Birth registration: Leaving no child behind

A lady health worker becomes the source of inspiration for her community

Fatima Shahryar
A lady health worker smiles as she sits with her daughter
28 February 2019

Badin, Pakistan - 28 February 2019: “When duty calls, I have to respond,” says Razia Abbasi, a lady health worker (LHW) who lives in a small village of Badin district, in the Sindh province. “My job is to ensure that all the mothers and children of my area are safe and healthy. I cannot let anything prevent me from doing my job, not even disability, because lives are at stake.”

Razia has been visually impaired since she was born and has difficulties reading and writing. Living in a small village, with limited access to health facilities and few resources, she could not afford medical treatment, but was determined to overcome the challenges life had thrown in her way. Despite her disability, she learnt how to read and write and was later accepted in the LHW programme by the Department of Health in Sindh.

"I cannot let anything prevent me from doing my job, not even disability, because lives are at stake."

Razia Abbasi, Lady Health Worker in Badin District, Sindh

Now 46 and a mother of four, Razia is the family’s breadwinner, a rather unusual situation in Pakistan. She goes to work every day while her husband takes care of the family and helps with household chores at home.

Razia’s second daughter, 16-year-old, takes a vivid interest in her mother’s job and often asks to accompany her after school. She was particularly excited when her mother attended a training on how to register children using a smart phone that transmits data directly to the dashboard of the local Union Council Secretary.

The use of innovative tools was life-changing in Badin. Located on the east of the River Indus and made up of largely barren land in a hot desert climate, this small district is populated by underprivileged families who rely on cattle-farming. Poverty, lack of information and the tedious birth registration processes resulted in about 700,000 children left unregistered, depriving them of the possibility of obtaining identity papers. This put their safety at risk since it is more difficult to protect children against child labour or child marriage when their age is not known.

Birth Registration is a fundamental right of all children, and a legal proof of their existence and identity. To ensure that all children are registered in Pakistan, UNICEF supports the transition to digital birth registration in partnership with the provincial government and with support from Telenor, a leading telecom network in Pakistan. The project, which started in one Union Council of Thatta district, has been scaled up to another four districts, including Badin.

A lady health worker records data in a smart phone
Attiya (16) helps her mother Razia Abbasi record data in a smart phone to register children of their community. Razia Abbasi is a frontline lady health worker from Badin District of Sindh province who is working for digital birth registration of children in her community.

Government-employed LHWs have been trained on the use of android-based digital devices, through which they enter data on birth registration onto the government dashboard in real time. The data is analyzed by the Union Council Secretary and processed, resulting in the registration of the child in the National Database and the issuance of a birth certificate.

LHWs like Razia are front-line workers based in communities, whose job is to help meet the primary health needs in underserved areas such as rural communities and slum dwellers. Those participating in the project have taken up the additional responsibility of identifying and registering children when they conduct the regular family visits that are part of their daily schedule.

During the implementation of the project, some LHWs expressed difficulties in understanding how to use mobile devices. This is why some of their adolescent children, including Attiya, were invited to attend the trainings. They can now assist their mothers in case of technical glitches.

Attiya sometimes accompanies her mother and observes her work on the field.

A lady health worker travels to conduct household visits for birth registration
Razia Abbasi, a frontline lady health worker from Badin District of Sindh province, accompanied by her daughter Attiya (16) conducts household visits in their village to register children at birth.

“It makes me happy to learn so many new things with my mother, especially considering that in our community, most girls my age are not even aware of their basic rights,” Attiya says.

“Initially I found my mother’s job difficult, as some people refused to listen and were rude to her, but I saw how she always remained patient and refused to give up. She will visit the same families again and again until they accept to register their children” she tells, adding that she has started to see change in her community.

“Some families who refused to even open their doors are now helping my mother reach more families. I am proud of my mom. Her job is difficult, but incredibly important. Every day she comes back home after registering more children is a day of celebration for us.”

Last year, about 300,000 children were registered in the province of Sindh, thanks to the efforts of Lady Health Workers such as Razia and other community workers including nikkah registrars (local clerics) and UC secretaries. The project will continue until 2022 in a bid to register up to three million children in five districts of Sindh. This will support Pakistan’s efforts towards the national goal of achieving universal birth registration targets by 2024.