Partnership for Health
January 2009

Since 2003 USAID's $254.6 million health program has focused on improving maternal, newborn and child health care, enhancing the accessibility of family planning services, preventing the spread of infectious diseases, increasing access to safe drinking water and strengthening key institutions in Pakistan’s health sector.

Improving Maternal and Child Health
In the Federally Administered Tribal Areas (FATA), 135 out of every 1,000 children under the age of five die from curable illnesses. USAID's health care projects in FATA deliver services to prevent this. Projects provide newborn care, immunization, prevention and treatment of respiratory infections and diarrhea, and nutrition counseling. USAID provides training for health care providers, improves community knowledge and attitudes towards child health, and expands access to health services across FATA.

One in 23 Pakistani women die in childbirth, compared to one in 5,000 women in developed countries. There is widespread poor reproductive and nutritional health among women. USAID trains health care providers to improve maternal health through better nutrition, effective timing and spacing of births, effective pre- and post-natal care, and safe childbirth practices, including emergency obstetric care. It is well established that appropriate timing and spacing of births greatly improve the survival and health of both mothers and infants.

Sixty-five percent of women in Pakistan deliver their babies at home and only eight percent of home births are supervised by a trained attendant. USAID and the Government of Pakistan (GOP) will train 10,000 new community midwives by 2012 to provide life-saving health services in rural villages.

Throughout Pakistan, water- and sanitation-related diseases are responsible for sixty percent of child deaths. In partnership with the Government of Pakistan, USAID/Pakistan recently signed a Memorandum of Understanding to support the GOP's Clean Drinking Water for All project, which aims to install over 6,000 water filtration plants. USAID is working with communities to ensure that these plants are properly maintained and sustainable.

Supporting Family Planning and Birth Spacing
Pakistan's average fertility rate of 4.1 children born per woman is one of the highest in South Asia. The GOP's official population policy recommends that the national fertility rate be reduced to 2.1 by 2020. To achieve this USAID is working with the GOP to boost the availability of contraceptves to Pakistanis. Helping couples to voluntarily control their fertility will have broad social benefits. Controlling the Spread of Infectious Diseases USAID works with the GOP to prevent and treat major infectious diseases, including Tuberculosis (TB), Polio and HIV/AIDS, and to minimize the impact of avian influenza. Together with the U.S. Centers for Disease Control and Prevention (CDC), USAID supports training in infectious disease control, including continuous disease surveillance, laboratory analyses and planning public health interventions to limit the impact of infectious diseases.

Tuberculosis remains one of the leading causes of death in Pakistan. USAID supports the World Health Organization's (WHO's) community-based program, DOTS (Directly Observed Treatment Short Course) which trains technical staff to deliver diagnostic services and treatment.

Pakistan is one of only four countries worldwide where polio has not been eradicated (the others are Afghanistan, India and Nigeria). USAID provides funding to UNICEF through the Pakistan Polio Eradication Initiative to strengthen routine immunization, and conduct national campaigns to immunize children.

While Pakistan has a low overall HIV/AIDS infection rate, there is a concentrated epidemic in high-risk groups. Among injecting drug users, infection rates can exceed 50 percent, and four percent among sex workers. USAID projects promote awareness about HIV-transmission, encourages preventive behaviors and provides voluntary counseling and testing.

Strengthening Pakistan's Health Systems and Institutions
USAID works closely with GOP counterparts and Pakistan's professional associations to build and strengthen the country's health care services. For example, USAID supports the Pakistan Nursing Council and the Midwifery Association of Pakistan in setting and enforcing standards for training midwifery tutors, midwives, Lady Health Visitors (community health aides) and nurses. USAID is also providing technical assistance to establish an accreditation system for hospitals and is helping the GOP strengthen its systems for training and managing human resources, collection and use of accurate health information, and its pharmaceutical and medical supply distribution.

Ongoing Activities

Pakistan Initiative for Mothers and Newborns (PAIMAN)
Period: October 2004 - September 2010
Funding: $92,800,000
Implementing Partner: John Snow Incorporated

Technical Assistance for Capacity-building in Midwifery, Information and Logistics (TACMIL)
Period: December 2007 - December 2009
Funding: $10,900,000
Implementing Partner: Abt Associates

Family Advancement for Life and Health (FALAH)
Period: June 2007 - May 2012
Funding: $60,000,000
Implementing Partner: Population Council Islamabad

Pakistan Safe Drinking Water and Hygiene Promotion Project
Period: October 2006 - September 2009
Funding: $17,900,000
Implementing Partner: Abt Associates

Improved Child Health in FATA
Period: September 2006 - August 2009
Funding: $14,750,000
Implementing Partner: Save the Children

Pakistan Field Epidemiology and Laboratory Training Program
Period: October 2005 - TBD
Funding: $5,700,000
Implementing Partner: Centers for Disease Control and Prevention

Strengthening Tuberculosis Control
Period: September 2004 – March 2009
Funding: $5,950,000
Implementing Partner: World Health Organization (WHO)

Polio Eradication Initiative: Surveillance
Period: 2004 - September 2009
Funding: $4,810,000
Implementing Partner: WHO

HIV/AIDS Prevention and Care
Period: February 2006 - June 2009
Funding: $3,300,000
Implementing Partner: Research Triangle Institute

Improving the health of millions of mothers & newborns across Pakistan by expanding access to quality health services for pregnant women & their babies | Photo: PAIMAN

Accomplishments

2002-2008 Budget: $254.6 M
2009 Budget: $ 101.1M (expected)

Improving Maternal & Child Health

• Conducted 268 one-day workshops for 5,738 teachers from 5,232 primary schools about safe hygienic practices, reaching more than 86,000 families
• Trained 48 community members in water resources management, maintenance of water filtration plants, quality testing & use of simple household water treatment practice
• Improving health care for more than 1.61M adults & more than 246,000 children in FATA
• Conducted 697 'child health days', providing 131,068 children in FATA with medical care, vaccinations & nutritional support
• Trained 522 health providers in FATA with newborn & child health care. Trained 1,225 women from rural villages in 18-month midwifery program
• Reached 1.8 M community members through campaign about pregnancy-related dangers
• Renovated & equipped 40 hospitals & rural health centers, 31 of which now provide 24 hour care

Women being taught effective effective family planning services & information about healthy timing and spacing of births practices and methods | Photo: Greenstar Social Marketing

Accomplishments

Supporting Family Planning & Birth Spacing

• 674,592 couples taught proper contraceptives practices in one year
• Hundreds of government health employees trained in protecting reproductive rights

Preventing the Spread of Diseases

• Training 8 physicians over two years as Master’s in Field Epidemiology
• All GOP health centers adopted USAID-supported community-based DOTS program training technical staff to deliver diagnostic services & treat TB
• Since 2003, TB case detection has tripled & treatment success rate has shown steady improvement
• Since 2004, through national immunization days,157.4M children vaccinated
• Supporting WHO to ensure a reliable surveillance system to improve immunization & disease control efforts towards the eradication of polio
• Since 2006, USAID’s HIV prevention & care program has reached 41,900 people, through counseling, testing, and treatment
• Provides voluntary counseling & HIV testing to approximately 3,700 people
• Provides home-based care for over 200 HIV-positive individuals & their 600 family members

In partnership with UNICEF and WHO, USAID is helping to strengthen routine polio immunization campaigns and develop surveillance systems for control and eradication of polio in Pakistan | Photo: WHO