30,000 newborns saved - Dr. Nabeela Ali on the PAIMAN Project

This week, the HNN interviewed Dr. Nabeela Ali, Chief of Party for the USAID-funded Pakistan Initiative for Mothers and Newborns - the PAIMAN project. The 6-year project, implemented in 24 Pakistani districts, reduced neonatal mortality by 23% - saving more than 30,000 newborn babies. 

Now that the PAIMAN project is over, how has maternal and newborn health in Pakistan changed?

The USAID-funded PAIMAN Project showed reduction in neonatal mortality by 23 percent through a replicable model of interventions where in Pakistan newborn mortality has remained static for the last two decades. An overall increase of 27% in births attended by skilled health providers- an indicator that is acknowledged internationally to significantly reduce chances of mothers and newborns dying during delivery or the postpartum period. The Project’s mass media messages reached 70% of those having mass media access with significant behavior improvements. Antenatal check-ups during pregnancy increased 29% while postnatal care within 24 hours increased by 33%. Pregnant women receiving two tetanus toxoid shots increased from 48% at baseline to 56% at endline.

Which PAIMAN achievements are you most proud of?

PAIMAN’s largest contribution to health systems is its ability to demonstrate a workable model fully owned by government and other stakeholders for improving MNCH in Pakistan. This model consists of a package of household to facility based interventions carried out according to the local needs, and in partnership with communities, civil society organizations, and public and private sector actors. The model was implemented in extremely diverse socio-cultural conditions during one of the most difficult phases of Pakistan’s history. Despite these challenges, PAIMAN managed to show that with a holistic approach which results in improvement in access and quality of services, major gains can be made in MNCH.

Where did the idea to engage the religious establishment – the Ulama – come from? What challenges did you face in engaging the ulema? What messages did PAIMAN convey to Ulama to support maternal and newborn care?

For any organization interested in engaging communities at large, working with Ulama is a necessity rather than an option. The reach of mass media in Pakistan in general and in PAIMAN districts in particular has been limited. Mosques and Ulama are a key medium to reach out to people in some of the remotest areas of our target districts.

The key challenge in working with Ulama was identifying a credible and trustworthy channel for contacting them. We found that channel of communication within Ulama by formulating an advisory council of senior most scholars that took all major decisions during the initiative. This advisory council also developed a special booklet of messages for Ulama which discussed their roles and responsibilities in improving knowledge about MNCH in communities. A model Friday sermon focusing on responsibilities of men in improving MNCH at household and community level was also part of the Ulama booklet.

What more needs to be done to improve maternal and newborn care in Pakistan?

PAIMAN had key elements of an exit strategy embedded into its model of integrated service delivery. From the outset, PAIMAN worked on increasing the level of awareness about MNCH issues and changing health seeking behavior; encouraging the incorporation of key aspects of the PAIMAN model for MNCH services into government institutional arrangements and programs in the health sector; building the capacity of the public health sector to plan for and deliver MNCH services; and encouraging and strengthening the private. In the last year of the project, PAIMAN worked closely with key government stakeholders to apprise them of best practices and lessons learned from the project’s experience. Two interventions will need special attention after the end of the project.

The Community Midwives Initiative (CMW), which is at a stage where the system related interventions must be streamlined and fine-tuned, so as to ensure quality service delivery by the CMWs. Also, several policy level and organizational development issues still need to be addressed. The District Health Information System (DHIS) scaling up so efforts need to be continued to provide ongoing support to provinces to scale up DHIS. The private sector in Pakistan is not fully engaged in preventive services in Pakistan. It is a missed opportunity as 70% of patients and clients seek health care from private sector. In general the coverage of interventions to save newborn and maternal lives needs serious efforts and attention of GOP. Healthy timing and spacing of pregnancy and FP services offered through all public and private sector health outlets. Introduce innovations to address diversity in different provinces to reach the women and families. Outsource management of health facilities which are non performing.