Dr. Atta Ullah

Treating Pneumonia in the Community

“In our baseline study, 1% of children were contacting lady health workers for acute respiratory infections,” says Dr. Atta Ullah, the ARI Research Coordinator for Save the Children, Pakistan. “After two years, it was 28%.”

Getting Started

This impressive increase was seen in a pilot program for community-based case management launched by the national government and Save the Children. At first, there was some reluctance to task community health workers — known in Pakistan as lady health workers — with another responsibility. The 100,000-member workforce is already involved in family planning, polio campaigns and health education. “There was some concern that the capacity was not there,” remembers Dr. Ullah. However, after sharing the findings of previous studies, the government signed a Memorandum of Understanding to being a pilot study in Haripur district.

The Pilot Study

The partners trained 570 community health workers and 24 of their supervisors in community-based management of pneumonia and severe pneumonia. Non-severe pneumonia was treated with antibiotics for 3 days, while severe pneumonia was treated for five days. The antibiotic, Amoxicillin, was provided by the WHO. In addition to learning about treatment, the community health workers were taught how to mobilize the community and educate them on the prevention and detection of pneumonia.

Over the next two years, the community health workers treated more than 20,000 cases of pneumonia and 3,500 cases of severe pneumonia. Care seeking for acute respiratory infections increased dramatically.

Next Steps

The funding for the antibiotics has ended, so the community health workers must now refer cases of pneumonia to health facilities. “The community is demanding the extension of the project,” says Dr. Ullah. So he is advocating at the national level for the scale up of the program and working with the WHO to continue providing amoxicillin to the community health workers of Haripur.

Words of Advice

When the pilot study first began, there was significant push back from the informal health service sector. The district’s unregistered local practitioners even launched a media campaign against the program.

In response, the study organizers went to the local assembly and local leaders, and they made announcements at mosques to inform the public of the study’s true aims. In the end, the community was convinced that the program would be helpful and cooperated fully with the community health workers.

Dr. Ullah advises advocates to know their audience and target their message accordingly. When developing initial partnerships, Dr. Ullah relied on scientific studies, but his team realized they needed a different strategy when interacting with the local community. Their proactive and collaborative approach with local leaders was vital to the ultimate success of their program.