An experiment in primary health care in Karachi, Pakistan
Objective: The Health Education and Literacy Project (HELP) set up a primary health care (PHC) project in the urban slum of Naleem Colony in Karachi, Pakistan, in 1992. The project integrated preventive health, literacy, sanitation, and income generation. Its focus was the community health worker (CHW). Its motto was self-sustainability.
Method: A rotating fund allowed the community to contribute towards maintaining the CHW. A community grass-roots organization had administrative control of the project. Researchers had conducted a baseline survey and one year later a knowledge, attitude, and practices survey of 150 households that had received health education and of 150 other households that did not receive health education. The two groups were located in geographically distinct areas.
Results: At follow-up, the intervention group consistently was more likely to have good hygienic health practices than the control group (garbage covered, garbage disposal in the garbage drum, washing hands before feeding, and wash hands and child after defecation; p 0.05). Mothers in the intervention group were significantly more likely to know about the vaccinations children needed than those in the control group (for all vaccinations, 76% vs. 21%; p 0.0001). They were also more likely to know how to make oral rehydration solution (ORS) at home than their counterparts (65% vs. 15%). Among intervention mothers, 27% of their children had had diarrhea and 92% of the mothers had used ORS during an episode of diarrhea. The knowledge of correct dietary sources of protein among the intervention group improved significantly between baseline and follow-up (23% vs. 55%; p 0.05), while it did not for the controls (23% vs. 30%; p 0.05).
Conclusions: These findings suggest that the project was on the right track towards overall community development by providing health education, sanitation, literacy, and income generation services to the people of the squatter settlement