This is the first of three stories on Jhpiego’s participation in a successful project, sponsored by the United States Agency for International Development, which served two million people and 126 health care facilities in two earthquake-damaged districts of northern Pakistan. The others will appear on www.jhpiego.org.
When Shenaz Begum’s cousin Shaheen gave birth at home, she was surrounded by family. But when complications developed, no one could save the new mother. The placenta became stuck and she began bleeding heavily. She died three hours later, leaving her newborn daughter an orphan.
Postpartum hemorrhage remains the leading cause of maternal deaths worldwide. Shenaz has spent her adult life trying to spare Pakistani women the fate of her cousin Shaheen.
As a Lady Health Supervisor for Pakistan’s National Program for Family Planning and Primary Health Care, Shenaz oversees a team of 22 health workers. A health worker prepares women for birth, educates them in their homes about risks and possible complications, and encourages them to give birth in a health facility with a skilled health provider.
Lady health workers provide vital information that could make the difference between a life saved or lost in a Pakistani village. The women are trained in prenatal and post-birth care and family planning as part of the PRIDE Project, a four-year program funded by the United States Agency for International Development and carried out in partnership with Jhpiego, the International Rescue Committee and Management Sciences for Health. PRIDE is helping improve health care services for women and children in two earthquake-damaged districts of northern Pakistan.
Shenaz, a 38-year-old mother of three, lives in the remote mountains of Thub in Bagh District, where women have difficulty accessing health care because of family constraints, distances to a health facility and the cost of getting there. She is called Shenaz Begum – Begum is a Pakistani endearment for respected wife and mother.
In Thub, lady health workers are essential to providing maternal and child health care. They visit pregnant women in their homes, as many as seven a day, making sure the women are attending prenatal checkups at health facilities, taking iron supplements and eating properly. The health workers also talk to relatives about the benefits of women delivering in a health facility, and continue visiting homes after a child is born to check for signs of illness and provide basic care, such as treatment for diarrhea.
To support mothers, Shenaz and her colleagues also host community meetings where women can openly discuss and share health concerns with their peers. In traditional families, women are seldom able to leave their homes on their own and talking about health matters is discouraged.
The lady health workers in Thub have been so effective that 100 percent of pregnant women in their village now receive prenatal checkups from trained health workers, says Shenaz, who has been supported in her work by the PRIDE Project.
The progress achieved in Thub is consistent with an increase in client participation at other health centers participating in the PRIDE Project. The average number of prenatal visits at eight facilities that offer essential obstetric care increased from 2,175 to 6,574 from January to December 2008, and postnatal visits tripled to 1,311 between April and June of this year.
The average number of monthly deliveries in eight government health facilities in the PRIDE Project tripled between January 2008 and December 2009, according to project data. The standard of care at those rural health facilities significantly exceeded the level of care offered at facilities that lacked an essential obstetric care package, the data show.
As part of her efforts to increase births in the local health facility, Shenaz works closely with the Mallot Health Center. Female staff assisting with births are trained in lifesaving techniques, infection prevention and safe delivery of the placenta, and are available 24 hours to provide patient care.
Shenaz prepares pregnant women for the health facility by describing the services available to them, discussing what to expect during a visit and advising them to save money to cover transportation costs if an emergency should arise.
“If I convince a woman to go to the health facility, I’m happy,” she says. “I know I’ve done my job well.”
Earlier this year, Shenaz received an award for the Best Lady Health Supervisor from Dr. Liaquat Ali Khan, the Health Secretary for Azad Jammu and Kashmir state. She was among 19 community health workers recognized for their efforts in the Bagh District. More than 500 lady health workers, district health managers and health officers attended the appreciation event.
Naseem Aktar, a lady health worker in the village of Dharyal, says the PRIDE Project has provided her with up-to-date information, tools and strategies to conduct health education sessions that interest and influence women. One of her patients, Shazia Iqbal, was dreading the birth of her second child because she experienced a difficult labor with her daughter. But Naseem looked out for her.
“Naseem came with me to the health facility. She helped me find a taxi and phoned ahead so the facility staff would be ready when we arrived,” says the young mother.
And one of the PRIDE-trained staff on duty, Nasreen Bibi, “was so kind and made me feel much calmer. She talked to me as though I was her own daughter,’’ says Shazia, who gave birth to a healthy baby girl, Sanam, on June 2.