Health and Nutrition

 

Save the Children focuses on strengthening the health system of Pakistan, ensuring access and availability of Maternal, Newborn and Child Health (MNCH), Nutrition, Primary Health Care and Family Planning services. We strive to increase the coverage of health services to those in the poorest hardest to reach places, so that no child dies of preventable causes. We test innovative models and approaches to generate evidence and create avenues to leverage resources for implementation at scale. During times of conflict or disasters, we ensure that life-saving healthcare, MNCH and nutrition services are provided to the affected population.

 

Signature Program Areas

·        Maternal Newborn and Reproductive Health (MNRH)

·        Child Health

·        Maternal Infant and Young Child Nutrition (MIYCN)

·        Adolescent Sexual and Reproductive Health (ASRH)

·        Water Sanitation and Hygiene (WASH)

·        Human Immunodeficiency Virus (HIV)

 

Common Approaches

We deliver high quality programmes across our organisation and we know what works best to solve some of the biggest problems children face today. By establishing an organisation-wide Common Approach to address these problems, we can replicate our best work and our best thinking and ensure we achieve better results for children in more places across the world.

Currently, SC has five endorsed common approaches in Health and Nutrition. These include:

·        Treating Children Close to Home (Integrated Community Case Management)

·        Saving Newborn Lives

·        Nourishing the Youngest

·        My Sexual Health and Rights

·        Contraception By Choice

·        Maternal, Newborn and Reproductive Health (MNRH)

 

Country Projects

 

Global Central Fund COVID-19

 

April 1, 2020 to June 30, 2021

SCI closely worked with National Institute of Health (NIH) and National Disaster Management Authority (NDMA) to support Government of Pakistan’s efforts on COVID-19 prevention and response. A contribution worth USD 100,000 were made in the form of donation of personal protective equipment (PPE) for frontline health care workers providing direct care to children and their families.  50% of PPEs were donated to NDMA, 40% to NIH and the remaining 10% were donated to SC’s implementing partners.

Moreover, a Home Isolation/Quarantine System (HIQS) was developed as an alternative to hospital-based care in consultation with NIH and District Health Office in Islamabad. The model was piloted with 122 beneficiaries who were provided with PPEs and infection prevention supplies. In addition, SC Pakistan’s COVID-19 response team also collected data on secondary impacts of COVID-19 from the households that were part of the HIQS pilot through a quantitative survey. The findings showed negative impacts of the corona virus on the physical, mental and psychosocial well-being of the HH members, as well as the economic situation of households was badly affected by COVID-19.

 

PAK Unilever COVID-19 UK Hygiene and Behaviour Change

May 2020 to May 2021

Over the course of the HBCC project implementation in Pakistan from May 2020 to May 2021, Save the Children Pakistan successfully reached 98,496,407 individuals after first launching HBCC’s mass, social and digital media campaigns on August 15, 2020. The project-targeted areas were spread across 9 districts and 2 provinces and the federal capital. The beneficiaries were reached through provision of WASH facilities, hygiene kits and behaviour change messages.

Multiple communication products including documentaries, TV commercials, radio messages and IEC material were designed by Save the Children during the project, all focused on improving hygiene and promoting behaviour change among the Pakistani population within the current COVID-19 context.

From April-May 2021, furthermore, SC launched the global HBCC hygiene campaign in Pakistan, Hands–Face–Space–Surface, connecting local audiences to the global effort to improve hygiene practices. The key campaign messages were informed by Unilever-HBCC technical guidelines, WHO, Government of Pakistan, and Save the Children COVID-19 advisories, while in some cases the content has been contextualized and translated into local languages of the targeted geographical area (Urdu and Sindhi) in order to effectively reach the local communities.

 

Humanitarian Response 2020

Sindh Floods Emergency Response

Save the Children in Pakistan responded to the Sindh flood emergency in coordination with the National Disaster Management Authority (NDMA). Under the response, 700 Food Packs, 400 Shelter Tents and 08 Dewatering Pumps were distributed to the affected communities in District Badin.

AJ&K Earthquake and Avalanche Response

Under Neelum Avalanche Emergency Response Project in AJK, medical equipment was handed over to health department for 14 health facilities and IPC supplies for 10 health facilities in Neelam and Jhelum Valley. Moreover, health related IEC material, IT equipment and tools to strengthen the DHIS was handed over to RMNCH Regional Directorate in Muzaffarabad, AJ&K. Minor WASH repair and maintenance work was also conducted in 6 health facilities (3 each in district Neelum and Jhelum valley).

 

Strengthening Kangaroo Mother Care (KMC) services in two Districts in Sindh

March 2018 to December 2020

The recommendation from the World Health Organization(WHO) is to use KMC as an alternative to conventional care, but as the best approach for routine care of clinically stable new borns weighing 2000 grams or less. Introducing KMC services in all facilities where deliveries take place can have a meaningful impact on the health and survival of low birthweight babies. For this reason, WHO formally endorsed KMC in 2003, and provided updated recommendations in 20151.  KMC is a proven intervention to address these chronic issues; this is partially part of the National Health policy. However, it has not been practiced in Pakistan because of multiple barriers including low awareness of communities, weak referral systems, readiness of health facilities, capacity of the service providers and acceptance of KMC.

In Sindh province, the Provincial Health Department and USAID introduced facility-based KMC in collaboration with MCHIP (led by Jhpiego) and Save the Children’s MNCH program, in two Department of Health (DOH) supported hospitals – Gambat Institute of Medical Sciences Khairpur and Rao Bahadur Udhawas Tara Chand in Shikarpur.

Under MCHIP project previously, Save the Children conducted formative research in the two pilot districts before KMC was introduced in the facilities, to understand opportunities and challenges specific to the local context. Study outcomes showed feasibility for initiating KMC at the health facility and its continuation in the community, with recommendations that included the need to focus on capacity building of health care providers, improve facility infrastructure, and introduce a community mobilization approach for KMC.

Save the Children then implemented Kangaroo Mother Care services in two district hospitals (Gambat Institute of Medical and Health Sciences (GIMS), Khairpur district and Jacobabad Institute of Medical and Health Science (JIMS), Jacobabad district in 2016 and 2018 respectively.  Under this proposed project, Save the Children aimed to strengthen and continue the KMC services units in both hospitals and further planned to scale up KMC services in three additional hospitals in the new districts (Tando Allahyar, Sanghar, Mirpurkhas). The KMC project bridged the gap between community and health facility through community awareness program and capacity enhancement of service providers and Lady Health Workers

(LHWs). The project technically support Department of Health to sustain the KMC services in five intervened hospitals.

 

Women and Children/Infant Improved Nutrition in Sindh (WINS-2) in Districts Thatta & Sujawal

 

(Feb 2016 to September 2017)

This award transitioned to SCUK from Merlin after its closure. SCUK taking over liability for whole contract. Overall Objective of the project is to improve the nutritional status of children and Pregnant and Lactating Women (PLWs) in Pakistan, in the districts of Thattha and Sujawal.

The overall objective of the action was to improve the nutrition status of children and pregnant women in Pakistan.  The specific objective were to strengthen capacity to address the high rates of malnutrition in Sindh Province, Pakistan.  The proposed action achieved this objective, by addressing both acute and chronic malnutrition amongst pregnant and lactating women and children (SAM: under 5yrs and MAM under two years old). The methodology included integration of community-based management of acute malnutrition (CMAM) into health services, through improved community outreach and health education and through Social protection driven food security interventions to tackle the root cause of malnutrition, poverty.

This action was a natural progression from the emergency food and nutrition interventions implemented in Thatta during the emergency flood response in 2010 and 2011 to a more sustainable mode of development to assist the people and institutions of Thatta in their long-term recovery.

The key beneficiaries targeted under this action were pregnant and lactating women, and children (SAM: <5yrs & MAM: <2yrs).  Wider stakeholders included district level health staff, community leaders, extension workers in relevant line ministries, Lady Health Workers, Community resource persons and members of village health committees. Many of these stakeholders were consulted in the inception phase to establish their opinions of the action, their nutrition habits and coping strategies (for the community especially), and their training needs in delivering nutritional services (for district level health staff).

The key actions were based around four expected results.  The first result, focused on improving population access to nutritional care through the district health system involved the following activities: community mobilization and screening, a supplementary feeding program, outpatient therapeutic program, stabilization centre (SC) services, referral of SAM cases to the SC, promotion of infant and young child feeding practices, multi micronutrient supplementation, and de-worming campaigns. This was implemented across 49 static health facilities in Thatta district.  The second result, which focused on improving maternal and child health/nutritional status through increased knowledge and practices by mothers/caregivers, was based on a behaviour change and communication strategy.  This included commissioning a number of surveys to establish baselines and to formulate the communication strategy to be implemented.  The strategy was implemented by using a network of Lady Health Workers, Community Resources Persons (CRPs), Community Health Committees, breastfeeding support groups, all to communicate good nutritional care practices, with supporting IEC materials.  The third result focused on improving food access to children 6-18 months old, through gender-sensitive social transfers (Conditional cash transfers), which in turn contributes to improving complementary feeding practices, and offers protection from stunting, in the long run. The final result focused on scaling up the evidence-base of sector-wide approaches to address malnutrition, and communicating the impact of the approach to wider stakeholders, through films, trainings, workshops, publications and seminars.

 

Maternal and Child Health Integrated Program (MCHIP)

 

(February 2013 – February 2018)

The Maternal and Child Health Integrated Program (MCHIP) is the USAID Bureau for Global Health’s flagship maternal, neonatal, and child health (MNCH) program.

The Project was implemented collaboratively and synergistically with the other four MCH Program components, which address health supplies, family planning/reproductive health (FP/RH), health systems strengthening (HSS), and behavior change communication (BCC) issues, and works closely with the Government of Sindh Department of Health (GOS DOH), local implementing partners, and private sector organizations.

The purpose of the project was to prevent maternal, newborn and child deaths by ensuring skilled birth attendance (SBA), empowered communities, timely referral to emergency obstetric and newborn care (EmONC) and improved access to child health care, immunization and nutrition.

Maternal and Child Health (MCH) Program contributed to improvements in maternal and neonatal health (MNH) through improved service delivery. Implemented in 22 districts of Sindh Province, the Project aims to reduce maternal and neonatal mortality by ensuring access to MNH services 24 hours a day and seven days a week.

Jhpiego implemented the Maternal and Child Health Integrated Program (MCHIP) project in technical collaboration with Save the Children, PATH and John Snow, Inc. (JSI). In this project, Save the Children provided technical back stopping in the areas of newborn, and child health, and community mobilization; PATH was technical lead for nutrition; and JSI leads the immunization interventions.

Helping Babies Breathe (HBB): Helping Babies Breathe services were introduced in 750 public and private facilities in the MCHIP supported districts 16 districts of Sindh. MCHIP-trained SBAs in these facilities revived asphyxiated newborns at birth.

Chlorhexidine for prevention of newborn sepsis scaled up in 16 target districts of Sindh. MCHIP has had distributed chlorhexidine gel tubes in 16 districts.

Case Management of Pneumonia and Diarrhea: Case management of pneumonia and diarrhea was made available in 520 MNCH Centers in MCHIP districts of Sindh.

Kangroo Mother Care: The MCHIP technical team finalized the training package for Kangaroo Mother Care (KMC). The package included separate training manuals for facility-based providers and community health workers (CHW), implementation guide, and KMC indicators.

MCHIP met all training (Healthcare providers) targets for newborn and child health in targeted 16 districts of Sindh. 

 

Institutionalizing Family Planning and Comprehensive Abortion Care in Save the Children’s Humanitarian Health Responses

(Phase 1 – January 2013 to December 2016; Phase 2 – January 2017 to December 2019)

The project focused on increasing access, availability and utilization of FP services and postpartum family planning services in two selected districts of Sindh , enhancing access, availability and utilization of post-abortion care and post abortion family planning among vulnerable population among two selected districts of Sindh, improving competency and knowledge of service providers for quality FP, PAC and postpartum FP services in two selected districts of Sindh, enhancing monitoring, evaluation accountability and learning on FP and PAC and synthesizing  FP and PAC program data for learning and dissemination at both national and international levels

Save the Children in Pakistan first time implemented the CIPs conceptual model of functional integration in two districts – Shikarpur and Jacobabad in Sindh Province.  The model was successfully piloted in collaboration with CIP secretariat, DOH, and PWD during period 2016-19.  Save the Children provided full technical insight and support to interdepartmental (CIP, PWD, DoH, IHS) consultation process for functional integration process at provincial and district level for provision of FP and PPFP services.

Several key initiatives were practically taken to strengthen working relationship between DOH and PWD at the district and sub-district levels. The model developed a clear road map and role matrix for each partner, management forums were formed to supervise activities and meetings, and regular performance reporting and feedback mechanism was established.  Moreover, the model proved highly result-oriented in terms of making substantial progress in increasing FP indicators through strengthening community outreach, referral mechanism from the community to service facility, more importantly from facility to facility referral produced significant increase in the service delivery mechanism. In addition to all forum were strengthened to gear-up efforts to ensure quality provision of services through the deployment of technical staff, equipping facility with necessary supplies and equipment, ensuring accountability and supportive supervision, ensure availability of FP commodities without any interruption.

The benefits of functional integration implementation in health and population sector to address family planning are clear, enormous, and robust in the two districts and Government of Sindh has institutionalized the functional integration in health and population sector in the entire province. 

Task sharing with midlevel care providers was also introduced that basically aims to increase access to clinical skills such as an insertion of contraceptive implants or skilled birth attendance from medical officers to nurses, lady health visitors, midwives and Family Welfare Workers (FWWs). There are Female Welfare Centers managed by Population Welfare Department in each district. These centers  led by Family Welfare Workers (FWWs) that provide FP information, counselling, follow-up for all methods except for implants and sterilization. FWWs are trained on short terms methods and Intra Uterine Contraceptive Device insertion and removal and referred all implant cases to RHSA center or the MSUs, only doctors are allowed to provide clinical methods of contraception, so there is lot of chances to miss the clients, the woman leaves for her long journey home— unprotected from an unintended pregnancy.

 

Integrated Maternal, Newborn, Child Health Project in Sindh Province 2016-2017

The IMNCH Sindh project contributed to the Pakistan Vision 2025 Pillar I, aimed at reducing infant and children mortality rates and will directly support the achievement of the Sindh Health Sector Support Strategy 2012-2020 by increasing the quality of MNCH services provided at all levels. The project also supported the delivery of DFAT Aid Investment Plan for 2015-2019, in particular, the second strategic objective ‘Investing in Pakistan’s people’ which focused on improving health outcomes for women and girls. The proposed project activities addressed the spread of preventable diseases by increasing vaccination coverage through community outreach and by strengthening integrated community case management of childhood diseases. It contributed to nutritional outcomes by raising awareness on health, nutrition and hygiene practices at school, supported comprehensive nutritional programming to be implemented in the proposed districts. The project also focused on investments in capacity building towards women through training opportunities provided to Lady Health Workers.

 

Expanding Coverage of Malaria Control Interventions in 38 Highly Endemic Districts of Pakistan (Global Fund to fight AIDS, TB and Malaria)

(September 2011 to September 2015)

Under this award, SC worked with the Directorate of Malaria Control to implement malaria control interventions and activities in 38 endemic malaria districts in Pakistan. SC and its five sub-recipients provided malaria case management services through public sector health care facilities and selected private sector general practitioners, as per the national malaria case management guidelines in all intervention districts. More than 446 microscopy and 943 rapid diagnostic test (RDT) centers were strengthened for standardized diagnosis by providing training to staff, and supplying microscopic equipment and RDTs. In 2013, approximately 240,000 malaria cases from these facilities were confirmed and treated as per national treatment protocols. Over the life of the grant, more than 2.2 million long-lasting insecticidal nets (LLINs) were distributed through public sector health facilities, including antenatal care and maternal and child health centers. Indoor residual spraying (IRS) interventions were implemented in all 38 districts, with 173,000 households sprayed with two rounds of IRS in selected localities of the targeted districts with a high annual parasitic incidence.

 

Public Private Partnership to Improve Harm Reduction, Care and support Services and Implementation Capacity for HIV/AIDS

(Phase I: March 2012–Sep. 2013); (Phase II – March 2013 to March 2015)

SC implemented a two-pronged strategy to reduce HIV/AIDS transmission within Pakistan in order to strengthen disease specific service delivery between private-public establishments, and to build capacity. First, SC worked to scale up care and support services to decrease the transmission of HIV among the most at risk populations. Secondly, SC supported ARV public treatment centers with technical and clinical experts in preventing parent to child transmission (PPTCT) of HIV, and building capacity to further decrease the mortality and morbidity due to HIV/AIDS in Pakistan.