PAKISTAN

PROJECT TITLE: Child Health Promotion

PROJECT AREA: KURRAM AGENCY, FEDERALLY ADMINISTERED TRIBAL AREA (FATA)

CONTEXT OF THE PROJECT

FATA comprises seven Tribal Agencies and six adjacent Frontier Regions with a total population of 3.1 million (1998 Census). Peshawar is the nearest city within the North West Frontier Province of Pakistan (NWFP). The Governor of the NWFP exercises administrative authority over the entire area.

Health service coverage in FATA is patchy with many senior staff posts vacant and health centres served by inexperienced staff with limited resources. Vaccine-preventable diseases cause considerable morbidity and mortality. Malaria, TB and leishmaniasis are all endemic in FATA. Many children are undernourished making them more vulnerable to ill health.

Limited access to health services and clean drinking water, poor sanitation and high levels of poverty and malnutrition all contribute to the appalling health status of the population of FATA, particularly amongst young children. UNICEF’s health indicators show Pakistan to rank as one of the worst countries for child mortality. (Infant mortality rate is 85 per 1000 live births, under 5 mortality rate is 110 per 1000 live births. UNICEF 2003)

Reproductive health care is also extremely limited and further jeopardises the health of newborn children in the region. Only 27% women receive any form of antenatal care, only 13% of deliveries take place in health facilities and only 18% of deliveries are attended by a skilled attendant.

Medical and health facilities in FATA, including the main hospitals, are under-resourced and under-staffed. Wards are cramped and dirty with inadequate water and sanitation and are subject to huge variations in temperature during the winter and summer months. Basic medical and nursing consumables are available but drug stocks are limited and qualified nurses are in extremely short supply.

Beyond the main hospital, each Agency and Frontier Region is served by a small number of Rural Health Centres (RHCs). These are supposedly staffed by a physician, surgeon, paediatrician and gynaecologist but in reality none of the specialist positions are filled and the units are staffed by medical officers. Maternal and Child Health Units (MCHUs) are similarly disrupted by the lack of specialist doctors and there are very few midwifes in the region.

More remote areas are served by a larger number of Basic Health Units (BHUs) and dispensaries. However, in reality many BHUs have no qualified staff nor receive a regular supply of drugs.

The World Health Organisation (WHO) and the United Nations Children’s Fund have bases in Peshawar and are supporting the Ministry of Health in implementing an Expanded Programme on Immunisations that is beginning to improve vaccine coverage and reduce the impact of such diseases as polio. Resources are limited, however, and there are no local or international NGOs providing child health services within FATA to support the public sector.

RESPONSE INTERNATIONAL’S PROJECT

The project started in August 2004 with the aims of:

• Conducting a detailed health and nutritional assessment of young children throughout FATA.
• Using the results of this needs assessment to develop and conduct a training programme for existing government health workers in FATA.
• Using the results to also develop and conduct health education workshops for local communities throughout FATA.
• Increasing childhood vaccination coverage, and reducing levels of childhood malnutrition.
• Reducing childhood morbidity and mortality rates in FATA (Long term goal).

The target population will be children under five within the 3.1 million total population of FATA. It is currently estimated that 20% of the total population is under five, totalling approximately 620 000 children.

SPONSORS AND PARTNERS

In August 2004 Response International was awarded a £400,000 grant by the Big Lottery Fund (UK) to implement this three year project throughout FATA in conjunction with the regional Ministry of Health, WHO, UNICEF and local communities.

FUTURE DIRECTION

We will be using the results of the health and nutritional assessments to continue to advocate (with government ministries and international aid organisations) for additional and improved health services in FATA. In particular we will be seeking funding for initiatives to further improve vaccination coverage and to tackle the main endemic diseases (TB, Malaria and Leishmaniasis).