MAC (Mother and Child) Health Project

Concept

District Delivery Challenge Fund (DDCF) aims at delivering unique and effective public service to the
people. When it comes to delivering public service in developing countries it is very often noted and
observed that people of such countries do not benefit from hard-infrastructural changes. To the
contrary, these people die from lack of basic amenities and utilities. Rather than investing in mass
level fixed assets; roads and other transport systems, these people can be better served by focusing
on effective delivery of basic services. No doubt, transport and communication services lie at the
heart of a modern industrialized country, but a developing country has to realize the priority and
urgency of its needs.

Pakistan is a country prone to the very same challenges of a developing country mentioned above.
Problems such as high infant mortality rate or the increasing number of malnourished children in
rural areas are just few of the problems highlighted by different NGOs and government agencies.
Surprisingly enough, the numbers of such problems can be cut effectively by some out of the box,
innovative yet very simple solutions. The requirement shall be that this simplicity of the solutions is
buttressed by innovative and effective delivery and accountability system. We propose the solutions
on these very lines; simple solutions with effective delivery system.

Identifying the Problems: Root Cause Analysis

In order to propose a set of solutions, weneed to identify the problems and their root cause.

While focusing on mother and child needs it is important to understand that malnourishment may
lead the expecting mother/ foetus or a mother/ new-born child towards severe medical conditions.
Malnutrition may result in stunted physical growth, behavioral changes and even death.
Malnutrition is estimated to contribute to more than one third of all child deaths, although it is
rarely listed as the direct cause. 1

Pakistan has an alarmingly high level of malnutrition; 24 percent of the population is

undernourished. The most recent estimates by the United Nations Food and Agriculture
Organization (FAO) state that 37.5 million people in Pakistan are not receiving proper nourishment.

Malnutrition is defined by World Health Organisation as insufficient nutrient intake. Let us examine
which important nutrients are deficient in the diet and cause health issues:

Water Borne Diseases (caused by lack of safe drinking water)

The presence of water borne diseases can have a disastrous affect on health of newborn child and
the mother after childbirth. The water-borne illnesses account for nearly 60 per cent of child deaths
in Pakistan with approximate 630 children dying daily from diarrhoea. Not less than 80 per cent of
infectious and parasitic diseases are related to contaminated water and 25 per cent of hospital beds
are occupied by people suffering from water-borne diseases.

1
World Health Organisation, ‘Maternal, newborn, child and adolescent health’
http://www.who.int/maternal_child_adolescent/topics/child/malnutrition/en/ accessed 6th September 2014
Iodine Deficiency

This is a major public health problem in Pakistan and is a threat to the social and economic
development of the country. The main factor responsible for iodine deficiency is a low dietary supply
of iodine. If iodine deficiency occurs during the most critical period of brain development, from the
foetal stage up to the third month after birth, the resulting thyroid failure will lead to irreversible
alterations in brain function. While cretinism is the most extreme manifestation, of considerably
greater significance are the more subtle degrees of mental impairment leading to poor school
performance, reduced intellectual ability and impaired work capacity. The recommended strategy
for Iodine deficiency disorder control is based on correcting it by increasing iodine through
supplementation or food fortification. Unfortunately, iodized salt consumption in Pakistan is at only
17 percent, according to the National Nutrition Survey, 2001-2002.

• Iron and Vitamin B12 Deficiency

The effects of Iron and Vitamin-B12 deficiency in pregnancy are low birth weight and possibility of
inferior neo natal health.It is well-documented that iron deficiency leads to impaired cognitive
development and poor performance in school. Iron deficiency is one of the most prevalent
nutritional disorders and has a large impact on economic productivity. For others at risk it causes
fatigue, shortness of breath, dizziness, cold hands,pale skin,chest pain, heart conditions etc. This can
be controlled by:

o Dietary intervention

o Dark green leafy vegetables

o Brown rice pulses and beans red meat, fish etc.

o supplementation

• Vitamin D and Calcium Deficiency

Vitamin D and Calcium deficiency causes rickets and osteomalacia. In pregnancy it can cause growth
retardation and skeletal deformities of the baby. Vitamin D helps in building teeth and bones of the
baby. According to national nutrition survey provincial data revealed vitamin D deficiency among
pregnant women in Punjab was 71.1%, and the levels of calcium in pregnant women at the
provincial level showed that 63.2% of pregnant women in Punjab, 50.3%

• Protein Deficiency

Lack of protein mainly causes Kwashiorkor and in addition may cause growth failure, loss of muscle
mass, decreased immunity, and weakening of the heart and respiratory system. A survey by the
World Health Organization (WHO) shows that the number of underweight pre-school children (0-5
years of age) in Pakistan is 40 percent. Such children often remain weak and undernourished
throughout life.

Proposed Solution
Having identified the main health problems (faced by the expecting mother/ foetus or a mother/
new-born and children) and having identified their root causes/deficiencies we now propose our
action plan.

We propose provision of safe drinking water and alteration of life styles of the target public.
Proposing these solutions is not the difficult part. The difficult part is implementing them effectively
and in a way which has never been adopted before. We put forth a two-pronged strategy for fighting
these primary health issues.

On the first level we plan to provide safe and affordable drinking water lack of which is the single
biggest cause of these health problems.

Water is one of the most basic necessities of human life and this makes water intake by each and
every person inevitable. The problem is that safe drinking water is not available in most areas.
Although the easiest solution for this is to educate people to boil the water and to filter it, it involves
a lot of discipline in its implementation which is not even demonstrated by well educated people in
the cities.

Our solution entails establishing 2 to 3 water boiling and filtration canters per village where water
will be boiled and filtered at insignificant costs.

Boiling water gets rid of unseen impurities which may cause diseases and importantly water borne
infections like cold, cough, fever, flu, etc

Bacteria and viruses while filtering it eliminates large particles, silts and sediments. These centers
can be established in cooperation with locals for which many alternatives can be exploited. The main
thing is that instead of waiting for people to change lifestyle we will provide them boiled and filtered
water. No cost shall be charged to those who bring their own bottles, and a very low charge shall be
made to those who take our bottles (pet bottles).

While the above methodology will provide and ensure use of safe drinking water, we will also add
iodine in the water to ensure this critical missing nutrient becomes part of their intake.

The safe drinking water will be the first tool for fighting malnutrition. This is something that does not
need a very massive public awareness campaign drive. But, this provisioning of clean water will have
to be eventually backed by altering lifestyles of the target public.

Secondly to ensure adequate intake of missing nutrients like iron, calcium, vitamin B12, vitamin D
and proteins our diet and government nutrition specialist experts will provide guidelines (along with
cooking instructions) which will incorporate all the missing ingredients in their diet from the regular
food items available to them and without adding any cost to their kitchen budget.

Implementation
The greatest of ideas in is this world can flop without proper advocacy and moblization
To implement our proposed solutions require small alterations in lifestyle to ensure healthy living.
E.g. going to safe drinking water centers to get water, incorporating nutrients in their menu by use
of food items as suggested by our expert.

To implement this CHRS nutrition expert will train the target BHUs LHWs on our proposed
methodology .These LHWs will our implementation team. LHWs will pick 200 women from each
union council of say 1000 households. These women will be trained by our experts and LHWS in
surveying households, screening them and later educating them to a level where habit formation is
established in using safe drinking water and nutrients.(they will incorporate practices into
households in such a way that they will become habits ! )

The key feature will be that we will back up our work force idea by providing “performance
incentives” to the LHWs who will be trained in targeted verbal messages, brochures (pictorials and
graphical illustrations) which will motivate them to perform. The details of these incentives can be
provided. They will be in slabs. E.g. 2 household habit formations will be given utility prizes like a
dinner set or a similar item. 5 household will get them a micro wave, 10 will get them a fridge etc.
There will also be a health worker of the month, quarter and other performance boosting awards.

To ensure that the habit formation data reported is genuine we will also have a “audit team” of 2 to
3 trained women per 25 heath force workers who will physically check habit formation.

The health force workers will be provided with professionally designed printed literature which will
comprise of graphical stories which will not need reading. They will be given proper training by our
experts how to use the very simple survey forms to collect household data as well as how to
encourage use of safe water and incorporation of ingredients.

In addition to this the health force team will be assisted with theatrical performances, prize winning
cooking lessons at villages, meena bazaars and other aids like posters, banners etc to facilitate their
efforts.