Mir Ali Mohammad, Gull Sadaf
Population Council, House 7, Street 62, F-6/3 Islamabad.
J Pak Med Assoc. 2012 Dec;62(12):1308-13.
To identify the challenges confronting the Pakistan province of Punjab in delivering maternal and child health services at the district level.
The qualitative assessment was done from May 15 to June 15, 2010, comprising 5 focus group discussions, 5 in-depth interviews with district managers, 49 in-depth interviews with providers, and direct observation of 19 facilities providing comprehensive emergency obstetric care in the districts of Multan, Muzaffargarh, Bahawalpur, Khanewal and Jhelum. Using skilled birth attendance coverage as an indicator, Punjab districts were stratified into three socio-economic strata, and from these the five-districts were selected.
Distribution of basic emergency obstetric care facilities by population size was found to be inadequate in all districts. Quality of care was compromised by lack of staff and equipment. No anaesthetist was available in majority of the district hospitals and tehsil facilities. Half of the teshil headquarter hospitals were devoid of staff nurses. Vital medicines used in obstetric care were not available. Partograph was not being used in any of the tehsil-level facilities. Chlorine solution was not present in any of the facilities. Governance issues included multiplicity of command channels, delays in receipt of medicines and political interference.
If the province has to achieve the related Millennium Development Goals (MDGs), related to maternal and child health, the existing facilities are not adequate. To achieve progress, proven and innovative approaches will have to be put in place that may influence the continuum of care from the household to the health facility.
确定巴基斯坦旁遮普省在地区层面提供母婴健康服务时所面临的挑战。
于2010年5月15日至6月15日进行了定性评估，包括5次焦点小组讨论、对地区管理人员的5次深入访谈、对提供者的49次深入访谈，以及对木尔坦、穆扎法尔格尔、巴哈瓦尔布尔、卡内瓦尔和杰赫勒姆地区19家提供全面紧急产科护理设施的直接观察。以熟练接生覆盖率为指标，旁遮普省各地区被分为三个社会经济阶层，并从这些阶层中选取了五个地区。
发现所有地区按人口规模分布的基本紧急产科护理设施都不足。护理质量因人员和设备短缺而受到影响。大多数地区医院和乡级设施都没有麻醉师。一半的乡级总部医院没有护士。产科护理中使用的重要药品短缺。任何乡级设施都未使用产程图。任何设施都没有氯溶液。管理问题包括指挥渠道多样、药品接收延迟和政治干预。
如果该省要实现与母婴健康相关的千年发展目标，现有的设施是不够的。为取得进展，必须采用经过验证的创新方法，这些方法可能会影响从家庭到医疗机构的连续护理。
