IRMNCH

History & Introduction:

The IRMNCH & NP was launched in July 2013 with the strategy to integrate 03 different programs (LHW Program, MNCH Program & Nutrition Program). From July 2017, the CM Chief Minister’s Stunting Reduction Program (CMSRP) and From June 2021, the Prime Minister’s Health Initiative (PMHI) Program is also being executed by IRMNCH & NP.

Program’s Overview:

Punjab’s estimated population of 110 million (as per the 2017 census) is growing at an annual rate of 1.9. The total fertility rate is currently reported at 3.5, which although lower than other provinces, but still much higher when compared to South Asian neighbors. Both the Infant Mortality Rate (IMR) and Under 5 Mortality Rate (U5MR) have steadily declined over the past few decades; however, the rate of decline over the years has been considerably slower – IMR being at 60 and U5MR at 69 per 1,000 live births. Unfortunately, the neonatal mortality rate has remained relatively stagnant in the country and has been reported to be 41 per 1,000 live births in Punjab Province. The rate of stunting and wasting remained at 31.5% and 7.5% respectively while the rate of exclusive breastfeeding till the age of six months is reported at 42.1%.

 

This snapshot of health status indicates that Punjab could not achieve the MDG targets. Now that the SDG targets are agreed upon globally, drastic measures need to be taken to improve the situation of maternal, newborn and child health and nutrition status in Punjab; which will directly contribute to an improvement in the national status of these indicators. To achieve these targets Punjab will have to significantly improve the quality of services in the RMNCH sector. Despite the slow progress towards health-related goals and other health outcomes, there is evidence that Punjab has made a significant level of progress, particularly at the intermediate outcome level during the recent years.

 

Looking at the above scenario, the Government of Punjab has taken a number of new initiatives, the most important one being the integration of LHWs Program, MNCH Program, Nutrition Program and 24/7 Basic EmONC services under the umbrella of the Integrated Reproductive, Maternal, Newborn & Child Health and Nutrition Program (IRMNCHNP).

 

Vision

To improve the health outcomes among women, children, and newborns by enhancing coverage and providing access of health and nutrition services to the poor and vulnerable in rural and less developed urban areas through implementation of the evidence-based RMNCH Package

 

Objectives:

Key components:

Lady Health Worker Program:

The National Program for Family Planning and Primary Health Care, also known as the Lady Health Workers Program (LHWP), was launched in 1994. The Program objectives contribute to the overall health sector goals of improvement in maternal and newborn child health and provision of Family Planning services. This countrywide initiative extended outreach health services to rural populations and urban slum communities through deployment of over 42,000 Lady Health Workers (LHWs) and 1757 Lady Health Supervisors (LHSs) in all over Punjab are working with 57% coverage (30% in Urban and 73% in Rural area) and contributed to bridging the gap between health facilities and communities.

MNCH Program:

National Maternal and Newborn Child Health (MNCH) Program (2006-2012) was launched nationwide with a goal to improve maternal, newborn, and child health of the population, particularly among its poor, marginalized, and disadvantaged segments. This Program was merged into IRMNCH & NP in 2013. The MNCH program is contributing to strengthening Emergency Obstetric care services at DHQ, THQ hospitals, and RHCs. Further, this program has introduced a new cadre of Community-Midwives (CMWs) for skilled deliveries at the community level.

CM Stunting Program:

Provision of health & nutrition services package to improve the nutritional status of women, adolescents, children, and newborns with particular focus on stunting reduction in rural and less developed urban slum areas of Punjab.

 

PMHI Program:

PMHI Program was launched to improve the health outcomes among the general public, with a special focus on vulnerable groups like the elderly, disabled, women, and children by enhancing coverage and providing access to health and nutrition services to rural areas, urban slums as well as pure urban areas of selected districts. Implementation of the Essential Package of Health Services (EPHS) and achievement of Minimum Service Delivery Standards (MSDS) in both outreach and facility-based services will be ensured.

 

Nutrition Program:

Under this Program, preventive services are being provided in 36 districts of Punjab through LHWs which include a screening of under 5 children and PLWs, IYCF counseling, provision of Iron, Vitamin-A, and MMS to mother and child. Curative nutrition services were initially started in 2010 in the selected BHUs of 7 flood-affected districts (D.G. Khan, Layyah, Muzaffargarh, Rajanpur, Mianwali, Bhakkar, and R.Y.Khan). By achieving the good results of this initiative, the Government of Punjab decided to implement it all over Punjab in 3 phases. Now a total of 1755 Outdoor Therapeutic Programs (OTPs) and 58 Stabilization Centers (SCs) are established in all 36 districts of Punjab. Treatment of Severely Acute Malnourished (SAM) children without medical complications by the provision of Ready to Use Therapeutic Food (RUTF) is carried out at OTPs established at BHUs 24/7, RHCs, THQs, and DHQs. Treatment of Severely Acute Malnourished (SAM) children with medical complications by the provision of medical treatment and therapeutic formulas F75 and F100 carried out at SCs established at DHQs/THQs.

Our Services:

   (Community-Based Services)

     (Lady Health Workers)

The IRMNCH & Nutrition Program provides community-based services at the doorstep through Lady Health Workers.

Scope of Services of LHWs

The services provided by the LHWs include registration of target groups, household visits, health education, awareness, and special campaigns. Each LHW is supervised by a Lady Health Supervisor, each supervisor having an average of 20-25 LHWs reporting to her.
The specific LHW target groups include:

1. Pregnant and lactating women
2. Children under the age of 5 years
3. Eligible couples

The LHWs visit every registered household of their catchment population once per month and provide the following services:

1. 1.Pregnant women:

   counseling on ANC, delivery, and PNC by Skilled Birth Attendants (SBAs); referral of pregnant women to appropriate health facilities; awareness on early identification of danger signs; birth preparedness, etc.

2. 2.Lactating women:

   advise on early initiation of breastfeeding, exclusive breastfeeding, and infant & young child feeding (IYCF) practices.

3. 3.Children:

   referral for immunization; linkage with vaccinator; screening of children for malnutrition; identification and referral of SAM and MAM children; basic treatment of pneumonia and diarrhea and appropriate referral.

4. 4.Eligible couples:

   counseling on healthy timing and spacing of pregnancy (HTSP); provision of condoms, oral contraceptive pills, and injectable contraceptives; referral for long term methods i.e. IUCDs and tubal ligation.

In addition to her door-to-door campaigns, the LHWs also conduct health education and awareness through community support group meetings on selected topics on weekly basis. Moreover, they also participate in various special campaigns conducted from time to time by District and Provincial Governments including:

1. Mother and child health week twice a year
2. Global breastfeeding week once a year
3. Nutrition week in urban slums once a year

Facility-Based Services:

   (24/7 Basic EmONC Services)

Following the floods of 2010, a special initiative was launched in the seven flood-affected districts for the provision of round-the-clock basic EmONC services. BHUs nearby flood-affected areas of these districts were selected for this purpose. Till 2014, this initiative was funded through UNICEF and UNFPA for 90 health facilities.
The Government started the provision of additional funds to 150 BHUs for the provision of round-the-clock services, followed by the addition of 550 more by end of 2015. Further 103 BHUs were included in 2017. At the moment:

1. 1234 Selected Basic Health Units (BHUs) 24/7 from all districts are providing round-the-clock provision of basic EmONC services.

1. Provision of additional HR (LHVs, Ayas, Security Guards)
2. Provision of additional equipment and supplies

1. 314 Rural Health Centers are also providing these services round the clock at the primary level
2. Way forward: 600 more BHUs 24/7 BHUs will be upgraded in the FY 2022-23.

Scope of service

The following services for maternal and child care are provided at these health facilities:

1. Antenatal care including history taking, general physical examination, obstetric examination, basic diagnostic tests including urine (for pregnancy and proteinuria), blood (for Blood Glucose levels, Hemoglobin levels, Hepatitis screening, and HIV screening).
2. Delivery services covering all aspects of basic EmONC.
3. Newborn care including helping babies breathe, use of chlorhexidine for cord care, early initiation of breastfeeding, and skin to skincare.
4. Childhood immunization (birth doses as well as other doses as per EPI schedule).
5. Pneumonia and diarrhea treatment and referral services for children under the age of five.

Nutrition Services

Following the floods of 2010, a special initiative was launched in the seven flood-affected districts for the provision of malnutrition treatment services. BHUs nearby flood-affected areas of these districts were selected for this purpose and Outdoor Therapeutic Program (OTP) counters were established at these BHUs. Moreover, stabilization centers were also set up at the DHQ level. Till 2014, this initiative was supported by UNICEF and WHO. However, as malnutrition was identified as a major issue in Pakistan in the National Nutrition Survey 2011, the Government of Punjab decided to scale up the OTPs to selected BHUs 24/7 and SCs to all DHQs and teaching hospitals.

Scope of Services

1. Screening of children and PLWs is being done at the community level by LHWs (all districts) and at the facility level by the SBAs at OTPs.
2. Preventive services are also being provided through the LHWs including the provision of iron-folic acid tablets, multi micronutrient sachets, Lo-ORS, and Zinc for diarrhea cases, etc.
3. MAM and SAM treatment and counseling services are offered in 36 districts through 1755 OTPs at the moment. Scale-up of 600 OTPs is planned in the FY 2022-23.
4. Treatment of complicated SAM children is offered at 58 stabilization centers (SCs). Each of these SCs has an OTP attached to it. Scale-up of 21 SCs is planned in the FY-2022-23.

 

IEC Material:

Official Website & Social Media Links:

1.      
2. 042-99205326, 042-99205327
3. punjab@gmail.com
4. https://pshealthpunjab.gov.pk/Home/VerticalProgramIRMNCH