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Theirfifth Birthday in Sindh, Pakistan Helping children reach their fifth birthday in Sindh, Pakistan Dr. Fauziah Rabbani www.knowledgetranslationmedia.com Helping children reach their Overcoming the paradox: fifth birthday in Sindh, Pakistan Children in Sindh dying Dr. Fauziah Rabbani of the Aga Khan University, Karachi has been at the helm of Project NIGRAAN since its inception in 2011. In this interview she discusses how the project has progressed and the measures being taken by policy makers to support the development of frontline in the presence of a vital healthcare in Pakistan. To start, please tell us about your background. the final proposal submitted in February 2013. A Lady Health Supervisor is counting Funding approval was received in May 2013 respiratory rate of a sick child at Civil human resource available I have been working as a public health specialist and the contract between AKU and WHO for Hospital Badin during her clinical for the past 26 years and I am currently head of NIGRAAN execution was signed in August 2013. assessment the department of Community Health Sciences at their doorstep (CHS); one of the largest departments of the What are the main outcomes you hope to see medical college at the AKU Karachi, with 38 from Project NIGRAAN? Aga Khan University, Karachi, is the leading academic institution faculty and 170 staff. I am a health systems expert within Pakistan. The Community Health Sciences Department has 38 faculty and with a focus on implementation research. I have The primary outcome is improvement in 170 staff, who work on a number of projects including those focused on the written several book chapters, indexed technical Community Case Management (CCM) of improvement of health systems through implementation research. One of these reports and I have more than 60 peer reviewed childhood diarrhoea and pneumonia in District is Project NIGRAAN, a WHO-funded project targeted at childhood mortality. publications to credit. Badin (rural Sindh). This would, in the long term, bring about a decline in childhood and regular monitoring through NIGRAAN. A Diarrhoea and pneumonia are currently the populated cities. Indeed, despite their future My qualifications include MBBS (Karachi), MPH mortality among under-fives (Millennium written feedback system has helped this. leading killers of children under five worldwide. prospects, Pakistan currently suffers from (USA), FCPS (Community Medicine) from College Development Goal 4). Indeed, according to the WHO, 2195 children approximately 700,000 diarrhoea and 350,000 of Physicians and Surgeons Pakistan, FRCP How can LHW and LHS improve their die of diarrhoea, and 2561 will succumb to pneumonia cases annually in under-fives, (Edin) and PhD (Health Systems Research) from How will you judge the success of the main knowledge? pneumonia every day. This means that in only 40% of which are adequately treated. To Karolinska Institutet Sweden. outcomes? the minute or so it takes to read the next few prevent this, and to provide medical treatment Regular refreshers on Lady Health Workers paragraphs, three children will have died across their entire population, the government How did Project NIGRAAN come to be? Through quantitative baseline and end-line Programme (LHW-P) curriculum and clinical without ever having had the chance to go to of Pakistan has developed a number of community caregiver surveys, focus group skills and mentorship training courses is the school, to learn to read, or to do any of the programmes including those reaching out to Like other health system experts I have always discussions and key informant interviews only way to improve knowledge. Unfortunately things which we take for granted in our lives. local communities at their doorsteps. felt that a critical challenge Pakistan is facing is with health workers/other stakeholders. The this has not been available for the last few years This is a shocking statistic, and indeed one of ‘governance within the health sector’. While focus knowledge and skills of health workers will be for LHWs and LHSs. the UN Millennium Development Goals is to THE LADY HEALTH WORKER PROGRAMME on particular diseases or services is important, measured via scorecards. reduce these deaths by at least two thirds. literature has shown that weak health systems How has the national and regional Unfortunately the majority of these deaths One of these programmes is known as the and poor policy planning result in unnecessary What are the secondary outcomes you hope government in Pakistan supported your occur in rural, remote, and under developed “National Programme for Family Planning and child deaths; many never reach their fifth to see emerge from Project NIGRAAN? work? areas, where distance and transportation time Primary Healthcare”, which is almost universally birthday. limit access to the hospitals and medical clinics referred to as the “Lady Health Workers Improved knowledge, skills and supervisory In January 2014 the first executive project which could otherwise treat the patients. Programme (LHW-P)”. This programme relies In 2011, I participated in a meeting held by the processes among LHSs for CCM of pneumonia management team meeting was held. Indeed, treatment for both of these diseases upon the recruitment of women from local Health Services Academy Islamabad where and diarrhoea in children under five. This will The meeting provided a platform to bring has been well established: antibiotics to kill the communities to act as health care workers, able experts from the World Health Organisation in turn lead to an improvement in knowledge, decision makers and implementers together. pneumonia-causing bacteria, Oral Rehydration to provide basic services to women and children (WHO) Alliance for Health Policy and Systems skills and performance of LHWs through A dissemination seminar in August 2015 Therapy (a solution of salts in water) to support including vaccinations needed for polio. Research (AHPSR) conducted a workshop on structured supportive supervision by LHSs. sensitised participants regarding the use of the patient during their diarrhoea. Actually These women, known as Lady Health Workers setting priorities in health research investments Finally there will be improved knowledge of evidence in health system decision making. providing these treatments is another challenge (LHWs) are usually responsible for catchment using a validated systematic methodology community caregivers through interactions Provincial and regional health departments will – one that depends upon getting reliable areas of 100-150 households (approximately called Child Health and Nutrition Research with LHWs and LHSs during community case be incorporating the value of written feedback medical support into remote areas. 1000 people), and are provided a salary by Initiative (CHNRI). Based on CNHRI criteria an management of children with diarrhoea and from LHSs to LHWs in their public policy the government. Importantly, they must have implementation research question that we pneumonia. development documents. One country that has been making major completed at least 8 years of schooling and presented scored highly during this meeting. The inroads into this problem is Pakistan. With need to be a resident within their catchment question posited whether supportive supervision Project NIGRAAN lasts almost 24 months, What can the international community do to almost 200 million inhabitants and a strong area, thus encouraging connections with the of Lady Health Workers (LHWs), a governance what are the most significant changes you’ve combat child mortality? industrial base (as well as some exceptional people under their care. issue, by Lady Health Supervisors (LHSs) could seen in this time? cricket players), Pakistan is considered to bring about a decline in child mortality due to Endorse and ratify through various conventions be one of the up-and-coming economies These LHWs are then supervised by Lady pneumonia and diarrhoea. There has been improved communication and that access to good quality health care is a (identified by investment bank Goldman Sachs Health Supervisors (LHSs), who are essentially co-ordination between LHSs and LHWs. LHSs fundamental human right. Declare that any as one of the ‘Next 11’). However, the majority experienced LHWs with additional training. Later in the year we were invited to a refinement now accompany LHWs during follow up visits child dying due to diarrhoea and pneumonia in of the population is located along the Indus Each supervisor has 20-25 LHWs working under and protocol development workshop by WHO to the household and have more of a problem- the presence of proven lifesaving community River, leaving large swathes of land to the north her, and they are responsible for ensuring that in Islamabad. It was here that Project NIGRAAN solving approach. There has been improved based interventions which can readily be and west that are thinly populated and lacking treatment is adequately provided, collecting was technically conceived. A follow up meeting knowledge and skill scores of LHSs in terms of delivered through peripheral health workers at in the amenities more common in the heavily information on cases, and acting as an interface in 2013 was held in Montreux, Switzerland with diarrhoea and pneumonia following training their doorstep is a crime. SCIENTIA www.knowledgetranslationmedia.com child by the LHW, notifying the immediate very promising. Those involved at all levels are name but a few. She is a visiting professor at supervisor via SMS, and then planning a follow-up interested in expanding the programme to larger ISTUD Fundazone Italy. Her work has won many visit together. The LHS is then responsible for parts of Pakistan, although a few kinks remain accolades including a gold medal in research from commenting on disease treatment by the LHW, to be worked out first. Training systems need to the Pakistan Academy of Medical Sciences, the including written feedback, and informing the be modified slightly to include more hands on Commonwealth Award of Excellence and the WHO central data manager at the same time. All cases work, and to encourage LHSs to be more direct in UNISOL prize.
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