By: Rati Bishnoi, Special Projects Intern at Women Deliver
In a nation where an estimated 14,000 women die each year from pregnancy related causes, the Pakistan Initiative for Mothers and Newborns (PAIMAN) has worked to both improve the ability of the nation’s health care sector to better meet mothers’ needs and increase demand for maternal and reproductive health services.
An estimated 260 women die for every 100,000 live births in Pakistan, with this figure reaching up to 490 deaths for every 100,000 live births in certain regions. Three common causes of poor health in women and children in Pakistan are very high fertility rates, a high unmet need for family planning services, and very low rates of skilled birth attendants. Furthermore, a poorly funded and structured health service delivery system—especially at the district level—exacerbates the problem of getting the right care to mothers and newborns at the right time.
For the last seven years, the JSI Research & Training Institute project PAIMAN has been working to build a health system and increase public awareness so that giving birth is no longer a danger in Pakistan with USAID funding. To achieve this goal, PAIMAN has enhanced public health facilities, trained public health care providers in essential maternal and newborn care, used media and pop culture to raise awareness about reproductive health, and formed alliances with regional religious leaders and nonprofit organizations—all in an attempt to help improve the delivery of health care services to more than 5.7 million mothers and newborns. As a result, it has reached more than 7.3 million people with the message that maternal health matters.
Building on the efforts of the national government to expand an existing health worker program, USAID funded the JSI Research & Training Institute in 2004 to launch PAIMAN to strengthen the maternal health service system in 24 districts. PAIMAN holistic approach to improving maternal and newborn health care at the district level includes:
- Enhancing public health facilities;
- Training more health workers in maternal and newborn care;
- Raising awareness among mothers, fathers, and families about reproductive health; and
- Establishing partnerships and alliances with civil sector organizations and influential community opinion makers to support maternal health initiatives.
As part of its effort to improve facilities, PAIMAN has upgraded and equipped 97 public health centers to provide emergency obstetric care services. However, recognizing that well equipped facilities alone won’t solve the problem, PAIMAN has also invested in transportation to help women and men in communities reach distant mother-child health centers, basic health units, rural health centers, or district hospitals. Specifically, PAIMAN operates 76 ambulances or mobile health units, which can be used to provide emergency obstetric care, and 50 vans for transporting patients to health facilities across five districts.
As part of its focus on expanding the number and skills of health care workers, PAIMAN has helped train 2,200 community midwives, 11,000 health workers in communication and group counseling skills, 6,500 health workers at the community level in neonatal and childhood illnesses, and 5,262 health facility staff in maternal and newborn health skills. In addition, PAIMAN has invested in helping health staff better manage the health system and gather data to improve health care delivery. For example, PAIMAN has helped train more than 1,000 health managers in basic finances, logistics, and managerial skills and nearly 6,000 staff in health information systems and reporting.
The project has helped raise awareness about the importance of proper maternal and newborn health care by using media and pop culture. Specifically, PAIMAN has created a commercial film and a TV drama series, which has reached more than 8 million women of reproductive age. Moreover, the project’s media campaign includes music videos with Pakistani pop stars Shafqat Amanat Ali Khan and Sajjad Ali to promote the “important but often neglected fact that the health and wellbeing of mother and child is a joint responsibility of husband and family members.” With many of the people in the 24 districts PAIMAN serves living in rural areas, the project also uses first-hand communication to raise awareness about maternal health. Through puppet shows and mobile TV vans have reached tens of thousands of villagers. After networking and raising awareness among more than 1,000 ulama, these religious leaders now often preach about health and safe maternal and newborn health care practices.
These combined efforts have saved more than 30,000 newborn babies by reducing neonatal mortality by 23 percent, 27 percent of births being attended by skilled health providers, and a 40 percent increase in emergency C-sections in target districts.
PAIMAN music video: