Implementation of package tour
Experience sharing by Midwife
Daw Khin Myo Win
Boe Ma RHC
• Boema RHC is 60 miles away from Pyinmanar Township.
• There are 4 sub-centers and 25 villages under Boema RHC.
• All the villages are hard to reach and situated on the hills.
• Population residing are mostly Kayan and Kayin races.
• Social barrier and financial barrier are also present .
Bawgahta sub-center is 20 miles away from Boema RHC
To reach Bawgahta subcenter from Pyinmanar--•First travel by public bus to
Yeni from Yedarshe
• from there by cycle taxi to
Yepu subcenter of Boema
RHC for night stop
•and then walk for 7 hours
in the next morning to reach
Package of Services
• Started in January to April 2012 according to CTHP .
• Service package cannot be conducted in rainy season.
• Two groups of BHS - (4) in each group
HA + 1 MW +1 PHSII + 1 AMW in one group
LHV + 2 PHSII + 1 AMW in other group
• Also plan to deliver package of service in November and
Preparation of Package Tour
• Prepare for HE session (IEC materials)
• Prepare for reports/returns (register book)
• Prepare some drugs/equipment (bathroom scale, salter
scale, BP cuff, Stethoscope, MAC tape, Test strips)
• Prepare to carry vaccines in vaccine carrier
• Information about package tour is sent to village
authorities one week before actual implementation
Implementation of Service Packages
• First, HE session is given using IEC materials as soon as
community is organized.
• Health talks and focus group talks are conducted according
to planned topics. (4 cleans, nutrition, danger signs of
• Hand washing - practical exercise by community.
• Then group of health staff conduct each activity separately
- one performing quality ANC,
- another performing immunization,
- another performing weighing of under five
• General examination of people for their illnesses and
treatment are given accordingly for ARI, hypertension
and minor ailments.
• After that inspection of latrines in the village is done by
group of health staff.
• VHWs (AMW & CHW) assist the activities by
- calling and gathering pregnant mothers for ANC
- weighing under five children
- assist in recording activities
- translate to the community
• Many services (EPI, MCH, Nutrition, EH & HE) can be given
during one visit.
• The unreached villages can be reached and provide
• Quality ANC and PNC can be done due to group activity .
PMCT also conducted.
• Under five children can be weighed and screening can be
done for malnutrition and referral.
• Iodized salt contents can be examined randomly in some
• Focus group talks to target population used to be
conducted as follows:
Pregnant mothers for ANC, danger signs of pregnancy
Adolescents in separate groups for RH
Elderly for nutrition
Mothers of under 5 children on EPI and ARI, breast feeding
Men group on risks of HIV/AIDS and STDs
• Hand-washing demonstration is being appreciated by the
• Time consuming for collecting the community if the
villagers are working in the fields.
• Village authority are not cooperative sometimes .
• More difficult to travel during rainy season.
• When hired/owned cycles are broken down during
package tour, it is difficult to compensate or could not
repair for high cost .
• Slip and fall due to thick mud and dust while climbing up
• Inadequate medicines for giving general treatment to
people who come for illnesses.
• No bathroom scale for weighing AN mother.
• Missed delivery cases while travelling for group tour to
• Sometimes health posts -not convenient for conducting
• Difficult to construct sanitary latrine and repair after
latrine inspection in the village.