By: A. Sami Malik
Rajanpur District, Punjab: December 2015– Managing household chores while raising young children is a challenge for all women especially those living in rural communities. Lack of awareness about pre and post-natal health care resulting in recurrent health issues, makes it even tougher. Twenty-seven-year-old Amina’s life is no exception. A resident of village Dajal in Rajanpur district of Punjab, she has been married for eleven years and has given birth to four children, the youngest being a six-month-old baby girl, Ayesha.
Like most women in her village, Amina has a routine life. Waking up at dawn, feeding the infant, preparing breakfast for her husband and children, cleaning the house and then getting back into her modest kitchen to prepare lunch. There is hardly anything special. However, today is an exciting day and she tries to finish her household chores quickly. Along with little Ayesha, she plans to go to the house of the local Lady Health Worker (LHW) Musarrat bibi, who has promised to show a film to the village women.
“My first three children were born at home and delivered by the (traditional) birth attendant,” says Amina. “Ayesha is the only one born at the local hospital (Rural Health Centre, Dajal). Being uneducated, I did not know much about child birth except for what I had heard from elderly women in the village. There was no one to tell us things that we now learn from Musarrat. When I was pregnant with Ayesha, she visited my house frequently and told me about the precautions that I must take to stay healthy myself and ensure that my child is born healthy too. She was the one who advised me about getting my child delivered in a hospital.”
Musarrat bibi is an experienced LHW who has been working in Rajanpur district for over five years. As a member of the strong and frontline force of the LHW programme, led by the Government of Pakistan and supported by UNICEF, she is well trained in all aspects of maternal and child health care which includes care during pregnancy, post birth and immunization of mothers and children against vaccine preventable diseases.
“I belong to Dajal and am familiar with most communities living here,” says Musarrat bibi. “My area as an LHW comprises 300 households of my village. In the beginning, the biggest challenge was ignorance amongst women about their own and their children’s health. Over the years, level of awareness has risen. Women have become conscious about their health and particularly about their children’s’ immunization process. If I come to know that a woman in my area is pregnant, I go over to her house and start educating her about prenatal care. My visits continue from birth till after the child is 5 years old including completion of immunization. A woman from my area can come to me for advice any time.”
Portable Projectors – a new initiative by UNICEF
As women, some of them carrying their new borns and infants, start gathering at Musarrat bibi’s house, there is a buzz of excitement. They have been told that they are going to see a film about taking care of their own and their child’s health. Musarrat is equally excited herself as this is the first time, she would be using a new gadget received from UNICEF – a portable projector. She had also been trained on how to use it. Once the women are settled in Musarrat’s lounge, she turns off the lights, draws the curtains and turns on the projector. Women watch attentively as images are projected on the wall and the sound comes through a small speaker attached to the projector stand.
The film being shown to village women by Musarrat is the first of a series of seven short films that UNICEF has prepared to educate women in remote rural areas about pregnancy, child birth and post birth care. A number of other health and hygiene related aspects have also been covered in this set of films. Though television is a common commodity in Pakistan, not all rural population has access to it because of poverty, electricity issues and access to cable television service. While the first film on mother and child health care was being produced, there was a concern about how to show it to the rural women.
A generous contribution by Johnson & Johnson, one of the largest manufacturers of family healthcare and pharmaceutical products, has helped UNICEF resolve the issue. Taking an innovative approach, UNICEF has procured 70 portable projectors with speakers and distributed them amongst equal number of LHWs. The portable projector has a rechargeable battery and can be operated without electricity for two to three hours making it easy to be used at any place, any time.
For last several years, Johnson & Johnson has provided funding to UNICEF for supporting the LHW programme in Pakistan. Received through UNICEF’s National Committee in the United States, The US Fund, part of these funds are being used by UNICEF for capacity building of nearly 2000 LHWs and Lady Health Supervisors (LHS) in two districts, Rajanpur and Narowal, of the Punjab province. The workforce of LHWs and LHSs has thus far delivered quality health services and messages to over 54,000 pregnant women in these districts.
The Green Book – A comprehensive guide and record keeping for mother and child healthcare
Another innovative initiative taken by UNICEF as part of the continuum of care approach is the Mother and Child Health booklet, popularly known as the Green Book. With easy to comprehend language and illustrations, the Green Book is a reference and record keeping booklet which a mother can use not only for seeking guidance on health issues but also for maintaining a record of her own and her child’s health status starting from pregnancy through antenatal, natal and post-natal care to growth monitoring of a child up to five years of age. The Expanded Programme for Immunization card, which records a child vaccination progress, has also been incorporated in the Green Book.
The Green Book is provided to a pregnant women by the LHW on her first visit after filling in the initial details about her. The LHW updates the check-up and vaccination record in the Green Book on every subsequent visit. After the birth, the child’s statistics are also fed into it and periodically updated. As part of her duty, the LHW ensures that a pregnant women receives all required services and a record of her antenatal status, birth preparedness, delivery, post-natal care, counselling on family planning, hygiene and nutrition, and growth monitoring of the child up to the age of five years is maintained in the Green Book.
“The Green Book is a big help for us as well as all mothers who are particular about their own health and the health of their children,” says Musarrat. “It serves two purposes – guidance and record keeping. When we guide them with the help of illustrations in the Green Book, they comprehend easily and keep referring to it as the book stays with them all the time. EPI card can be lost or torn but this book is definitely a better option for maintaining the health record of a mother and her child.”
After watching the film on pre and post-natal care at Musarrat’s house, village women ask her questions about issues pertaining to their personal health and that of their children. In case a woman is not comfortable asking a personal question, Musarrat is happy to sit with her for an exclusive meeting. She tries to explain what has been shown in the film relating it to illustrations in the Green Book.
Close collaboration with the Department of health, Punjab has been very useful in supporting new initiatives and their long term sustainability,” says Dr. Naila Shahid, UNICEF Health Officer MNCH. “LHWs are closest to the community, and strengthening their capacity of counselling and communication helps them to reach out to the women for health awareness more effectively. Undoubtedly, this effort will go a long way in improving health of the marginalized mothers and children of province Punjab.”