Monday, November 28, 2011

Pak Lady Health Workers "Best in the World"!

“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).

Related Links:

Haq's Musings

Government to Hire 300,000 Lady Health Workers

South Asia Lags in Millennium Development Goals

Disease Burdens in Pakistan

MDGs in Pakistani Village

Explore the World--Gapminder.org

UN Millennium Development Goals Report 2010

India Poorer Than Africa

India and Pakistan Off-Track, Off-Target

India is Home to the World's Largest Population of Poor, Hungry and Illiterate People

Can Global Pakistanis Invest $10 billion in Reconstruction?

27 comments:

Riaz Haq said...

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

Riaz Haq said...

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/

Riaz Haq said...

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

Riaz Haq said...

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

Riaz Haq said...

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

Riaz Haq said...

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/

Riaz Haq said...

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

Riaz Haq said...

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/

Riaz Haq said...

Here are excerpts of a report on Pakistan's mobile hospitals serving tribal areas:

PESHAWAR, Mar 4 2012 (IPS) - With no money to see a doctor, Gul Lakhta,50, had resigned himself to blindness when a ‘mobile hospital’ drove into his village in the Bajaur Agency of the Federally Administered Tribal Areas (FATA), on Pakistan’s rugged border with Afghanistan.

“They operated on me the same day. Now, my eyesight is excellent,” says Lakhta, a beneficiary of the Mobile Hospital Programme (MHP) started by the government in 2003 to provide healthcare to people in the war-torn areas of northern Pakistan.

After the United States-led coalition forces toppled the Taliban government in Afghanistan in 2001 its leaders fled across the border to the FATA and adjacent areas, bringing with them their fundamentalist ideology and culture of violence.

Before long, the Taliban had unleashed a campaign of bombings against their hosts, targeting schools, health facilities, markets, government buildings and forces, bringing life to a virtual standstill in the seven agencies that make up the FATA.

“In the process, Taliban militants also destroyed 60 health facilities, forcing patients to travel to Peshawar and beyond to seek treatment for even minor ailments,” said Dr Niaz Afridi, head of the MHP in the FATA.

The government allocates Pakistani rupees 60 million (660,000 dollars) per year for the programme and there are plans to expand it, Afridi said.

These clinics-on-wheels have proved a blessing for the patients because they are well-equipped and manned by dedicated teams. Currently they provide treatment to 90,000 patients annually.

“We also organise medical camps in areas which are inaccessible by the regular medical workers and our medical teams visit the remotest areas to reach the patients and provide diagnosis and treatment free,” Afridi said.

Dr Nauman Mujahid, development officer for health services in the FATA, said the MHP is manned by a staff of 150, including physicians, surgeons, gynaecologists and other specialists like ophthalmologists and dentists.

Each vehicle is equipped with a generator that powers a mobile operation theatre, a dental unit, x-ray and ultrasound machines and laboratories that allow for quick diagnostics.

“Critically-ill patients who require hospitalisation are referred to tertiary care centres in Peshawar,” said Mujahid.

The programme started with the South Korean government donating 14 mobile clinic units in 2003 to help the people in the insurgency-hit areas of the FATA.

Although the process of the rebuilding damaged health outlets is in progress, the MHP will, because of its popularity, continue to operate in the FATA with a fleet that was augmented in 2010 by the government.

Mobile hospitals are particularly effective in ensuring that patients who need to be on drug regimens lasting several months get their doses. This is especially so in the case of tuberculosis (TB) patients who, if improperly treated, can develop drug resistant strains that can endanger a community.

Waqar Ali, 46, who was diagnosed with TB at a free medical camp in North Waziristan three months ago, is now on medication he must take for eight months. “I am feeling better and do my farming like normal people,” he told IPS.

Authorities take care to notify people in areas where the camps are going to be held about a week in advance. Often announcements are made from the mosques.

Talking to IPS, Dr Bilqees Qayyum, a gynaecologist on the rolls of the MHP, says that people often come to the medical camps in droves with a variety of complaints.....


http://ipsnews.net/2012/03/pakistans-hospitals-that-come-home/

Riaz Haq said...

Here are excepts of an Op Ed by Andrew Michell, British secretary of DFID, published in The News:

Over the last year, the UK has worked closely with Pakistan to deliver strong results, including supporting nearly half a million children in school; providing practical job training to more than 1,100 poor people in Punjab; providing microfinance loans to more than one hundred thousand people across Pakistan so they can start small businesses and lift their families out of poverty; and helping millions of people affected by the floods in 2010 and 2011.

Education is the single most important factor that can transform Pakistan’s future. With a population that is expected to increase by 50 per cent in less than forty years, it is worrying that half the country’s adults can’t read or write, and that more than a third of primary school aged children are not in school. That’s why the UK is committed to working in partnership with Pakistan to tackle its education emergency.

If educated, healthy and working, this burgeoning youth population will provide a demographic boost to drive Pakistan’s economic growth and unlock Pakistan’s potential on the global stage.

That’s why education is the UK’s top priority and why over the next four years, the UK will work in partnership with Pakistan to:

* support four million children in school;

* recruit and train 90,000 new teachers;

* provide more than six million text book sets; and

* construct or rebuild more than 43,000 classrooms.

Every full year of extra schooling across the population increases economic growth by up to one percentage point, as more people with better reading, writing, and maths skills enter the workforce.

The UK government is also working with Pakistan to empower and protect women and girls, to end violence against them and to help harness their talent and productivity. I welcome the legislation recently passed by Pakistan’s parliament that bans domestic violence, and congratulate Pakistan on its first Oscar for an outstanding film which throws the international spotlight on the horrific crime of acid attacks on women.

Other priorities for the UK include working with Pakistan to prevent 3,600 mothers dying in childbirth; enabling 500,000 couples to choose when and how many children they have; providing practical job training (such as car mechanics, cooks, weavers, carpenters, etc) to tens of thousands of people living in poverty; and enable millions of people, half of them women, to access financial services such as microfinance loans so they can earn more money and lift their families out of poverty.

The UK’s aid to Pakistan could potentially more than double, to become the UK’s largest recipient of aid. However this increase in UK aid is dependent on securing value for money and results, and linked to the Government of Pakistan’s own progress on reform at both the federal and provincial levels. This includes taking steps to build a more dynamic economy, strengthen the country’s tax base, and tackle corruption.


http://www.thenews.com.pk/Todays-News-2-97151-UK-and-Pakistan-partners-for-the-long-term

Riaz Haq said...

Here are excerpts of David Brooks Op Ed in NY Times:

Usually, high religious observance and low income go along with high birthrates. But, according to the United States Census Bureau, Iran now has a similar birth rate to New England — which is the least fertile region in the U.S.

The speed of the change is breathtaking. A woman in Oman today has 5.6 fewer babies than a woman in Oman 30 years ago. Morocco, Syria and Saudi Arabia have seen fertility-rate declines of nearly 60 percent, and in Iran it’s more than 70 percent. These are among the fastest declines in recorded history.

The Iranian regime is aware of how the rapidly aging population and the lack of young people entering the work force could lead to long-term decline. But there’s not much they have been able to do about it. Maybe Iranians are pessimistic about the future. Maybe Iranian parents just want smaller families.
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If you look around the world, you see many other nations facing demographic headwinds. If the 20th century was the century of the population explosion, the 21st century, as Eberstadt notes, is looking like the century of the fertility implosion.

Already, nearly half the world’s population lives in countries with birthrates below the replacement level. According to the Census Bureau, the total increase in global manpower between 2010 and 2030 will be just half the increase we experienced in the two decades that just ended. At the same time, according to work by the International Institute of Applied Systems Analysis, the growth in educational attainment around the world is slowing.

This leads to what the writer Philip Longman has called the gray tsunami — a situation in which huge shares of the population are over 60 and small shares are under 30.
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Rapidly aging Japan has one of the worst demographic profiles, and most European profiles are famously grim. In China, long-term economic growth could face serious demographic restraints. The number of Chinese senior citizens is soaring by 3.7 percent year after year. By 2030, as Eberstadt notes, there will be many more older workers (ages 50-64) than younger workers (15-29). In 2010, there were almost twice as many younger ones. In a culture where there is low social trust outside the family, a generation of only children is giving birth to another generation of only children, which is bound to lead to deep social change.

Even the countries with healthier demographics are facing problems. India, for example, will continue to produce plenty of young workers. By 2030, according to the Vienna Institute of Demography, India will have 100 million relatively educated young men, compared with fewer than 75 million in China.

But India faces a regional challenge. Population growth is high in the northern parts of the country, where people tend to be poorer and less educated. Meanwhile, fertility rates in the southern parts of the country, where people are richer and better educated, are already below replacement levels.

The U.S. has long had higher birthrates than Japan and most European nations. The U.S. population is increasing at every age level, thanks in part to immigration. America is aging, but not as fast as other countries.

But even that is looking fragile. The 2010 census suggested that U.S. population growth is decelerating faster than many expected.....


http://www.nytimes.com/2012/03/13/opinion/brooks-the-fertility-implosion.html?_r=1&scp=2&sq=david%20brooks&st=cse

Riaz Haq said...

Here's an AP report on Benazir Income Support program in Pakistan:

Clutching photocopied ID cards in bony fingers, a roomful of Pakistan's poorest women sit on gray plastic chairs and wait in silence for something many have never experienced: a little bit of help from the government.

It comes in the form of a debit card that is topped up with the equivalent of $30 every three months, enough to put an extra daily meal on the table, buy a school uniform or pay for medical treatment in a country where soaring food and fuel costs are hurting millions who already live hand-to-mouth.

The program is something of a success story for a government widely seen as corrupt and inefficient, as well as for international donors that help implement and fund it. But the very need for the scheme highlights the poverty stalking a country whose stability is seen as key to the fight against Islamist extremism.

Other cash-transfer programs in Pakistan have been plagued by graft and allegations that only supporters of the party in power received the funds. Many feared this program, named after Benazir Bhutto, the late wife of President Asif Ali Zardari, would go the same way.

But that hasn't happened, at least not significantly. The Benazir Income Support Programme is modeled on similar efforts in Africa and South America, part of a quiet revolution in the way countries and development agencies are helping the poor. Initial concerns that recipients would fritter away the money have proven unfounded, and giving cash is now accepted as a vital and cost-effective aid tool.

"I spend the money on my kids, what else would I do?" said Rifat Parveen, a mother of five who sometimes has to serve only bread and boiled chili peppers for the evening meal. "Even if a poor person gets 10 rupees (5 cents), he or she will be grateful."

When a woman is called, she goes to a room where her identity is checked against an electronic database and her thumb print taken electronically. A bank employee then gives her the card — and a crash course in how to use it — before she returns to her village.

As they do elsewhere in the world, women in Pakistan must receive the money on behalf of their families because research shows they spend it more responsibly than men do. They must also first obtain a valid identity card to be eligible. Both requirements have been credited with pushing women, discriminated against in Pakistan, a little into the mainstream.


http://www.foxnews.com/world/2012/04/17/in-pakistan-welfare-scheme-shows-signs-success/

Riaz Haq said...

Here's a Businessweek story on fake medicines in Pakistan:

In Pakistan’s biggest market for wholesale medicines, it pays to be observant.

More than 2,500 stalls wedged along dirt lanes in Karachi’s busiest trading district offer everything from Pfizer Inc. (PFE) (PFE)’s cholesterol pill Lipitor to GlaxoSmithKline Plc (GSK)’s painkiller Panadol. Closer study of the remedies lining rickety shelves reveals the source of an unfolding medical crisis: Lipitor sold in obsolete packaging, Panadol packets missing tell-tale ribbing, and allergy medicine Zyrtec mislabeled as Zytrec.

Now, the free flow of fake medications channeled through the market for decades may soon be slowed. Lawmakers are poised to pass legislation in June creating an agency to quash the trade after 107 heart patients were killed this year by pills tainted with lethal amounts of an anti-malarial agent. That may help break the ring of counterfeiters in Pakistan, part of a wider network supplying what the World Health Organization estimates is a $431 billion global market for spurious drugs.

“The issue is serious, demanding serious steps,” said Salman Burney, chief executive of GlaxoSmithKline Pakistan Ltd. (GLAXO) in Karachi. “Better regulation will generate more investment in the pharmaceutical industry, which will mean better quality medicines.”

The problem spans national borders. Pakistan was one of the 10 largest sources of counterfeit goods seized in the U.S. last year, U.S. Customs and Border Protection said in January. Medicines accounted for 85 percent of the value of the Pakistani items obtained.

At least 30 percent of medicines bought in the country are either counterfeits or substandard, said Kulsoom Parveen, a lawmaker who chairs a Senate health committee. Pharmacies nationwide sell drugs without a doctor’s prescription, enabling the treatments to be taken without medical supervision.
’Exploiting Weaknesses’

Pakistan has 4,000 registered pharmacists and 25 times more merchants dispensing medicines illegally, the Pakistan Pharmacists Association said.

It’s no coincidence that fake and substandard drugs are flourishing in Pakistan, said Laurie Garrett, senior fellow for global health at the Council on Foreign Relations. The New York- based think-tank prepared six recommendations to fight the drug- safety crisis for consideration by the Group of Eight summit at Camp David, Maryland, today and tomorrow.

“Individuals that are exploiting weaknesses in global drug safety and regulation will base themselves in places where they know the system is fragile or nonexistent,” Garrett said in a telephone interview. “Pakistan is really struggling to keep its entire public health infrastructure alive.”
Damaging Brands

Protecting product integrity would also benefit makers of brand-name medicines. Pharmaceutical sales in Pakistan, with a population of 196 million, total $2 billion annually, compared with $12.4 billion in neighboring India, with 1.2 billion people.

GlaxoSmithKline Pakistan, based in Karachi, made 1.14 billion Pakistani rupees ($12 million) in profit on sales of 21.75 billion rupees last year. In India, Mumbai-based GlaxoSmithKline Pharmaceuticals Ltd. (GLXO) had net income of 6.3 billion Indian rupees ($118 million) and revenue of 23.9 billion rupees.

Prime Minister Syed Yousuf Raza Gilani’s government hasn’t had a federal health minister or a central drug regulatory agency since powers were handed to the country’s four provinces last year. A new bill, to be voted on by Pakistan’s senate next month, will strive to fill the void....


http://www.businessweek.com/news/2012-05-17/stopping-fake-drugs-from-pakistan-is-too-late-for-victims#p1

Riaz Haq said...

Pakistan's private health care spending rises to $7.3 billion, reports Express Tribune:

Pakistanis are increasingly spending more on health, with spending rising to a total of Rs665 billion in 2011, up 14.5% over the previous year, according a to research report released by Business Monitor International (BMI), a UK-based research and consulting firm.

Within the overall sector, the largest in terms of total spending was that of hospitals and other healthcare facilities, which saw their total revenues rise to Rs456 billion in 2011, up 14.1% from the year before. The fastest growing segment was medical devices, which saw sales rise 18.1% to Rs35.5 billion. Pharmaceuticals grew a little slower, at 13.1%, to reach Rs173 billion in gross sales in Pakistan.

There are also several developments taking place within the sector that are likely to allow for even further expansion, according to BMI analysts.

In August 2011, the Drug Registration Board (DRB) approved the registration of 30 medical devices and 210 medicines after a meeting was held at the request of the Prime Minister Yousaf Raza Gilani, who called for the uninterrupted provision of medicines to patients. Products approved for registration included vaccines, biologicals, cancer therapeutics, drugs for the treatment of blood disorders such as thalassaemia, and devices used in cardiac procedures.

BMI points out that there are many reasons why investors, particularly those outside the country may want to consider investing in this sector. “Pakistan has one of the most liberal foreign investment regimes in South Asia, with a commitment to low tariffs and 100% foreign equity permitted,” said BMI analysts in the report.

The analysts also note that Pakistan’s rapidly growing population – currently closing in on 190 million – should also be considered an asset. “A growing population is feeding increased demand for pharmaceuticals.”
------------
Pakistan’s overall business environment gets a poor rating from BMI, which ranks the economy 16th out of the 18 economies that it tracks in the Asia-Pacific region. The only two economies behind Pakistan are Sri Lanka and Cambodia. “The business environment still suffers from poor infrastructure and, most problematically, an uncertain security situation that has declined considerably since March 2007,” said BMI analysts.

In addition, there are several structural challenges to the Pakistani healthcare industry itself that have little to do with the external environment of Pakistan that they operate in. “Procurement processes are bureaucratic and often lack transparency, raising the risks of corruption,” said BMI in its report.


http://tribune.com.pk/story/384773/money-and-doctors-private-healthcare-spending-in-pakistan-rises-to-7-3-billion/

Riaz Haq said...

Here's an ET story on Pakistan's chances of meeting MDG 5:

Pakistan will not be able to achieve the Millennium Development Goal (MDG) 5, that relate to bringing about an improvement in maternal health, by the targeted year of 2015. This was stated by Special Adviser to the Prime Minister and Chairperson National Assembly Special Committee on MDGs Shahnaz Wazir Ali on Thursday.

She was addressing participants at a National Policy Dialogue on Monitoring Implementation of MDG 5 in Pakistan at a local hotel.

Ali said dictatorship, slow pace of work, lack of integrated coordination and planning between the federal and provincial ministries after the 18th amendment and unavailability of credible data on health and family planning are major factors behind the failure to achieve the set targets on time.

She expressed concern over low prevalence of safe family planning measures which is one of the major reasons behind high maternal mortality rate in Balochistan despite heavy funding. Ali revealed that allocations under the NFC Award for Population Welfare were need-based rather than determined by population size and hoped that these would be used to promote maternal health. “Now the provinces have to come up with strategies to enable the country to achieve the targets. The federal government will, however continue to offer financial support,” she said.

Presenting the findings of the research on progress achieved so far under the MDG 5, Khawar Mumtaz said that the maternal mortality rate (MMR) is 276 per 100,000 live births in the country which needs to be reduced to 140 by 2015. Similarly, contraceptive prevalence rate (CPR) is 30% which needs to be increased to 55% by 2015, while total fertility rate (TFR) is 4.1 live births per woman which need to be reduced to 2.1.

In Balochistan, MMR is 785 per 100,000, CPR is 14%, while TFR is 4.1. Discussing the appalling situation in his province, Balochistan Health Minister Haji Ainullah Shams said the term family planning is taken as a plan for not having children in the province, which needs to change.

Similarly the province is deprived of all basic health facilities and health officials who are deputed in the BHUs they are not given any incentives or facilities, he added.

Moreover, the report presented by Mumtaz stated that widespread unmet need for family planning among women and no safe abortion or post-abortion care is available across the country. In rural areas, basic health units have inadequate staff while some are inaccessible due to inconvenient location. A whole range of unregulated informal and formal health services result in widespread quackery, negligence and malpractice....
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Meanwhile, Secretary Federal Bureau of Statistics Sohail Ahmed emphasised on the need for federal government to re-invent its role post-18th amendment for coordination of international commitments and to serve as a bridge between provinces and donors for achievement of MDGs. He suggested the federal government should offer matching grants to provinces for achievement of MDGs.


http://tribune.com.pk/story/404268/maternal-health-pakistan-cannot-achieve-mdg-5-by-2015/

Riaz Haq said...

Pakistan become first South Asian nation to start pneumonia vaccination, reports Reuters:

Pakistan has become the first country in South Asia to introduce a vaccine against the deadly pneumococcal disease in children, with GlaxoSmithKline's Synflorix selected for the programme.

Worldwide more than 1.3 million children under the age of five are killed each year by pneumonia and in Pakistan it accounts for almost 20 percent of child deaths, according to the Global Alliance for Vaccines and Immunization (GAVI).

The move comes at a time when healthcare experts are still struggling to get polio vaccination accepted in parts of Pakistan, one of the few countries where it is still endemic.

The introduction of Synflorix in Pakistan, which began on Tuesday, is possible thanks to GAVI's advanced market commitment scheme, which provides incentives for drug companies to produce large quantities of vaccines for poor countries at low cost.

"In Pakistan, with a successful roll-out we can save tens of thousands of lives," GAVI's chief executive Seth Berkley told reporters at a briefing at its Geneva headquarters. "It will make a dramatic difference in life expectancy in the country."

GSK, Britain's largest drugmaker, said it would provide a minimum of 480 million doses of Synflorix to GAVI for programs against pneumococcal disease in 73 developing countries by 2023.

GAVI also has a similar global deal with Pfizer for its rival pneumococcal vaccine Prevnar. The agency chooses between the competing vaccines in each country.

GAVI is a public-private partnership backed by the Bill & Melinda Gates Foundation, the World Health Organisation, the World Bank, UNICEF, international donor governments and others. It funds bulk-buy immunization campaigns for poorer nations that can't afford vaccines at rich-world prices.

Berkley noted problems with Pakistan's polio eradication effort, which has been hampered by mistrust and rejection among local people, but said he expected the introduction of the pneumococcal vaccine to be smoother, and potentially helpful to the polio campaign in the longer run.

"The government of Pakistan assures us they will do everything they can to roll out this product," he said. "This is a vaccine that families understand, (along with) the importance of this disease and children dying, so it actually may help the effort."
----------
Latest United Nations estimates show that pneumonia accounts for 18 percent of child deaths globally. In Pakistan more than 352,000 children die before they reach their fifth birthday and almost one in five of those deaths are due to pneumonia.

GAVI said that while pneumococcal vaccines cannot prevent every case of pneumonia they can prevent a significant proportion and have the potential to protect tens of thousands of children from preventable sickness and death.


http://www.chicagotribune.com/health/sns-rt-us-pakistan-glaxosmithkline-vaccinebre8980oj-20121009,0,5963496.story

Riaz Haq said...

Here's an excerpt of MIT Technology Review piece on controlling dengue fever outbreak using smartphones in Lahore, Pakistan:

Last year, the city of Lahore, Pakistan, was hit with the worst outbreak of dengue fever in its history. The mosquito-transmitted disease infected some 16,000 people and took 352 lives. This year was a completely different story. There were only 234 confirmed cases and no deaths. The magnitude of the disease varies year to year, but some of the turnaround could be credited to a new system of tracking and predicting outbreaks in the region.

Researchers working for the Pakistani government developed an early epidemic detection system for their region that looked for telltale signs of a serious outbreak in data gathered by government employees searching for dengue larvae and confirmed cases reported from hospitals. If the system’s algorithms spotted an impending outbreak, government employees would then go to the region to clear mosquito breeding grounds and kill larvae. “Getting early epidemic predictions this year helped us to identify outbreaks early,” says Umar Saif, a computer scientist at the Lahore University of Management Sciences, and a recipient of MIT Technology Review's Innovators Under 35 award in 2011.

“This year, because of the tracking system and the efforts of government employees on the ground, we could look at a map and tell if certain areas were going to develop into an epidemic,” says Saif, who has been working with the government during a sabbatical. “The key is to be able to localize and quarantine a disease like this and prevent it from developing into an epidemic,” he says.

The groundwork for the early detection system was another project headed by Saif: Flubreaks. This system processes data from Google Flu Trends, which estimates the spread of flu based on search terms related to the disease. “That whole idea of being able to scrape digital data has helped us find outbreaks faster,” says Mark Smolinski, director of Global Health Threats at Skoll Global Threats Fund, a nonprofit that recently helped launch a site called Flu Near You, which tracks flu based on a weekly electronic survey that asks people about their health and any flu symptoms.

Smolinski was part of the team at Google to develop Google Flu Trends, which he says can speed up outbreak identification. “You can gain a couple of weeks just by aggregating data of search terms on the Internet,” he says.

While Google Flu Trends identifies outbreaks as they occur, Flubreaks can see them before they start by teasing out global flu trends and making early epidemic predictions.

The results from Flubreaks closely matched actual outbreaks reported by the Centers for Disease Control, says Saif. “We found that idea very exciting,” says Saif. Countries like Pakistan typically do not have a well established disease surveillance network, he says. “We want one for dengue in Pakistan, but it’s a very expensive and difficult thing to manage.”
----------
The dengue monitoring system relies on real-world field testing of mosquito larvae and reports from hospitals to predict where dengue outbreaks are starting. If a certain neighborhood is suspected to be at the beginning of an outbreak, then government officials could search out mosquito-larvae reservoirs such as pools of water that are likely causing the problem.

The system was put to use this summer. Using 1,500 Android phones, government workers in the region tracked the location and timing of confirmed dengue cases and the mosquito larvae that carry the disease. Each case was tagged by time and location. “Because of the Android phones, we could localize the outbreak to a couple of hundred houses. Inevitably, we would find some water in or near these houses.” ....


http://www.technologyreview.com/news/506276/pakistan-uses-smartphone-data-to-head-off-dengue-outbreak/

Riaz Haq said...

Pakistan to get closer to meeting MDGs, reports News Tribe:

...According to the reports, Pneumonia kills an estimated 1.5 million children under the age of five years every year over the world – more than AIDS, malaria and tuberculosis combined. “Here in Pakistan the lack of awareness among masses has been furthering the rise of chronic diseases, which is alarming,’ he added.

But, he adds, luckily expensive pneumonia control vaccinations are being provided free of cost at EPIcenters in the country, as the government of Pakistan is introducing pneumococcal vaccine in the EPI programme with the help of Global Alliance for Vaccines and Immunization (GAVI).

Moreover, Dr. Tariq Bhutta added that reducing child mortality rate is one of the eight MDGs, which are the world’s time bound targets for reducing poverty in its various dimensions by 2015. Pakistan is heading towards achieving that targets, while the MDG on child mortality will require urgent action to control childhood deaths by pneumonia, which is 19 percent of the all the deaths of under-five children in the country.

Dr. Bhutta said that Pneumonia kills more children than any other illness – more than Aids, Malaria and Measles combined. ‘Yet, little attention is paid to this disease. After free availability of pneumonia vaccine at all government hospitals public awareness regarding the availability of vaccine needs to be increased for the EPI program to have its full time impact.

It is worth adding that Pneumonia is a severe form of acute lower respiratory infection that specifically affects the lungs. ‘Chest X-rays and laboratory tests are done to confirm the extent and location of the Pneumonia infection and its cause,’ he said, adding that but here in Pakistan suspected cases of pneumonia are diagnosed by their clinical symptoms due to non-availability of latest technologies. This becomes severe when transformed to other organs through the bloodstream causing meningitis, bacterimia and sepsis.

Dr Bhutta further said that during or shortly after birth babies are at higher risk of developing pneumonia. The statistics of World Health Organization (WHO) show that more than 150 million episodes of pneumonia occur every year among children under five in developing countries, accounting for more than 90 per cent of all new cases worldwide. Between 11 million and 20 million children with pneumonia will require hospitalization, and almost 1.8 million will die from the disease.

But, he adds, luckily Pakistan is fortunate in the sense that pneumonia prevention vaccine has been provided free of cost by GAVI Alliance, a global NGO, to vaccinate all 5 million babies that are born every year in Pakistan. ‘A course of three injections to newborns was previously costing approximately Rs 14000, but with the funding of GAVI this treatment is available free of cost across the country for the masses. Three vaccines include the measles, Hib and pneumococcal conjugate vaccines have the potential to significantly reduce child deaths from pneumonia,’ he added.

It is to be noted that immunizations help reduce childhood deaths from pneumonia in two ways: first, vaccinations help prevent children from developing infections that directly cause pneumonia such as Haemophilus influenzae type b (Hib); secondly, immunizations may prevent infections that can lead to pneumonia as a complication (e.g., measles and pertussis).

Dr Tariq Bhutta encouraged all parents to take their infants at 6, 10 and 14 weeks of ages to the government EPI center and hospitals in their vicinity for vaccination.


http://www.thenewstribe.com/2012/11/04/pakistan-to-get-closer-to-millennium-development-goals/

Riaz Haq said...

Here's a Wall Street Journal piece on health care in Pakistan:

Given the absence of comprehensive public health-care services, a largely unregulated private sector, with hugely disparate services and prices, has sprung up to fill the void. But currently only 0.8% of Pakistan's GDP is allocated to insurance products, including health insurance, according to the country's insurance regulator. Poor patients often end up taking out loans and falling into debt to pay for private-sector services.

To address such needs, Asher Hasan set up Naya Jeevan—"new life" in Urdu—a nonprofit micro-insurance program for the urban poor.

"Everyone should have access to quality health care irrespective of their level of income," said Dr. Hasan, who grew up between Karachi and the U.K. and then moved to the U.S. to study medicine.

Naya Jeevan, one of 12 finalists in The Wall Street Journal's Asian Innovation Awards, offers an insurance program at subsidized rates under a national group health-insurance model. It tied up with large multinational corporations and local companies to offer subsidized health-insurance plans for their low-income and contractual employees as well as the employees' domestic helpers, who are often poor.

Dr. Hasan's sales pitch to these companies was that health is a right and this is a way for the companies to help their low-income employees. For their domestic staff his pitch was: If a maid or a baby sitter of an executive fell ill, it would disrupt that executive's productivity in the office for as long as it took for the problem to be resolved.

But the program is under scrutiny from the country's insurance regulator, which comes under the jurisdiction of the Securities and Exchange Commission of Pakistan.

Mohammed Asif Arif, the insurance division commissioner at the SECP, said that Naya Jeevan is in violation of the country's insurance laws because it isn't registered as a broker and can't legally offer these products. The regulator issued a notice in September to insurance companies reminding them that it is illegal to sell insurance to unregistered entities. (Naya Jeevan buys insurance in bulk at discounted rates from several insurance companies.)

Mr. Asif Arif said his agency would allow Naya Jeevan time to comply with the rules, without offering a specific deadline.
----------
Dr. Hasan started Naya Jeevan with $75,000 that he won in 2008 in a New York University Social Entrepreneurship competition. Since then he has received funding from the International Labor Organization, USAID, the Asia Foundation, Google/Tides Foundation and J.P. Morgan Chase JPM +0.36% .

Naya Jeevan has locked in subsidized rates with a handful of Pakistani insurance companies. Under the agreements, it costs a company $1.50 a month per employee to enroll its lower-income employees and home helpers such as janitors, drivers and maids. Of this amount, at least 80% is typically covered by the company and the rest by the employee who is being covered. These employees also can enroll their families in the insurance program, at an additional monthly cost to them of up to $1.50 a person.

If a claim exceeds the amount of an individual policy, the balance of the cost is paid for by the individual's corporate employer. Naya Jeevan says 17,000 people are enrolled in its program.
--------
"One of the issues in society is that when you send in a low-income person to a gleaming fancy hospital, they may not get treated properly," even though their treatment is covered by the insurance program, Dr. Hasan said. To prevent that, Naya Jeevan works with doctors who can liaise with hospitals on behalf of their patients.


http://online.wsj.com/article/SB10001424052970204846304578090713421035962.html

Riaz Haq said...

Here's an assessment of Pakistan's Rural Support Network Program:

In the global search for poverty alleviation and sustainable development, Pakistan’s ‘Rural Support Programmes Network’ remains little known, yet offers enormous potential for the eradication of rural poverty across the world today.

The power of a collective community vision is what Pakistan's little known 'Rural Support Programmes Network' (RSPN) has used to empower rural communities to alleviate poverty. RSPN, Pakistan’s largest rural development NGO, is one of the most effective rural poverty alleviation models of the previous three decades. Yet its secret is surprisingly simple - community organizing.

The Network consists of eleven Rural Support Programmes, or RSPs. Founded in the early 1980’s, the Aga Khan Rural Support Programme (AKRSP) was created to improve agricultural productivity and raise incomes in poor, remote northern regions of Pakistan. Building on the success of AKRSP, other RSPs spread across the country, out of which came the birth of RSPN in 2000.
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Since its inception, the model has received widespread international recognition. The World Bank's Independent Evaluation Group noted the RSPN's "impressive record of performance”. It has also been described as the NGO encapsulating one of 13 development ‘Ideas That Work’. Founding RSPN Chairman Shoaib Sultan Khan was nominated for Nobel Peace Prize for his work in "unleashing the power and potential of the poor". He has addressed the UN General Assembly to showcase RSPN's proven model of sustainable development.

Yet if the model is really so effective why has there not been an even greater transformation across rural Pakistan, especially given the high concentration of rural poverty? After all, the RSPN model has been widely replicated outside of Pakistan. In 1994, the UN Development Programme requested that RSPN Chairman Shoaib Sultan Khan set-up demonstration pilots of the model in Bangladesh, India, the Maldives, Nepal and Sri Lanka. The success of those pilots led India to subsequently launch a similar countrywide programme that benefited over 300 million poor.

One reason for this discrepancy lies in the very secret of RSPN's success; the RSPN model is an effective but long-term one, where significant results can only be gauged in the long-term over periods of more than a decade. As such, international aid agencies fail to provide the level of support RSPN needs to kick-start the crucial early stages of new programmes across different regions. These agencies have also failed to continue servicing current programmes before rural communities achieve some semblance of self-sufficiency.....


http://www.globalpovertyproject.com/blog/view/603

Riaz Haq said...

Here's a Nation report on 30th anniversary of rural support network in Pakistan:



ISLAMABAD - The Rural Support Programme (RSPs), the largest development network in Pakistan, mark their 30th anniversary on Thursday across Pakistan.

On 7th December 1982, the Nobel Peace Prize nominated development guru Shoaib Sultan Khan initiated the Aga Khan Rural Support Programme (AKRSP) in northern Pakistan as a project of the Aga Khan Foundation. Since then, the RSP movement has grown across Pakistan, touching the lives of 32 million people.

This model has been replicated in development programmes of India, Afghanistan and Tajikistan.

The RSPs will kick off their 30th anniversary celebration in January 2013 with renewed commitments and organizing series of events of which the most significant will be a large community convention and Book launch event of Shoaib Sultan Khan.

In Pakistan, there are now 12 RSPs nationwide, which have fostered almost 300,000 community organisations. These have demonstrated that poor Pakistanis are willing and able to improve their own lives. These 12 RSPs come together at the RSP Network (RSPN), a national level network of which they are all members.

The approach of the AKRSP has led successive governments to replicate this approach across Pakistan. The commitment of government and donors has enabled the RSPs to reach so many people who are engaged in the largest self help movement in Pakistan.


http://www.nation.com.pk/pakistan-news-newspaper-daily-english-online/islamabad/07-Dec-2012/rsps-mark-30th-anniversary-with-renewed-pledges

Riaz Haq said...

Here's a Reuters' report on clerics protest call against polio worker killings by the Taliban:

An alliance of Pakistani clerics will hold demonstrations across the country against the killings of polio eradication campaign workers, leaders said on Thursday, as the death toll from attacks this week rose to nine.

Tahir Ashrafi, who heads the moderate Pakistan Ulema Council, said that 24,000 mosques associated with his organization would preach against the killings of health workers during Friday prayers.

"Neither Pakistani customs nor Islam would allow or endorse this. Far from doing something wrong, these girls are martyrs for Islam because they were doing a service to humanity and Islam," he said.

Ashrafi's words are a clear signal that some of Pakistan's powerful clergy are willing to challenge violent militants.

Gunmen on motorbikes have killed nine anti-polio campaign workers this week, including a man who died of his wounds on Thursday. Some of the dead were teenage girls.

Following the violence, the United Nations pulled back all staff involved in the vaccination campaign and Pakistani officials suspended it in some parts of the country.

"The killers of these girls are not worthy of being called Muslims or human beings," said Maulana Asadullah Farooq, of the Jamia Manzur Islamia, one of the biggest madrassas, or religious schools, in the city of Lahore.

"We have held special prayers for the martyrs at our mosque and will hold more prayers after Friday prayers tomorrow. We also ask other mosques to come forward and pray for the souls of these brave martyrs."

It is not clear who is behind the killings.

Pakistani Taliban militants have repeatedly threatened anti-polio workers, saying the vaccination drive is a Muslim plot to sterilize Muslims or spy on them. But they have denied responsibility for this week's shootings.

"ESSENTIAL GOODNESS"

Suspicion of the campaign surged last year after revelations that the CIA had used the cover of a fake vaccination campaign to try to gather intelligence on Osama bin Laden before he was killed in his hideout in a Pakistani town.

But many of Pakistan's most important clerics have issued fatwas, or decrees, in support of the polio campaign. Muslim countries like Saudi Arabia encourage vaccinations against polio, which can kill or paralyze within hours of infection.

The disagreement between some clerics and militants may be indicative of a wider drop in support for militancy in Pakistan, said Mansur Khan Mahsud, director of research at the Islamabad-based think-tank the FATA Research Center.

Opinion polls the centre carried out in ethnic Pashtun lands on the Afghan border, known as the Federally Administered Tribal Areas (FATA), showed support for the Taliban dropping from 50 percent 2010 to about 20 percent in May 2012.

Mahsud said many people had welcomed the Taliban because they believed Islamic law would help address corruption and injustice. But as the Taliban began executing and kidnapping people, some turned against them.

In a widely publicized incident in October, Taliban gunman shot a 15-year-old schoolgirl campaigner for girls' education in the head and wounded two of her classmates.

Schoolgirl Malala Yousufzai survived and the wave of condemnation that followed the attack prompted the Taliban to release statements justifying their action.

The killings of the health workers struck a similar nerve, Ashrafi said. The girls got a small stipend for their work but were motivated to try to help children, he said.

"You think they went out to administer the drops despite the threats and risked their lives for 200 rupees ($2) a day? They were there because of their essential goodness," he said.

"Imagine what the families are going through."


http://mobile.reuters.com/article/idUSBRE8BJ08F20121220

Riaz Haq said...

Kudos to the brave workers carrying out the vaccination campaign. It's because of their service that polio cases in Pakistan significantly declined from 198 in 2011 to 57 in 2012.

http://www.riazhaq.com/2012/12/why-are-taliban-attacking-women-polio.html

Riaz Haq said...

Here's a report on rising use of contraceptives in Pakistan:

ISLAMABAD - In year 2011-12, Pakistanis used 149.278 million condoms, 6.223 million cycles of oral pills, 1.315 million insertions of internal uterine devices (IUDs) and 2.705 million vials of injectables, revealed a report released by the Pakistan Bureau of Statistics (PBS).

The PBS report showed an unprecedented rise in the use of condoms as a contraceptive tool during the year 2011-12 as compared to last year.

The Federally Administrated Tribal Areas (FATA) witnessed a 60 percent increase in the use of condoms while the federal capital stood second with a rise of 27.9 percent.

In Khyber Pakhtunkhwa, the ratio of using condoms as a contraceptive tool remained 24.5 percent while Sindh showed a rise of 20.7 percent. In Punjab, rise in the use condoms was recorded at 18.7 percent.

However, according to the report made available to Pakistan Today, a contradictory trend was witnessed in Balochistan, Gilgit-Baltistan and Azad Jammu and Kashmir where the use of condoms as a contraceptive tool saw a decline in the year 2011-12.

Balochistan recorded a decrease of 11.8 percent in the trend of using condoms as a contraceptive tool whereas the popularity graph of condoms fell down in Gilgit-Baltistan where a decrease of 5.4 percent was recorded.

In Azad jammu and Kashmir, there was a decrease of 1.3 percent in the use of condoms.

For oral pills, the report showed that FATA remained at the top with an increase of 46.2 percent in their use followed by Gilgit-Baltistan with a rise of 20.8 percent and the third place was occupied by Khyber Pakhtunkhwa with 12.0 percent.

In federal capital, the use of oral pills as a means of contraception showed a rise by 4.5 percent, Punjab 3.2 percent and Sindh showed a rise of 2.1 percent.

Again in the case of Balochistan, the use of oral pills was discouraged by locals. The report showed that the use of oral contraceptive pills had decreased by 21.3 percent.

The province/sector-wise comparison of contraceptive performance during the financial year 2011 -12 in terms of Couple Year of Protection (CYP) – an international indicator for data collection – has been made with the previous year 2010-11 which showed that at the national level, an increase of 0.7 percent had been observed for all programme and non-programme outlets during 2011-12 as compared with 2010 -11.

As far as the district Islamabad and FATA are concerned, the contraceptive performance for the financial year 2011-12 compared with 2010-11 depicted an increase of 19.5 percent and 37.4 percent respectively, whereas a decrease of 2.9 percent and 12.0 percent had been recorded in AJK and Gilgit-Baltistan.


http://www.pakistantoday.com.pk/2013/01/27/news/national/pakistanis-used-149-278m-condoms-in-2011-12/

Riaz Haq said...

Here's a Daily Times report on ADB assistance for BISP:

The Asian Development Bank (ADB) has announced $ 200 million assistance for Benazir Income Support Program (BISP) so that it may reach out to the families not benefiting its various schemes. The announcement was made recently while a delegation of the bank was visiting the country with a special objective to look into the areas where the social safety, extended over the poverty-stricken people of the country four years back could be helped out.

Due to transparency and effective utilization of the funds, BISP has received direct technical and financial support from international donors. World Bank, Asian Development Bank (ADB), UK Department for International Development (DFID), USAID, China, Turkey and Iran has doled out funds to support different BISP initiatives. Some countries in the Asian regions, including India, have approached Pakistan for replicating BISP model. BISP conducted countrywide Poverty Survey/Census for the first time and collected the data of almost 180 million people and 27 million households using GPS devices for the informed decision making (to cope with natural disasters and other emergencies). The poverty census completed in record time of one year across all Pakistan including Azad Jammu & Kashmir, Gilgit-Baltistan and FATA.

BISP took start with Rs34 billion (US $ 425 million approximately) for the financial year 2008-09 aiming to cover 3.5 million poorest of the poor families. The allocation for the financial year 2012-13 is Rs. 70 billion to provide cash assistance to 5.5 million families, which constitutes almost 18% of the entire population. The Program aims to cover almost 40% of the population below the poverty line.

More than 7 million beneficiary families have been identified through Poverty Scorecard Survey for disbursing Rs1000/month through ‘branchless banking system’ (Smart Card, Mobile Phone, and Debit Card). Called as Martial Plan and having focus on poverty alleviation through empowering the women, BISP has so far disbursed more than Rs146 billion to the deserving and needy of the country with complete transparency in about 4 years time through the elected representatives of the people, regardless of their party affiliation.

Waseela-e-Haq provides interest free loans up to Rs 300,000 to help recipients set up small businesses. The most striking feature of this program is that the female beneficiary is the sole owner/proprietor of the business and the counseling, monitoring and training for starting the business is provided through Pakistan Poverty Alleviation Fund (PPAF).

Waseela-e-Rozgar has been launched for provision of demand-driven technical and vocational training to the deserving youth, who do not have any skill, through public/private training institutes. A total of 10,000 young males and females have been trained and another 20,000 are currently undergoing training. The target is to train 150,000 students every year.

Besides helping the poor and the marginalized sections of the society in terms of income support and skill development, the BISP is providing insurance cover of Rs.100, 000 in the case of the death of the bread earner of the poor family registered with the authority. With a view that health shocks are the major reason for pushing people below the poverty line, Rs25000 health insurance is being provided to the poorest families for the first time in Pakistan. Pilot phase has been launched from Faisalabad.

Finally, as the Poverty Survey had indicated, millions of poor children never attend any school due to financial limitations. BISP has signed contracts with all the provinces, under its Waseela-e-Taleem Program, initiated with generous help of the World Bank and DFID, to send 3 million children to school through additional cash incentives of Rs.200 per child....


http://www.dailytimes.com.pk/default.asp?page=2013\03\21\story_21-3-2013_pg7_15

Riaz Haq said...

Here's a story about a telehealth facility for women in Karachi:

Karachi: Pakistan’s largest city and commercial centre, Karachi, is a city of extremes where the richest live alongside the country’s poorest. Perfectly coiffed women with foreign degrees and fancy handbags tour around the city’s designer malls. At the other end of the spectrum, a range of hurdles leave women from the poorest sections of society struggling to access basic services, particularly healthcare.
But a recently launched telehealth service is hoping to change that by giving women in Karachi, Pakistan’s largest city with a population of around 18 million, access to basic health advice for free from a mobile phone.
“This is a big opportunity to improve access to woman in urban areas who have no access to basic healthcare and information, particularly during pregnancy,” says Zahid Ali Fahim, head of the telehealth service run by the Aman Foundation, a Pakistan-based non-governmental organisation. Dr Fahim oversees the 26-seat call centre that has been working around the clock for the past 18 months.
According to the World Health Organisation’s Global Health Observatory report, 40 per cent of premature deaths in adults in Pakistan would have been preventable through early intervention. Though there is no official WHO breakdown by gender, experts say a significant portion of those premature deaths are women. Distance to hospitals and clinics, the cost of transport, and low levels of trust in government-run services leaves men and women unable to seek the medical help they may need.
A strict social code for many women presents an additional obstacle. Low literacy rates — 57 per cent of women are illiterate in Pakistan compared with 26 per cent of men — and a lack of basic health knowledge compound the problem.
When women are able to travel to a clinic or hospital, they are usually accompanied by a male relative, leaving many unwilling — or unable — to explain their medical problem to the doctor.
“Women don’t want to get healthcare services without their [male relative] presence,” explains Dr Fahim, “But she cannot say anything when she goes to the facilities. The head of the family does all the talking.”...


http://gulfnews.com/news/world/pakistan/pakistan-women-can-now-dial-a-doc-1.1218545

Riaz Haq said...

Here are some findings of UNICEF's Child Survival Report 2013:

1. Pakistan's infant mortality rate is ranked 26th worst in the world.

2. Pakistan remains high though it has been coming down from 138 per 100,000 in 1990 to 112 in 2000 to 86 in 2012.

3. Pakistan is among the five countries (India 22%, Nigeria 13%, Democratic Republic of Congo 6%, Pakistan 6% and China 4% in that order) across the world where half of all under-five deaths occur.

4. The report recommends exclusively breastfeeding all newborns till six months of age, immunizing children and newborns with all recommended vaccines, and eliminating all harmful traditions and violence against children. To ensure children grow up in a safe and protective environment. Besides this feed children with proper nutritional foods and micronutrient supplements, where available, and de-worm children; give oral rehydration salts (ORS) and daily zinc supplements for 10-14 days to all children suffering from diarrhea.

http://www.unicef.org/publications/files/APR_Progress_Report_2013_9_Sept_2013.pdf