Sindh supports scaling up of Nigraan project

By Abdul Qadir Qureshi
(Pakistan News & Features Services)

Nigraan, an innovative research and capacity building project, has been extended to a second district in rural Sindh, Mirpurkhas, under the project name, Nigraan Plus. The Nigraan Plus project was formally launched by the Sindh health secretary and AKU’s Community Health Sciences (CHS) Department at an event.

The initial phase of the Nigraan project in Badin has helped Lady Health Workers and Lady Health Supervisors to manage potentially fatal diseases in children such as pneumonia and diarrhea, which lead to over 140,000 child deaths a year equating to 46 per cent of all child deaths in Pakistan before the age of five. 

Since the majority of deaths from these two diseases occur in the home, Nigraan focused on boosting the knowledge, skills and performance of Lady Health Supervisors (LHSs), who supervise the performance of Lady Health Workers (LHWs), and LHWs who provide relevant home-based health services to communities. 

Commenting on the programme’s extension to Mirpurkhas, Sindh Health Secretary, Dr Fazlullah Pechuho said: “The basic unit of the health system are the caregivers, the LHSs and LHWs. If we empower them we can achieve great results. Nigraan has already provided high quality training in Badin and AKU’s research will help us replicate these results across the province. Good research leads to good policy formulation and I look forward on continued cooperation with AKU’s CHS team through a formal agreement.” 

Nigraan introduced LHSs to supportive management practices that resulted in both the LHWs and the LHSs providing more adequate care during visits to households. In Badin, LHSs who were trained in enhanced supervisory skills through the project, noted a doubling in their supervision skill scores, a remarkable improvement on their ability to provide quality support to LHWs in the field. 

The ability of LHSs, trained under Nigraan, to correctly diagnose and treat diarrhea and pneumonia also improved markedly. Moreover, LHWs who were supervised by the Nigraan-trained LHSs, showed improvement in their ability to correctly manage diarrhea and pneumonia in children under five compared to those outside the programme. 

Speaking about the impact of Nigraan, Assistant District Coordinator for Family Planning and Primary Healthcare, Badin, Taskeen Fatima said: “The trainings were practical and hospital-based which helped us improve our skills to identify cases of diarrhea and pneumonia and also boosted the ability of LHWs to diagnose cases at the community level. The tools developed by the project had a very positive effect on our skills and it was very memorable to see how LHWs appreciated the support being provided by their supervisors because of Nigraan.” 

In the next phase of the project, Nigraan Plus will introduce similar evidence-based, supportive supervision system practices in Mirpurkhas so that healthcare workers can correctly detect, diagnose, report and treat cases of pneumonia and diarrhea at an early stage, when care is the most effective. 

Nigraan Plus is also asking LHWs to use their mobile phones to record and relay data about children suffering from pneumonia and diarrhea to their supervisors. The LHSs use this information to maintain location-specific records on these diseases and to coordinate LHWs visits. 

The Provincial Coordinator for Family Planning and Primary Healthcare, Sindh, Dr Jai Ram Das said: “I’m pleased at how the AKU’s Centre of Excellence in Women and Child Health and the CHS department are working together to upscale Nigraan. We look forward to working with AKU so that Nigraan’s training materials can be formally included in the training programme for lady health workers.” 

Highlighting the contribution of such programmes to the country’s health priorities, AKU’s Community Health Sciences Department Chair, Professor Fauziah Rabbani, who is working as the project’s principal investigator, added: 

“Building awareness about the importance of early administration of oral rehydration solutions (in the case of diarrhea) and the timely prescription of antibiotics (in the case of pneumonia) can save many lives.” 

“Nigraan Plus’s system of constant training, feedback and community visits not only builds the capacity of healthcare workers but also ensures that at-risk children get the attentive care they need at their doorstep. In the long term, such interventions will help Pakistan achieve targets under Sustainable Development Goal 3 on reducing childhood mortality.” 

The first phase of the Nigraan project was funded by the Alliance for Health Policy and Systems Research, an international collaboration hosted by the World Health Organization. Nigraan Plus is part of the Umeed-e-Nau project that is being implemented by AKU in collaboration with Pakistan’s provincial health ministries with the support of the Bill and Melinda Gates Foundation. 

Present at the meeting were Mirpurkhas District Health Officer Dr Anwer Palari, Assistant Provincial Coordinator for Family Planning and Primary Healthcare Dr Pir Ghulam Hussain, and members of AKU’s Community Health Sciences faculty Dr Shagufta Perveen, Dr Kashif Sangrasi, Dr Aysha Zahidie and Dr Wafa Aftab.