Sexual & Reproductive Health

Introduction

PPHI Sindh's goal in terms of SRH is to make family planning and reproductive health services accessible to all. In order to achieve this PPHI Sindh has been organizing camps, community awareness sessions and has also been addressing social behavior regarding SRH.

Family Planning
  • Pakistan is the sixth most populated country in the world with an estimated population of 199.71 million. The estimated population growth and fertility rate is 1.86 and 3, respectively.

    Although Pakistan initiated Family Planning (FP) programs in the private sector in 1953 and in the 1960s in the public sector, the Contraceptive Prevalence Rate (CPR) had increased by only 0.25% annually until 1990. The CPR rose more sharply from 12% in 1990 to 33% in 2000; with much of this increase occurring in rural areas and in traditional methods. Pakistan committed to FP 2020 Commitment for working toward achieving universal access to reproductive health and raising the contraceptive prevalence rate to 55% by 2020 (1). For this FP 2020 Costed Implemented Plan (CIP) cell was established. It is headed by Minister of Health and Population Welfare, Dr. Azra Fazal Pechuho in Sindh.

    PPHI Sindh’s contribution in the area of family planning especially Long Acting Reversible Contraceptives (LARC) can be recognized from the fact that from 2014 to 2018, 121,227 implants have been inserted by PPHI Sindh’s healthcare providers by organizing special family planning campaigns. The special feature of these camps is that the transport is provided to the families for pick and drop from far flung villages where access is issue. Initially, these camps were on quarterly basis and so far, 13 FP camps have been organized till June 2018. PPHI Sindh has been providing Routine FP services through counselling of mothers in Antenatal, Postpartum, lactating, etc. FP training is regular feature of capacity building activities and is provided to all healthcare providers.

    For implants, more than 600 male and female doctors and 2000 female paramedic staff have been trained in inserting IUCDs, PPIUCDs and implants. These trainings have been provided in collaboration with PWD with support from UNFPA.

    For monitoring, PPHI Sindh has its very own Smart Phone Monitoring System at health facilities which is used for observing regularity and punctuality of staff, verification of essential equipment’s, medicine, vaccine and stock out status. While, for data collection at the primary health care facilities, mainly District Health Information System (DHIS) is used. The technical visits are also monitored through dashboard to see the quality of visits.

    PPHI Sindh has divided its FP related efforts in two phases. In the first phase, the focus has been on building the system and making services available. Now in the second phase, it will be on making quality services accessible, ensuring the availability of competent staff, commodities coupled with innovative ways for delivering MNCH services.
Infertility
  • Most people have desire to conceive a child. It is important to understand normal fertility so that timely medical care could be approached. Infertility is major component of sexual and reproductive health. WHO defines infertility as “failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse” (2). Infertility can also be resulted as if woman has irregular menstrual cycles, previous pelvic infections, uterine fibroids, or due to males if having semen abnormalities. Due to stigmatization Infertility kept under reported in Sindh since many years. PPHI considered infertility as essential element to be part of primary health care and hence PPHI build capacity of their staff according to WHO guidelines to recognize this issue and take appropriate measure accordingly. PPHI also indulge in raising awareness among community to consider infertility as medical problem and seek its cure. PPHI involved this indicator in its district health information system and mentioned there identified cases. PPHI tries its efforts to strong its referral mechanism so that Infertile clients could refer to other secondary and tertiary care hospitals.
STIs/STDs
  • Sexually transmitted infections also recognized as sexually transmitted disease (STD) which is transmitted through sexual activity including vaginal intercourse or oral or anal sex and vi non sexually way that is due to blood transfusions. STIs can also be transmitted from mothers to babies.

    STIs has different types bacterial., fungal, viral and due to parasites. STIs has profound impact as more than 1 million people acquire STIs everyday worldwide (3).

    PPHI adapted WHO guidelines so that majority cases can be identified that can be treated, and referred accordingly. PPHI also emphasized on counselling for prevention purpose. PPHI build capacity of its staff to recognize, treat and prevent STIs. PPHI conducted awareness session and in result many under reported cases identified. PPHI also promotes counselling strategies that can help people to recognize symptoms of STIs and increase likelihood to seek medical care. PPHI has built good health information system which helps to identify total no. of STIs cases.
HIV/AIDS
  • HIV stands for Human Immunodeficiency Virus which is at progressive stage end up with AIDS (Acquired Immune deficient Syndrome). HIV is global major public health issue which is spectrum of conditions caused by infections. Even in 2017 more than 35 million people were living with HIV (4). HIV itself can increase susceptibility to have multiple other disease like cancer etc.

    PPHI promote screening of people with HIV/AIDS. Hence PPHI has arranged HIV/AIDS camps to screen and identifies people with HIV infection and take appropriate measures accordingly. Moreover, PPHI has strengthen its laboratory services through initiation of rapid diagnostic testing which detect the presence or absence of HIV antibodies. There is no cure of HIV infection. However, PPHI has initiated providing Antiretroviral Therapy to clients with HIV which can control he virus and helps in preventing further transmission to other people who are at substantial risk.

    PPHI recognized that lack of public awareness, stigma associated with STIs and lack of training among health care providers are major barriers to approach to treatment and prevention of HIV. Therefore, PPHI has also arranged awareness sessions in community for providing consciousness among people about HIV symptoms, diagnosis, prevention and early approach to heath facilities. PPHI not only trained its staff for HIV but it also reinforces its information system to capture accurate number of clients with HIV.
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