Sindh Health Department Announces New Midwifery Plan

Health Minister of Sindh  inaugurated first 6 of 55 Government Dispensaries (GDs) in order to address Maternal Mortality Rate (MMR), Neonatal, Infant Mortality Rate (IMR), Family Planning (FP) targets, stunting, Nutrition support issues in a more holistic way. The Mother Neonatal Child Healthcare (MNCH) program was initiated by international donor agencies years back. The idea was that a community midwife (CMW) with matriculation qualification would be selected and trained for two years to provide prenatal, postnatal care and help in skilled-delivery of baby.

 These midwives would be provided birthing stations to be established in the community so that the women of the community could avail a skilled birth attendant in their vicinity. Various academic research papers and health indicators show that little benefit was accrued from the program due to various concept flaws and typical social milieu in Pakistan; however the program did provide some hard lessons to be learnt if we want to start afresh to target MMR, IMR, stunting, mal-nutrition, achieving FP targets, detect disease at an early stage, health education.

       Pakistan one of the top ten populous country in the world with one of the lowest ranking in Human Development Index. Its population would be doubled in the next 30 years if growth is not arrested. Sindh’s projected population is around 50 million with not-so-good health and poverty indicators. Despite challenges, Sindh has shown a level of policy consistency, innovative reforms, legal frameworks, increasing trend in financing etc. This has developed a trust and confidence of donors and development partners. All this required a new initiative.

     A new design in MNCH program, nutrition and FP support under 1000 days plan through social registry is afoot; revamping Community Midwives program through provision of service structure and regularization. The thousand Days program will be driven by the Department of Health and Population welfare Department in partnership with the Social Registry. It will create a continuum of care based on patient identity for mother and child during critical 1000 days from the day of conception. A range of health, nutrition and population welfare services and behavior change communication will be offered to women from the day of enrollment of a pregnancy till the second birthday of the child. The supply side will be implemented by the Health and Population welfare departments; while demand side, which is Conditional Cash Transfer (CCT) is aimed at overcoming poor women’s opportunity cost of attending services, will be administered by the Social registry through mode of mobile cash. The women will get cash each time visiting the health facility with more cash if the baby is delivered at the health facility. This facility would be available for new mothers or mothers having 2-3 children provided that there is a gap of two years between two pregnancies so that the facility may not be misused. The 1000-days window is very critical for number of policy objectives including maternal mortality, neonatal and infant mortality, child-stunting and wasting.

    The deployment of CMWs at health facilities will increase the proportion of institutional deliveries and they will also provide home-based antenatal and postnatal care services in their communities through outreach services. The midwifery cadre has to be created with new structures with vertical, horizontal mobility for the talented rural girls who opt for the profession. The Chief Minister has already approved the design in principle. The recruitment will be started soon after taking care of relevant rules, regulations and court directives.



The idea is there should be at least one 24/7 health facility with all services provided in each union council at an approachable place to all. A good lab facility to a cluster of GDs, medical universities to provide notified periodic visits, ambulance service, and referral to nearby big hospital. Even philanthropy will have a fixed identified point for providing help and see tangible results. This will also ensure proper gate-keeping to lessen pressure on taluka and district hospitals.

There will be teething problems to roll-out this design to the whole of Sindh. Availability of matriculate girl is a big issue that’s why LHW coverage is just 48% in Sindh. The system will be fine-tuned in a couple of years. Even at this initial stage it is promising at least some action is better than inaction.

This initiative will roll-out in the next 8 years in the whole of Sindh but it is being started from Tharparker due to special directions of Supreme court for Thar; in fact the Supreme Court Monitoring Committee has directed to make Tharparker a model district as far as health is concerned .. lets do it... thar badle ga Pakistan! Thar will change Pakistan!