Overview

Pakistan Initiative for Mothers and Newborns (PAIMAN) was a six-year project funded by USAID designed to reduce Pakistan’s maternal and neonatal mortality and improve child health. Led by JSI Research & Training Institute, Inc., the initiative aimed to ensure women have access to skilled birth attendants during childbirth and throughout the postpartum period, to improve maternal, newborn and child health at the household level and to increase the quality of care delivered in the public and health sectors. PAIMAN developed a community-based approach that provides care to mothers and newborns through supportive linkages from home health care to hospital-based care. As the lead strategic communication partner, CCP developed the Communication Advocacy and Mobilization (CAM) strategy for the project, which was adopted by all partners during project implementation, and in 2009 was adopted by Pakistan’s Ministry of Health.

Accomplishments

Overall, the project saved more than 30,000 newborn lives resulting in a 23% decrease in neonatal mortality. All key indicators were significantly improved from baseline to endline data collection in 10 original PAIMAN districts. These include an increase of 27% in births attended by a skilled provider, 40% in emergency cesarean sections, 29% in antenatal care, and 33% in postnatal care within 24 hours. Communication interventions were the most known interventions and some of the most cost effective. Mass media interventions including TV dramas and spots were the most known among PAIMAN audiences (26%), followed by women’s support group meetings held by lady health workers (LHWs) (12% overall and 18% in LHW areas), and NGO and CBO health education activities (6%).

Policy impact and sustainability outcomes included the adoption of the project’s Communication, Advocacy and Mobilization Strategy, and signing of a Karachi declaration in October 2009 scaling up best practices. CCP-led advocacy initiatives led to a public commitment by the Ministry of Information and Broadcasting, dedicating TV and radio airtime to address maternal, newborn and child health (MNCH) issues, and inclusion of MNCH issues on the national Ulama (religious scholars) agenda in 2010.

Mass media

• Reached 70% of those with access to mass media, with significant behavioral improvements
• Produced over 40 hours of diverse TV and radio materials on MNCH from a commercial-free feature film to a series of TV magazine shows and radio talk shows
• Produced and aired mass media entertainment-education products including 9 TV spots and a TV drama series Paiman (Promise) that reached over 13 million people and improved MNCH knowledge, attitudes and behaviors among women
• Those who were exposed to mass media interventions significantly increased knowledge, and improved MNCH attitudes and healthy behaviors compared to others. Full antenatal checkups increased from 36% to 51%, hospital deliveries increased from 69% to 82%, and postnatal checkups increased from 64% to 81% during the intervention.

Community media

• Delivered traditional folk media such as puppet shows and innovative media such as mobile TV shows that reached over 340,000 people in communities with limited mass media access to mass media
• Networked 1,000 Ulama (religious scholars) to improve health in their communities by delivering MNCH messages to men during Friday sermons, and by encouraging other religious leaders to disseminate health messages to men
• Men exposed to messages through Ulama had higher levels of knowledge and more positive attitudes towards healthy behaviors for maternal and newborn health

Capacity building

• Collaborated with Ulama (religious scholars) to develop and disseminate health messages to men through mosques
• Built capacity for MNCH reporting and advocacy through a sensitized, trained, and health competent network of more than 400 journalists, and Safe Motherhood awards were given for excellence in MNCH reporting for three consecutive years

Advocacy

• Efforts led to the national government publicly committing dedicated TV and radio time to address MNCH
• Ulama included MNCH on their national agenda for their annual convention in 2010