Maternal and child surveillance in peri-urban communities: Perceptions of women and community health workers from Pakistan

Abstract

Community health workers (CHWs) in maternal, newborn, and child health (MNCH) programs play an important role in demographic surveillance activities; however, there is lack of literature regarding the community and CHWs’ perceptions about these activities. The purpose of this study was to explore perceptions of married women of reproductive age (MWRA) regarding the role of CHWs involved in maternal and child surveillance and explore facilitators and barriers for CHWs involved in surveillance activities. A qualitative study was conducted in five peri-urban surveillance sites along the coastal belt of Bin Qasim Town, Karachi, Pakistan. In-depth interviews were conducted with 25 randomly selected MWRAs and 15 CHWs. A thematic analysis was performed to explore perceptions, barriers, and facilitators of the study participants about maternal and child surveillance activities. The results showed that MWRAs perceived surveillance CHWs as service providers with regards to standard counselling i.e. importance of antenatal care, nutrition, immunization, and distribution of iron and folic acid tablets to pregnant women, child growth assessment, and referral of sick children to the health facility. Trust in the CHWs was an enabler for MWRAs, whereas lack of incentives was cited as a barrier to share their health data. CHWs perceived themselves as a bridge in liaising community with the primary health care facility. They highlighted an enabling environment such as appreciation, supportive supervision, training, and utilization of digital data collection tools as facilitators for their work. Low health literacy of the communities, lack of provision of incentives by CHWs to the community, and facility-based experiences of the community were reported as barriers. Surveillance CHWs are an integral link between the health facility and MWRAs. Hence an enabling environment may lead to improved health service delivery, translating into meaningful impact for the mother and child.

Public health surveillance through community health workers: a scoping review of evidence from 25 low-income and middle-income countries

“…The studies adopted quantitative, qualitative and mixed methodologies with some studies specifically describing interventions to train CHWs. 11 12 Studies were from 25 LMICs across the world including Africa, [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] Asia, [27][28][29][30][31][32][33][34][35][36] Latin America 37 38 and the Caribbean. 39 Although most studies focused on specific infectious diseases including HIV/AIDS, 20 malaria, 15 18 37-39 tuberculosis (TB), 16 19 Ebola, 12 neglected tropical diseases (NTDs) 13 24 26 and COVID-19, 34 others focused on maternal and child health, 14 25 29-32 35 general health/overall mortality 17 21 23 33 and specific outcomes such a suicide.…”

“…These data points are then transferred to appropriate facilities via mobile technologies or physical papers and folders. In Zimbabwe, Kambarami et al 25 highlighted that as part of pregnancy surveillance, CHWs collected data on women’s menstrual health, while in Pakistan, Khalid et al 32 described CHWs as playing a critical role in collecting data on pregnancies, births, and maternal and child deaths during household visits. In rural Nepal, Bhatta et al 33 also highlight the role of CHWs in improving surveillance by collecting data on fatal injuries and other demographic data.…”

Maternal Health Services in Pakistan

“…Men and women have different health care needs, but they both have the same right to live longer and in better health. On the other hand, gender discrimination prevents many women and girls from accessing health care for a variety of reasons, primarily in low-income countries due to a lack of financial means, knowledge, and awareness [30] . If new-borns and their mothers had access to affordable, highquality healthcare, wholesome food, and clean water, millions of human lives could be saved every year.…”