Low Cost Actions, Long Term Benefits through Child Health and Sanitation Week
By Fatima Raja
KHANPUR, Pakistan, November 2008 – Kubra Tariq holds her son Zahid close. "He is my only child," she says. Her usual strong, forthright manner is subdued as she remembers. "He is my only child, but not my first born. I have been married ten years and had a daughter before him. When she was nine months old she got diarrhoea. Water flooded out of her body and she became dehydrated. She died before we could reach a doctor. I didn't know what to do."
"I know that if I need health advice, Sadia Mushtaq and the other LHWs will be there to help me."Today, Ms Tariq feels she is better informed. "I know how to prepare Oral Rehydration Salt solution in case of dehydration," she says. "I know that if I need health advice, Sadia Mushtaq and the other LHWs will be there to help me."
Sadia Mushtaq is a Lady Health Worker (LHW) who works in Khanpur, a small settlement of factory workers in Sheikhupura District, about 50 kilometres from the provincial capital, Lahore. Her main job is to bring information about health and nutrition to mothers and families. As a woman and a neighbour she moves freely within homes in a society where women are reluctant to visit public spaces. She is trained to assess illness and advise mothers when to treat the child at home and when to take him or her to a health facility.
Today, Ms Mushtaq is working for Child Health and Sanitation Week, a biannual initiative of UNICEF, the Government of Punjab and other partners, in which she and her colleague go door to door, administering free deworming tablets, counselling on infant and child care. If a child or a pregnant mother has not received routine vaccinations or tetanus toxoid shots, she refers them to a vaccinator in a nearby fixed site in her community. She tells them about the importance of exclusive breastfeeding, how to mix Oral Rehydration Salt, recognize signs of pneumonia and emphasises the need to wash hands with soap.
These are important lessons. Of every 1,000 Pakistani children born, 97 die before they are five years of age. About 78 never complete even one year of life. Poor nutrition, respiratory tract infections, and diseases related to sanitation and hygiene are major causes. Intestinal worm infestations weaken many children, stunting growth and causing anaemia.
Winter is approaching, and temperatures will soon fall into the single digits. Accordingly, this Child Health and Sanitation Week is focused upon the prevention and management of pneumonia and infections of the respiratory tract. After finishing her rounds, Ms Mushtaq gathers all the village women in a small veranda. "Winter is coming. What have I told you about keeping your children warm?" she asks.
"After the first health week, brick kiln workers started building latrines. People started coming to us, asking for information about their children's health."
Sheikhupura is one of three Punjab districts where Child Health and Sanitation Week is being piloted. By creating partnerships between sanitation and health programmes, and using pre-existing health networks, it is possible to deliver information and change behaviour at low cost: only US$ 0.33 per child per year. In Kasur and Nankana Districts, where the project was launched in 2007, the effects are already visible. A study showed that the number of mothers who could correctly identify two signs of pneumonia increased from 25 per cent before to 65 per cent after the October 2007 activities.
Dr Mohammad Saeed, the project's focal person in Sheikhupura District, has also observed its benefits. "Not only are health practices better, we have seen concrete improvements," he says. "After the first health week, brick kiln workers started building latrines. People started coming to us, asking for information about their children's health." In the coming years, UNICEF and its partners hope to expand the initiative province-wide, and ultimately emulate Ghana's example where a similar project helped cut infant mortality from 82 to 33 per 1,000 births in only five years.
In Kubra Tariq's home, Ms Mushtaq carefully mashes up a deworming tablet in a tablespoon of water and pours it into Zahid's mouth. He grimaces and protests but swallows it down. As Ms Mushtaq turns to leave, Ms Tariq calls out to her. "Wait," she says. "Wait, first come and tell me what vaccinations my son should get. I don't want to miss any." At once Ms Mushtaq returns to her side.