Practices and challenges of infectious waste management: a qualitative descriptive study from tertiary care hospitals in Pakistan

Infectious waste management practices among health care workers in the tertiary care hospitals have been questionable.The study intended to identify issues that impede a proper infectious waste management. Besides direct observation, in-depths interviews were conducted with the hospital administrators and senior management involved in healthcare waste management during March 2014. We looked at the processes related to segregation, collection, storage and disposal of hospital waste, and identified variety of issues in all the steps. Serious gaps and deficiencies were observed related to segregation, collection, storage and disposal of the hospital wastes, hence proving to be hazardous to the patients as well as the visitors. Poor safety, insufficient budget, lack of trainings, weak monitoring and supervision, and poor coordination has eventually resulted in improper waste management in the tertiary hospitals of Rawalpindi. Study has concluded that the poor resources and lack of healthcare worker's training in infectious waste results in poor waste management at hospitals

Knowledge, attitude and practices of health staff regarding infectious waste handling of tertiary care health facilities at metropolitan city of Pakistan

Health Care Waste [HCW] is considered as the second dangerous waste in the World that needs to be properly disposed by trained health care staff. Good knowledge, positive attitude and safe practices of medical staff is very imperative while managing this infectious waste. This assessment has been conducted to determine the situation and KAP of infectious waste management in health care workers working at tertiary care settings health facilities of Rawalpindi, Pakistan. This study was part of an ongoing quasi-experimental with control and intervention design and was conducted in tertiary care governmental hospitals of Rawalpindi by interviewing healthcare workers [HCWs] who were selected randomly after the sample size calculation. The participants were selected according to the proportional size of the each HCWs for their equal representation from all the groups. Selfadministered valid and reliable questionnaire were adapted after taking the written consent. Ethical consideration was taken from ethical committee of Health Services Academy Pakistan. Total 275 HCWs including doctors, nurses, paramedics and sanitary workers were interviewed during this baseline survey. The mean age of the health workers were 30 +/- 5 years. Infectious waste management practices with in both hospitals were not found statistically significant [p=0.33]. However, the sociodemographic information like age, gender, level of education and experience, when compared with the practices were found statistically significant [p<0.05]. Doctors and nurses have better knowledge, positive attitude and good practices compare to paramedics and sanitary staff regarding infectious waste management and was found statistically significant [p<0.05]. Practices among HCWs were not found up to the standards in these tertiary care hospitals of Pakistan and were not following the proper guidelines and WHO rules

Emergency obstetrics care services in district neelum, Azad Jammu and Kashmir

Globally 529,000 women die annually due to pregnancy related problems and in Pakistan alone this toll is about 35,000 deaths per annum. This situation is even more critical in the rural remote areas of Azad Jammu and Kashmir [AJK]. The whole phenomenon needs a contextual assessment to ascertain the geographical, financial and socio cultural accessibility, and availability of EmOC services in order to generate fresh evidence for the decision makers and concerned stakeholders for improving these services. A cross-sectional study was conducted using a structured questionnaire with the women delivered in the last 15 days, whereas the geographical accessibility and availability of EmOC services were assessed by visiting EmOC facilities in the district Neelum of AJK. Over a hundred women delivered in the last 15 days, participated in the study. Geographically, a central EmOC facility is far away and the terrain is hilly and dangerous. Women's social status, education, husband's employment and household income were found to have a significant association with the use of EmOC services. The health facilities audit showed that around 90% centres do not have a female medical officer appointed. Moreover, the state of the equipment, medicines and the basic utilities such as water, sanitation, and electricity are not satisfactory. Accessibility of EmOC services is poor in the district Neelum. Evidence on ground calls for organisational reforms at EmOC service delivery level as well as for long term planning in other sectors for improving socioeconomic and education status of the women in Azad Jammu and Kashmir

Leadership in family planning and reproductive health: a university based capacity building and networking initiative in Pakistan

Pakistan's DHS 2006-07 showed gloomy indicators of reproductive health in the country especially of the women and children. Family planning [FP] and reproductive health [RH] programs date back to late 50's and yet failed to deliver the desired results. Among other weaknesses in the programs, it has been recorded that lack of effective management and good governance have resulted in either questionable quality of FP and RH services and low utilization of services. This dismal state of affairs has left the country with a high growth rate [1.9%], a large unmet need for contraception [33%] with a fertility rate of over 4 children /woman, an unacceptably high maternal mortality ratio [276/100,000], an under 5 mortality of 0.4 million a year, and an ironically strong urban bias of doctors [80%] and that also focusing on curative care. Lack of training and incentives for staff have resulted in a fragile health system and weak human resource management. For redressing this appalling situation in the country, and particularly in RH and Population sector, a new vision has to be thought out through strategic thinking of all the issues. A pilot training course comprising a whole range of pedagogy on 'Leadership in Family Planning and Reproductive Health' was launched and was successfully implemented in 2008 at the Aga Khan University, Karachi with the underlying objectives of capacity building of mid-top level managers, policy makers, advocacy specialist, academia, NGO and civil society representatives to work effectively and acquire leadership positions in family planning and population programs with deeper understanding of RH. This critical mass of trained leaders would work effectively with leadership skills using multi-sectoral approach; and will create and implement a strategic action plan to improve quality of and access to FP/RH services in their respective areas in the wake of achieving the millennium development goals by 2015.

Do we need to be skeptical about millennium development goals?

Pakistan still presents huge gaps in catering to the massive health needs of the large segment of its population living in rural and remote areas. High maternal mortality, neonatal, infant and child mortality, the population pressure on meager resources and ever increasing differentials in urban and rural, rich and poor and among genders is becoming noticeable. Poverty has compounded the toll of preventable illnesses, preventable malnutrition and preventable deaths. Where are gone the primary health care pledges? Poverty and hunger has been increasing the toll of morbidity and mortality in Pakistan. The dearth of political commitment compounded by current economic crisis does not allow a respectable allocation to health, education and other social sector projects. The international economic trends and their repercussions on the national agendas are having serious implications for common man's day to day living and public grievances are on the rise. Access to quality health care and education has become even more difficult. The efforts to revitalize the whole political economy in the country seem invisible or feeble at both government and development partners' end. Having gone through devastated crisis of population displacement because of terrorism, earthquake and floods, government has shown minimal interest in seeking external debt relief which appears to be a pre-condition for at least keeping the hopes up for meeting the targets of MDGs. The pledges and assistance of the international community has not been sufficient to support the economy of Pakistan and in this scenario, the social sector has suffered the most. Local and national level efforts must continue to safeguard all the determinants of health, particularly in the developing and under-developed countries. There is an intense need of meaningful inter-sectoral collaboration and political and economic reforms in both government and within private sector to achieve the millennium goals directly related to health. What would be the post-MDGs new roadmap, given all the human rights violations and social exclusion across the developing countries? The picture becomes even more skeptic because the MDGs need not only to be attained, but also sustained for a longer term-post 2015

Availability and affordability of essential medicines: exploring the health seeking behaviours and health service utilisation for children under-5 years living in squatter settlement of Karachi, Pakistan

Child health outcomes in the poor communities are largely affected by the nonavailability of essential medicines at government health facilities and non-affordability of prescribed medicines at private retail pharmacies. This phenomenon largely defines health seeking behaviours and health service utilisation patterns of the families of the children. Using observational visits, we examined the shelf-availability of medicines for children less than 5 years of age at a rural health centre and conducted focus group discussions with the mothers to explore the effects of nonavailability and non-affordability of medicines. We also validated all information by interviewing the health care providers of the area. We found that erratic and insufficient supply of essential medicines at the government health facility and a limited purchasing power to buy medicines from a retail pharmacy, led to considerable 'financial burden' on the poor people, non-compliance with the treatment, health care seeking from informal health providers and healer shopping. This trend has a serious repercussion on the health seeking behaviours and of course the health outcomes, especially among children. On the users' side, health education and health promotion campaign must be instituted to explain the adverse effects on child health ensure appropriate health care seeking behaviours. For the supply side, the health care authorities must ensure the availability of essential medicines for the children at the government facilities. Local community representatives must be involved in the matters related to medicines stock management at the facility.

Developing an equitable and gender sensitive health system for women of reproductive age

Differentials in access, control and choice of resources including health has rendered women as vulnerable segment of many societies though developing, yet conservative. The resultant implications on health are also veritably different. Women's health is a blend of physical, emotional, social, cultural and spiritual well being. However, deplorably functioning health sector, lack of appropriate training for health care providers, negative cultural practices and poverty are amongst multiple factors that have a perilous impact on the status of the women. Investing in women has become an international concern and an effective conduit to improve the indicators of women health. This paper discusses issues around women health, health seeking behaviours, gender sensitization of health providers, performance of health services and role of family physicians. Gender influences health seeking behaviour and health service utilization; and socio-cultural and religious customs reinforce these behaviours. If sensitized and mobilized to address the gender specific needs of women clients; family physicians can ensure quality, effective and affordable services for women in the health care system. Pakistan is trying to cope with a daunting challenge of developing an equitable and gender-sensitive health system that could address the basic and special needs of women, especially those of reproductive age. A respectable women's health status would be achieved through the empowerment of the fair sex, by augmenting their access to socio-culturally appropriate health care services. In a polarized healthcare system with a variety of formal and non-formal health services available and accessible to all, family medicine have a vital role to play in research, service provision and advocacy for women's health