Since early 1970’s, provision of maternal and child health services received greater emphasis in the overall health delivery system. This led to a more concerted effort to strengthen the health infrastructure to provide an efficient and effective family health service through out the country.
Health is one of the devolved subjects and family health services are being provided in coordination with central and the provincial health authorities.
At national level, Family Health Bureau is the central organization of the Ministry of Health responsible for planning, coordination, monitoring and evaluation of Maternal and Child Health and Family Planning programmes within the country.
At Provincial level, Provincial Director of Health Services (PDHS) is the departmental head and is assisted by Regional Directors of Health Services (RDHS) who are the regional (district) heads of department in each of the districts. The RDHS is supported by a team of technical officers and others. The technical team includes Medical Officer / Maternal & Child Health (MOMCH), Regional Epidemiologist (RE), Supervising Public Health inspector, Divisional (SPHID), Regional Supervising Public Health Nursing Officer (RSPHNO), Health Education Officer 1-3 (HEO), Regional Dental Surgeon (RDS), Statistical Survey Officer (SSO) and Programme Planning Officers (PPO). MO (MCH) is responsible for planning and monitoring the MCH care and services.
Within a region (district) services are provided through a network of medical institutions and Health Units. Medical Officer of Health area is the smallest Health unit which is managed by Medical Officer of Health (MOH) and each district comprises of seven to twenty Health Divisions (7-20).
The MOH is supported by a team of public health personnel comprising of Public Health Nursing Sisters (PHNS), Public Health Inspectors (PHI), Supervising Public Health Midwives (SPHM) and Public Health Midwives (PHMs).
The Public Health Midwife (PHM) is the “front line” health worker providing domiciliary care to mothers and children within the community. The PHM is given a well-demarcated area having a population ranging from about 2000 to 5000. Through systematic home visiting, she provides care to pregnant women, newborns, infants and preschool children and offers family planning services within her area. She provides education and advice on health and health related activities and necessary counseling on family planning to potential clients. She also distributes contraceptives (orals and condoms) and regularly follows-up contraceptive users within her area. She also motivates women above 35 years to attend the area Well Woman Clinic and thereafter follows them in the field to ensure that the instructions are carried out by the individual clients. In addition to her domiciliary care, she also participates in the area clinics linking the community with the health care system.
This system had been well developed and effective in delivering preventive and promotive maternal and child health services to the population and had been highly spoken of as a model for other developing countries.