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Mortality rate and Girls’ education

 District Health Information System (DHIS) of KP Govt has released its report of 1st Quarter 2017. As a continuous monitoring system, reports talk about various health dimensions & profiles in each district. Punjab also had a DHIS which probably now is working under some other name. I tried to find some details from Punjab but couldn’t get yet. However, I will update for comparative study purpose once I get hold of those.

There are few numbers in KP’s report that got my attention. Neonatal mortality (death in 1st 28 days) rate recorded in 1st Q of 2017 is 32 deaths per 1000 live births. In Pakistan average rate of this is 46 and the world average rate is 19.2. Likewise, Infant mortality (death before 1st birthday) rate reported in KP is 27 deaths per 1000. Pakistan’s average rate on this is 66 and the world average is 31.7. Another aspect that came out here is about maternal mortality (death of the mother within 42 days of delivery). KP reported 208 deaths per 100,000 live births whereas Pakistan’s average on this is 178 and the world average is 216. Data for Pakistan & the world is for years 2015 &16. This data is taken from the world bank.

One more thing worth taking seriously is the Low birth-weight babies. It is also of concern when there is so much variation among districts. Only in 3 districts percentage of babies born with low weight (less than 2.5kg) is in double digits (Haripur [30%], Buner [27%] & Battagram [15.5%]) while in all other districts of KP it’s in single digit. The above data covers only the cases at Government Health facilities and the cases attended by Lady Health Workers. Report is available here

Paul O’Neil, an American civil servant, Later US Secretary of the treasury in Bush Administration. He was investigating high infant mortality rate in the US. At that time infant mortality rate in the US was even higher than in Europe. His research analyses lead him to the conclusion that infant mortality is mainly due to malnourishment. For the remedy, he proposed that govt should start educating women about nutrition before they become sexually active. The proposal came in with changes to school curriculum and teacher training. With his focus on curriculum and teacher training, together with other interventions, today the US has 68% lower mortality rate than that when Paul left that role.

Where do we stand and how we tackle this matter? We don’t have only this challenge; we have some other health challenges as well. National Survey 2016-17 on Diabetes revealed that 26% of our population is affected by diabetes. Another research study revealed that even bigger population is at arsenic poisoning risk. There is no stand-alone solution to our problems. Whatever approach we take, we sure will have one thing common in all our approaches. That common thing is our household & our eating habits. Our women need to be well aware of nutritious requirements in a household. This will not only help them but other family members as well.

What can we do?

Like Paul’s approach, we need to target our girls in school. We need to educate them in order to protect our future generations at or around delivery times. We need to educate them to protect our current & upcoming generations from the risks of diabetes and obesity. This solution sure is not the lone-fighter but a frontline soldier against our various health risks. How we do this education thing? My approach to the matter will be to start a program on “Nutrition and Public Health” for the students of class 9, 10, 11 & 12 conducted by Health Department of the province. Health Department, for each district, on a need basis, can engage full-time lecturers on the subject.  Then, together with Education Departments plan out to one lecture to each class ones in every 6 months.

Working out on such rotation is not a difficult thing. Punjab Govt’s has already a plan whereby they have one inspector who visits each School once a month so does the KP Govt. Movement/rotation planning is not an issue at all. This Lecture frequency can be twice a 6 month for students of grade 9 & 10 as in our rural areas post-secondary opt-out chances are higher. Health departments can work out with private schools and chalk out plans to educate students enrolled there. Ultimately these students, too, are as much part of the society as those in Govt schools. To include “Nutrition and Public Health” course for assessment, say shifting a few marks share to it from Pakistan & Islamic studies, will be a bad idea?

Such a program will produce results in 4-5 years’ time. This will assist to significantly improve our eating habits, diets and reduces our chances of illness. Well-nourished moms-to-be can give birth to healthy kids and they may survive early departures associated with malnutrition. In return for Govt, it will reduce Govt’s & public’s medical expenditures. It will help for a shift to more healthy foods and living style

 

(Featured image is taken from @PH2dayAffairs Twitter feed.)

 

Another Court-battle

A long battle of rights for the “patients”, as claimed by both Govt. and protesting unions, came to an end with the judgment of Peshawar High Court (PHC) dismissing all seven petitions challenging Medical teaching institutions reforms act (MTI Act 2015) and declaring it an enactment of competent legislature and hence constitutional. Just after a short break, now parties are back in the court and this time, it’s about the dissolution of Postgraduate medical institute (PGMI). As the matter is sub judice and Govt. has yet to submit its position so hoping that it will be settled soon.

Meanwhile looking at the response from the doctors and suspending healthcare function for a time, one wonders what’s so serious happening in this regard. There have been some negotiations between doctors association (twenty plus unions and it’s so confusing that I don’t know who is who) with the chief minister who attended their grievances and one shall hope that govt. will fulfill the promises made during negotiations. On 26 January 2016 govt. notified the decisions of the competent authority with regard to PGMI Hayatabad, Peshawar.

PGMI was created in 1984 with an aim to impart postgraduate medical training to doctors and was headed by a Dean. PGMI is affiliated with Khyber Medical University, Peshawar for the award of degree and accredited by College of Physicians & Surgeons Pakistan (CPSP) & Pakistan Medical & Dental Council (PMDC) with respect to award of diploma certificates. PGMI acts as a central body to select and distribute trainee medical officers (TMOs) among its constituent & affiliated colleges for FCPS, MCPS & other PG Diploma courses. In 2013, PGMI was administering training, salary and other general matters of 1413 TMOs spread over ten medical colleges and 5 cities of Khyber Pakhtunkhwa.

Govt. notified on 26 January 2016 that each MTI shall have a Postgraduate wing (PG Wing) to be headed by Associate Dean. Under MTI regulations, a Dean of the MTI will select an associate dean for approval from Board of Governors to be appointed as head of PG Wing. The associate dean will be responsible for PG Medical education in the institution, will report academic council after every 3 months. This will certainly offer an opportunity for the closer monitoring of PG training at the institutional level.

It further notified a Central Induction Committee comprising Associate Deans of all MTIs. Chairman of the central induction committee will be appointed by govt. from amongst the Ass. Deans in central induction committee for 2 years on the rotation basis. Central induction committee will induct trainee medical officers for different specialties twice a year however the inductions for specialty and diploma shall be with prior input from the MTIs with respect to teaching capacity and specialties sanctioned by CPSP.

All administrative, financial and academic activities of the TMOs deployed in nearly 10 hospitals in 5 cities through PGM Peshawar will now be managed by right at the medical institute they are attached with, provided govt. passed the test before PHC. The finance department will release the stipends of TMOs to each medical institute where MTI Act 2015 is in force and Health department will pay stipends to those TMOs deployed in medical institutes currently not under MTI Act 2015.

Protecting the employment of medical faculty & administrative staff of the PGMI, the medical faculty of PGMI currently assigned to LRH and all administrative staff of PGMI will be absorbed by MTI Lady Reading Hospital (MTI LRH). Both medical faculty & administrative staff absorbed in MTI LRH will have freedom to exercise their right to be absorbed either as government servant or institutional employee. Accordingly, medical faculty of PGMI currently assigned to Hayatabad Medical Complex (HMC) will be absorbed by MTI HMC and absorbing employee can choose to be absorbed as government servant or institutional employee. Govt will continue to pay for these absorbed employees. All such proportional payments will be included into grant-in-aid to these MTIs thus taking complete ownership of all these employees and protecting their employment.

In order to monitor and improve PG training quality, Associate Dean in each MTI is required to report every 3 months on training quality matter to the academic council of the institute. Further, in this regard Associate Deans of all PG Wings are required to meet quarterly with chairman central induction committee as the head. The final outcome responsibility on the PG training has been shifted from one PGMI Dean to all MTIs thus causing a competitive environment for the PG Training.

Going through the existing PGMI administrative system, knowing concerns of doctor unions represented by Dr Alamgir, reported concerns from the petition filed before PHC by Dr Hussain Haroon and notified PG training set up by govt one shall be able to have a clear picture on nature of the conflict on PGMI dissolution and subsequent impact on Doctors pursuing PG training and for the public at large.