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

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?


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....
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.

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.
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.
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....

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.

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

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.”

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.....

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.

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.
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.
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.....

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....

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.

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....
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.

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.,0,5963496.story

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.

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.
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.....

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.

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.


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."

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.

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....\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.”...

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.

Riaz Haq said...

Since the 1990s, Pakistan has reduced its maternal mortality ratio by 50 per cent and infant mortality ratio by 30 per cent. However, it still remains off track with regards to meeting targets of Millennium Development Goals 4 and 5. The majority of under-five deaths are due to birth asphyxia, infections, pneumonia, diarrhoea and severe malnutrition. In terms of under-five mortality, it ranks 26 in the world (UNICEF). Pakistan remains one of only three countries in the world with endemic polio.

Multiple disasters such as earthquakes and floods coupled with armed violence has resulted in much damage and destruction to the social infrastructure including health facilities, especially in the tribal and rural areas of Pakistan. This situation has been further exacerbated by a shortage in nurses, paramedics and skilled birth attendants. Furthermore, there are major disparities between urban and rural areas in terms of access to health services. Routine immunization access and coverage in both urban and rural settings, remains a challenge.

The Pakistan Red Crescent Society operates three basic health units and one mobile health unit in three districts – Quetta, Sibi and Chamman, providing curative and preventive health services with special focus on mothers and children. The teams include male and female doctors, lady health visitors (part of the Government of Pakistan launched programme for family planning and primary care in 1994) and two community mobilizers, linking the communities with the formal health system.

The basic healthcare services package includes appropriate clinical and preventive services with access to free medicines. The priority diseases being treated include diarrhoea, acute respiratory tract infections and malnutrition among children.

In some areas, literacy levels are low and cultural values do not encourage women to make independent decisions. The National Society also provides counselling sessions to tackle cultural beliefs that prevent women from using family planning services as well as health checks and access to contraceptives. There has been a significant increase in uptake of family planning services, growth monitoring and child immunization.

In 2013, the four clinics run by Pakistan Red Crescent Society provided basic healthcare services to more than 70,000 vulnerable people including 27,000 women and 28,000 children. During the same period 15,000 clients accessed family planning services, 4,200 children were screened for growth monitoring and 4,400 children immunized for vaccine preventable diseases.

In another project, the Swiss Red Cross, in collaboration with the Aga Khan University and their local partner Mother and Child Care Trust, is contributing to the pool of lady health visitors by training and expanding midwifery skills and increasing their number at different levels of healthcare, i.e. village, basic health unit and secondary health provider (the thesil [administrative division] headquarters and district hospital) in rural areas of Dadu district, Sindh province.

The mother-in-law of a pregnant woman says, “We are very happy with the services this hospital [tehsil headquarters hospital] has given to us. We are poor, we cannot pay, but still everything is available. We are treated nicely with good behaviour by the staff. I brought my daughter-in-law to deliver here because I have full trust in the staff and that all goes well”.

- See more at:

Riaz Haq said...

How #Pakistan’s National Health Insurance Program Will Work via @WSJIndia

Pakistan’s government launched a national health insurance program for its poorest households Thursday, marking the start of the most-ambitious public health project in the country’s history.

The Prime Minister’s National Health Program will from Thursday cover families that make less than $2 a day through a gradual rollout. In the first phase, over 3 million families will get health insurance in 23 districts, with the ultimate aim to cover 22 million households across the country, officials said.

“This is another step towards the welfare state that we promised to create when we came into power,”said Pakistani Prime Minister Nawaz Sharif.

The Pakistani government already subsidizes health care to varying degrees in public hospitals, but officials acknowledge these facilities are unable to handle the patient load or achieve public health targets.

The government said earlier this year that it wouldn’t be able to meet the United Nation’s targets for child and maternal mortality rates that formed part of the Millennium Development Goals, which had a deadline of 2015. Critics have blamed Pakistan’s low health spending and inadequate management as key factors in the poor health provision. Between July 2014 and March 2015, Pakistan spent just 0.42% of its GDP on health. The U.S. government spends about 8.3% of GDP on healthcare.

The new insurance program will cover treatment at both public and private hospitals. Private hospitals that sign up will then be offered loans on easy terms to upgrade their facilities, officials said, without providing further details about interest rates and conditions.

Saira Afzal Tarar, minister of state for health Services, regulations and coordination, said most Pakistanis pay out of pocket for treatment. “There is treatment at government-run hospitals, but there are long lines. Those who don’t have a recommendation have to wait months for treatment,” Ms. Tarar said at the launch ceremony in Islamabad. “With this [health insurance] card, you’ll be able to go to the hospitals where you weren’t allowed to even go to the front door. Now, you’ll be treated there with dignity and respect.” Ms. Tarar said.

The national health program, with an initial funding of 9 billion Pakistani rupees ($86 million) will pay for the treatment of the types of illnesses identified by the government as critical: heart disease, diabetes and related illnesses, cancer, kidney and liver diseases, complications from infections like HIV and Hepatitis, road accidents, and burn injuries. Officials said coverage can be extended to other conditions considered life-threatening.

The government said Thursday that the program will be run in partnership with provincial governments, which will share the financial burden. Beneficiaries will receive insurance cards, after selection from a database of low-income Pakistanis set up in 2008 for a separate cash support program.

The coverage includes 50,000 rupees for general treatment, and 300,000 rupees for serious illnesses. Mr. Sharif said on Thursday that the government is making arrangements for an emergency fund that would extend coverage to 600,000 rupees for cases that require longer treatment.

Officials on Thursday didn’t provide specific timelines for the rollout of the next phase, which is expected to cover another 3.3 million households. The finance ministry said earlier this year that the program aims to cover 22 million families.

The finance ministry, quoting World Bank data and 2008 population estimates, said last year that if living on $2 a day is taken as the poverty line, over 60% of the population would fall in that category.

Riaz Haq said...

The 'Avon ladies' of #Pakistan selling contraception door to door. #BirthControl #Pills

From 8am to 4pm, 25-year-old Samina Khaskheli travels door-to-door in rural Pakistan handing out free samples of condoms, birth control pills, and intrauterine devices.

“I was told ‘This is sinful’,” Samina says about the initial opposition to her selling birth control. She took the job warily. Her off-the-map village, Allah Bachayo Khaskheli, is home to roughly 1,500 people in the country’s south-eastern Sindh province. The flatlands are covered by livestock, and economic desperation leaves women toiling alongside men as farmhands, livestock breeders and cotton pickers.

Samina is a worker for the Marginalised Area Reproductive Health Viable Initiative – Marvi – once a popular emblem of female independence in Sindhi folklore. Today, Marvi refers to a network of literate or semi-literate village women aged 18 to 40 who travel door-to-door selling contraceptives. “In our village, there was no information about family planning. Many women died during childbirth,” says Samina about what inspired her to join.

Trained by the Karachi-based Health and Nutrition Development Society (Hands), roughly 1,600 Marvis are dispersed throughout Pakistan’s remotest villages, where government healthcare facilities are scant or nonexistent. In the Sanghar district where Samina’s village is located, at least 400 Marvis fill a gap left by a lack of government funded lady health workers (LHWs).

Pakistan’s contraceptive prevalence rate is low – out of a population of more than 190 million, only 35% of women aged 15-49 use contraception. Nevertheless, demand is high in rural areas, where women give birth to an average of 4.2 children, compared to 3.2 children in cities. “In villages, electricity is not there and health facilities are not there, but the need for contraceptives certainly is,” says Dr Talat Abro, the deputy secretary of reproductive health service for Sindh’s population welfare department.

Marvi workers receive a six-day initial training by Hands and have their sessions in the field supervised by LHWs. Marvis emerge from the underserved populations they work with, so understand how family planning is best presented to the women they target.

“I wish I had learned about birth control 15 years ago,” says Azima Khaskheli, a 45-year-old livestock breeder in Allah Bachayo Khaskheli village, her black bangles clinking together as goats bleat nearby.


“We are not trying to limit the number of children – a woman or a family has a right to choose as many number of children as they want, but they must keep in mind the pregnancy period is important for a woman’s health,” says Anjum Fatima, the general manager for health at Hands.

Opposition to birth control in Pakistan often takes on a religious hue, so Marvis are trained to sensitise local religious leaders on the health benefits of family planning. The Marvi programme relies on community mobilisers – ranging from religious leaders to influential landlords – to communicate the benefits of contraceptives. In 2014, approximately 40 Islamic religious leaders approved birth spacing for women in Pakistan. Samina adds that she enjoys the support of the village’s maulvis, or religious authorities, who endorse her door-to-door campaign, and never issue anti-contraceptive messaging over the mosque’s loudspeakers.

“Before the culture was rigid, but now they’ve gradually accepted family planning,” says Samina, the Marvi worker, motioning to the group huddled around her. “I am proud I can teach women about both the Qur’an and birth control.”

Riaz Haq said...

#Saudi #German Hospitals to foray into #Pakistan with 150-200 beds each Bahria Town in #Islamabad #Lahore #Karachi

The Saudi German Hospitals (SGH) group will build and manage hospitals in Bahria Town gated-communities in Pakistan, top management of the two companies announced on Thursday in Dubai.

The partnership will revolutionise Pakistan’s health care sector, eliminating the need for Pakistanis to travel to the West for treatment, Riaz Malik, chairman of Bahria Town, said at a press conference at Saudi German Hospital Dubai, where Sobhi Batterjee, president of Bait Al Batterjee (BAB) Medical Company, the founder of SGH, also spoke.

Under the agreement, SGH will build a 150-300 bed hospital in each Bahria Town development, starting with Lahore, Karachi and Islamabad in the first stage. BAB will also take over the upcoming new hospital of Bahria Town in Lahore as an operator and possibly also manage all hospitals of Bahria Town.

Each SGH-built hospital will have an investment of $100 million (Dh367 million), Batterjee said, and be built on a 12-acre plot of land provided for free in Bahria Town communities.

Malik said Bahria Town hospitals “will not stop treatment because of [patients’] financial problems. Bahria Town will put in its own money [to cover the remaining cost]”.

Batterjee said the partnership will lead to “reverse medical tourism” where patients and doctors from outside Pakistan will travel to SGH and SGH-managed hospitals in Pakistan. He said SGH’s foray in Pakistan will set a benchmark to which all other health care facilities will be compared.

“This will increase the corporate investment injection into health care, which is missing in Pakistan. Health care is an industry in itself, many people miss that fact,” Batterjee added.

Malik said Bahria Town hospitals meanwhile will gain from the 30-year expertise of SGH. “Unfortunately, there are too many health issues in Pakistan. We wanted to focus on this sector and after researching for the best health care provider, we found that SGH would be our ideal partner,” Malik added. “We are one team and I commit to giving Pakistan the best treatment ever,” said Batterjee.

Riaz Haq said...

#Hospital on wheels for patients in rural #Pakistan. disruption empowering rural women in Pakistan has been brought by RingMD, an international healthcare company headquartered in Singapore which is operational in 10 countries around the world. It came to Pakistan thanks to global healthcare sales specialist and now Country Head of RingMD Hassan Chattha. He realised it was needed most in Pakistan considering our local healthcare system is in doldrums. With 400 Pakistani doctors and 40,000 international doctors on board, this telemedicine platform allows doctors and patients to talk via phone or video call through a computer, tablet or smartphone even in low bandwidth environments.

With a team of 30 in Pakistan, RingMD has been able to provide consultations to thousands of patients in rural areas around Lahore, Okara, Kasur, Bahawalpur, Sheikhupura, Rawalpindi, Faisalabad and Sargodha. After a positive response in Punjab, they have the support of Sindh government to start their operations in the province very soon.

Before these WiFi-enabled mobile vans arrive to connect rural patients with city doctors, the company takes permission from the village leaders and explains the concept to them in detail. Once the leader agrees, influential people in the community spread the word through the mosque’s loudspeakers or share a place where the camp can be set up for maximum attendance. These influential people are essentially “enablers” for RingMD’s programs and once they see how the camps operate, they are then trained to carry out these activities independently for their villages. “We are also training teachers and educated young people to arrange tele-consultations. This way we are able to create new jobs and give confidence to people,” Chattha says.

Most of all, RingMD provides privacy to female patients as they can sit alone in the van with a laptop and explain all their symptoms to a female doctor without any fear of being heard or judged by others. Shame is also a factor that restricts women in urban centres from getting treatment for their psychiatric problems in Pakistan and this is an area where RingMD can make a big difference by providing a range of mental healthcare professionals so that women are able to get treatment and support for taboo illnesses like stress anxiety and depression.

Riaz Haq said...

In Pakistan, empowering midwives to empower women

In 2014, UNFPA – together with the Department of Health and Sindh Province’s Maternal, Newborn and Child Health programme – launched a pilot effort to supplement the midwifery courses with hands-on training. Midwifery coaches visited the midwives’ clinics, offering guidance and mentorship.

Today, Ms. Tresa proudly says she “provides quality of services like a medical doctor.”

Overcoming doubt and criticism

But the midwives also faced challenges beyond education and training.

In rural Pakistan, many people consider it shameful or unorthodox for women to work outside the home. According to a 2012 survey in Pakistan, 70 per cent of respondents said that when women work, their children suffer.

Many of the midwives faced these attitudes, as well.

“My in-laws and other relatives were against me,” said Shabana Jabir Ansari, 27, from Mushtrika Colony. “Sometime due to my duties – morning and evening shifts – people said negative comments. That hurt me.”

Fozia Foto, 32, had the same experience in Hussain Khan Laghari Village. “I was the first girl who studied in my family and the first to become a midwife, so initially our relatives were against me,” she said.

She stayed in hostels while enrolled in the midwifery school, which critics also used against her.

“People said that I was living alone at the school and said so many bad things about my character,” she remembered.

Empowered women saving lives

Community members were also sceptical of the midwives’ abilities.

The midwifery school and coaching programme gave them the skills to save lives, but they were not always afforded the opportunity.

“People didn’t trust me initially. Even for delivering babies, they didn’t refer cases to my birthing station,” said 30-year-old Reshma Korejo, from Meer Mohammad Korejo Village.

She had to deliver two or three babies safely before she gained villagers’ trust.

“It was a big challenge for me to face those types of negative behaviours,” she said, but “slowly and gradually things changed.”

And as the midwives became established, they started changing minds, even raising awareness about issues that were not widely accepted – such as family planning.

“There are myths in the minds of women,” said Ms. Ansari about contraceptives like the intrauterine contraceptive device (IUCD).

Slowly, the midwives say, use of modern family planning methods is increasing.

And they are also accomplishing the goal that motivated them in the first place: They are saving lives.

Kousar Dahri, 32, remembered reviving a newborn baby in her village of Khamiso Khan Dahri.

“There was a woman in the community. She already had six babies, and she came for the delivery of the seventh,” Ms. Dahri said. “She delivered a son who required resuscitation, which I had been trained on. I started CPR, following the steps, and the baby was successfully resuscitated.”

Expanding training and support

So far, over 300 midwives have benefitted from the coaching and mentorship programme.

Plans are now underway to scale up midwifery training efforts.

The 18-month midwifery training programme is being expanded to 24 months, with help from UNFPA. And the midwifery coaching programme will be rolled out to all the districts in Sindh through 2018.

These programmes will empower more women to save lives.

As for Ms. Dahri, she says the experience of saving that newborn stays with her.

“Saving any child feels like saving all of humanity,” she said.

Riaz Haq said...

‘Pakistan ahead of developed countries in neurosurgery’

LAHORE: At a three-day international conference on neurosurgery, Prof Dr Khalid Mahmud in the presence of international delegates, professors of Punjab Institute of Neurosciences and Lahore General Hospital Unit 2 gave live training of endoscopy operations.

All the participants were delighted with the professional capabilities and expertise of Dr Khalid, who also presented his research papers and enlightened the audience with some of his career’s most complicated cases.

He said that Pakistani doctors in the past had to go abroad for training, but now the experienced doctors from Pakistan were sharing their experiences with those in other countries. Dr Khalid said that Pakistan was ahead of the developed countries in neurosurgery, especially in endoscopy. He called upon the young doctors to opt for modern techniques and provide the best possible medical facilities to the patients.

It is pertinent to mention here that apart from Pakistani doctors, the Neuro Surgeons Conference was attended by those from the US, KSA, Korea, Nepal, Russia, Italy, and the Czech Republic, who also shared their experiences. Surgical anatomy, brain path and sinonasal also came under discussion during the Skype sessions that were held to demonstrate endoscopy tumour biopsy and a live surgery was also undertaken.

Dr Khalid claimed that brain tumours were being removed in the Punjab Institute of Neurosciences of the Lahore General Hospital without opening the head, and that too free of cost for the poor. He told that the loss of blood in the process was minimal and the patient has to minimum time at the hospital.

He said that state-of-the-art facilities were available in the Punjab Institute of Neurosciences where complicated operations were being undertaken in large numbers.

Riaz Haq said...

Infrastructure and Personnel in Pakistan

Currently, there are 21 dedicated hospitals which treat only cancer where the bulk of the work centres around cancer diagnosis and treatment. Another 50 general hospitals have facilities to treat cancer with chemotherapy and/or radiation. These tend to be larger hospitals in major urban centres. Nationally, there are approximately 125 oncologists of all descriptions with some sort of post-graduate qualification practising medical and radiation oncology (17).

Education and Training
Significant challenges exist for the future of oncology within Pakistan. Among the most serious are those related to training of physicians, nurses and allied technical staff. It has become much more difficult, in the last decade, for Pakistani physicians to train overseas, adding impetus to the need for well-designed and relevant training programmes within the country. There are currently insufficient numbers of training slots and a second fellowship means an additional two to three years of work at a relatively junior, and thus financially unrewarding, level. It is, nevertheless, essential that the number of training positions in the various oncologic disciplines be increased. Job opportunities within the country are also limited, particularly in the government sector hospitals, which have traditionally provided employment for specialist physicians. Only when we can provide adequate employment opportunities to our trained personnel can we hope to stem the continuous attrition of the country's trained workforce by employers overseas.

Infrastructure Development
The relatively small numbers of radiation machines and allied treatment facilities often mean that despite training in radiation oncology, radiation oncologists still have to practise largely as medical oncologists. Investment in infrastructure has occurred, as described above, and needs to continue. Over the last decade, 25 cobalt machines and 12 linear accelerators have been installed in government sector hospitals, while a further ten linear accelerators have been installed in private sector facilities.

The costs of treatment of cancer continue to rise, coupled as they are to ever-increasing drug costs as well as the costs of improving technology, for both diagnosis and treatment. Over the last decade, the expense on cancer drugs has nearly quadrupled at the SKMCH&RC, partly due to increasing numbers of patients seen and treated but also because of the increasing availability of new and expensive cancer treatments. Interestingly, despite this huge overall increase in drug budgets, the institution has managed to keep the moving average price of high-cost cancer drugs stable by use of high-quality generic drugs as they become available, coupled with a decrease in price of drugs coming off patent. This represents an example of the kind of innovative strategies needed to be able to provide high-quality care to the maximum numbers of patients.

Riaz Haq said...

SIUT (Sindh Institute of Urology and Transplant) Provides free medical treatment for kidney and liver diseases and cancers. It is a renowned center for ethical kidney transplantation.

Our patients are predominantly from the rural and poorer urban strata with virtually no access to medical facilities. They are financially incapable of affording modern diagnostic, treatment and transplant facilities which are very costly in the private sector.

SIUT’s extensive facilities house state-of-the-art equipment which enable us to provide free treatment related to a vast area of medicine. This also means that many patients, who would have to go abroad for costly treatment...

Riaz Haq said...

In Pakistan since 2000, there has been the notable improvement in some health indicators mainly as a result of public, private programs and NGOs contributions [16]. Despite, health profile of Pakistan is illustrated by high population growth rate, infant and maternal mortality rates, and dual burden of communicable and non-communicable diseases [17]. Regardless, the country is undergoing considerable social, environmental, and economic changes. The basic food requirement and health are problems for the people, the paper by Nishtar [18] indicated that malnutrition is worst in the rural areas of Sindh, and Baluchistan with 20-30% children are being retarded, and high infant mortality is as a result of malnutrition, diarrhea, and pneumonia. Furthermore, about 40% of deliveries are attended by skilled birth attendants, and the high maternal mortality rate is related to high fertility rate, low skilled birth attendance, malnutrition and inadequate access to emergency obstetric care services [19]. The key demographic and health indicators of both countries are summarized in Table 1. Bangladesh despite its challenging circumstances, has proven to be remarkably resilient and achieved significant human development gains, and impressive progress was made in health outcomes, especially in maternal and child health [20]. Population growth slowed considerably during the past thirty years and falling from 2.7 percent per year in the 1980s to around 1.3 percent in 2010 [21]. The contributions of the overall disease in terms of percentages in Pakistan and Bangladesh are shown in Table 2.

Indicators Pakistan Bangladesh
Population under 15 years 34% 30%
Population over 60 years 7% 7%
Infant mortality rate/1000 42 41
Maternal mortality rate/100,000 170 170
Crude birth rate/1000 31 20
Crude death rate/1000 8 5.59
Fertility Rate (F.R) 3.2 2.2
Immunization coverage 65% 87.5%
Table 1: Key Demographic and Health Indicators.

Diseases Pakistan Bangladesh
Communicable, maternal, perinatal, and nutritional diseases 41% 46%
Non-communicable diseases 59% 54%
CVDs 21% 23%
Injuries 16% 10%
Cancer 6% 7%
Diabetes 2% 1%
Respiratory diseases 7% 5%
Other Chronic diseases 7% 8%
Table 2: Contributions of the disease.

Goals and Expectation
Since the time of independence, HCDS of Pakistan has undergone major reforms start its journey from National Health Policy, Primary Health Care services, TB control, and Immunization Program [22]. Regardless of settled goal and expectations Pakistan health system showed dissatisfactory progress and failed to achieve desired outcomes [23]. Furthermore, Pakistan failed to achieve goals of “Health for All” in Alma Ata Declaration and failed to attain Millennium Developmental Goals (MDGs) 2015. Currently, Pakistan is aiming to attain the Sustainable Development Goals 2025. In addition, Pakistan has also settled the National Health Vision 2016-25 to improve the health of all population particularly women and children, through universal access to affordable quality essential health services, and delivered through resilient and responsive health system. On the other hand, Bangladesh has surpassed many neighboring countries in South Asia as well as other developing countries in terms of progress in achieving the health-related MDGs. Similarly, Bangladesh also achieved significant progress towards achieving the twin goals of eradicating poverty and promoting shared prosperity 2007. Furthermore, Bangladesh became successful in achieving almost universal immunization coverage and reducing child and maternal deaths. Recently, Bangladesh has set National Five Year Strategic Investment Plan (SIP) in order to improve the health of the population, reforming the institutions, and improving performance. However, poor access to services, low quality of care, and high rate of mortality and poor status of child health still remain as challenges of the health sector of Bangladesh [24].

Riaz Haq said...

BISP, Citizenship and Rights Claims in Pakistan

By Rehan Rafay Jamil

Taking Stock of Ten Years of the Benazir Income Support Programme (BISP)

Over ten years since its establishment, the Benazir Income Support Progamme (BISP) has become Pakistan’s largest social safety net, providing coverage to over 5.6 million women and their households across the country. The expansion of BISP over the past decade marks an important shift in social policy in Pakistan. BISP has now been overseen by three elected governments and has resulted in a significant increase in federal fiscal allocations for social protection. Despite vocal reservations about its name expressed by some political parties, the program remains Pakistan’s largest flagship poverty alleviation program with international recognition.[1]

Third party impact evaluations of BISP have largely focused on its poverty alleviation, nutritional and gender empowerment impacts.[2] [3] These evaluations point to important reductions in poverty and improved nutritional levels for beneficiaries and their households. Oxford Policy Management’s 2016 evaluation finds reductions in BISP households’ reliance on casual labor and an increase in household savings and asset accumulation.[3]

BISP is one of the largest cash transfer programs targeted exclusively at women in the Global South, making the gender impacts of BISP important to understand. In their evaluation, Ambler and De Brauw (2017) find some changes in gender norms and attitudes amongst beneficiaries and their families. Their study finds that female beneficiaries are more likely to have greater mobility to visit friends without their spouse’s permission, are less likely to tolerate domestic violence and male members are more likely to contribute to household work.

BISP and the transition from Cash Transfer Beneficiaries to Citizens

The evaluation reports provide some evidence that BISP has also had a wider set of intended and unintended consequences in influencing beneficiaries’ access to public institutions and spaces. Perhaps the most frequently cited impact of BISP has been a marked increase in rural women’s access to computerized national identity cards (CNICs), a prerequisite for obtaining the program. CNICs can be seen as the first step to citizenship and rights claims in Pakistan. The most significant impact of the rapid increase in CNIC registration amongst BISP beneficiaries has been with regards to voting. Ambler and De Brauw (2017) find evidence that BISP beneficiaries are more likely to vote in national elections. But whether BISP beneficiaries are empowered by the cash transfer to make a wider set of rights claims and access local state services, is less clear.

In order to understand some of the changes brought about by BISP in the lives of rural women, I conducted qualitative field work, including in-depth interviews and focus group discussions with beneficiaries and their spouses, in the district of Thatta in Lower Sindh. Thatta has a high proportion of BISP beneficiaries (47 percent), being a high poverty district. The aim of the fieldwork was to develop an understanding of how beneficiaries and their families perceive of BISP and whether the program has brought about any changes in their engagement with local state services.

Riaz Haq said...

#Pakistan National #Security Committee Announces Country's Response to #Coronavirus Outbreak. Shuts #schools, Cancels #PakistanDayParade , closes western borders, sets up testing/isolation/quarantines at borders, bans public gatherings & big weddings.

The National Security Committee (NSC) on Friday decided to take a number of steps to contain the spread of coronavirus in the country, including closing the border with Iran and Afghanistan and banning all large public gatherings.

The high-level NSC meeting, chaired by Prime Minister Imran Khan, was attended by the provincial chief ministers and the civilian and military leadership.

Major decisions taken by the NSC:

Border with Iran, Afghanistan to be closed for two weeks
Schools shut until April 5
Large public gatherings including weddings banned for two weeks
International flights to operate only from Karachi, Lahore and Islamabad
Pakistan Day parade cancelled
Remaining PSL matches to take place in empty stadiums
Special Assistant to the Prime Minister on Health Dr Zafar Mirza and other government officials detailed the decisions taken by the body at a press conference, with Mirza revealing that Pakistan now has 28 cases of COVID-19.

"There is a lot of speculation about the total number of cases in the country. However, I can confirm that Pakistan has 28 cases of coronavirus," said Mirza, who was accompanied by government spokesperson Firdous Ashiq Awan and PM's Special Assistant on National Security Division and Strategic Policy Planning Moeed Yousuf.

He said the seven new cases had all been reported in Taftan among Pakistani pilgrims who have returned from Iran. All seven people are stable and recovering.

Mirza announced that Pakistan's border with Afghanistan and Iran will be closed "completely" for two weeks, following which the situation will be reviewed. During this period, the system for screening and preventing further infections from entering the country will be made stronger.

He said the first batch of pilgrims who have returned to the country from Iran has left for provinces after completing its 14-day quarantine period at the Taftan border. The details of these pilgrims will be provided to the provincial governments, which can test or place the pilgrims under quarantine again.

It was decided during the meeting that only three airports in the country — Karachi, Islamabad and Lahore — will be allowed to operate international flights, a move intended to reduce the entry points and ensure better arrangements there.

Mirza said all large public gatherings will be banned, including weddings and conferences, for a period of two weeks. Cinemas will also be closed while all remaining Pakistan Super League (PSL) 2020 matches will take place in empty stadiums.

The matter of whether religious congregations should be banned has been referred to the religious affairs minister and the chairman of the Council of Islamic Ideology. They have been tasked with consulting with all stakeholders and give their advice to the government based on which a decision will be taken, Mirza said.

Schools closed
It was decided to close all educational institutions in the country for three weeks. Education minister Shafqat Mehmood tweeted that schools will remain shut until April 5.

Mirza said the government will also request the chief justice to close civil courts and adjourn cases for a period of three weeks. Judicial magistrates and judges of sessions courts will be requested to decide criminal cases within jails while relatives of prisoners will not be able to meet them for three weeks in jails.

A media campaign will be started to brief the public regarding coronavirus prevention measures and a system will be established to prevent misinformation and relay facts to the people from a "central" source.

Riaz Haq said...

March 16, 2020—Aisha Yousafzai, associate professor of global health (at Harvard University), is the principal investigator of two large randomized controlled trials focused on early childhood development in Pakistan—Pakistan Early Child Development Scale-Up (PEDS) and Youth Leaders for Early Childhood Assuring Children are Prepared for School (LEAPS).

What do you see as policy and research priorities in early childhood development?

We know that young children need good health, proper nutrition, and early learning opportunities. But they also need security and stability. It’s important that they have consistent caregivers in early life who they can trust and rely on. When children don’t have these things, it can be harmful to their development and impact their health and future prospects.

Policies that support families and help children thrive include investing in parenting programs and ensuring access to good quality, affordable child care and parental leave. And we should not be separating children from their caregivers who provide safe stable nurturing care.

We still need to better understand what works for the most vulnerable and disadvantaged children, such as those living through a humanitarian crisis. It’s not enough to focus just on the immediate emergency phase. We need to address the long-term needs of these children and their families. Another understudied population is children with developmental delays and disabilities. We need to look at how to strengthen health care systems to address their needs.

What results have you found from PEDS and LEAPS?

In the PEDS trial, we wanted to see if Pakistan’s Lady Health Workers (LHW) program—which provides home visits to promote health and nutrition in mothers and young children—could also effectively promote children’s development. Community health worker interventions like the LHW program were set up in recent decades in low- and middle-income countries to promote child survival. Now that we are seeing improvements in child survival in many countries, we need to think about how these programs can deliver interventions beyond survival that help children thrive.

For this study, we adapted a curriculum developed by the World Health Organization and UNICEF, and evaluated it in a randomized controlled trial. Results were favorable up to age two, and some of the benefits to children’s cognitive-language and motor development were sustained at age four.

But alarm bells were raised when we saw that only about a quarter of children in rural communities had access to preschool—and even those who did weren’t necessarily getting quality education.

That challenged us to think about the continuity of services for children, from the first 1,000 days of life to the early years of education and beyond. We developed a way to address the need for better preschool in Pakistan that also helped fill a gap in training and employment for young women. Working with Pakistan’s National Commission on Human Development, we established a training program for women ages 18–24 to become preschool teachers (LEAPS) and placed trainees in villages with no established preschool services.

Our pilot found that this program provided a good school readiness benefit for children as well as a boost to youth employment. Now, we’re scaling up across four districts, and also looking at how well the country’s education system is able to absorb this intervention.

Riaz Haq said...

Social Safety Program Amid COVID19 Pandemic:

India is able to reach a high percentage of households through the combination of multiple programs including food rations, pensions, LPG cooking gas subsidies, food-for-work programs, farmer subsidies and making transfers to holders of Aadhaar-linked Jan Dhan accounts. Already, this approach appears to have been able to support quite a high proportion of poor households by scaling up food rations and various financial transfers. Initial survey results suggest that the system has provided material assistance, although some difficulties have been reported in cashing out payments and using the funds to purchase supplies.

In addition to the federal government, many states have announced their own programs to help people who fall through the system, especially migrants. But states face hard budget constraints due to expenditure ceilings imposed by the Fiscal Responsibility and Budget Management Act. Although the central government has allowed states to borrow up to 50 percent of their yearly credit needs upfront, the current uncertainty may prevent them from significantly expanding the range, scope, and scale of social assistance programs.

Lessons so far: The architecture of direct benefit transfers and JAM facilitates both scale-up and portability of benefits. But it is not possible to get an integrated view across programs which hinders coordination between the central and state-level initiatives. Many people fall through the cracks, especially migrants whose place of current residence does not match their registration location. In crises that disrupt supply chains there is an important role for efficient in-kind systems, but these have to be designed to ensure portability across states.

Building on the platform for BISP, the main social safety net program, Pakistan has announced a major scaleup of financial assistance to people affected by COVID-19. The Ehsaas Emergency Cash program distributes cash to 12 million families whose livelihood is severely impacted by the pandemic or its aftermath. People apply for the benefits through mobile phones. Their claim is assessed, which can include a check against databases, linking records with the national ID number. If they are approved, they can collect their benefit, after biometric authentication, at one of 17,000 cash disbursement centers that have been set up. From its inception in early April, cash has reportedly reached about one quarter of those entitled to the transfer, indicating a significant degree of state capacity to scale up transfers quickly.

Lessons so far: Pakistan is able to use its ID system and mobiles to initiate a large-scale centrally managed transfer program to uniquely identified and verified recipients. Because of the links with the National Socio-Economic Register and several other databases, the government can apply a range of exclusion rules to help target the transfers without making beneficiaries go through time-consuming application and verification procedures. Drawing on its past experience disbursing flood relief in 2007, Pakistan is also using mobile technology to offer recipients a choice of providers, although special payment points are needed because of low financial inclusion. It is not known how easily people are able to purchase supplies with their financial grants.

Bangladesh has announced a range of programs but has not yet begun to implement them, and faces questions on how it will proceed. Some programs will be able to disburse through mobile money accounts, but many will not. There are also questions about the resilience of the mobile agent network: many agents provide service as a side business while their main income is from small shops, including in markets. They may not find it worthwhile to offer cash-out services if they are not able to open for normal business.

Riaz Haq said...

Lancet Study: Non-infectious diseases cause early death in Pakistan

Pakistan has considerable control over infectious diseases but now struggles against cardiovascular diseases, diabetes and cancer as causes of early deaths, according to a new study published Thursday.

The Lancet Global Health, a prestigious British-based medical journal, reported that five non-communicable diseases — ischaemic heart disease, stroke, congenital defects, cirrhosis, and chronic kidney disease — were among the 10 leading causes of early deaths in the impoverished Islamic nation.

However, the journal said some of Pakistan’s work has resulted in an increase in life expectancy from 61.1 years to 65.9 over the past three decades. The change is due, it said, “to the reduction in communicable, maternal, neonatal, and nutritional diseases.” That’s still 7.6 years lower than the global average life expectancy, which increased over 30 years by 8% in women and 7% in men.

The study says “despite periods of political and economic turbulence since 1990, Pakistan has made positive strides in improving overall health outcomes at the population level and continues to seek innovative solutions to challenging health and health policy problems.”

The study, which was based on Pakistan’s health data from 1990 to 2019, has warned that non-communicable diseases will be the leading causes of death in Pakistan by 2040.

It said Pakistan will also continue to face infectious diseases.

“Pakistan urgently needs a single national nutrition policy, especially as climate change and the increased severity of drought, flood, and pestilence threatens food security,” said Dr. Zainab Samad, Professor and Chair of the Department of Medicine at Aga Khan University, one of the authors of the report.

“What these findings tell us is that Pakistan’s baseline before being hit by extreme flooding was already at some of the lowest levels around the globe,” said Dr. Ali Mokdad, Professor of Health Metrics Sciences at IHME. “Pakistan is in critical need of a more equitable investment in its health system and policy interventions to save lives and improve people’s health.”

The study said with a population approaching 225 million, “Pakistan is prone to the calamitous effects of climate change and natural disasters, including the 2005 Kashmir earthquake and catastrophic floods in 2010 and 2022, all of which have impacted major health policies and reform.”

It said the country’s major health challenges were compounded by the ongoing COVID-19 pandemic and last summer’s devastating flooding that killed 1,739 people and affected 33 million.

Researchers ask Pakistan to “address the burden of infectious disease and curb rising rates of non-communicable diseases.” Such priorities, they wrote, will help Pakistan move toward universal health coverage.”

The journal, considered one of the most prestigious scientific publications in the world, reported on Pakistan’s fragile healthcare system with the Institute for Health Metrics and Evaluation at the University of Washington’s School of Medicine. The study was a collaboration with a Karachi-based prestigious Aga Khan University and Pakistan’s health ministry.

The study also mentioned increasing pollution as one of the leading contributors to the overall disease burden in recent years. Pakistan’s cultural capital of Lahore was in the grip of smog on Thursday, causing respiratory diseases and infection in the eyes. Usually in winter, a thick cloud of smog envelops Lahore, which in 2021 earned it the title of the world’s most polluted city.