At a world level, pneumonia and diarrhea are the leading causes of morbidity and mortality in children under five years, after malnutrition. In Pakistan, around 25% of the children up to five years suffers from diarrhea each year, and one out of six children experiences at least one episode of pneumonia yearly: however, only 38% of children receive ORS (oral rehydration salt) for diarrhea, and approximately 41% receive antibiotics for suspected pneumonia.
A “National Program for Family Planning and Primary Healthcare”, commonly named “Lady Health Workers Program”, was established in Pakistan in 1993-1994: the program aimed to provide maternal and child health services to the 60% of rural population. With this program, the women from the local community who met the specified eligibility criteria in terms of education and residence were recruited and trained as “Lady Health Workers” (LHWs) to work as a “focal point of care” for their respective communities.
However, despite all these efforts, yet after twenty years, the overall impact on the rural population health status has been minimal, especially in reducing early childhood morbidity and mortality ascribable to diarrhea and pneumonia. The 2008 “Fourth External Evaluation of National Program for Family Planning and Primary Healthcare” (FENP) provided insights into the causes and determinants of this stuck mortality rate.
“NIGRAAN” – an Urdu word that means “supervision” – is the name of the implementation research project designed to bridge these structural gaps in the existing LHW program. This project’s aim is to improve community case management (CCM) of childhood diarrhea and pneumonia by health workers and community caregivers (mothers, for example) through strengthened supervision and mentorship by Lady Health Supervisors (LHSs).
Now, we are pleased to announce the kick off of the collaboration between the Health and Wellbeing Area team of ISTUD Foundation and the Aga Khan University of Karachi (Pakistan) on the NIGRAAN Project context.
The collaboration provides for the revisal of research tools, and – until now – it has consisted in four parts: a first meeting in ISTUD in Baveno, that took place in April 2015 between the two players; a deep work on line in which the fieldwork notes was reviewed through Narrative Medicine tools, a webinar in which Maria Giulia Marini leaded a seminar for the Project tutor (who trained the fieldwork team); finally, a fourth meeting in Milan between professor Fauziah Rabbani (the Project Leader) and the Health and Wellbeing Area of ISTUD Foundation.
As Maria Giulia Marini notes, “the introduction of Narrative Medicine was an action of absolute innovation in the framework of a very well structured WHO program. Again, a further evidence that narrative medicine can be applied to every condition, in every geographical setting and with every kind of provider in healthcare“.
Fauziah Rabbani highlights how “the Narrative Medicine tools have helped to provide Evidence-Bases data on a very important outcome in NIGRAAN – i.e. the caregiver’s (mother and family) perspectives on how they take care of a sick child with pneumonia and diarrhea and whom they seek treatment from under specific contextual chain of decision making. The results would then inform the policy makers in Lady Health Workers Program how best to train health workers in involving significant “others” (family members besides mothers) in the appropriate management of a sick child for better health outcomes“.