Sindh government launches major upgrade to health worker curriculum

By Abdul Qadir Qureshi

(Pakistan News & Features Services)

The Sindh government has approved a major upgrade to the curriculum for lady health supervisors (LHSs) in a move aimed at enhancing the quality of door-to-door preventive healthcare services delivered by lady health workers (LHWs).  

 

The new curriculum, which incorporates the latest treatment guidelines for pneumonia and diarrhoea: two preventable diseases that caused over 670,000 deaths in the country in 2015, was unveiled during a meeting of provincial stakeholders and researchers involved in the Nigraan Plus study at Aga Khan University.

 

The new curriculum includes directives on how LHSs can effectively support and supervise the work of LHWs thereby empowering them to apply the latest knowledge and clinical skills to manage pneumonia and diarrhoea at early stages; when care is the most effective.

“This revised LHS curriculum will now be used for training purposes and it is envisaged that it will ultimately help in better management of childhood diarrhoea and pneumonia. I express my sincere gratitude to representatives of the Sindh Lady Health Worker’s Programme for Family Planning and Primary Healthcare, and the Nigraan Plus team at AKU for their voluntary participation to revise this curriculum. They have made great efforts in reviewing and translating it to Sindhi and in producing the first-ever electronic copy of this curriculum,” the Sindh Lady Health Worker Programme Director, Dr Ghulam Hussain Sheikh, observed.

Nigraan Plus, a community research and management intervention in Mirpurkhas, saw AKU researchers work alongside provincial health officials to investigate the real-world barriers hindering the fight against pneumonia and diarrhoea.

 

One of the components of Nigraan Plus was a knowledge assessment survey of 32 LHSs and 160 LHWs in the district which found that most health workers lacked the minimum knowledge to manage cases of the diseases. It also noted a need to improve the quality of mentorship provided by LHSs to LHWs.

 “Most of the discussion about improvements to health systems revolves around LHWs. This means that LHSs are vastly underutilized. An LHS who effectively mentors 15 to 20 LHWs under his/her guidance can have a massive multiplier effect since every LHW is responsible for 100 households. Our revised curriculum and the policy recommendations flowing from our findings have highlighted cost-effective and simple measures that will help Pakistan achieve targets under Sustainable Development Goal 3 on reducing childhood mortality,” Professor Fauziah Rabbani, the project’s principal investigator, stated.

The researchers and health officials from the Sindh government also discussed a range of relevant findings from research under the ongoing Nigraan Plus project.  

 

Over the first year, community health workers surveyed over 4,000 mothers and caregivers in low income areas of Mirpurkhas. They found that fewer than one in three caregivers were aware of the symptoms of dehydration, a complication associated with diarrhea, while less than four out of ten households surveyed could detect breathing difficulties, a symptom of pneumonia.

A lack of awareness of these symptoms resulted in 70 per cent of families paying to visit a private clinic for treatment even though these health issues could be easily treated at the doorstep by an LHW, members of the Nigraan Plus team noted.

 

The researchers also noted that parents often stopped giving food and drinks to a child suffering from loose motions in order to ‘give the body rest’. This widespread practice often resulted in a worsening of dehydration often requiring hospital care.

 The findings from the study also noted unnecessary delay and expense in the treatment of dehydration. This is because most families went to the market to buy sachets of oral rehydration salts (ORS) even though they could quickly boost their child’s health by making a home-based solution with salt, sugar and water. This delay in providing ORS also raised the likelihood of dehydration worsening to a dangerous level.

Similar misconceptions were also noted in the case of pneumonia with the majority of caregivers viewing signs of respiratory infection as being a ‘mere cough’ meaning that only 12 per cent of respondents provided appropriate antibiotics to their children.

The researchers called on the government to enact the measures in order to protect children from pneumonia and diarrhea like the LHWs should have access to antibiotics, zinc supplements and ORS. This will help them provide essential treatment at home instead of urging caregivers to visit the hospital.

It was also suggested to launch a mass awareness campaign on the importance of home-based rehydration to treat diarrhoea, and the use of antibiotics to tackle pneumonia and expand SMS-based surveillance system so that LHWs can highlight critical cases to their supervisors. Which will enable a follow-up visit to be made within 24 hours.

 

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.

 

Other officials present at the event included Special Secretary (Admin), Department of Health, Sindh, Mr Abdul Waheed Shaikh; Provincial Monitoring Coordinator, Sindh Lady Health Worker Programme for Family Planning and Primary Healthcare, Dr Pir Ghulam Hussain; and District Coordinating Officer, Mirpurkhas, for the Sindh Lady Health Worker Programme for Family Planning and Primary Healthcare, Dr Hamza Ali Panhwar.

Dr Sameen Siddiqi, chair of the Department of Community Health Sciences at AKU, University Provost and Vice-President, Academic, Dr Carl Amrhein, and AKU’s Community Health Sciences faculty Dr Shagufta Perveen, Dr Imran Naeem and Anam Feroz were also present.

Greater value, prestige desired for teachers

By Abdul Qadir Qureshi
(Pakistan News & Features Services)

The misconceptions present in phrases such as those who can’t do, teach and you’re just a teacher are at the heart of Pakistan’s education problems, according to speakers at the Teachers Matter symposium organised by AKU’s Institute for Educational Development (IED).

The symposium brought together 250 policy experts, principals, teacher educators and researchers who noted that the low status of the teaching profession is one of the major issues affecting the recruitment, development and retention of qualified teachers. 

“Teachers are looked down upon even though their work lays the foundations for an educated, prosperous society. The country’s commitments under the sustainable development goals require education stakeholders to attain universal access to primary and secondary education by 2030. You cannot achieve education for all without having teachers for all,” Dr Sarfaroz Niyozov, Director, IED, remarked. 

The speakers at the event noted that many aspiring teachers choose to follow other professions because of concerns over pay and career development. They highlighted the need for school systems to introduce formal career development plans as well as continuing professional development schemes to boost teachers’ subject knowledge, teaching skills and their broader understanding of the profession. These initiatives would keep teachers motivated and participants noted that research shows that it is good for students too.

A study commissioned by UNESCO cites research into how students who are taught by two underperforming teachers in a row, are at risk of never catching up on their peers. 

“An enthusiastic teacher cultivates a love for learning in students which prompts them to apply what they learn in class to the real world. Everyone wants high test scores however the centrality of teachers in ensuring those scores is often ignored. Teachers need to be provided a facilitative environment in which they can prosper and inspire their students,” Dr Sajid Ali, an associate professor at IED, reckoned. 

The speakers at the event recognized that attending a variety of professional development programmes should be mandatory for all teachers and encouraged schools to reward teachers who apply novel techniques and learning methods in the classroom. 

However, speakers also noted that technological advances mean that today’s teachers have a wealth of resources at their fingertips. Teachers must also take charge of their performance by striving to innovate in the classroom and by constantly reflecting on how well students are learning, they added. 

While the participants at the symposium noted that government statistics highlight major shortages in the number of teachers in public schools, they viewed the education system’s failings as being a result of shortcomings in both the quantity and quality of teachers. The poor perception of teaching as an occupation has also had an impact on teachers entering and exiting the profession. 

The speakers noted that many schools suffer from a high turnover with large classes, poor working conditions, low job satisfaction and low salaries relative to other industries being cited as reasons for teachers leaving their jobs. 

“Teachers are agents of change; the conduits of knowledge and education. Yet, the teaching vocation remains one of the most undervalued. The search for and retention of good teachers will continue to be a challenge until we can begin to value those who teach,” Sabrina Dawood, CEO of Dawood Public School, stated. 

The participants at the seminar also pointed to the gap between working conditions in private and state schools. They noted that public sector schools offer much better pay packages and job security than the private sector. 

However, they also pointed out that public sector schools need to improve their mechanisms to hold teachers accountable for their performance. The other speakers at the event included Asim Iftikhar from Aga Khan Education Services Pakistan, Unaiza Ayub from The Citizens Foundation and Sadiqa Salahuddin from the Indus Resource Centre.