PAIMAN was a six-year project that assisted the Government of Pakistan in addressing mother and newborn health challenges through behavior change and systems-strengthening interventions.
Pakistan’s maternal and newborn mortality and morbidity rates are high despite an extensive health service network. One of the main reasons is insufficient awareness among women, families, and birth attendants of major maternal and newborn complications. Most maternal and newborn deaths occur at home without a skilled health provider attending.
From 2004 to 2010, the Pakistan Initiative for Mothers and Newborns (PAIMAN) worked to:
- Promote positive maternal and neonatal health behaviors
- Increase access to and integration of maternal and child health services
- Improve quality of care in the public and private sectors to manage complications; and
- Increase the capacity of healthcare providers and managers.
The project was implemented by a coalition led by John Snow Inc. (JSI) with partners from Pakistan and international organizations. The Council oversaw monitoring, evaluation, and operations research for the project. PAIMAN interventions fell into two categories: health system improvements and behavior change communication/community mobilization.
Health system improvements were carried out to ensure that more than 31 health centers were equipped to provide high-quality maternal care, including safe childbirth and continuous emergency obstetric care. Public and private healthcare providers received training to improve the quality of care and service delivery outcomes. Community midwives also participated in a national training program that sought to increase skilled birth attendance during home deliveries, especially in rural areas.
Behavior change communication/community mobilization included women’s support group meetings, television and radio advertisements, and puppet shows in rural and remote areas with the goal of creating awareness about the benefits of skilled birth attendance and maternal and newborn healthcare services; and involvement of ulama and religious scholars to promote education about the value of effective maternal health care in light of the teachings of Islam.
PAIMAN improved the quality of maternal and neonatal health services across rural districts in Pakistan. Communities achieved significant declines in newborn mortality in PAIMAN project districts as a result of improved knowledge and higher use of post-pregnancy care. Public-sector facilities were upgraded, and the availability of skilled birth attendants increased. Women who were reached by PAIMAN communications efforts were significantly more likely to obtain maternal health services during pregnancy, delivery, and after giving birth, and were more likely to know about danger signs compared to women not reached by PAIMAN.
Maternal health also improved in urban areas, mainly as a result of mass media campaigns. Improved healthcare practices at home deliveries have contributed to a reduction in newborn mortality.