“It’s one of the best community-based health systems in the world,” said Dr. Donald Thea, a Boston University researcher, talking about Pakistan's Lady Health Workers Program. Thea is one of the authors of a recent Lancet study on child pneumonia treatment in Pakistan. He talked with the New York Times about the study.
Published in British medical journal "The Lancet" this month, the study followed 1,857 children who were treated at home with oral amoxicillin for five days and 1,354 children in a control group who were given standard care: one dose of oral cotrimoxazole and instructions to go to the nearest hospital or clinic. The home-treated group had only a 9 percent treatment-failure rate, while the control group children failed to improve 18 percent of the time. 
Launched in 1994 by former Prime Minister Benazir Bhutto's government, Pakistan’s Lady Health Workers’ program has trained over 100,000 women to provide community health services in rural areas. The program website introduces it as follows: "This country wide initiative with community participation constitutes the main thrust of the extension of outreach health services to the rural population and urban slum communities through deployment of over 100,000 Lady Health Workers (LHWs) and covers more than 65% of the target population. The Programme contributes directly to MDG goals number 1, 4, 5 & 6 and indirectly to goal number 3 & 7. The National Programme for Family Planning and Primary Health Care is funded by the Government of Pakistan. International partners offer support in selected domains in the form of technical assistance, trainings or emergency relief."
A recent comprehensive review of the program found that as compared to communities not served by the LHWs, the served households were 11% more likely to use modern family planning methods, 13% were more likely to have had a tetanus toxoid vaccination, 15% more were likely to have received a medical check-up within 24 hours of a birth, and 15% more were likely to have immunized children below three years. The improvements in health indicators among the populations covered by the LHWs were not entirely attributable to the program alone; researchers noted that other positive changes such as economic growth, increased provision of health services and better education services helped to enhance the impact. While the program had managed to sustain its impact despite its large expansion, evaluators found that serious weaknesses in the provision of supplies, and equipment and referral services need to be urgently addressed.
The program is now a major employer of women in the non-agricultural formal sector in rural areas, and is being more than doubled in size if budget allocations can be sustained. If universal coverage is achieved, every community in the country will have at least one lady health worker, one working woman and potential leader, who could serve as a catalyst for positive change for women in her community. The health officials say that unlike the mid-1990s when it was difficult to recruit women because of the minimum 8th grade education requirement, now there are large numbers of women who meet the requirement lining up for interviews in spite of low stipend of just Rs. 7000 per month.
Private sector is also helping the LHW program. Mobile communications service provider Mobilink has recently partnered up with the United Nations Population Fund (UNFPA), Pakistan's Ministry of Health (MoH) and GSMA Development Fund in an innovative pilot project which offers low cost mobile handsets and shared access to voice (PCOs) to LHWs in remote parts of the country. Mobilink hopes to bridge the communication gap between the LHW and their ability to access emergency health care and to help the worker earn extra income through the Mobilink PCO (Public Call Office).
Due to economic downturn and security challenges in several conflict areas since 2008, Pakistan's chances of achieving its Millennium Development Goals (MDGs) by 2015 appear to be slim. However, significant timely expansion in the LHW program and making it more effective can still help Pakistan get close to its MDGs on important health indicators like the infant mortality rate (IMR) and the maternal mortality rate (MMR).
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US CIA's fake vaccine ploy to get bin Laden has hurt Pakistan's polio fight, reports the Wall Street Journal:
The United Nations says a reportedly fake vaccination campaign conducted to help hunt down Osama bin Laden has caused a backlash against international health workers in some parts of Pakistan and has impeded efforts to wipe out polio in the country.
A number of families across Pakistan refused vaccinations from July, when news of the reportedly fake campaign broke, to September, said Dennis King, chief of polio vaccinations in Pakistan for Unicef. "Following the early reports, some families in the provinces did refuse to have their children vaccinated citing the fake campaign as the cause," Mr. King said.
The refusals, he added, have declined since September due to vigorous campaigning by international and local health workers to ensure families they are working only to vaccinate against polio, a disease eradicated in most of the world but still prevalent in Pakistan.
Pakistan military intelligence in July detained a local doctor, Shakeel Afridi, on charges of involvement with the reportedly fake vaccination campaign, supposedly involving vaccine against hepatitis B. Pakistan officials believe the campaign was an attempt to get DNA samples from bin Laden's family to confirm his location in a house in Abbottabad.
In May, U.S. Navy SEALs raided the house, killing bin Laden. A Pakistani judicial committee has recommended Dr. Afridi be charged with treason, which carries the death penalty. He hasn't been made available to comment since his arrest.
The U.S. Central Intelligence Agency, which Pakistani officials say carried out the purportedly fake program, hasn't publicly commented. Officials familiar with the bin Laden operation say the CIA did indeed institute a mock vaccine program with a local doctor who had previously been an informant in the tribal areas. The plan was to obtain DNA from residents of the Abbottabad compound as they got a vaccine injection, helping confirm bin Laden's presence there....
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Ghulam Rasool, a laborer from Khyber, found out in March that his 18-month-old son had polio after militants had warned off health workers.
"I know my child's future has been ruined, but I won't let it happen to my other kids," he says. "Now I have brought eight children of my extended family to Peshawar to get them vaccinated despite threats."
Senior Pakistani health officials condemn Mr. Afridi's role as unethical.
"Everybody in the medical profession resented his deceptive role. Defeating polio in Pakistan is challenging anyway, and this created negative associations," says Janbaz Afridi, deputy director at Khyber-Pakhtunkhwa's provincial health department in Peshawar.
Pakistan is one of the last significant polio reservoirs in the world, imperiling global eradication efforts, Unicef warns.
http://online.wsj.com/article/SB10001424052970204190504577038781784474056.html
Here's an Express Tribune story of a Pakistani young man of humble origins helping terror victims after studying Emergency Medicine at Yale:
.Today, Razzak is a renowned emergency medicine expert and the executive director of the Aman Foundation. He started his schooling at a humble primary school in Lyari, completing his secondary education from Nasira School in Depot Lines. Not one to be held back, the hard-working student subsequently attended Adamjee Science College where his impressive grades and unbounded enthusiasm won him a scholarship at the prestigious Aga Khan University Hospital (AKUH), the top private medical institution in the country.
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In collaboration with the Edhi Ambulance Service, an arm of the philanthropic Edhi organisation and the largest volunteer ambulance network in the world, he researched and analysed road traffic injuries and emergency cases. Edhi had a mountain of documentation for every call and every case it had handled in the last two decades. The downside? None of it was digitised, so he spent days sifting through it manually.
The experience stayed with him, and the data revealed a disturbing pattern. Gruesome injuries, often suffered by the poorest members of society, were often improperly handled by well-meaning doctors, simply because of a lack of know-how. These mistakes frequently, and literally, led to the loss of life and limb.
Yet, Razzak soon realised that he needed more professional training and specialisation courses before he could progress further. He sat for the US Medical Licensing Exams (MLE) and had observations at the Beth Israel Medical Centre, New York, and the Yale-New Haven Hospital, Connecticut. In 1996, his residency and training programme at Yale University’s School of Medicine started and in 1999, he was given the ‘Best Trainee’ award by the State of Connecticut.
On the personal front, Yale was also important for the doctor since he met his future wife there. Following graduation, the two stayed in the US for a few years, always looking forward to the time when they would return home. “The plan was always to come back,” says Razzak. “That’s why we never bought a house, never completely settled in.”
Before they could come back, Razzak did his PhD in Public Health at the world-renowned Karolinska Institutet in Sweden, where he focused on the use of ambulance data for monitoring road traffic accidents. Finally, in 2005, the studious boy from Kharadar returned to Pakistan as a successful, qualified expert in emergency medicine.
He joined his alma mater, AKUH as a faculty member and went on to successfully found Pakistan’s first emergency medicine service (EMS) training programme at the university. “There were many doctors who were awarded their degrees without ever administering cardiopulmonary resuscitation (CPR) as it wasn’t a requirement,” he reveals.
This changed when his EMS programme became a mandatory rotation that all students had to serve. Subsequently, Razzak went on to build and head a new emergency department. Yet, the battle was just half won. Students in the new department faced a dilemma, similar to the one Razzak had as a student. They were required to go to the United Kingdom to sit for their exam, otherwise they would not be considered qualified.
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Determined to remove, for others, the hurdles that he himself had crossed only after many toils, Razzak collaborated with the College of Physicians and Surgeons Pakistan (CPSP) to organise a curriculum for the specialised field. The first batch for this course was enrolled last year. Now students wanting to specialise in emergency medicine will be able to obtain certification in their chosen field, without having to travel abroad....
http://tribune.com.pk/story/300042/positive-pakistani-call-of-duty/
United Kingdom will likely to increase its aid to Pakistan upto 350 million (Pounds) a year till 2015, prioritizing uplift of education and health sectors, according to APP:
"The major portion of our aid will focus on getting more than four million children into school, recruit and train 90,000 new teachers and provide more than six million text books," George Turkington, Head of the UK's Department for International Development (DFID) in Pakistan said.
During his visit to a crisis centre for women (Bedari) in Chakwal, he said the UK government would provide assistance to prevent 3,600 mother's deaths in childbirth; another half a million children from becoming under-nourished and another 400,000 couple’s access family planning and contraceptives.
The UK will also support the country to empower women by strengthening legislation on land rights, marriage rights and domestic violence and get more girls and women involved in decision making at community and federal level so that they can demand their basic rights.
Head of DFID said that over recent years, UKaid has provided 35,096 women victims of violence with counselling, refuge, rehabilitation support and legal aid.
He said that UKaid provide monthly stipends to some 680,000 poor girls to help keep them in school and provided millions of free school text books.
He said that UKaid has also facilitated 1.2 million micro finance loans to poor women, helping them to lift their families out of poverty.
The DFID official also met beneficiaries at Bedari office a local NGO.
http://www.brecorder.com/pakistan/banking-a-finance/38265-uk-likely-to-rise-aid-to-pakistan-upto-350m-pounds-.html
Here are excerpts of a Washington Post report on faltering family planning effort in Pakistan:
The government says it is committed to slowing population growth, which it referred to in a report last year as a “major impediment to [Pakistan’s] socioeconomic development process.” But public health experts say they have seen little beyond lip service.
In rural areas, access to family planning services is limited and hampered by deteriorating security, while government health workers are overburdened. International donors want bang for bucks, and working in the countryside is more expensive, said Mohsina Bilgrami of the Marie Stopes Society in Pakistan, another nongovernmental organization.
Greenstar is the country’s largest contraceptive provider, but “we’re a drop in the bucket in a country of 180 million,” said Shirine Mohagheghpour, the technical adviser for Greenstar, an affiliate of the Washington-based Population Services International. “You have to do this community by community.”
Shahid keeps her message basic. In one colorful illustration she shows on home visits, grimy children wail in a tattered house. In another, a mother shakes a rattle at a baby, a father frolics with a toddler and a child reads a book in a tidy dwelling. Intrauterine devices can help make the second picture a reality, she says.
“You can live tension-free,” she said to a room full of women in Mirwah. “Your husband will be happy. Your mother-in-law will be happy. You can pay attention to the children you already have. If you continue having children year after year, you will get sick.”
In urban, middle-class areas, the message is slowly resonating. Two hours away, in the city of Mirpurkhas, a similar discussion with women and a few mothers-in-law sparked boisterous discussion. Several said children were simply too expensive.
“If it’s a sin, there shouldn’t be doctors who offer it,” one said of contraception, eliciting nods.
At a private clinic in Mirwah, a woman named Buri, 35, said firmly that a small family is best. But it was too late: Married at age 13, she was pregnant 12 times before she opted for tubal ligation, a sterilization procedure. Ten of her children lived. None attends school.
“They are uninterested in school,” she said. “Parents are too busy in the fields to pay attention.”
Next to Buri lay her sister-in-law, silently shivering under a floral sheet, in labor with her first child. Presiding over the scene was their mother-in-law, a woman in ornate silver jewelry, who matter-of-factly stated that the newborn should be the first of at least eight.
http://www.washingtonpost.com/world/asia_pacific/family-planning-is-a-hard-sell-in-pakistan/2011/11/08/gIQANeGcuO_story_1.html
Here's a National newspaper report on UAE funding hospitals and clinics in Pakistan:
Seven UAE-funded hospitals and clinics will be built in Pakistan at a cost of nearly Dh63 million, Wam, the state news agency, reported yesterday.
After a signing ceremony between Abdullah Khalifa Al Ghafli, director of Emirati projects to assist Pakistan, and Maj Gen Zahir Shah, commander of the GOC 45th Engineers Division of the Pakistani Armed Forces, it was announced that two hospitals will be built under the names of Sheikh Khalifa and Sheikha Fatima.
Mr Al Ghafli said the UAE would also fund medical equipment for both hospitals and all of the clinics.
The increasing number of healthcare projects in Pakistan was a sign of the strong co-operation between Pakistan and the Emirates, said Sheikha Fatima bint Mubarak, chairwoman of the General Women's Union and of the Family Development Foundation.
"Pakistan was one of the first three countries in the world to recognise the UAE, following the declaration of the Union on December 2, 1971," she said.
Sheikha Fatima said the active role the UAE plays in places of crisis was due to the generosity of the president, Sheikh Khalifa.
"We thank Allah that when humanitarian work anywhere worldwide is mentioned, the name of the UAE comes up, thanks to its generosity and its strong commitment to shoulder its responsibilities and to preserve human dignity," she said....
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In February of this year, a medical team from the RCA and 400 local volunteers initiated a programme to provide measles and polio vaccines to Pakistani children.
The Campaign to Cure One Million Children, sponsored by Sheikha Fatima, also provided free medical treatment to more than five million children who suffered from malnutrition and digestive and respiratory diseases as a result of the flooding.
The UAE ambassador to Pakistan, Eissa Abdullah Al Nuaimi, noted that last month a UAE-funded school for 400 pupils was completed.
It will take 18 months to build the hospitals.
http://www.thenational.ae/news/uae-news/health/uae-to-fund-hospitals-in-pakistan
The World Bank on Thursday said it would provide Pakistan with $5.5 billion in development aid over the next two years, according to AFP:
“The Bank has responded flexibly in the face of the tremendous challenges Pakistan has gone through over the past year or so,” said its Pakistan country director Rachid Benmessaoud.
“We will continue our strong support to Pakistan, while keeping a keen eye on implementation to ensure that these efforts translate into real results on the ground,” he said.
The bank’s progress report on its Pakistan program said its efforts had been disrupted over the past two years by the devastating floods of 2010-2011, ongoing security problems as well as “slow economic reform”.
“Shifting the focus and resources in response to the floods led to a delay in infrastructure investments,” it said.
It said Pakistan’s economic recovery from the floods and other problems remains slow, with growth of 3.9 percent expected next year.
“A range of governance, corruption and business environment indicators suggest that these areas remain a challenge,” it added.
The funds include $4 billion in development assistance and $1.5 billion from the bank’s International Finance Corporation, which helps private sector firms.
“We are committed to helping Pakistan realize its potential especially in key sectors such as infrastructure, renewable energy and agribusiness,” said IFC Middle East director Mouayed Mahlouf
http://tribune.com.pk/story/310881/world-bank-sets-5-5-billion-in-aid-for-pakistan/
Here's an APP report on the use of technology by US to teach and treat in Pakistan:
U.S. Ambassador to Pakistan Cameron Munter Thursday highlighting Pak-US cooperation in science and technology said that it has trained more than 100 doctors nationwide, and treated more than 2,000 patients remotely through the use of cutting-edge technology. During his visit here Thursday the Ambassador and his wife Marilyn Wyatt met with the faculty and students of the Rawalpindi Medical College at Holy Family Hospital’s telemedicine facility, working together with U.S. hospitals.
He said Pak-US cooperation in science and technology focused on many elements, including innovations in Pakistan’s public health sector. During a tour of the hospital with the hospital’s Telemedicine E-Health Training Center Project Director Dr. Asif Zafar, Ambassador Munter stated, “Holy Family’s partnership with American hospitals is an example of the true spirit of our people, who work together, across oceans, to improve access to healthcare in remote areas of Pakistan and treat the sick.” He said, “We commend Dr. Asif Zafar and the Holy Family Hospital team for its efforts to strengthen the health sector in Pakistan, and look forward to more shared successes that bring Pakistanis and Americans closer together.”
http://pakobserver.net/detailnews.asp?id=134092
Glaxo Smith Kline plans to expand in Pakistan, reports Express Tribune:
Focused on emerging markets, GlaxoSmithKline’s Pakistan subsidiary is gearing up for expansion in its consumer healthcare arm. The company has been making targeted acquisitions and is looking to expand its core area away from the products in which the government regulates prices.
“GSK Pakistan is still mainly pharmaceutical; its consumer healthcare arm is about 10% of the business,” CEO Salman Burney said in an interview with The Express Tribune. The company wants to grow its consumer healthcare unit, he added.
The GSK chief said they want to do it in two steps: maximise support for the existing portfolio brands that include Panadol, Sensodyne and Aquafresh – in oral care – and Horlicks on the nutrition side. In the second step, Burney said, GSK – which has revenue growth of about 12% in its pharmaceutical line – may also go for new opportunities such as acquisitions and other new launches.
Paul Marson, GSK’s head of finance for their Middle East and Near East consumer healthcare division, in an interview with The Express Tribune earlier this year, already announced that GSK has decided to invest at least Rs2 billion in Pakistan in consumer healthcare over the next five years. “Pakistan is one of the countries where we want to aggressively invest in the near future,” he added.
On the pharma side, the company has been acquiring rival industries on a targeted basis – antibiotic manufacturers for example. It has been investing heavily on acquisitions of new assets and rebranding of certain products. “The current strategy is to broaden our business base and rebalance,” Burney said. GSK Pakistan, therefore, made acquisitions on a targeted basis.
“GSK launched five new products this year including Votrient, Duodart, Avamys, Synflorix and Fixval,” Burney said. The company is soon going to launch one or two antibiotic products, he added.
GSK’s selling marketing and distribution expenses amounted to Rs2 billion for the nine months ended September 30, up 20.6% from Rs1.68 billion in the corresponding period last year – reflecting its recent investments.
“We re-launched some of our products and these are mostly consumer side expenses,” Burney said.
GSK’s operating profit for the nine months ended September 30 amounted to Rs1.8 billion, up 33% from Rs1.4 billion in the corresponding period of 2010. However, earnings per share in the third quarter of 2011 dropped to Rs0.99 from Rs1.44 in the third quarter of 2010.
“Inflation hit our cost of production,” Burney said, “and at the same time we did not make price adjustments. With the exception of few products, we have not had a price increase since 2001.”
Rupee devaluation also affected gross margin, Burney said. “We also capitalized some capital base reserves which diluted the gross margin,” he added.
Burney said increase in profits – to some extent – will depend on business growth, inflation, price increases and how fast GSK can expand its products portfolio. Burney said the government should approve a pricing policy and allow a price increase across the board to urgently support the industry.
The government of Pakistan currently controls the price of pharmaceutical products it deems “life saving”, a policy that has hurt investment in the sector. Sources say the Swiss pharmaceutical company Roche wound up its operations in Pakistan for this very reason....
http://tribune.com.pk/story/307833/pharma-and-healthcare-gsk-looking-to-aggressively-expand-in-pakistan/
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