New initiative helps keep every child alive in Pakistan

Punjab’s Health Department and UNICEF help treat sick young infants suffering from possible serious bacterial infection (PSBI) close to home, including during COVID-19

Raheel Khan and Catherine Weibel
Eight month old Kabir with mother
UNICEF/Pakistan/Sameer Ahmad Khan
29 October 2020

Kasur District, Punjab, Pakistan - October 2020: In a modest dwelling of Kasur, a district of Pakistan’s Punjab province, 15-day-old Ajwa is coughing and panting. Her mother Khalida Bibi tries to calm the newborn down as her body temperature rises hour after hour.

Khalida Bibi is not sure what to do. She is alone at home with baby Ajwa and three other children while her husband is at work. Like many families living in rural Kasur, she doesn’t really know where to go to seek services and is too poor to afford healthcare.

This is why Punjab’s Health Department has launched a network of Lady Health Workers who routinely visit families and refer them to local health care facilities as needed.

On that day, Lady Health Worker Umme Kalsoon, who lives in the village, pays a visit to Khalida Bibi as she knows that she has recently given birth. The front-line worker comes to check the newborn’s health and provide the first immunization, but she soon realizes that little Ajwa is not well and might suffer from a bacterial infection. She advises Khalida to take her to the nearby Basic Health Unit (BHU) in Fatehpur. Khalida waits until her husband Ghulam Nabi comes back to take care of their other children and goes to the BHU with the baby.

Once there, doctors say that little Ajwa may suffer from a Possible Serious Bacterial Infection (PSBI). In line with the protocol of the World Health Organization, they suggest that the mother take her for treatment to Kasur’s District Headquarters hospital, a higher-level health facility. However, Khalida says that she cannot travel there; the city is 20 kilometers away and she cannot take the baby there alone while her husband works at a factory.

Thanks to a new initiative supported by UNICEF with generous funding from the Bill and Melinda Gates Foundation, there is now an alternative.

Newborn baby
UNICEF/Pakistan/Sameer Ahmad Khan
Baby Ajwa recovered from possible bacterial infection thanks to a programme supported by UNICEF with funds from the Bill & Melinda Gates Foundation.

Fatehpur’s Basic Health Unit is a beneficiary of the Possible Serious Bacterial Infection (PSBI) Initiative. Doctors, Lady Health Visitors / Workers and nurses working in primary healthcare facilities such as Rural Health Centers and Basic Health Units have been trained on how to manage PSBI cases among children age up to two months on location in cases when parents cannot go to a higher-level health facility. This usually happens when parents do not have any means of transportation, cannot afford to travel, need to stay home to take care of other children or simply refuse to go.

“I could not afford traveling to Kasur as it is far away. I am scared to think of what could have happened, had the treatment not been available here.”

Khalida Bibi

Thanks to the training, medical staff at Fatehpur’s BHU have been able to treat little Ajwa on location. They baby girl, who was injected with antibiotics and given syrups, recovered after one week.

“I am so happy to see that my Ajwa is fine now,” says Khalida Bibi as she takes the infant back home. “I could not afford traveling to Kasur as it is far away. I am scared to think of what could have happened, had the treatment not been available here.”

Working in partnership with Punjab’s Health Department, UNICEF has implemented the PSBI initiative in Punjab’s primary and secondary health facilities since 2018. The project is now implemented in ten districts of Punjab, Pakistan’s most populous province. So far 245 doctors, nurses and lady Health Workers have been trained on Integrated Management of Newborn & Childhood Illness (IMNCI) which includes PSBI. Tis has already benefited 250 infants in three districts. UNICEF has also provided facilities with medical supplies. The initiative has also been piloted in two districts of the neighboring Sindh province. More trainings are planned in the near future.

Lady Health Worker Razia is briefing a mother on child care and protection from infections, in BHU Fatepure, District Kasur.
UNICEF/Pakistan/Sameer Ahmad Khan
Lady Health Worker Razia is briefing a mother on child care and protection from infections, in BHU Fatepure, District Kasur.

Dr. Amna Aslam, a Medical Officer at Fatehpure’s BH, is one of the medical workers who benefited from a training and are now offering a safe pair of hands to help every child survive.

“I am a medical graduate, but I didn’t know how to deal with serious bacterial infection among infants aged up to two months,” she tells. “Now that I have completed the training, I can efficiently treat and manage PSBI cases. This is a vital service, which benefits every child in the community.”

The programme has been especially useful since the beginning of COVID-19 as the lockdown made it often impossible to travel. An increased number of sick infants had to be treated in primary health care facilities and survived thanks to the PSBI initiative. Medical staff have been following all safety rules, such as systematically washing their hands with soap between two patients, wearing face masks at all times, allowing only one relative to accompany infants inside medical facilities and making sure that patients are seated at a distance from one another in waiting areas.

With support from UNICEF, the PSBI Initiative has now reached a total of 682 primary health care facilities across Punjab. The Government is expected to scale up the initiative across the province in the coming months, “Before this Initiative, medicines were available at health facilities, but the staff did not have the necessary skills to identify and manage seriously sick children,” says Dr. Samra Khurram, District Coordinator for the Integrated Reproductive Maternal Newborn Child Health and Nutrition Programme (IRMNCHNP) in Kasur. “Now they have been trained and are treating children with PSBI efficiently. We are now planning to train more doctors and paramedics.”

Kanganpur is another community in Punjab’s Kasur District where the UNICEF-supported PSBI initiative has made it easy and convenient to provide sick infants with treatment closer to home.  

“Some months ago, Muhammed Kabir fell sick. His body temperature was high, his umbilicus was red and drained pus, which we found worrisome,” says his mother Zainab, as she holds the eight-month-old baby boy close to her heart. “On the advice of the local Lady Health Worker, my mother took him to Kanganpur Rural Health Centre but she could not take him to the bigger hospital in Kasur, as doctors suggested, because it is 60 kilometers away. Happily, the Health Centre here was able to give him injections and medicines, and he recovered after a week. Having access to treatment locally saved my child.”

Eight-month old Muhammad Kabir
UNICEF/Pakistan/Sameer Ahmad Khan
Eight-month old Muhammad Kabir is one of many children who recovered from possible bacterial infection thanks to a programme supported by UNICEF with funds from the Bill & Melinda Gates Foundation

Umme Ammara, a para medic at Kanganpur Rural Health Center, is the one who identified the infant as a PSBI after being trained on IMNCI in 2019.

“I have since screened more than 100 children for PSBI and referred those who might be seriously sick to the programme. All of them were treated and have recovered,” she tells.

Under the programme, UNICEF is also procuring medicines and providing recording Forms or IMNCI Display Charts to help identify, record and treat PSBI cases.

The outcome is easy for all to see. Little Ajwa, now 28 days old, and little Muhammed Kabir have survived and are ready to thrive.