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Disease Control Priority-3

1. The document discusses essential reproductive health interventions presented by experts at Disease Control Priority-3, including family planning, adolescent health, safe abortion, and ending violence against women. 2. It highlights challenges facing Pakistan related to each intervention, such as low contraceptive use, child marriage, unsafe abortion, and widespread violence against women. 3. Recommendations are made to improve data collection, increase accountability, enhance family planning services, prioritize adolescent health education, and support community health workers.

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Abubakar Abdhoo
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69 views

Disease Control Priority-3

1. The document discusses essential reproductive health interventions presented by experts at Disease Control Priority-3, including family planning, adolescent health, safe abortion, and ending violence against women. 2. It highlights challenges facing Pakistan related to each intervention, such as low contraceptive use, child marriage, unsafe abortion, and widespread violence against women. 3. Recommendations are made to improve data collection, increase accountability, enhance family planning services, prioritize adolescent health education, and support community health workers.

Uploaded by

Abubakar Abdhoo
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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You are on page 1/ 23

DISEASE CONTROL

PRIORITY-3
(DCP-3)
Presented by:
Dr Abubakar
Dr Ali Tahir Rana
Mr Moazzam
Dr Mirza Khurram Baig
Dr Ahmad Ismail
INTRODUCTION
Dr. Mirza Khurram Baig
Introduction
• Disease control priority is a guideline for resource allocation for tightly
constrained budgets,such as in developing countries,including
Pakistan.
• First published by World Bank in 1993 as Disease Control Priorities in
Developing Countries (DCP1) which aimed to assess cost effectiveness
of basic/essential interventions which could potentially be employed
in developing countries.
• DCP 2 assesses implications for health systems of expanded
intervention coverage.Focuses on packages and platforms instead of
individual interventions.
Introduction(contd..)
• DCP 3 focuses on extending and consolidating the concepts of
platforms and packages and by considering the financial risk
protection objective of health systems.DCP 3 proposes essential cost-
effective interventions that can be implemented across the board and
which do not overwhelm the already constrained health systems.
INTERVENTIONS
Dr.Ali Tahir Rana
Dr.Ahmad Ismail
Essential interventions related to
Reproductive Health
• Family planning
• Adolescent sexual and reproductive health
• Safe abortion
• Ending violence against women
Family Planning
• A highly effective programme: from 6 children/woman in the 1960s to
less than 2 children/woman in 1990s
• Cost effective:For every US$1 spent on family planning, from US$2 to
US$6 can be saved from the reduced numbers of people needing
other public services, such as immunizations, health care, education,
and sanitation (UN Population Division 2009)
• Family planning promotes sustainable economic
development,maternal and child health and upholds human rights.
Adolescent Health
• Legal protection of adolescents(against child marriage and rape)
• Reduce gender inequality
• Keep girls and boys in school
• Offer age-appropriate comprehensive sex education
• Awareness through mass media
• Availability of adolescent friendly contraception
• Involving out-of-school and married adolescents.
Adolescent Health(contd..)
• Laws for adolescent protection are highly needed and protect against
gender-based violence
• Girls who attend school are less likely to get pregnant and less likely to
marry at a younger age
• Evidence shows that comprehensive sex education taught by trained
teachers, can affect behavior, including delaying sexual debut,
decreasing number of sexual partners, and increasing the use of
condoms or other contraceptives
Safe abortion
• Even with all precautions,unintended pregnancies do occur,where
contraception fails or sex is forced.
• Abortion in early pregnancy (less than nine weeks) performed with
appropriate techniques by trained personnel is one of the safest
medical procedures, with a case fatality rate of 0.6 per 100,000
procedures
• This rate is much less than the mortality rate associated with
childbirth
• Mifepristone+Misoprostol remains a safe procedure
Violence against women
• Female victims of sexual violence are often in urgent need of supportive
care.This includes emergency contraception,prophylaxis for HIV and
other STIs,access to safe abortion services and psychological support to
prevent further harm.
• Health professionals can provide assistance to women suffering from
violence by:
1. facilitating disclosure
2. offering support and referral
3. gathering forensic evidence— particularly in cases of sexual violence
—and providing the appropriate medical services and follow-up care.
SITUATION IN PAKISTAN
Dr.Abubakar
Family Planning
• Family planning remains largely a taboo topic in Pakistan with most
opposition from religious factions.
• The contraceptive prevalence rate (CPR) remains alarmingly low at
about 34%. The total unmet need for family planning is 17.3% which
is highest age-wise for the 25-29 cohort(20.4%) and region-wise for
Balochistan(21.6%) and KPK(20.5%)

--Source:PDHS Key Indicator Report 2017-18


Adolescent and sexual reproductive health
• According to PDHS 2012-2013, 8% percent of adolescent women aged
15-19 were already mothers or pregnant with their first child and 35%
percent of women aged 25-49 were married by age 18.
• Early pregnancy is a known cause of increased morbidity and
mortality in this age bracket. The most common reason of early
pregnancy is early/forced/child marriages in Pakistan and it has a
correlation with poverty,illiteracy and lack of understanding on sexual
and reproductive health matters.
Safe Abortion
• A national study on abortion in Pakistan (Population Council 2004)
estimated that 890,000 induced abortions were performed in 2002,
despite legal restrictions on abortion in Pakistan.
• In 1990, the law was relaxed to permit abortion to save the mother’s
life or to provide “necessary treatment” (Government of Pakistan
1990).
• Legal barriers do,however, lead to a higher incidence of unsafe
abortions (WHO 2012b), because health clinics cannot openly provide
abortion services and most women seek help from unqualified
providers and/or use traditional methods.
Safe Abortions (contd..)
• The health risks associated with abortion are well-established especially in
countries like Pakistan where legal and safe abortion services are generally
unavailable.
• The majority of post-abortion complications in Pakistan arise when abortions are
sought from untrained midwives or administered by the women themselves.
• In the developing world, including Pakistan, morbidity and mortality associated
with unsafe abortion exert an enormous health, financial, and social burden on
women and on the health care system as a whole (WHO 2003).
• Lack of appropriate post-abortion care can lead to lifelong morbidity, contribute
to maternal mortality, and adversely affect the health of future children.
Violence against women
• Between 20 and 30 percent of women in Pakistan suffered some form of abuse in
2009.(Human Rights Watch,2009)
• Women have reported attacks ranging from physical to psychological and sexual
abuse from intimate partners.
• A survey carried out by the Thomson Reuters Foundation ranked Pakistan as the
third most dangerous country in the world for women, after Afghanistan and the
Democratic Republic of Congo,followed by India and Somalia.
• The majority of victims of violence have no legal recourse.Law enforcement
authorities do not view domestic violence as a crime and usually refuse to register
any cases brought to them.(Health Care for Women International. 34 (9): 795–813)
• Given the very few women's shelters in the country, victims have limited ability to
escape from violent situations.
RECOMMENDATIONS
Mr. Moazzam
The greatest challenge is the lack of appropriate data at the global,
regional, national, and subnational levels Even available data are often
not adequately disaggregated by important characteristics

Facility Level Assessment Secondary data analysis using GIS or maps & HIMS

Community Level Assessment Secondary data analysis, review of households


surveys & population based surveys

Health System Level Assessment Document reviews, Secondary data analysis,


primary data collection through interventions
with key informants at state and district levels
RECOMMENDATIONS
To identify Accountability gaps and address them with clear
targets/results and indicators to track progress in RMNC

Need to develop multi-tiered monitoring and evaluation system linked


to Accountability forums at district, provincial and national level

There is the potential need for a high-level “Inter-ministerial forum for


health and population” and an “Inter-agency coordination forum” at
national level
RECOMMENDATIONS
Need to develop Institution of key performance indicators and health
regulatory measures at provincial & district level aiming to improve
governance & accountability mechanism

To adequately provide Family Planning service delivery includes; IUD


(Intra-Uterine device), implant, OCP (Oral Contraceptive Pill)

Need to engage all key stakeholders like Religious scholars, media will
be helpful in addressing myths and misconception on family planning
RECOMMENDATIONS
Family planning (FP) is one of the most cost effective interventions to
reduce maternal and newborn deaths

Closing the gap between FP knowledge and practice through


comprehensive service that encompasses family planning awareness,
options, commodity security with focus on modern methods

Dire need to focus on sexual & reproductive health education among


adolescents, both boys and girls in school and out of school
RECOMMENDATIONS
Induction and strategic deployment of lady health workers/community
health workers/lady health visitors is needed, retention of
qualified/trained LHWs/CHWs is required

To provide extra training and education to community workers to


support pregnant women during pregnancy for positive outcomes and
thereby preventing still births and neonatal deaths

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