Factors Conclusions and Summary Findings Informational • <strong>Newborn</strong>s are not taken to health care providers for regular check up, except for immunization. Socio-cultural • Decisions for antenatal and neonatal care seeking are made by husbands, mothers-in-law or in few places by fathers-in-law. • Mothers are the ones who initiate the idea that neonate need health care and should be taken for treatment, however, decision to seek care and from where is taken by father, mothers-in-law or by fathers-in-law. • Lack of adequate support from the family hampers ANC seeking. • Faith healing for evil eye in new born is a general practice. Economic • Lack of money was mentioned as the main reason for not seeking antenatal care. • Money is one of the important factor in seeking treatment for neonates, however, people prefer to go to private doctors as they are not satisfied with government health facilities. Transport • Distance and non availability of transport negatively affect care seeking for ANC as well for neonates. Supply • Lack of access to health facilities, non-availability of adequate health facilities, attitude of staff and malpractices in government facilities, were reported as reasons for not seeking care from them. 48 l Formative Research on Neonatal Sepsis, Low Birth Weight AND Birth Asphyxia
Theme 8 - LHWs 8.1 Service availed from LHWs Following were reported as the services received by mothers from LHWs: • Polio drops (Khuzdar, Pishin, Charsadda, Haripur, DG Khan, Jhelum, Dadu, Sukkur). • TT injections for women (Khuzdar, Pishin, DG Khan, Jhelum, Dadu, Sukkur). • Maintaining cards for immunization of women (Pishin, Jhelum). • Medicines for pregnant women (Khuzdar, Sukkur, Pishin, Haripur). • Flu, fever and cough medicines for newborn (Pishin, Haripur, Charsadda, Lakki Marwat, DG Khan, Jhelum, Dadu, Sukkur), ORS (Haripur, Lakki Marwat, DG Khan, Dadu), lotion for itching (Sukkur), polyfax (Charsadda, Haripur), antiworm medicines (Charsadda). • Nutritional supplements (Charsadda, Haripur, Lakki Marwat, Jhelum, Dadu). • Weighing the newborns at home (Khuzdar, Pishin, DG Khan, Dadu). • Advice for diet about pregnant mother (Khuzdar, Pishin, Lakki Marwat, DG Khan) and workload (Lakki Marwat). • Advice about diet of the baby (Sukkur). • Advice on breastfeeding and care of newborn (Pishin, Lakki Marwat, Dadu). • Registration of newborn (Pishin, Lakki Marwat). • Advice on cleanliness of mother (Pishin), on cleanliness of baby (Charsadda, Lakki Marwat). • Advice to use boiled water for newborn (Charsadda). • Advice for family planning (Khuzdar, Pishin, Haripur, Lakki Marwat , DG Khan, Jhelum, Dadu, Sukkur), contraceptives tablets (Charsadda), condoms (Lakki Marwat, DG Khan, DG Khan, Jhelum, Dadu). • Check the newborn to see if s/he is alright (Kuzdar, Haripur). • Accompany women to go to a doctor (Khuzdar, Jhelum) It becomes evident from above that LHWs are providing only limited service and not the range of activities that is expected from them. Also, many participants, especially from rural areas, reported that the LHW never or seldom comes to visit them and even if the LHWs come in some areas they usually give polio drops only and do not visit in between. “We have never seen an LHW. She never visits us…… she never comes to see the newborns. She doesn’t even come to give polio drops” (FGD-Badal Bakus, Sukkur). “The LHWs never visit. They just take their salaries and sit at home. We see them only at the time of giving polio drops.” (IDI, Dai- Saleh Pat, Sukkur) Many mothers and mothers-in-law thought of LWHs as providers of polio drops and family planning services. “People of the area say that they (LHW) are there only to administer polio drops, and that is their only job” (IDI, MIL-Taunsa Sharif, DG Khan). “No, we have never benefited from them; they only administer polio drops because they get 100 rupees for this” (FGD- Sokar, DG Khan). Many mothers and mothers-in-law mentioned that various negative concepts prevail about the LHWs and their services. They are believed to provide low cost, expired and low quality medicines and only provide good medicines to their relatives and acquaintances. It is also believed that medicines that LHWs provide have family planning medicines/contraceptives mixed in them. Some women also opined that the LHWs are literate women and have a bad character. “Women think that the medicines given by LHWs are family planning medicines, which is why they do not take it” (FGD-Sakhi Sarwar, DG Khan). “They deceive us by saying that they do not have any medicine but they give medicine to those with whom they have personal relations” (FGD-Sokar, DG Khan). “Once an LHW came to our home and she was Matric fail. She made a visit list while sitting in my home and went away after taking tea” (FGD-Nissata, Charsadda). “She visits homes, gives polio drops and ORS to children, and tablets to mother if they are suffering from fever. All other medicines are sold at medical stores.” (IDI, MIL-Sarai Saleh, Haripur). “The LHW here does no work. Even the polio drops are given by her brother. She comes only once in two months and gives Nimkol or cough medicine. This is all she does” (FGD-Landiwah, Lakki Marwat). “We have never seen an LHW. She never visits us…… she never comes to see the newborns. She doesn’t even come to give polio drops” (FGD-Badal Bakus, Sukkur). SAVE THE CHILDREN l 49