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CHRISTIAN HOSPITAL EXTENSION PROGRAMDr. HOLLAND HEALTH CENTER, MASTUNG ROAD Progress Report for the Year 1999Overall Program Focus Building on the experiences of Christian Hospital Extension Program (CHEP), Dr. Holland Health Center, under the auspices of the Christian Hospital Quetta (CHQ), inter alia, will continue to provide promotive, preventive curative and rehabilitative health care, with the necessary supportive and referral services, that is feasible, sustainable and satisfactorily addresses the health needs of the people in Mastung District and surrounding areas. Program Strategies As stated in the long term proposal, the emphasis during Phase I is to strengthen the relationship with the communities and the various health and socio-economic programs which are operational in the area. Accomplishments i . Site Development The assessment of the physical structure and the plan for site development was done, and CHQ contractor was given the job to renovate the health center. When the center had its eye camp on July 27 and 28, the surgery of those who were screened for operation was done at the health center in Mastung rather than being referred to our base hospital in Quetta, which was the practice in the past. The point that we want to make is that, given the need for a front line hospital, with a back-up from CHQ, that can provide secondary and tertiary level services, the health center in Mastung has a great potentiality to offer more services like emergency obstetric care, which is a priority need and request of the community in Mastung and the adjacent areas. ii - Staff Development The staff, as envisaged in the project proposal, have been employed. The implementation of the program development of Phase I, however, required more human resources and we had to make some adjustments. When the plan for Phase I was drafted, there was some skepticism, which was genuine and well founded, even if 30 % of the program can be implemented. It is the CHEP team that turned that around and proved the skeptics, delightfully, wrong. We now have a field staff who are committed and conscious of the need to understand the traditional and religious values, the environmental and socio-cultural factors that do effect health and of the need for advocacy and social mobilizations. At the moment, the core group of the field staff includes the field coordinator, who is a community health specialist with nursing and teaching background; a midwife with several years of work experience in a hospital and community set ups; and a nurse assistant, originally from Mastung, who works with compassion and dedication to serve her people; and a driver. The field staff has been supported by a male doctor, a pharmacist and student nurses from the Christian Hospital. An ophthalmologist from the Helper Eye Hospital and a psychiatrist, who is a private practitioner and an old colleague, have both been separately, accompanying CHEP field team, regularly, once a month. We are committed to provide quality service, which does require to have competent staff members. However, we do not plan to employ everyone full time, but develop a panel of professionals whom we can engage. We will try to entice, particularly, those who belong to the community where we have a presence. During Phase I, we tried hard to look for a lady doctor, but did not succeed. We now have to look from outside the country, and this post needs to be filled urgently. During Phase I, the coordination of the program has been accomplished by the CHEP Program Coordinator. The coordinator is to be assisted by a management team including Mr. Innis, an old colleague of CHEP, Ron-Mayer and Dr. Sadrak. However, all three have been out of the country for a long time, and we hope that the management team will be more structured, with well defined responsibilities during Phase II. A working group, including the program and field coordinators and Dr. Sadrak, has been instrumental during the initial period of Phase I. More staff members will be included to have a working group that will be responsible in the overall implementation of the field activities. iii- Relationship Development We now have a functional Community Health Committee (CHC) of eight: 2 tribal elders, 1 union council representative, 1 religious leader (mullah), the DHO ( district health officer), 1 school principal, 1 teacher, and 1 medical officer of the Prime Minister's Health Program in the area. The Committee, inter alia, has a mandate to identify and prioritize needs, actively participate in policy and program development, mobilize the community and its resources (local and gov't) and provide support and security to CHEP operation. CHC meets quarterly, and any one or more members can be approached, on any day, for any pressing needs. Since the program's main thrust is to address the health needs of women and children, at a gathering of some 40 influential women leaders of the area, a working committee of 10 ladies has been formed, inter alia, to liaize with CHEP; identify: needs, high risk cases and defaulters; mobilize the community; and participate in the implementation of certain preventive and promotional health activities. CHEP has also established a work relationship with 10 of the lady health workers (LHWs ) assigned to different parts of the Mastung District, under the Prime Minister's Health Program. That relationship has been mutual and we do value it very much. Meetings have been held at our health center and at different centers run by the LHWs. iv- Health Care Development During Phase I, the health center has been providing curative, preventive and promotive health care, regularly, 3 days a week, on Mondays, Tuesdays and Wednesdays, as planned. The team leaves from Quetta at 8:00 and arrives at the health center after 50 minutes. The center is open for four hours, from 9:00 to 13:00 hrs. On Thursdays and Fridays, the team members help at the Christian Hospital, and no Saturdays, the team goes to run the health center in Ziarat. According to the project proposal, during Phase I, the health center in Mastung Road was to provide:1. mother - child health care, and 2. community health. Both activities have been attempted. For the given input, during Phase I, the output has been very impressive. The community has been very satisfied with the health work. The Community Health Committee and the staff have also expressed their satisfaction. The mother - child health care included care of women of child bearing age, antenatal care, postnatal care and child spacing. The child care included providing advice and/or treatment when problem arises like with diarrhoeal diseases and acute respiratory infections. Mothers are advised on breast feeding and on preventive and promotive health practices. The center did not provide services and care during labour and delivery, per se, but the staff have been very active in identifying and referring high risk cases and advocating for delivery by a trained female health worker. Advocating and educating both the expecting mother, her family members and the concerned community health workers, alone, is not enough. Most life threatening obstetric complications, like heavy bleeding after delivery, can neither be predicted nor prevented. In such circumstances, what is required is prompt and adequate emergency obstetric care. Most maternal deaths can be prevented by avoiding delays in reaching an appropriate health facility and receiving adequate care. The community realizes that, and has made the request for an emergency obstetric care at the health center. That need cannot be overemphasized, and will be a priority during Phase II. During Phase I, the community has been very appreciative of the referral of high risk cases and the care that they have received at the Christian Hospital in Quetta. The work relationship and cooperation between the staff of the Christian Hospital and the CHEP field staff, in handling referral cases, has been unprecedented. Sustainability The first medical director of the Christian Hospital visited Mastung Road and started an outreach health work in 1888. What could have been done to have a sustainable community-based health work, which we are trying to revive today? The purpose is not to answer that question, per se, but to reflect on what needs to be done today to have a sustainable health care in the area. When we think of sustainability, the first thing that comes to mind is the concern for financial resources. However important that is, finance may be less critical in the long run than lack of vision, commitment and managerial progress. In no way, are we trying to underestimate the financial constraints. Particularly, with services of community-based primary health care that advocates for equity, it is very difficult to break-even through cost recovery mechanism. The issue that needs to be addressed is, after the five years plan that we are entertaining now, with significant donor input, what type of financial and managerial resources will be required for the sustainability of the health work. What should be initiated, now, to develop local capacity that would help promote a gradual transition from dependence on external financing and management to a greater reliance on local institutions and resources. Reflecting on CHEP's work experience with the Christian Hospital, the Hospital is not a vibrant institution, today, not because of financial constraints but because of managerial constraints and lack of technical progress. This is not a new phenomenon or specific to the Christian Hospital, but is the fact with many humanitarian services. The point we want to make is the need to reflect and learn from past lessons, but, moreover, as we did underscore on the need for a senior lady doctor, the need for an experienced program coordinator cannot be overemphasized. Pending the discussion on the institutional arrangements and program development, we, in CHEP, do anticipate that the engagement of those two qualified professionals: a lady doctor and a program coordinator, can have direct and indirect benefits on the work of the Hospital as well! Assumptions Pakistan, in general, the province of Baluchistan in particular, is very difficult place to work in. Over the last few years, we have witnessed several good institutions and programs closing, not only because of financial, managerial and technical constraints, but because of the political and economic instability and the transitional Phase that the people are exposed to in their socio-cultural values. Moreover, when religion is used as a scapegoat or as a tool to rationalize those socio-cultural, political and economic difficulties through conscious misinterpretation of the religious teachings, then, the difficulties in providing services could be insurmountable. The life within the church and its institutions does reflect the difficulties in the country, and we do have to take the work environment into consideration while developing the program. We do not want to sound alarmist and scare away people who are determined to make a difference in the life of so many needy people, but we want to have our assumptions right, in order to have a sustainable, effective and efficient outreach work that can also help to strengthen the work of the Christian Hospital and revive its mission to reach out to the people in the region. STATISTICAL REPORT July 28 through December 8, 1999
CHEP, Quetta January 2000 |
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