Mobile Health Clinics Help Maintain Access to Care in Rural Pakistan During the Coronavirus Pandemic

“Previously I visited this basic health unit with my child but the pediatrician was not available. This time, there was a camp with a pediatrician who checked my child,” said Razia, the 35-year-old mother of a six-month-old Hassan Zai.

Razia is from district Charsadda in Khyber Pakhtunkhwa Province in Pakistan, and she attended one of the camps organized by the mobile health service unit (MHSU) in her village. She said that she suffered two miscarriages and Hassan Zai is her first surviving baby. This is why she is taking great care of his health and growth.

“My son had a fever a few days ago. While he is better now, I would like the doctor to check and confirm that he is fine. Normally, we cannot afford a child specialist because of high fees and difficult access to the city hospital. Having this opportunity at an MHSU is such a luxury for us.” Many mothers like Razia wait patiently for their turn to get a free health checkup for themselves and their children.

In Khyber Pakhtunkhwa, most people live in hard-to-reach areas with limited access to health care. Though the government established basic health units and rural health centers at the local level, non-functioning and under-performing facilities limit the availability of high-quality care. One way to extend services and increase access in remote areas is through mobile health services. The Integrated Health System Strengthening & Service Delivery (IHSS-SD) Activity, funded by the United States Agency for International Development (USAID), piloted the MHSU with support of from the government of Khyber Pakhtunkhwa in Swat, Charsadda, and Lakki Marwat districts. The Activity refurbished, equipped, and deployed an MHSU in each district to provide services, with a focus on maternal and child health, starting in November 2019.

The MHSUs operate maternal clinics at “camps,” where female medical officers provide reproductive and primary health care services. The camps include pediatric clinics and provide preventive services like immunization and nutrition in coordination with district health services authorities. Trained social mobilizers called community resource persons (CRPs) conduct health awareness sessions for male and female clients and people in the waiting areas. As of September 2020, IHSS-SD had trained 1,680 CRPs. All MHSU services are provided free of charge and include essential medicines, family planning commodities, nutrition supplements, and obstetric ultrasound services. Patients are referred to higher-level facilities for specialized care as needed.

During Pakistan’s lockdown earlier this year in response to the COVID-19 pandemic, all IHSS-SD field activities, including MHSU camps, ceased. The halt in MHSU lasted four months in Charsadda and Lakki Marwat, and almost seven months in Swat. During this period, people had no access to routine health services.

Irshad Bibi, a 32-year-old pregnant woman from Darmai in Swat District, spoke of her experience. “Before COVID, I attended a few health awareness sessions and medical camps organized by the MHSU. This was very convenient since it happened in my village. I received both a pregnancy checkup and advice from the camp doctor. When the camp stopped because of the lockdown, I had to go to the private clinic three kilometers away. The limited mobility, high cost of travel, and feeling unsafe at the private clinic [due to COVID] made life very difficult for us.”

When the lockdown eased in June, the IHSS-SD team approached the district health officers and local government in each district to resume MHSU camp activities. After several meetings with government officials and persistent follow-up, MHSU camps in Lakki Marwat resumed on July 14, on July 16 in Charsadda, and on August 8 in Swat. To mitigate the health risks for health care providers and community members as the pandemic continues, the IHSS-SD team follows World Health Organization’s standard operational procedures, including social distancing and infection control measures. The IHSS-SD team added handwashing and hygiene awareness sessions in all districts to help prevent the spread of the coronavirus and other diseases.

Irshad is pleased that she is again able to access the MHSU. “I am so happy that the camp resumed near my house. I just had an antenatal check-up and, to my surprise, the doctor did an ultrasound for me. I was told that I had a breech pregnancy and was referred to Tehsil Head Quarter Hospital for follow-up. I am confident that everything will be fine. It is good to have this important information beforehand.”

Every month from November 2019 to September 2020, each MHSU held at least six medical camps in each district, for a total of 58 camps (16 in Swat, 21 in Charsadda, and 21 in Lakki Marwat). Of these, 39 were held during the COVID-19 pandemic. Many people benefitted from these services: 13,643 came for outpatient care; including 622 women for ultrasounds; 1,309 people for nutrition screening; and 1,105 people for family planning counseling services.

The MHSUs are an important complement to static facilities and a critical feature of basic health care service provision during natural and manmade disasters. The integration of this model into the existing health care system is expected to improve the use of primary health care services and strengthen community trust in public health care.