28-year-old Jonny Barty from East Grinstead in Sussex has spent the last seven months living in Punjab, Pakistan, helping to deliver a series of major health reforms that directly impact the lives of millions of people, particularly women, children and babies.
There are two million births per year in Punjab – one of the largest provinces in Pakistan – which has a population of over 100 million. Working for a niche development consultancy called Acasus, Jonny is part of a team focused on improving the provision of primary health care in Pakistan. Basically, this means improving the quality of health facilities, reducing infant and maternal mortality rates, and increasing vaccination coverage to help eradicate preventable diseases in children, such as polio, pneumococcal, measles and rotavirus – an extreme form of diarrhea and the leading killer of under fives in the developing world. “That’s where it gets really cool," Jonny tells Refinery29, "as by assisting the government in strengthening vaccination programmes, we’re helping to prevent the deaths of thousands babies every year."
According to a recent report by the Punjab government, over 41% of births in Punjab are handled by “unskilled birth attendants.”
“By upgrading primary health facilities to provide 24/7 baby delivery services," Jonny explains, "the government has created capacity for an extra 45,000 deliveries to be overseen by skilled birth attendants each month. This means that roughly one in four babies in Punjab is now born safely in a primary health facility, preventing untold tragedies from birth complications that might otherwise have resulted in the loss of baby, mother, or both.”
For all the shortcomings of the NHS, we take for granted the preventative measures it takes to protect the population against things we didn’t even know we were supposed to worry about. For example, it is very rare for a child in the UK to die from polio, measles or rotavirus nowadays. While all three were major health issues in the past, now, according to nhs.uk, instances are “rare” / "uncommon" due to vaccinations “routinely given to children in the UK, the U.S. and many other countries around the world.” Clearly, not all countries are operating at this standard – which is where organisations like Acasus come in.
Acasus works directly with the Punjab government to ensure that the policies put into place are not just implemented in the present, but sustainable for the future.
The problems facing women and children specifically in Pakistan, while documented, are not widely known in the UK, mostly because – for organisations like Acasus – there are more pressing things to do than talk to the press. We think the work they do is worth shouting about though, so here we talk to Jonny directly about the projects he works on, what’s on offer for a young person living in Punjab, and the practical and emotional challenges it brings.
Tell me about your job, what are you working on?
I work at Acasus, a niche development consultancy with around 15 people. We work with governments across the world to improve the health and education of the world’s poorest children
For the last seven months I’ve been working in Punjab – Pakistan’s biggest province – on the Punjab Health Reforms Roadmap. For a long time, Pakistan has faced significant challenges in healthcare. The most critical of these include high infant and maternal mortality rates, low immunisation coverage against deadly diseases, and a legacy of weak public health facilities.
The Roadmap is a big government-led health reform programme focused on resolving these challenges by delivering a few high-impact initiatives to save the lives of women and children. A team from Acasus, and supported by DFID, helps deliver the Roadmap, working closely with the Punjab Government to achieve ambitious goals in four areas:
• Raising immunisation coverage
• Reducing child and maternal deaths during delivery
• Improving the basic functioning and quality of healthcare facilities
• Improving family planning services
By upgrading primary health facilities to provide 24/7 baby delivery services, the government has created capacity for an extra 45,000 deliveries to be attended by skilled birth attendants each month. This means that roughly one in four babies in Punjab is now born safely in a primary health facility.
More staff, improved basic utilities, greater availability of supplies, contraceptives and medicines have all contributed to one of the fastest improvements in the performance of a primary health system ever seen. As of December 2015, when a patient goes to one of Punjab’s 2400 Basic Health Units they have a 61% chance of finding a doctor, versus just a 36% chance a year ago. Similarly, doctors now have essential medicines in stock to treat patients 99% of the time, versus just 50% of the time a year ago.
Of course, while we provide support, the real heroes of this work are the people delivering the results, and the Government of Punjab.
What are the main challenges you face?
As much as I love what I do, our work work isn’t easy. It takes a lot of persistence, and can be frustrating at times.“That can’t be done,” is one of the most common things we hear. In the past, barriers were often accepted, problems were intractable, and because it often seemed like too much hard work, nobody really tried. Reversing this mindset has been one of our biggest challenges. We still hear these kinds of phrases every once in a while, but this just serves to further galvanise us to achieve what we would be led to believe was impossible.
When I first started at Acasus, I found it really difficult to accept that you can’t solve every problem straight away. It would really frustrate me, and sometimes I’d take it pretty hard, especially because knowing the details meant knowing the cost of any delay or inaction. As in most cases, experience has served me well, and I now know that prioritising what initiatives we do and when we do them is critical. This can be tough – choosing your focus areas and their respective battles is not an easy task. We have to constantly put aside any emotional arguments and objectively assess what can realistically be achieved with our limited resources.
Can you tell me any personal stories, do you ever work at ground level, meeting families?
In any given week, I’d say that 80% of the team’s time is spent in the office or with government. The remaining 20% is spent going out into the field across Punjab. The time we spend in the field is always humbling; you're constantly exposed to families living in extreme poverty, striving to do the best for their children. This is a powerful reminder of the day-to-day realities, and a great motivator to make sure the interventions we design work for the people who need them.
What’s it like to live in Punjab day to day?
I’ve been in Punjab for around six months. I had little idea what to expect upon arrival, but I’ve really come to love Lahore – it’s an incredible place and has begun to feel quite homely.
Social life in Lahore revolves around a buzzing café and restaurant culture. Lahore has some surprisingly good cafes, my favourite being a minimal, Scando coffee joint that wouldn't look a touch out of place in Hackney. The food on offer is generally excellent, although Punjabi cuisine has a tendency to be incredibly rich, with salads existing only as a subtle garnishes to (consistently delicious and often insanely spicy) bbq dishes. My new found fondness for nihari or rich buttery daal has had the annoying consequence of totally ruining any beach body I was hoping to cultivate.
Thankfully, to accommodate my ghee-led weight gain, sport, and in particular cricket, is a big deal here. Although my technique is dire and my free time scarce, I play as much as I can. The last time we played, we drove off into the wilderness to play at a private ground someone had booked. On arrival, one of the groundsmen met us on a battered motorbike, sporting an AK 47 and a bulletproof vest. He guided us in to the compound, before promptly warning us to be careful of fetching any balls that cleared the boundary wall, as the owner kept lions in the next field. Sport in Pakistan is fun. This probably wouldn't fly on the village green back home, but I’ll continue to blame the distant roars (albeit in my head) on my numerous dropped catches.
What other projects are Acasus working on?
We’ve worked across a wide range of areas, including:
• Supporting the implementation of a major education reform in South America.
• A major review of efforts to support Girl’s Education in Northern Nigeria.
• A project to design market based interventions to support the diagnosis of HIV.
• Support to a major school reform programme in Pakistan.
How can normal people in the UK help? Will donations help? Petitions?
My view is that, if you can, then you should support causes that resonate with you personally. There are some really big problems all over the world, from increasing development in the poorest countries to overcoming challenges closer to home, and it's going to take all of our collective energies to resolve them. There's really no shortage of things to donate to or ways to volunteer; it's really more a case of each person deciding which challenges are most meaningful for them, and then supporting that cause however they can.
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