This year, that was the morning of July’s Tuesday when Auditorium of a well-known hospital in Karachi was full of the audience. A team of a social welfare program called Sindh Peoples Health Program (SPHP) was ready to present their work. The team comprised of following: Dr. Qadeer Ahsan, Dr. Misbah Muneer, Mr. Amjad Mirani, Ms. Musarrat Rani and Mr. Shakeel Ahmed. The conference was about a comprehensive health program for the poor people of Sindh. All presenter belonged to a Non-Governmental Organization (NGO), created in 2002 with an aim to reduce the poverty burden in Pakistan.

“For the betterment of the poor lives, we have four components in our program” Dr. Qadeer had started his talk. “Sindh extremely needs a program which can be helpful in strengthening (i) Primary health care system (ii) Sustainable maternal & newborn child health initiatives (iii) Medical supplies distribution system for the poor and (iv) Promoting healthcare awareness among children” Dr. Qadeer briefed the components and handed “over” to Mr. Amjad Mirani to continue.

“Pakistan’s health sector is characterised by urban-rural disparities and an imbalance in the health workforce, with insufficient numbers of health managers, nurses, paramedics and skilled birth attendants. Sindh Lady Health Worker (LHW) program provides door-to-door primary health care services in a context where male-controlled norms of seclusion constrain women's access to healthcare facilities.  An innovative intervention is the introduction of civil vital registration system by LHWs program that promotes healthy lifestyle practices and advocates for policy reforms that would lead to a more affordable, accessible and responsive healthcare.  A customised mobile application ‘m-Health’ has been developed by SPHP for LHWs. The application is designed for real-time collection of routine data including information related to communicable diseases and enhance linkage including referrals to health care providers such as community midwives for prompt medical care if required. Since the data will be shared in real time this application will also help in planning and quick decision making” Mirani informed the audience about the component.

Following this, Ms. Musarrat Rani presented her major activities under the component: “Sustainable Maternal & Newborn Child Health Initiative”. This is one of the core components of SPHP, aiming to reduce maternal and neonatal mortality by ensuring access to 24/7 Maternal, Newborn and Child Health (MNCH) services in Thatta, Hyderabad, Mirpurkhas, Dadu, Larkana & Khairpur.  SPHP supports the introduction, scale-up, and further development of high-impact and evidence-based maternal, neonatal, and child health interventions while incorporating micro-health franchise model, or ‘Umeed-Se’ and set up, effective referral, transport, and telecommunication systems into public and private sector services. The project will support the continuum of care, from home to hospital, and from pre-pregnancy to newborn care, and functionalise 450 Community Midwives (CMWs) led the birth center to cover 17% of under-served areas across Sindh. The support also includes provision of refresher training, mentoring, equipment and supplies, and development of a robust patient referral mechanism.

 ‘Umeed Se’ is a sustainable MNCH initiative to equip 450 CMWs with modern tools for strengthening MNCH services. SPHP is introducing a mobile application for Community Midwives(CMWs). It is a customised, clinical decision-making tool. It facilitates on-field clinical decision making regarding pregnancy-related referrals by CMWs. The application analyses algorithms (medical history, gestational age, expected date of delivery, lab reports, and nutritional status). It will contribute towards reducing maternal mortality by preventing the “three delays”. In real time, it will directly connect to an expert advice; a referral doctor, in case of a complication and will also have automatic connection to emergency and transportation services in close vicinity of the client. All 450 CMWs will be provided with a hands-on training for the options of this application. Android mobile phones including and connections will also be provided to the CMWs. SPHP will continue on job coaching of CMWs on the application. CMWs will be generating a daily report.

This intervention will support the effective deployment of 450 trained community midwives (CMWs), especially in underserved areas, to provide MNCH services in order to establish and strengthen their practices in the community through midwife-led birthing centres (MLBCs). This intervention will enhance the technical capacity of 450 identified CMWs to provide high quality MNCH services through implementation of a quality improvement process and on-the-job mentoring and supportive supervision. The CMWs will be trained on MNCH related skills including Pregnancy, Childbirth, Post-natal and Newborn Care (PCPNC); Helping Baby Breathe (HBB), Post Abortion Care, Infection Prevention, Misoprostol, Chlorhexidine, Family Planning including Post-Partum Family Planning. Trained CMWs will provide province-wide support for high-impact interventions, including Helping Babies Breathe, and postpartum haemorrhage (PPH) prevention using misoprostol. All the trainings will be conducted at Sindh Health department’s Provincial Health Development Center (PHDC), Jamshoro”

“The universal access to health means that all people can use the services they need, when they need them, throughout their life course without increased financial burden thus reducing out of pocket payments”, this was stated by Dr. Misbah Muneer while presenting her work to the audience. “One such effort to decrease this financial burden is provision of 2300 types of medical and surgical supplies to 200 public sector hospitals across Sindh to improve quality medical services, especially for the poorest members of the community. SPHP has established help desk named as Mrs. Shamshad Masood Memorial Counters in hospital across 29 districts of Sindh for provision of medical and surgical supplies to facilitate poorest of the poor attending both out and in-patient facilities.  In relation to provision of medical and surgical supplies, SPHP ensures that all supplies are fully and appropriately utilised by healthcare providers. In this regards a comprehensive series of Clinical Skill Enhancement Training for Healthcare Providers” has been designed in collaboration with The Aga University Hospital, Karachi to enhance the clinical skills of healthcare providers. Therefore, a pool of health care providers is planned to be trained as master trainers from each participating hospital to enhance their basic clinical skills and to conduct trickle down trainings, accordingly. The master trainers will also ensure quality healthcare practices as per internationally accredited healthcare standards” Dr. Misbah concluded her talk while handing over to Shakeel Ahmed.

“Since children are naturally curious, there is a need to provide them opportunities for new exploration and development of healthy behaviours. Education is one of the main pathways towards improving healthy behaviour among children. It also requires the involvement of parents, caregivers, peers, health care practitioners, policy makers, and other target groups in order to increase knowledge and change attitudes and behaviour. Examples of areas in which education about risks is crucial include the healthy practices, road safety, outdoor safety, household safety, problems of disabled children and habit of saying “No” to substance abuse. Sindh People’s Health Program (SPHP) is implementing a Child Health Initiative (CHI) in the six districts of Sindh in collaboration with Departments of Education and Health. Under this initiative, around 600,000 children are being reached out in the communities. The program also engages about 24 00 school teachers from the public sector and about 10,000 parents of the children through parent teacher committees of selected schools” Shakeel ended his speech and thanked all the people for their arrival, and this is how program got an end.

Yet, the month of August is near to be ended. Though many days have passed but I was still thinking about the poor and ill people of our country who do not have appropriate health facilities. “we need these types of programs” “we have to save lives”. . .  “yes, we need it”  perhaps it was the voice from my inside but it has a genuine “reflected sound” too.

Indeed, these types of programs can be a milestone towards social welfare reforms; ensuring that the identified under-privileged citizens across the country get access to their entitled medical health care in a swift and dignified manner without any financial obligations. Such programs can improve the quality of life of underprivileged citizens of the country, especially targeting those population groups which fall below the poverty line i.e. earning less than dollar a day. Hence, program such as SPHP is surely a “ray of hope” for the vulnerable people of Sindh.


The writer is a poet & former student of Economics at Karachi University