Insights

Optometrist Dr. Irfanullah examining a student at a health screening in District Buner

A silent disease lurking behind the eyes of a grade five student, a teacher unequipped with the resources to identify the problem, and a community with limited access to affordable healthcare. These challenges become an everyday reality in the remote areas of District Buner, at the far north of Khyber Pakhtunkhwa (KP), Pakistan. The lack of access to affordable healthcare, coupled with limited opportunities to screen young children for health issues that could make it difficult for most children to continue their education contribute to an already high percentage (38%)[1] of out of school children (OOSC) in the community.

Palladium is implementing the USAID-funded New Partnerships Initiative (NPI) EXPAND Human Development Activity (HDA) in Pakistan to advance access to quality education, family planning, and health services in KP, Pakistan. Partnering with the Human Development Foundation (HDF), NPI EXPAND HDA implemented an integrated health and education project aimed at sustainably changing the ways local communities and schools approach healthcare and health screening. HDF worked in coordination with the Department of Education (DOE) and Department of Health (DOH) to launch initiatives in 45 girls’ and 64 boys’ public primary and middle schools in Tehsil Gagra, District Buner. Through meetings with representatives from the DOE, DOH, district health officers, school heads, and health facility heads, the HDF engaged and sought support from the relevant government stakeholders for sustainable implementation of health and hygiene improvement initiatives at public schools.

The objectives of the project remained focused on improving health, hygiene, and nutrition among the 25,000 schoolchildren in the district. To achieve this objective, the HDF took a two-pronged approach with a focus on comprehensive health and hygiene screening at one end and training public school teachers on health and hygiene screening at the other end. The first task was accomplished through comprehensive screening of students to identify physical disabilities, visual impairment, nutrition challenges including malnutrition, obesity, and anemia, dental hygiene issues, infectious diseases, and skin problems. By May 2023, the HDF’s efforts culminated in the screening of 25,082 (12,572 male, 12,510 female) students, surpassing the initially set target of 25,000 children. Among them, 594 students were identified as underweight or malnourished through the nutrition screening. These students were referred to the nutrition center at Tehsil Headquarters Hospital Dewana Baba for further evaluation and management. Students with visual impairment were tested and provided with spectacles, enabling them to navigate the world with newfound clarity. 18,162 students received vital deworming medication, ensuring their continued well-being and attendance. The mobile health and hygiene screening teams consisting of a medical doctor, optometrist, audiologist, enumerator, and public health staff, facilitated these health and hygiene screenings.

Children in need of special care were promptly referred to government health facilities, ensuring access to necessary treatments and support. Muhammad Esa, a grade five public school student from Tehsil Gagra is one of the students who was screened and helped with a disease that could have had a lasting impact on his life. During the HDF’s screening, Esa was diagnosed with cataracts in his eyes, something he and his parents were unaware of. The screening team immediately referred him for eye surgery at Al Shifa Eye Trust Hospital in Rawalpindi. The free of cost treatment helped Esa retain his vision and helped him with a disease that, if left undiagnosed, could have caused permanent damage to his vision. The robust referral mechanism established by the HDF between the Health and Education Departments in Buner for children who need specialized care helped several children like Esa to access the right treatment for their visual and auditory problems from the right platforms.

Through this experience, the HDF learned that communication is the key to mobilizing the community to adopt better health and hygiene practices. Through radio, the HDF aired eight short messages in Urdu and Pashto every hour during the campaign, delivering valuable information and key messages on children’s health and hygiene. Two 30-minute talk shows aired during the campaign provided a platform for senior representatives from the KP Department of Population Welfare and the KP Pediatric Association to share their expertise. The communication strategy was focused on bringing out a community-centric approach where importance of health and hygiene screenings is inspired from within the community as a transition towards positive health practices.

The second aspect of the HDF’s campaign focused on sustainability and lasting impact through creation of local resources at public schools. The HDF trained 150 male and 150 female public-school teachers on health and hygiene screening. The teachers were provided comprehensive training on health and hygiene screenings through training modules adapted from the World Health Organization (WHO) and United Nations International Children Emergency Fund (UNICEF). The trainings mobilized the teachers in the target schools to not only impart their learnings to other teachers but also to senior students from the ninth and tenth grades.

Consulting closely at the early stages of project implementation built confidence and motivated them to play a supporting role in project implementation. The meetings bore fruit when the district education officer formally directed all the government schools in Tehsil Gagra to conduct health hygiene awareness sessions and health screenings of school children every six months. The project’s sustainable methodology highlights that a coordinated approach to health and hygiene screening not only leads to early detection and treatment, but can also create a sustainable cohort of local resources with roots in the community. As Marriam Muhammad, another government school teacher from District Buner acknowledges, “these trainings are crucial in equipping us with the knowledge and tools to address the health and hygiene needs of our students.”

With the communities, government bodies, and teachers having all hands on deck, the health screenings are set to bring a positive change for the children in District Buner and can help more children like Muhammad Esa lead a healthier life.

[1] According to the Pakistan Social and Living Standards Measurement District Level Survey 2019-2020, 38% of children aged 5-16 in District Buner are out of school, of whom 54% are girls. https://www.pbs.gov.pk/content/statistical-tables-pslm-2019-20