Report of Profiles of Slums/Underserved Areas of 08 Largest Cities of Pakistan Punjab (Lahore, Rawalpindi, Multan, Gujranwala, Faisalabad) Khyber Pakhtunkhwa (Peshawar) Balochistan (Quetta) Federal Capital (Islamabad) July 2020 Acknowledgements This study was conducted with the technical support and oversight from UNICEF Immunization team Pakistan, with financial support of Gavi- the vaccine alliance and executed by Civil Society Human and Institutional Development Programme (CHIP) under the leadership of Provincial and Federal EPI programs. The report in hand presents the results of ‘Profiling of Urban Slums/Underserved Areas’ held in 08 largest cities of Pakistan. Our sincere thanks to UNICEF for their technical support throughout the process to achieve the planned results. Our sincere thanks to UNICEF Provincial and Country office colleagues, CSOs and expanded partners for their technical support and facilitation to complete this assignment. Special acknowledgement is extended to Federal and Provincial EPI Programs, Directorate of Health Islamabad and District Department of Health in 10 largest cities of Pakistan who extended their leadership and fullest cooperation for the successful execution of the survey. Specific acknowledgement is also extended to all the respondents for participating in this study and adding their valuable input to this discourse. It would not have been possible to present such in-depth, relevant and reliable information without their cooperation. Table of Contents Executive Summarys ................................................................................................................................... 1 Chapter 1: Introduction ....................................................................................................................... 3 1.1 Global Context ............................................................................................................................. 3 1.2 National Context .......................................................................................................................... 4 1.3 Provincial Context ........................................................................................................................ 5 1.4 Objectives .................................................................................................................................. 10 1.5 Rationale .................................................................................................................................... 10 Chapter 2: Methodology .................................................................................................................... 13 2 Methodology ...................................................................................................................................... 13 2.1 Study Design .............................................................................................................................. 13 2.2 Study Sites ................................................................................................................................. 13 2.3 Study Duration ........................................................................................................................... 13 2.4 Study Respondents .................................................................................................................... 14 2.5 Sampling Procedures and Sample Size .................................................................................... 14 2.6 Key Variables ............................................................................................................................. 15 2.7 Data Collection Instruments ....................................................................................................... 15 2.8 Operational Definitions ............................................................................................................... 15 2.9 Data Analysis Techniques ......................................................................................................... 17 2.10 Monitoring Mechanism ............................................................................................................... 17 2.11 Study Team & Training .............................................................................................................. 17 Chapter 3: Profile of Slums/Underserved Areas ............................................................................. 19 3.1 Slums/Underserved Areas ......................................................................................................... 19 3.2 Demography .............................................................................................................................. 21 3.3 Health Resources ...................................................................................................................... 22 3.4 Infrastructure .............................................................................................................................. 24 3.5 Social Welfare ............................................................................................................................ 27 Chapter 4: Health Resources in Union Councils ............................................................................ 31 4.1 Administrative Lay Out ............................................................................................................... 31 4.2 Health Facilities .......................................................................................................................... 32 4.3 EPI Facilities .............................................................................................................................. 33 4.4 Nutrition Services ....................................................................................................................... 34 4.5 Human Resources ..................................................................................................................... 34 Chapter 5: Status of EPI Facilities ................................................................................................... 37 5.1 Infrastructure .............................................................................................................................. 37 5.2 Systems ..................................................................................................................................... 40 5.3 Equipment and Supplies ............................................................................................................ 40 5.4 Waste Management ................................................................................................................... 41 5.5 Human Resource ....................................................................................................................... 42 Chapter 6: Situation in Super High Risk Union Councils .............................................................. 44 6.1 Health Resources of SHRUCs ................................................................................................... 44 6.2 Slums/Underserved Areas ......................................................................................................... 46 6.3 Status of Childhood Vaccination ................................................................................................ 47 Chapter 7: Conclusion and Recommendations .............................................................................. 50 7.1 Conclusion ................................................................................................................................. 50 7.2 Study Limitations ........................................................................................................................ 51 7.3 Recommendations ..................................................................................................................... 51 Annex 1: Questionnaire for Group Discussion in Slums/Underserved Areas............................... 54 Annex 2: Questionnaire for Compiling Health Resource in Union Councils ................................. 59 Annex 3: Questionnaire for EPI Facility Assessment ...................................................................... 61 Annex 4: Analysis of Profiling of Slums/Underserved Areas.......................................................... 63 Annex 5: Analysis of Health Resources of Union Councils ............................................................ 79 Annex 6: Analysis of Results of EPI Facility Assessment............................................................... 84 Abbreviations AIDS Acquired Immune Deficiency Syndrome BCG Bacille Calmette Guerin CBVs Community Based Volunteers CHIP Civil Society Human and Institutional Development Programme CI Confidence Interval cMYP Country Multiyear Plan CNIC Computerized National Identity Card CSO Civil Society Organisation DDMA District Disaster Management Authority DEFF. Design Effect Factor DPT Diphtheria, Pertussis, and Tetanus DSV District Supervisor Vaccination EOC Emergency Operation Centre EPI Expanded Programme on Immunization ESS Effective Sample Size FSD Faisalabad GDP Gross Domestic Product GJR Gujranwala IBD Islamabad ILR Ice-Lined Refrigerator Lead Leadership for Environment and development LHR Lahore LHV Lady Health Visitor LHW Lady Health Worker MDGs Millennium Development Goals MICS Multiple Indicators Cluster Survey MMR Maternal Mortality