Union Council Gulbella, Sardaryab which was one of the many union councils that was housing displaced persons. With an average OPD of 50 patients a day, 15,763 individuals, mostly women and children were treated for illnesses; over 14 months.

When the Government BHU in Gubella was reestablished at the end of 2011, RMF relocated our health centre to an area which was in dire need of primary health care facilities. In February 2012 the Union Council Agra BHU was established along with partners Pakistan Health Foundation.

Brief description of project

To implement a sustainable, scalable model for comprehensive, integrative primary health care in UC Agra, one of the worst flood affected areas of District Charsadda, which can be shared with NGOs, entrepreneurs, and government for replication across the country. The model is composed of four components:

Component of Primary Health Care (PHC): High quality PHC to be provided free of cost to the poor and vulnerable people of UC Agra, District Charsadda; augmented with a strong referral system to secondary and tertiary care facilities for complicated medical cases.

Component of Maternal and Child Health Care (MCH): Basic MCH services inclusive of antenatal care, gynecological/obstetric care and family planning with a strong referral system to secondary and tertiary care facilities for cases of problematic delivery and post-partum complications.

Component of Laboratory for routine Diagnostic Investigations: To augment both primary health and MCH services.

Component of Outreach Community: To conduct outreach activities focused on preventive health/hygiene education & promotion and capacity training of community health workers.

3 Months Consolidated Morbidity Report: January 2011 to March 2013

From January 1^st, 2013 to March 31^st, 2013, 4,171 patients were diagnosed and treated at the RMF-PHF Hospital Agra for a variety of medical conditions. 61.9% of patients during this period were female, 38.1% were males and 13.8% were children.

During this reporting period, 201 women came for antenatal visits, 338 women visited the hospital for gynecological problems and 141 women visited to discuss family planning demonstrating the local demand for MCH services and the rapport the hospital has already established with the local community.

Most of the diseases diagnosed and treated resulted from poor living conditions of the patients living in this community which is still recovering from the floods:

· Acute Respiratory Tract Infections (ARI): 31.8%

· Gynecological and Obstetric Cases: 16.3%

· Diarrhea (bloody and non-bloody): 9.1%

· Dyspepsia: 9.2%

· Scabies: 6.3%

· Hypertension: 7.8%

· Urinary Tract Infections: 3.5%

· Constipation: 2.5%

· General Body Aches and Weaknesses: 3.3%

171 cases were seen and subsequently referred to secondary and tertiary care hospitals like Lady Reading Hospital (LRH) and Khyber Teaching Hospital (KTH) in Peshawar for further treatment. The RMF-PHF Hospital has not only served the patients of Union Council Agra but also serves the poor patients from non-flood affected areas of other adjacent Union Councils of District Charsadda.

Polio Eradication and Advocacy activities

The RMF-PHF Hospital also interacts and coordinates with local health authorities at the district and provincial levels. For detailed report see box on page 3.

Number served/number of direct project beneficiaries:

A patient with mild hypertension is presented in the hospital OPD