Integration of sexual and reproductive health in the medical curriculum in Pakistan

To assess the knowledge of medical practitioners regarding management of selected reproductive tract infections, diagnosis of sexual dysfunction and identification of sexual abuse and to assess the attitudes and practices of health care providers regarding sexual and reproductive rights in order to recommend areas that need to be incorporated in a sexual and reproductive health curriculum. A cross-sectional survey. From March to August 2003 in the District Turbat of Balochistan, Pakistan. Selected indicators of knowledge, attitudes and practices regarding sexual and reproductive health of primary care physicians were assessed using a pre-tested questionnaire and formal/informal interviews. Variables were identified from the literature and previous in-depth interviews, and then formulated into respective questions. A Lichert scale marked from 1 to 5 was used for categorizing responses into agreed, neutral and disagreed. Descriptive statistics were computed using SPSS version 10 for windows. Qualitative interviews were translated and transcribed and analyzed according to pre-judged and emerging themes Out of 45 physicians interviewed, nearly half scored less than 50% in the knowledge section. Attitudes and practices assessed suggested a tendency to be judgmental, gender/rights discriminatory and with little provision for enabling clients to make their own decisions, so essential for quality sexual health service provision. Keeping in view the importance of the sexual health issues and a lack of ability of health care providers to handle it effectively, deficient areas of sexual health must be integrated into the medical curriculum. Medical educators have the responsibility to train physicians and other health professionals in the core competencies to improve the sexual and reproductive health of their communities

Outcome of patient referral made by the lady health workers in Karachi, Pakistan

The outcome and consequences of referral made by the Lady Health Workers [LHWs] are largely unknown. This cross sectional study was conducted as part of a larger study and aims to assess outcome of patients' referrals made by the LHWs in Karachi, Pakistan. Only 4% of patients referred visited government facilities, the rest having visited private physicians and in-formal practitioners. The median cost of the treatment was 200 Pakistani Rupees [PKR] and 1230 PKR as out -patient and in-patient respectively with almost half the patients [41.3%] borrowed money to finance their treatment. Seventy-eight [31.6%] patients were not satisfied with the management they received from the referral health facilities. Major reasons cited were non-improvement in their condition, expensive, long waiting time and rudeness of the health facility staff. Factors identified in this study should be taken into account to ensure continuity and quality of care and to provide efficient, effective and equitable health services to all.

Recommenndations to strengthen the role of lady health workers in the national program for family planning and primary health care in Pakistan: the helath workers perspective

This study was planned to assess the strengths and weakness of the National Program for Family Planning and Primary from the Lady Health Workers [LHW] perspective. We conducted this study in order to develop recommendations for strengthening LHW's role in Primary Health Care [PHC] in Pakistan in consultation with the health workers. A qualitative study, based on key informant interviews, was carried out in Karachi, Pakistan. A total of 20 workers were interviewed. Analysis was carried out by grouping similar responses in a matrix and then analysis with reference to context. Motivations for joining program included financial benefits, convenient timings and an opportunity to serve humanity. Training was deemed satisfactory but clinical training was resented because of doctors' attitudes. Further training needs identified included basic information about common ailments, reproductive issues and basic clinical skills. Major strengths of the program mentioned included provision of survices at grass root level, reinforcement of health messages and the community acceptability of workers. Weaknesses mentioned included the contractual nature of job, low- salaries, irregularity' of payment, no career development and poor logistical support. Giving LHWs permanent government employee status and a raise in salary may strengthen the workers functions. Eligible LHWs should be given incentives [skills, career development, financial]. The community must be educated about assigned role and responsibilities of LHWs and patient referral system by the LHW needs to be strengthened. The valuable role of LHWs in PHC in Pakistan must be acknowledged and further improvements pursued