Preventable childhood diseases are a major national health concern throughout Pakistan, where just slightly more than half of all children are fully immunized. Nowhere is the occurrence of measles, pneumonia and hepatitis B—to name just a few of the common illnesses—more glaring than in remote villages.
That’s why the government focused on rural Sindh—one of Pakistan’s largest provinces, where only 26 percent of children have completed routine immunization—for improved vaccination coverage through the U.S. Agency for International Development’s Maternal and Child Health Integrated Program (MCHIP), led by Jhpiego. MCHIP, a consortium of partners, is dedicated to supporting Pakistan’s Expanded Program on Immunization within the Ministry of National Health Services, Regulation and Coordination in efforts to end preventable deaths of women and children; John Snow Inc. (JSI) is the technical partner for assistance on immunization.
Over a period ranging from 10 to 22 months, there was improvement in the number of children immunized, especially those who had never been reached before. Now, 62 percent of children in project-supported sites in Sindh have completed their immunizations and are protected from deadly diseases, according to MCHIP data monitoring.
MCHIP focused on improving the planning process, strengthening the ability to identify where each child and pregnant woman lived, establishing regular immunization services and providing information to parents about immunization. Working together with the government of Sindh health department, MCHIP organized regular outreaches and followed up with children in the eight focal districts to ensure maximum coverage.
Dr. Tariq Masood, Immunization Manager of JSI/MCHIP, who is leading the Routine Immunization intervention, said, “It took a lot of continuous efforts and follow ups to ensure that the plans are well implemented in the field to vaccinate [children who were due or overdue for immunization].”
Villagers can be wary about vaccination because of persistent myths that they cause infertility and bring down the Muslim population. As a result, parents refuse vaccines that could prevent their children from contracting diseases that have been eliminated from other countries in the region.
In Sindh, however, fear wasn’t the biggest barrier that MCHIP encountered. Rather, it was a combined lack of understanding, awareness and accessibility to vaccination services—whether due to transportation problems or knowing when and where vaccines are provided.
“When effective parent education is combined with a reliable network of service providers and resources, more children get vaccinated,” said Dr. Farid Midhet, country director of Jhpiego/MCHIP, Pakistan. “That means more kids living longer, healthier lives.”
First, MCHIP strengthened the operations of the rural health care system by working with the Rural Support Program Network to create a network of professionals dedicated to ensuring that from planning to implementation, the routine immunization process runs efficiently.
Vital to this network are the designated field assistants who alert parents and escort families to sites where vaccinators are working. When an MCHIP assessment revealed that nearly all villagers own cell phones, it instituted a backup SMS notification service to remind parents about what vaccinations their children require, as well as when vaccinators will be visiting locally and providing outreach service in their communities.
Finally, to make sure all 27 vaccinators in the district can travel to their sites, MCHIP provides fuel for their motorbikes, as well as for their supervisors’.
When the service was readily available, MCHIP set out to generate demand by getting families on board with routine vaccinations. “Together, MCHIP and the district health department developed a program with health educational sessions tailored to the needs of local communities,” said Dr. Farhana Shahid, a senior technical and program advisor at Jhpiego/MCHIP.
“The awareness sessions opened our eyes,” a villager named Mithu said, referring to local efforts that informed parents about the powerful positive impact of vaccines. “Now I know very well how to treat [my child] Meena’s side effects and about what difficulties, problems and sorrow I could face if she were not immunized.”
With an eye on sustainability, the project team also identified and trained a member of Mithu’s community to generate demand for immunizations by correcting any lingering misinformation.
“Our kids are our life”
“The program in Tando Allahyar district is one of the tremendous examples of where MCHIP is reforming maternal and neonatal health,” Dr. Midhet observed. “My team and I stand with the children of Pakistan.”
So far, 222,353 children and 57,603 pregnant women from 28,566 registered villages have been vaccinated through MCHIP.
“Though pregnancy is mostly about happiness, it is also a time when I must be extremely cautious,” said Janant Bibi of the Tando Allahyar district, referring to her fear that she or her baby could get tetanus.
Another parent from the same village who observed that far too many children were suffering from diseases, probably because they weren’t vaccinated, added, “Now we [understand] prevention methods we could adopt to save our child’s life. Now we are well aware of our nearest center for vaccination, and we can take our children there.”
“Our kids are our life.”
Kashif Siddiqui works with the MCHIP communications team in Pakistan; Maryalice Yakutchik is a senior communications manager in Baltimore.