May 23, 2011 – One program in Pakistan is attempting to combat urban poverty, the root of many Pakistanis’ problems, by providing affordable health insurance. Special correspondent Saima Mohsin reports from the nation’s largest city, Karachi.
An excerpt from the transcript: The private sector serves nearly 70 percent of Pakistan’s population. Yet, out of the estimated 40 million low-income families here, 99.3 percent of them don’t have health insurance.
The introduction of Naya Jeevan in Pakistan hopes to change that. This new program is simple and affordable for employers, sponsors and beneficiaries. The equivalent of just $2.50 a month provides access to private health care and, crucially, regular health checks for contagious or infectious diseases as a preventive measure for a country that is still battling polio, malaria and hepatitis.
And hundreds of local companies, restaurants and multinational corporations are signing up for the plan for their low-income employees.
Link to podcast, transcript and video: http://www.pbs.org/newshour/bb/world/jan-june11/pakistanhealth_05-23.html
ISLAMABAD: Deforestation is the main cause of rising temperature in the Capital.
Deforestation at a fast pace has eroded the old cliche that it would rain in the Capital after some hot days. The average temperature during these days of year is around 40 Degree Celsius, which is five to six degrees more than the normal.
An official of the Capital Development Authority (CDA) told this news agency that they were committed to conservation of forests.
He said the government had set a target of increasing the forest cover by 5.6 percent in the current year and 6 percent by 2015 in the Mid-Term Development Framework.
Deforestation is the main cause of extraordinary change in temperatures in Pakistan and elsewhere. The continuing loss of forests in Asia is a result of many elements.
A combination of mismanagement and corruption, economic development, and an ever-widening gap between classes continue to cause deforestation across the continent.
Tree plantation is not an activity reserved only for the environmentally conscious West. It is a sustainable and easy way to improve environment, whether we are living in the United States or Pakistan. Deforestation and desertification are just some of Pakistan’s environmental problems, according to the latest edition of the CIA World Fact Book.
EPA did a wonderful job when it was headed by incumbent President Asif Ali Zardari. The then administration of the agency chalked out a comprehensive plan to increase tree plantation in the country and cooperation of various financial institutions was sought for the purpose.
EPA also undertook tree plantation of Islamabad-Murree Highway at that time, which added to the beauty of Potohar plateau and greatly reduced average temperature.
Trees help recharge ground water and sustain flow of streams. Trees have a positive impact on the incidence of asthma, skin cancer and stress-related illness by filtering polluted air, reducing smog formation, shading out solar radiation and by providing an attractive and calm setting for recreation.
Trees strengthen neighbourhood communities by providing people with an opportunity to work together for the benefit of the local environment.
Trees play a vital role in the urban ecosystem, by helping to support a great variety of wildlife, which people can enjoy close to home.
High-density housing that works for all.
Full-text – http://www.iied.org/pubs/pdfs/17079IIED.pdf (pdf, 158KB)
Arif Hasan. Published: Mar 2010 – IIED
In an urbanising world, the way people fit into cities is vastly important – socially, economically, environmentally, even psychologically. So density, or the number of people living in a given area, is central to urban design and planning.
Both governments and markets tend to get density wrong, leading to overcrowding, urban sprawl or often both. A case in point are the high-rise buildings springing up throughout urban Asia – perceived as key features of that widely touted concept, the ‘world-class city’.
While some may offer a viable solution to land pressures and density requirements, many built to house evicted or resettled ‘slum’ dwellers are a social and economic nightmare – inconveniently sited, overcrowded and costly.
New evidence from Karachi, Pakistan, reveals a real alternative. Poor people can create liveable high-density settlements as long as community control, the right technical assistance and flexible designs are in place. A city is surely ‘world-class’ only when it is cosmopolitan – built to serve all, including the poorest.
USAID Global Development Alliance. (2010). Safe Drinking Water Alliance – Experiences in Haiti, Ethiopia, and Pakistan: Lessons for future water treatment programs.
To address some of the challenges created by lack of access to safe water, in 2004, the United States Agency for International Development’s (USAID) Global Development Alliance (GDA) brought together Johns Hopkins Center for Communication Programs (CCP), Population Services International (PSI), CARE USA, and Procter & Gamble (P&G) to create the Safe Drinking Water Alliance (SDWA). The general goal of the Alliance was to test three marketing models to increase demand for water treatment and to identify the potential of P&G’s PUR in each model as an alternative POU technology. PUR is a household-based water treatment product that combines disinfection with removal of dirt and other pollutants and transforms turbid contaminated water into clear, potable water. The three models tested by the SWDA included:
(1) a commercial marketing model with full cost recovery in Pakistan;
(2) a social marketing model where some promotional costs were subsidized in Haiti; and
(3) an emergency relief model in Ethiopia.
In Pakistan and Haiti a combination of behavior change communication activities and PUR-branded messages and materials were disseminated to increase the demand for water treatment and to introduce PUR. In both countries, CCP led the behavior change campaigns, while in Haiti PSI handled the specific promotion and distribution of PUR. In Pakistan, P&G focused on creating demand for PUR. In Ethiopia, CARE staff working in the Community-Based Therapeutic program were fully in charge of introducing PUR and providing the motivation and information for its use.
In all three contexts SDWA partners also studied barriers and facilitators to sustained water treatment behaviors, as well as reactions to and use of PUR specifically. Findings have clear programmatic relevance, and add to the emerging literature on water treatment behavior and the adoption of new technologies, and particularly provide insights about feasible directions for PUR.
In Karachi, Pakistan, the majority of citizens suffer from poor levels of water and sanitation services, especially those in low-income settlements. To help them create a plan to improve their services, the Karachi City District Government formed a partnership with the Water and Sanitation Program (WSP).
The partners began by giving citizens an opportunity to ‘grade’ the performance of the Karachi Water and Sewerage Board (KWSB) using ‘citizen report cards‘. This method was piloted in Bangalore by the Public Affairs Centre in 1993 and has proven to be a demand-responsive, positive force for change, not just in Bangalore, but internationally.
Asking customers to grade the performance of the utility provided the Karachi government with neutral, credible and apolitical information on consumer preferences and concerns surrounding water supply and sanitation services.
“The report card has provided us information about those areas which we considered as outside the coverage of KWSB” said Ayub Shaikh a staff member of the Karachi Water and Sewerage Board.
Nearly 5,000 men and women in nine towns in Karachi representing low, middle, and high income groups were asked to grade the utility. Women are generally involved in accessing water for their familieswhile men typically bear the cost of services.
The partners launched a communications strategy early in the process to make sure the findings of the report card were broadly disseminated to increase and encourage public debate. They turned to PANOS, a global program created to engage the media and increase public debate through training, orientation, and opportunities for understanding and learning.
The communications program was designed to build a partnership between the government and the media to build awareness of civic rights and responsibilities, highlight the need for reform, and most importantly create a constituency that has a loud voice so their demands can be heard for improvement of services.
The reasons for this outbreak include a lack of proper sanitation system, a huge open drain running in the centre of the colony and absence of clean potable water.
The health experts working in the colony have declared this an emergency situation and said if the government does not take any immediate safety measures, the condition could worsen. They also warned that the disease might spread in other parts of the city.
“Since last week, diarrhoea has become epidemic in the colony and children are dying,” said Dr Aisha Siddique, a young lady doctor at Mother and Child Heath Centre, which is run by a non profit and non government organisation Concern for Children Trust (CFC). She said that she receives 60 patients everyday, but since the spread of diarrhoea, the majority of the patients visiting the centre are children.
“A child in almost every home is suffering from diarrhoea in this colony, which has a population of about 0.7 million,” said Dr Siddique. She said that there are about 72 clinics working in different areas of the colony and almost every clinic is receiving large numbers of children with viral diarrhoea.
Located in the backwaters of Karachi Port, just off the edges of the Arabian Sea, Machhar Colony is the second largest slum settlement after Orangi Pilot Project and is home to approximately 0.7 million people of different ethnic backgrounds and nationalities including Biharis, Burmese, Bangladeshis, and Afghans. As the colony is illegal on government records, therefore it is suffering from a lack of basic facilities such as clean drinking water and proper sanitation.
“There is no water supply system in the colony, therefore the people get water from other localities through a network of plastic pipes, and you can see these pipes are spread amongst the garbage on the surface of the main sewerage drain passing from the middle of the colony, Dr Siddique explained. “Sometimes when the garbage catches fire, these pipes are burnt resulting in sewerage water getting mixed with drinking water causing the spread of diseases” She said that the practice is common in the colony, but the reasons for the diarrhoeal disease as well as its spread need to be ascertained through a study.
Official data from different international organisations reveals that in Pakistan, 38.5 million people lack accesses to safe drinking water, and 50.7 million lack access to improved sanitation, due to which 25 percent of the total hospital beds in Pakistan are occupied by the people suffering from waterborne diseases.
The study further reveals that diarrhoea is the leading cause of mortality and second leading cause of morbidity among children under five years of age.
“Due to poverty, there is almost one patient of tuberculosis in every house in the colony, besides this typhoid fever, viral fever and other diseases are also common, but this recent diarrhoeal epidemic could be very fatal if certain measures are not taken,” said Dr Siddique.
The Urban Resource Centre, Karachi: The roles of local organisations in poverty reduction and environmental management, 2008 (pdf, 542KB) by Arif Hasan.
The Urban Resource Centre is a Karachi-based NGO founded by teachers, professionals, students, activists and community organisations from low-income settlements. It was set up in response to the recognition that the planning process for Karachi did not serve the interests of low- and lower-middle-income groups, small businesses and informal sector operators and was also creating adverse environmental and socioeconomic impacts. The Urban Resource Centre has sought to change this through creating an information base about Karachi’s development on which everyone can draw; also through research and analysis of government plans (and their implications for Karachi’s citizens), advocacy, mobilisation of communities, and drawing key government staff into discussions. This has created a network of professionals and activists from civil society and government agencies who understand planning issues from the perspective of these communities and other less powerful interest groups. This network has successfully challenged many government plans that are ineffective, over-expensive and anti-poor and has promoted alternatives. It shows how the questioning of government plans in an informed manner by a large number of interest groups, community organisations, NGOs, academics, political parties and the media can force the government to listen and to make modifications to its plans, projects and investments. Comparable urban resource centres have also been set up in other cities in Pakistan and also in other nations.
Neonatal mortality, risk factors and causes: a prospective population-based cohort study in urban Pakistan, WHO Bulletin, Feb 2009. (pdf, full-text)
Imtiaz Jehan, Hillary Harris, Sohail Salat, Amna Zeb, Naushaba Mobeen, Omrana Pasha, Elizabeth M McClure, Janet Moore, Linda L Wright & Robert L Goldenberg
Objective – To evaluate the prevalence, sex distribution and causes of neonatal mortality, as well as its risk factors, in an urban Pakistani population with access to obstetric and neonatal care.
Methods – Study area women were enrolled at 20–26 weeks’ gestation in a prospective population-based cohort study that was conducted from 2003 to 2005. Physical examinations, antenatal laboratory tests and anthropometric measures were performed, and gestational age was determined by ultrasound to confirm eligibility. Demographic and health data were also collected on pretested study forms by trained female research staff. The women and neonates were seen again within 48 hours postpartum and at day 28 after the birth. All neonatal deaths were reviewed using the Pattinson et al. system to assign obstetric and final causes of death; the circumstances of the death were determined by asking the mother or family and by reviewing hospital records. Frequencies and rates were calculated, and 95% confidence intervals were determined for mortality rates. Relative risks were calculated to evaluate the associations between potential risk factors and neonatal death. Logistic regression models were used to compute adjusted odds ratios.
Findings – Birth outcomes were ascertained for 1280 (94%) of the 1369 women enrolled. The 28-day neonatal mortality rate was 47.3 per 1000 live births. Preterm birth, Caesarean section and intrapartum complications were associated with neonatal death. Some 45% of the deaths occurred within 48 hours and 73% within the first week. The primary obstetric causes of death were preterm labour (34%) and intrapartum asphyxia (21%). Final causes were classified as immaturity-related (26%), birth asphyxia or hypoxia (26%) and infection (23%). Neither delivery in a health facility nor by health professionals was associated with fewer neonatal deaths. The Caesarean section rate was 19%. Almost all (88%) neonates who died received treatment and 75% died in the hospital.
Conclusion – In an urban population with good access to professional care, we found a high neonatal mortality rate, often due to preventable conditions. These results suggest that, to decrease neonatal mortality, improved health service quality is crucial.
ISLAMABAD: Pakistan’s urban population is likely to equal its rural population by 2030, according to a report titled ‘Life in the City: Pakistan in Focus’, released by the United Nations Population Fund (UNFPA).
The report was released to coincide with the launch of a UNFPA report on the global urban population, titled ‘Unleashing the Potential of Urban Growth’, which says that more than half of the world’s total population will live in cities by 2008.
According to the report on Pakistan, the proportion of females is lowest in rural to urban migration and highest in rural to rural migration. The same pattern has been observed in India. In the rural-urban stream, the share of females is 51 percent in Pakistan. A relatively large fraction of rural-urban migrants crosses provincial boundaries. The perception that “the urban migrant is invariably a male” is incorrect; females make up a considerable proportion of migrants.