Challenges in access to and utilization of reproductive health care in Pakistan

Pakistan's maternal mortality rate is high, and adequate and timely emergency services could prevent most maternal deaths. A woman's right to life-saving services of skilled health care providers in childbirth is undeniable. This paper examines factors restricting women's access to emergency obstetric care services in Pakistan. This cross-sectional survey on emergency obstetric care services collected information at the health facility level using UN process indicators. The study enrolled 170 health facilities from nineteen randomly selected districts in Punjab and NWFP. Diverse factors limit women's access to Emergency Obstetric Care [EmOC] services. EmOC services were unavailable in most health facilities surveyed. Staff absenteeism, geographic remoteness, delayed access, and ambulance shortages jeopardize the transferral of seriously ill patients to higher level care facilities. Cultural norms dictate that women should be examined by women doctors, whose dearth makes these services inaccessible. Many maternal deaths would be avoidable if EmOC health services were accessible. The geographic obstacles to timely access, poor hospital infrastructure, and high staff absenteeism rates require immediate attention. Health facilities' working hours were inconsistent with the provision of around-the-clock essential services, depriving and endangering the lives of many in need. It is imperative to increase skilled female workers capable of managing EmOC problems through proper incentives. A focused approach at local levels through proper supervision, motivation, and management would unquestionably save women's lives

Introduction of Provider Initiated Testing & Counseling (PITC) to HIV testing for Pregnant Women in Cambodia / 国際保健医療

<b>Objective</b><br> Provider initiated testing and counseling (PITC) for HIV testing, which is not a mandatory HIV testing policy, to pregnant women was being introducing in many countries. The aim of this study was to assess impact and issues raised by the PITC approach for prevention of mother-to-child transmission (PMTCT) of HIV services at an antenatal clinic (ANC) in the capital of Cambodia.<br><b>Method</b><br> Impact of the PITC approach on the acceptance of PMTCT services was determined by comparing quantitative data indicating the uptakes of PMTCT services during the first one year of PITC with the prior one year.<br><b>Results</b><br> The acceptance rate of HIV testing dramatically increased from 35.9% (3,033/8,459) to 95.3% (7,780/8,162) (p<0.001), however the acceptance rate of post-test counseling after tested declined from 92.1% (2,793/3,033) to 73.9% (5,753/7,780) (p<0.001). The return rates of pregnant women tested with partners and without partners to post-test counseling were, respectively, 85.5% (1,913/2,237) and 69.7% (3,840/5,507) in PITC approach (p<0.001) although this difference was not significant in VCT approach.<br><b>Conclusions</b><br> Although it can be agreed that the PITC approach was an effective strategy to increase the uptake of HIV testing, the remarkable declines of the post-test counseling acceptance lead concern about unexpected needs of counselors and the possibility of negative response to the HIV testing by their partners since the women tested without partners in PITC approach are less likely to return to post-test counseling compared to VCT approach. Further investigation on the reasons why some tested women didn’t receive post-test counseling is needed to find out strategies to keep or increase the acceptance of post-test counseling safely in the PITC approach. It was suggested that we still need to take into account the roles of counseling and partners’ involvement in careful consideration of women’s personal safety even in the implementation of PITC approach.

Women's Rights Equal Women's Lives: The Case of Pakistan / 国際保健医療

<b><big>Objectives</big></b><br>The Constitution of Pakistan offer guarantees regarding women s rights, but unfortunately some laws and also customs violate the above commitments seriously affecting the health of women and even endangering their lives. The purpose of the study is to describe various aspects of women s health in Pakistan vis- -vis human rights.<br><b><big>Methods</big></b><br>Review of available literature was undertaken. The scientific electronic database (such as PubMed, Science-Direct & Pakistani database) was searched for women health issues in Pakistan, covering a period from 1980s to present. Published government reports have also been included as sources of information for this paper.<br><b><big>Results</big></b><br>In Asia, Pakistan s, maternal mortality ratio is among the highest; more than half of the women are anemic. Access to health services is deprived whether be it economic, geographical or social. Majority of women are illiterate. Pakistan is among the countries with low gender indices and where female life span is less then men, and men outnumber women. Government spending on health and particularly women health is low compared to other countries.<br><b><big>Conclusion</big></b><br>Women s disproportionate poverty, low social status, gender imbalances, and inadequate maternal services at the community level play a significant role in contributing to maternal deaths. In view of the fact that given accessible, quality health services, many maternal deaths can be avoided, demonstrates maternal mortality is clearly an issue of human rights.<br>There is a strong need that health sector spending is increased, role of women health care providers in rural areas be expanded (such as LHW) and involvement of private and NGO sector to fill gaps in service delivery, be ensured. In order to meet the targets of MDGs, the gender dimensions of demographic and social change need to be stressed further in all policies and development plans, which may result in narrowing of gender disparities and improving women lives.

Emergency obstetric care availability, accessibility and utilization in eight districts in Pakistan's north west frontier province

Reducing maternal mortality is a critical issue in Pakistan. Do public health care centers in Pakistan's North West Frontier Province [NWFP] comply with minimum UN recommendations for availability, use, and quality of basic and comprehensive Emergency Obstetric Care [EmOC] as measured by UN process indicators? All public health facilities providing EmOC [n=50] in 30% of districts in NWFP province [n=8 districts] sampled randomly in September 2003 were included in a cross-sectional study. Data came from health facility records. Almost all indicators were below minimum recommended UN levels. The number of facilities providing basic EmOC services was much too low to be called providing comprehensive coverage. A low percentage of births took place in hospital and few women with complications reached EmOC facilities. Caesarean section was either underutilized or unavailable. The case fatality rate was low, perhaps due to poor record-keeping. The findings of this first needs assessment in NWFP province can serve as a benchmark for monitoring future progress. In resource-poor countries like Pakistan, it is important to upgrade existing facilities, giving special emphasis to facilities that provide basic EmOC services, since many problems can be resolved at the most basic level. Health policy makers and planners need to take immediate, appropriate rectifying measures to, inter alia, improve staffing in rural areas, enhance staff skills through training, upgrade management and supervision, ensure medical supply availability, mandate proper record-keeping, and observe progress by monitoring process indicators regularly

Towards equal partnership and evaluation of the international organizations: Lessons learnt from JICA projects on polio eradication in Laos / 国際保健医療

As globalization has been accelerated, the partnership is getting important in the international society. JICA projects in Laos on "Public health" and "Pediatric infectious disease prevention" had achieved its goal of regional polio eradication under the strong partnership with Laos government, JICA, WHO and UNICEF. The global commitment at the WHO assembly contributed to the achievement by sharing common goal and partnership, which enabled to draw sufficient financial supports. However, in general, fewer efforts have been done among Japanese researchers/experts to examine the appropriateness of top-down global health policies. JICA should break away form the power of ministries which possess huge vested interests in ODA business so that the agency can find and address problems actively in the project sites. In this way, as one of influential nations in Asia, we can build equal partnerships in the international society, respecting diversity of environment and cultures of developing countries. It is also important to evaluate the funding flows and activities of the international organizations, which have been widely criticized for being lack of transparency.