Pakistan : Health

The BRAC Health Programme in Pakistan is very new – the programme in Sahiwal and Pakpattan in Punjab province and Nowshera in North West Frontier Province started in 2009, covering 15,000 households in all three districts. To support the cadre of Community Health Workers (CHWs), BRAC has created a team of Community Health Volunteers (CHVs) to serve each household within the vicinity of their homes.

As a result of BRAC’s extensive door-to-door surveys in these communities it has deployed teams of CHWs and CHVs; the latter live in proximity of the households they cover, and make door-to-door home visits. The majority of these field workers are also BRAC microfinance clients.

CHWs and CHVs are given extensive technical and field work training to enable them to deliver quality services to the community. They are knowledgeable and equipped to treat many common illnesses that can be treated effectively with common medicines. They are also educated on many basic health matters, such as sanitation, family planning, ante/post-natal care, vaccinations, respiratory and stomach illnesses. They attend regular refresher courses to stay current on new health matters.

As CHVs have become the first point of contact for reporting any health problem in the local community, they are also the first and primary source of new health information. For example, many people first learnt about a government campaign against malaria and polio, which began last year, through BRAC CHVs who regularly serve them. BRAC adopted the messages in the government campaigns and educated its members on diseases like malaria and polio through door-to-door visits and at community Health Forums run by BRAC.

Like their counterparts in Bangladesh and other countries, CHVs in Pakistan will soon begin selling basic health care products to households under their coverage. The products will include Oral Rehydration Solution (ORS), sanitary napkins, condoms, and medicines for common ailments like colds and fevers. This will give the volunteers an opportunity to earn some income for their work, and effectively turn their homes into mini-dispensaries in an area where such services are out of reach.


Programme Description

BRAC’s health programmes have been one of the integral components of its development intervention work since 1972. By improving people’s health and promoting the capacity of communities to deal with health problems, BRAC contributes to achieving its twin objectives of poverty alleviation and empowerment of the poor. BRAC’s international experiences have proven that in order to make a sustained impact on the overall health status of the poor, health care services must be designed at the grassroots level.

BRAC launched its health programme in Pakistan in August 2009, with services in Punjab’s Sahiwal and Pakpattan districts, followed by Nowshera district in North West Frontier Province. The programme started with awareness building on the BRAC Health Programme itself, and its intentions and objectives within the area. This was followed by the recruitment of CHVs and CHWs. They then began conducting door-to-door surveys to orient households in the area about the programme.

Poor people from remote locations do not enjoy health services and also lack awareness about basic health needs. The level of progress towards the
Millennium Development Goals (MDGs) to reduce child mortality and improve maternal health is worst in the remotest districts of Pakistan. BRAC’s health programme in Pakistan has been developed to demonstrate BRAC’s commitment to support the Government of Pakistan to achieve the MDGs. The project draws on BRAC’s rich experiences in Afghanistan and Bangladesh to reach poor members of society with an essential package of health services, which is consistent with the government designed health care service package.

BRAC’s health programme aims to reach poor households to provide first line treatment, health education, primary health care, as well as services for maternal and child health and ante and post-natal care. Our experiences in Afghanistan and Bangladesh show that information and education services delivered by Community Health Workers (CHWs) and Community Health Volunteers (CHVs) have immense potential to improve the health of the poor.

It is rare for health practitioners to knock on doors of people who are at the bottom 50% of the population, therefore, BRAC's CHWs can act as a bridge and facilitator between people in the community and registered medical practitioners. Each CHW supervises 10 CHVs. Each CHV covers a cluster of 150 households, visiting eight to 10 households a day. The Health Programme in Sahiwal is run by a Regional Health Coordinator, under the supervision of a locally hired project manager, who was trained by BRAC’s health programme in
Bangladesh.

To immediately engage the community with the health programme, BRAC commenced a course of immunisations, targeting 100% of children under five, as well as antenatal check-ups for all pregnant mothers in the area of coverage. BRAC’s CHVs and CHWs have been effective in educating people in Sahiwal about malaria, polio and diarrhoea through home visits and Health Forums.


Programme Objectives
 

•   Provide equitable and accessible health services for all children, women and men, the poor and ultra poor;
•   Reduce the vulnerability of the poor and ultra poor to common diseases;
•   Intensify existing efforts to reduce maternal and child mortality and morbidity;
•   Mobilise women for education and dissemination of health information;
•   Strengthen national policy of community based tuberculosis, malaria, and HIV control and treatment;
•   Collaborate with the government to implement national programmes on immunisation, sanitation and other health matters.

In the medium-term, BRAC plans to increase the number of CHVs nationwide; staff each BRAC Health Programme branch office with a medical officer; conduct extensive training for traditional birth attendants and start a TB control programme.

The expected outputs and benefits that BRAC seeks to achieve include:

•   The targeted communities will have widespread equitable access to quality health services;
•   Continuous health education will bring change in the behaviour and false traditional practices in rural areas;
•   Overall health status of the poor, particularly women and children will be improved;
•   Improved health status of the community will bring about sustained economic development;
•   Interventions will complement and catalyse uptake of existing programmes by the Government of Pakistan and other organisations.

Health Care Objectives
 

• Awareness building of the Health Programme
• Pregnancy related care: Antenatal check ups for all pregnant mothers in the area of coverage
• Collaboration with government to educate about malaria, polio and diarrhoea
• Immunisation programme targeting 100% of children under five
• Safe drinking water, sanitation and hygiene