Pakistan

UNICEF Helps Generate Demand for Immunization and Promotes Positive Health Behaviours among Marginalized Communities

By Fatima Shahryar

Jacobabad - Sindh - Sept 2014: Mai Sakeena (40) has four sons and six grandchildren. A resident of village Sardar Shah in Jacobabad District, she has spent most of her life without access to basic resources essential for a healthy life. However, she now is a role model for women of her community having adapted positive health behaviours being inculcated by UNICEF among marginalised communities.

"When I got married, we had no concept of prevention through immunization or even consulting the doctor for our illnesses," says Mai Sakeena. "For us, a dai (traditional birth attendant) was the doctor and our guide to all mother and child health related issues. If a new-born died, we would accept it as fate, not knowing that we could have saved a life with taking a preventive action," she exclaims, happily adding, "Now we know the importance of routine immunization, both for women and children, and I encourage not only my daughters-in-law but other women of the community as well, to be vaccinated on regular basis."

A PROBLEM FORETOLD:

In 2010, Jacobabad, Hyderabad, and three towns of Karachi (Baldia, Gadap and Gulshan) were declared as high risk districts/towns because of persistent virus circulation, as the coverage for routine immunization was quite low.

Village Sardar Shah in Jacobabad comprises nearly 65 households but remains deprived of health facilities and presence of any skilled birth attendant such as a Lady Health Visitor. Women have to travel several kilometres to reach the nearest hospital provided they manage to arrange a transport.

In rural communities of Sindh, mother-in-law is a prominent figure and can influence the behaviour of the daughter-in-law. She influences decisions ranging from everyday matters to seeking medical advice during pregnancy and for childbirth. In the absence of health services within communities, the mother-in-law's advice on travelling to the nearest health facility and seeking proper medical attention plays a very important role.

"It is very difficult for us to travel to the health facility," says Farzana, mother of two and Mai Sakeena's daughter-in-law. "Poverty, non-availability of transport and harsh weather keeps us from travelling to the health facility to seek proper medical advice."

THE INTERVENTION

UNICEF, with financial support from the Canadian International Development Agency (CIDA) and in collaboration with the Government of Pakistan (GoP), launched the Immunization and Healthcare for Vulnerable Children - Immunization Plus (+) project to reduce morbidity and mortality caused by vaccine-preventable diseases.

The project adopted World Health Organization (WHO) recommended Reach Every District (RED) strategy to support the National Expanded Programme on Immunization (NEPI) in achieving its targets. One of the key outputs was to address bottlenecks, ensuring children in the identified districts have access to quality immunization services and are reached and fully immunized.

In addition, it also focused on increasing knowledge of over 90 per cent of care providers for newborns to 24 month old children on safety of immunization and utilization of immunization services. The project interventions contributed towards a steady increase in provincial coverage for BCG (92 per cent to 93 per cent), Penta-III (86 per cent to 87 per cent) Measles-1 (84 per cent to 87 per cent) and Measles-II (43 per cent to 61 per cent).

Keeping in view the factors affecting poor health behaviours of the community, Syed Mumtaz Ali Shah (42), a resident of village Sardar Shah, was taken on board as the local community mobilizer. He is the nephew of the local religious leader Pir Syed Liaquat Ali Shah. Mumtaz is well connected and enjoys a good reputation.

With UNICEF's support, Mumtaz and his team established a small space in the village to hold mobilization sessions on health for community and as an outreach point for mothers to get their children vaccinated.

Sharing his experience, Mumtaz says, "Initially it was difficult as we did not know where to start. Issues like insecurity, harsh weather, unavailability of a health facility and healthcare provider, and low awareness level made it all the more difficult to convince people to be immunized."

"The locals and nomads, however, strictly follow the advice of our local religious leader so we requested Pir Liaquat to pay regular visits to this health centre so that community members could be influenced.

During his visits, while lecturing on religion, he also advised people to attend health sessions and practice positive health behaviours. This worked wonders for us. People of the community not only attended the sessions but also regularly got their children vaccinated."

WITNESSING REAL CHANGE

Jacobabad district, in a small period of time, has emerged as an example for other districts. Health services have been established and are being strengthened with constant increase in demand. Women follow their vaccination schedules and get their children immunized regularly.

"The ethos of the 'RED Strategy' is to empower the EPI field workers for developing their micro-plans and reaching the unreached children and pregnant women, especially in the underserved and unreached areas," says Dr. Saadia Farrukh, Health Specialist, UNICEF.