Aga Khan University and Government of Sindh Mark Two Years of Essential Health Services in Tando Allahyar

Aga Khan University (AKU), in partnership with the Sindh Department of Health and the People's Primary Healthcare Initiative (PPHI), and supported by the Gates Foundation, convened a province-wide symposium marking two years of implementing the Essential Package of Health Services (EPHS) in Tando Allahyar district. The event, held at AKU on 15 September, brought together government officials, development partners and frontline health workers to review progress and discuss scaling the model across rural districts of Sindh. Representatives from 13 different districts in Sindh, were present at the event.

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Tando Allahyar, home to nearly one million people, with 78 percent of them in rural areas, has served as the pilot district for EPHS, a 62-intervention package of care delivered across community, primary, and first-level hospital settings. Since the program's launch, the district became the first in Sindh to roll out daily digital health reporting through DHIS2 and EMR, opened a Specialized Care Nursery at the District Headquarters (DHQ) Hospital, trained nearly 500 Lady Health Workers on clinical guidelines, and introduced General Anaesthesia services at DHQ Tando Allahyar for the first time in the hospital's history.

Over 55 health facility staff have been trained on digital reporting, and progressively more of the district's 55 facilities are now actively reporting in real time. At DHQ Hospital, the new specialized care nursery, staffed by nine specially trained doctors, nurses, and technicians, has added a newborn intensive care capability that did not exist in the district before. Surgical services have also expanded, with almost 30% procedures carried out under General Anaesthesia. These services were not available earlier in the district.

“I hope this implementation is not limited to Tando Allahyar alone. Obviously, we want a scalable and sustainable model because too often, once an intervention ends and the people driving it move out of a district, things fall through the cracks. That is exactly what we want to avoid. Sustainability has to be built in from the start,” expressed Dr Azra Fazal Pechuho, Minister for Health & Population Welfare, Government of Sindh.

The symposium's technical sessions covered the development of clinical guidelines across all 62 EPHS interventions — translated into Urdu, English, and Sindhi — as well as costing analysis, provider behavior-change initiatives. Speakers noted that the district's Public Financial Management training and Service Coverage Index surveys have laid groundwork for accountable, evidence-based scale-up to other districts in Sindh.

According to Dr Sameen Siddiqi, Professor, Department of Community Health Sciences, AKU, “over the past two years we had multiple learnings with regards to training and capacity enhancement, information system digitization, community engagement, and costing of services that can guide how EPHS can be implemented elsewhere in Sindh and in Pakistan. This serves as a model of how stakeholders can work together to close persistent gaps in essential care and lay down the path for Universal Health Coverage.”

The symposium also featured remarks from Dr David Wilson from the Gates Foundation, and Mr. Javed Jagirani, CEO of PPHI Sindh, alongside representatives from UNICEF, WHO the World Bank, US State Department, and Sindh's Department of Health.