Fauziah Rabbani, Shagufta Perveen, Wafa Aftab.
Investing in universal health coverage for childhood Diarrhea and Pneumonia: Lesson learnt from nigraan implementation research.
Pak J Public Health Jan ;5(1):36-8.

Universal Health Coverage (UHC) is emerging as the dening theme of the post-millennium development goals (MDGs) global health agenda. However, lack of adequate, well-trained, and motivated work force is a hindering factor in most low- and middle-income countries (LMICs). A number of LMICs have rapidly provided coverage to large populations utilizing community health workers (CHWs). Higher likelihood of retention, cost savings for households, and effective communication of health messages make CHWs effective for providing cost-effective primary health care. CHWs provided care also signicantly lowers out-of-pocket expenditure. Pakistan's Lady Health Worker Program (LHW-P) covers about 60% of Pakistan's rural population. LHWs' unlimited access to households, free interaction with local women, and community acceptability makes them highly effective CHWs in Pakistan's context. LHWs provide community based case management of diarrhea and pneumonia - the two most common childhood diseases in Pakistan. These factors make the LHW-P well placed as a platform for providing UHC for diarrhea and pneumonia. However, almost 30% of all child deaths in Pakistan are due to diarrhea and pneumonia even in the presence of LHW-P. Lack of supportive supervision, irregular salaries, lack of training, inadequate supplies, lack of transportation, and selections based on political inclinations hinder program performance. Our on-going implementation research project NIGRAAN in district Badin, Sindh has identied that while LHWs and Lady Health Supervisors (LHSs) had some level of knowledge about danger signs, diarrhea, and pneumonia, practical skills were quite decient. NIGRAAN has developed a coordinated system of case identication, reporting and timely management of childhood diarrhea and pneumonia by promoting communication between LHWs and LHSs. However, shortage of tools for feedback, non-availability of medicines, and inadequate supplies are critical issues. Unsurprisingly, NIGRAAN surveys have found that few caregivers seek care from LHWs for childhood diarrhea and pneumonia. While LHW-P has the potential to achieve UHC for at least two major childhood killers (diarrhea and pneumonia), political commitment, skill development, ensuring regular supplies, and transport are essential prerequisites. Keywords: Child Hood Diarrhea, Pneumonia, NIGRAAN, Universal health Coverage. (Pak J Public Health 2015;5(1):28-30)

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