ERA

View Communities

Global Health (Public Health)

Number of results to display per page
Items in this Collection
  1. Menstrual Hygiene Managment - the Sindh experience.pdf [Download]

    Title:
    Creator: Mumtaz, Zubia
    Subjects: Adolescent Health
    Date Created: 2017/06/09
  2. Formative Menstrual Hygiene Management Research: Adolescent Girls in Pakistan. [Download]

    Title: Formative Menstrual Hygiene Management Research: Adolescent Girls in Pakistan.
    Creator: Bhatti, A
    Description: Menarche is the onset of menstruation, and is part of the complex physical changes that occur during girls’ transition from childhood into young adulthood. These changes relate to lifestyle, behavior, growth and development. While menarche is a physiologically normal process, in many countries it is embedded within a host of cultural beliefs, values and practices. In Pakistan, these include dietary restrictions including eating eggs, beef and fish, hygienic practices that forbid bathing, religious practices that restrict prayer and contact with the Quran. A small body of literature suggests a key element of cultural practices surrounding reproductive health in Pakistan, including menstruation, is the ‘culture of silence’. Part of a larger value system that is embedded within the gender order of society, information around menstruation is actively withheld until after the onset of menstruation. A number of studies have suggested girls’ knowledge around menstruation and hygiene practices may be inadequate. Lack of knowledge about menstruation is associated with profound psychological and emotional problems. Alongside growing attention to the MHM needs of girls in schools that lack adequate WASH facilities, a growing body of literature recommends menstrual health and hygiene education in order to improve health and education-related outcomes of adolescent females. Dr. Marni Sommer at the Mailman School of Public Health, Columbia University, has addressed this gap by developing girls’ puberty books that provide essential, culturally sensitive information on puberty and menstrual hygiene management (MHM) for 10-14 year old girls in Tanzania, Ghana, Ethiopia and Cambodia8. Her project is now expanding into Pakistan with a plan to develop a culturally contextual puberty book for girls. As a first step in development of the puberty book, qualitative data were collected to understand girls’ experiences of menarche, explore cultural values, beliefs and practices surrounding menstruation, and how the lack of water, sanitation and disposal infrastructure may be negatively impacting girl’s management of menstruation in schools, and their ability to participate in the classroom. The original project was conducted in the province of Punjab, Pakistan. UNICEF commissioned the researchers to expand the research site to the province of Baluchistan to ensure the book captures the cultural beliefs and values of an additional key province of the country. This report focuses on the findings from Baluchistan only. Methods A comparative case study (rural vs. urban) was conducted from September to December 2015 in rural and urban Baluchistan. Urban data were collected from Kuchlaak, a neighborhood in Quetta City, District Quetta and rural data from village Sakuran Goth, Tehsil Hub, in Lasbela District. Both sites were selected by UNICEF, Pakistan. In each site, data were collected from both in-school and out-of-school girls. Three methods of data collection were utilized: 1) Participatory activities were conducted with groups of adolescent girls (n= 177); 2) observations were conducted of school water, sanitation and disposal facilities; and 3) in-depth interviews were conducted with key informants such as parents, teachers, and health workers. Preliminary Results Overall, our data identified six key themes: 1) Menarche is generally experienced by girls as a traumatic event characterized by fear, distress and worry. 2) Prior knowledge of menarche normalized the process, leading to positive experiences of the first menstrual period. 3) Currently, girls’ knowledge of puberty and menstrual practices was rooted in local, cultural epistemology. However, they were skeptical of this knowledge and questioned it. 4) There are significant information needs, specifically around physiology of puberty and menstruation; recognition and relief of menstrual symptoms; appropriate menstrual hygiene and management practices; and social, physical, religious and dietary restrictions. 5) Water, sanitation and hygiene facilities in schools are inadequate to meet menstruating girls’ needs. 6) Participants identified a range of WASH and menstrual management resources to develop Girl-Friendly school facilities. Recommendations Based on the research findings, we recommend: 1) Development of an information resource to provide girls knowledge of puberty, menarche and menstrual hygiene management. This could be a book, pamphlet, an animated video or a web-based resource. 2) Development of a MHM health education module that should be taught as part of girls’ school curriculum. 3) Train teachers to deliver MHM information in a sensitive and objective manner. 4) Develop school WASH facilities, including availability of clean washrooms, running water and disposal facilities, located in safe spaces. 5) Create positions for cleaners to clean the washroom facilities through advocacy with provincial government. 6) Develop menstruation support facilities such as availability of sanitary supplies in schools. 7) Conduct further research to understand why teachers are reluctant to engage students around MHM issues, why is there a blindness to dirty toilet facilities, why there is reluctance to clean toilet facilities, what are appropriate mechanisms for menstrual waste disposal and if there are opportunities to manufacture sanitary pads using local, cheap materials.
    Subjects: Adolescent girls, Knowledge needs, Menstrual Health Management, Puberty
    Date Created: 2016/07/16
  3. Improving the community midwife program performance: Policy Recommendations [Download]

    Title: Improving the community midwife program performance: Policy Recommendations
    Creator: Zubia Mumtaz
    Description: This briefing is for policy-makers, program managers and donors concerned with the performance of the Community Midwife Programme and the poor status of maternal health in Pakistan. Why is this important? Despite a supportive policy environment and funding, the Pakistani Community Midwife program has not achieved optimal functioning, particularly in relation to raising levels of skilled birth attendance. Our survey from districts Jhelum and Layyah found that CMWs attended 11.7% and 3.1% of all births that took place in the last two years. Our research also discovered the reasons why the CMW program was performing sub- optimally and the factors that enabled some CMWs to practice. Based on these findings, we make the following policy suggestions to improve program functioning
    Subjects: Health systems,, Community Midwives, Maternal Health Policy, Maternity care
    Date Created: 2014/02/03
  4. Can Community Midwives establish financially sustainable practices in the private sector? Lessons from the Integrated Afghan Refugee Assistance Program Midwifery Training Project, Baluchistan [Download]

    Title: Can Community Midwives establish financially sustainable practices in the private sector? Lessons from the Integrated Afghan Refugee Assistance Program Midwifery Training Project, Baluchistan
    Creator: Mumtaz, Zubia
    Description: Afghan refugees have been migrating to Pakistan to escape the recurring conflict in their home country since 1979. Most refugees are women and children, who need high quality maternal and child health services. However the host country itself has a fragile maternal and child care system, reflected in its high maternal mortality ratio of 276/100,000 live births. The province of Balochistan, which hosts the largest numbers of Afghan refugees, has the highest maternal mortality rate (785 per 100,000) in the country.1 Not surprisingly, maternal mortality among Afghan refugee women in Pakistan is the most common cause of death in women aged 15-49. Of the many challenges refugee women face in receiving maternal healthcare services, a lack of skilled birth attendance is one of the most important.2 A large body of evidence - both historic from Sweden and more recently from Sri-Lanka - suggests skilled birth attendance is a key intervention that reduces maternal mortality rates.3 However, worldwide, skilled birth attendant programs have had mixed results. A common variable in successful programs is their location in the public sector, while private-sector models have faced challenges in ensuring universal coverage and equity of care. In 2010-2011, Mercy Corps Pakistan (MC) introduced a midwifery training project as part of its poverty alleviation Integrated Afghan Refugee Assistance Program (IARAP). This project aimed to provide Afghan refugee women with self-sustainable, market-oriented, home-based livelihoods, while simultaneously improving maternal and newborn health status of these women’s communities. Four years after launch of the program, Mercycorps commissioned the present research to document if the Community Midwives trained in the IARAP project had managed to establish their practices, the quality of care provided and whether these practices were financially sustainable. The present research aimed to address these queries and in addition, identify factors that enabled (or disabled) establishment of such practices. Methods A mix of methods was used: document review, a financial analysis of CMW practices, in-depth interviews and observations. Data were collected from two primary sources: 1) Program personnel and program documents; 2) CMWs, their family members and female clients over a period of 14 days from June 2- June 20 2014. A total of 6 program personnel, 12 CMWs, 8 family members and 7 clients were interviewed using semi-structured interview guides. Financial data was collected from 11 CMWs using a piloted financial analysis tool. Findings Ten out of the sample of 12 CMWs were practicing midwifery. They earned a mean net income of Rs 8323 per month. When stratified by current MC support, CMWs no longer receiving MC support (in the form of supplies, drugs or stipends) earned Rs 16,975, while the CMWs currently supported by MC earned Rs 3,380. However, using Pakistan’s minimum wage (Rs 11,000 per month) as a benchmark and assuming it is a living income, the data show that two of three CMW practices previously supported by MC and only 1 of 8 CMW practices currently supported by MC were financially sustainable. The former is a small number, the result of loss of MC contact with CMWs after their repatriation to Afghanistan and the latter rate was not unexpected given these women had established their practices just 6-months prior to evaluation. Cost recovery ratio, a key indicator of financial performance, was Rs 3.32 amongst senior CMWs and Rs 1.75 amongst junior CMWs. General overhead ratios were, on the whole, low because most clinics were home-based. CMW productivity ratios, measured as the ratio of total income to number of hours worked, averaged Rs 4.24 for senior CMWs and Rs 4.11 for junior CMWs. In other words, the senior CMWs earned Rs 4.2 for every hour worked, while the junior CMWs earned Rs 4.1. These rates are comparable to the average income of Afghan refugee women in Quetta who work outside the home (Rs 3000 in 2014). Qualitative data identified poverty, family support, interest in practicing midwifery and professionalism as key individual-level factors that led young women to work as midwives. The program structures and processes - sensitive recruitment criteria, targeted advertisement, and on-going, active and continuous support - greatly enabled the CMWs to establish their practices. The overarching enabling program factor was that program plans were implemented as designed. The data suggested some concerns about the midwives’ practices when assessed against recognized standards of good practice. However, the CMW-clients were happy with the care they had received from our sample of CMWs. Conclusion Within the context of the sample, our data suggests CMWs can establish financially sustainable practices in the private sector, but only if they serve clients who can afford to pay their fees. It should be noted, however, that the poorest of the poor by definition will not be able to pay for services. Nonetheless, and despite this challenge, two out of the three senior CMWs have managed to establish financially sustainable practices. If we include CMW4, the Kabul-based CMW, this proportion increases to 3 out of 4. Amongst the junior CMWs, one out of eight had established a financially sustainable practice in only six months. These are not un-remarkable achievements given the context of poverty and the design of the strategy: serving a very poor population with private sector services. Nonetheless, there remains a need to devise more innovative ways to ensure the very poor women receive essential maternal care while the CMWs, themselves poor women, are fairly remunerated.
    Subjects: Private sector health care, Afghanistan, Afghan refugees in Pakistan, Financial sustainability, Refugees, Community Midwives, Baluchistan
    Date Created: 2014/09/30
  5. Addressing invisibility, inferiority, and powerlessness to achieve gains in maternal health for ultra-poor women [Download]

    Title: Addressing invisibility, inferiority, and powerlessness to achieve gains in maternal health for ultra-poor women
    Creator: Mumtaz, Zubia
    Subjects: social exclusion, ultra-poor women, maternal health
    Date Created: 2013
  6. Improving quality and equity of maternal health services in Malawi: Why is the Standards Based Management - Recognition for Reproductive Health intervention not achieving its desired outcomes? [Download]

    Title: Improving quality and equity of maternal health services in Malawi: Why is the Standards Based Management - Recognition for Reproductive Health intervention not achieving its desired outcomes?
    Creator: Mumtaz, Zubia
    Description: A study protocol aimed at addressing a key concern of the Malawian Ministry of Health (MOH), namely the persistence of a high maternal mortality ratio (MMR) of 675/100,000 live births despite a facility birth rate of 73%. This implementation research aims to provide a detailed understanding of how evidence-based quality improvement interventions are being operationalised on the ground and avenues to overcome current obstacles within the Malawian context, thereby providing the MOH with knowledge of how to enhance their effective implementation.
    Subjects: Malawi, Standards Based Management-recognition, Emergency Obstetric Services, Implementation Reasearch, Quality of Care
    Date Created: 2014/05/18
  7. Disparities in access to maternal health care in Pakistan: poverty, gender, and social exclusion. Policy recommendations (long form) [Download]

    Title: Disparities in access to maternal health care in Pakistan: poverty, gender, and social exclusion. Policy recommendations (long form)
    Creator: Mumtaz, Z.
    Description: This briefing is for policy-makers , program managers and donors concerned with the poor status of maternal health in Pakistan.
    Subjects: Social Exclusion, Maternal Health, Poverty, Health Services, Pakistan
    Date Created: 2012/12/01
  8. Saving Mothers and Newborns in Communities: Strengthening Community Midwives to provide high quality essential newborn and maternal care in Baluchistan, Pakistan in a financially sustainable manner [Download]

    Title: Saving Mothers and Newborns in Communities: Strengthening Community Midwives to provide high quality essential newborn and maternal care in Baluchistan, Pakistan in a financially sustainable manner
    Creator: Mumtaz, Zubia
    Subjects: Baluchistan, Pakistan, Coverage of CMW services, Community midwives, Private sector health care
    Date Created: March 2015
  9. Floods in Southeast Asia: A Health Priority. [Download]

    Title: Floods in Southeast Asia: A Health Priority.
    Creator: Torti, J.
    Description: Out of all the natural disasters, floods are the most common in both developed and developing countries, accounting for approximately 40% of all natural disasters [1,2]. Flooding has severe implications on human health before, during, and after the onset of a flood. Southeast Asia is a region that is especially prone to frequent and severe natural disasters [3]. The Association of Southeast Asian Nations is comprised of Cambodia, Laos, Thailand, Vietnam, Brunei, Malaysia, Indonesia, the Philippines, Singapore and Myanmar [4]. In this manuscript, I discuss why flooding is a problem is Southeast Asia and why I feel flooding warrants attention compared to other problems in the area due to the serious health impactions that arise as a result of flooding. I also explore why flooding warrants attention compared to other health concerns in the region.
    Subjects: floods, natural disasters, Southeast Asia, public health
    Date Created: 2012
  10. Disparities in access to maternal health care in Pakistan: poverty, gender, and social exclusion. Policy Recommendations (short form) [Download]

    Title: Disparities in access to maternal health care in Pakistan: poverty, gender, and social exclusion. Policy Recommendations (short form)
    Creator: Mumtaz, Z.
    Description: This briefing is for policy-makers , program managers and donors concerned with the poor status of maternal health in Pakistan.
    Subjects: Social Exclusion, Poverty, Health Services, Pakistan, Maternal Health
    Date Created: 2012/12/01