In 1985, the Community Health Sciences Department at the Aga Khan University in Karachi, initiated the Urban Health Programme (UHP) with the intention of introducing a Primary Health Care model in the various squatter settlements across Karachi. This was accomplished in collaboration with communities, District Health Organizations, Urban Health Organizations, and union councils. Rehri Goth is included as one of the field sites. Each site includes a Community Management Team (CMT), which consists of community leaders (men and women), volunteers, school teachers, religious scholars and local health care providers such as traditional birth attendants. Community participation is encouraged through priority setting exercises with the CMT to identify health and developmental needs of the community that require immediate intervention. This promotes ownership and empowerment of community members. Management and accounting training is also provided to CMTs so as to build their leadership skills and allow these teams to run the project as their own. Community mobilization is then further enhanced through the provision of training and capacity building. Women are selected from the communities to be trained as Community Health Workers (CHWs). These are volunteers who are trained to provide basic preventative, dispensary and referral services.

Health care facilities have been established in these squatter settlements, as identified by CMTs and local government representatives. These facilities provide basic preventative and curative services on a private, free-for-service basis so as to maintain sustainability of the program. Services provided include immunization, antenatal and postnatal care, and family planning as well as those directed towards malnutrition and anemia. A referral system has been established to secondary and tertiary (both non government and government) facilities nearby. As part of health promotion and disease prevention, health education is the hallmark of the Urban Health Programme. Sessions are conducted by UHP staff and trained community volunteers to the community both at the facility and on an outreach level on various health topics. As Primary Health Care also includes rehabilitative services, a rehabilitation center has been established for disabled children at the field sites. Additionally, physiotherapy services are also provided for those with muscular-skeletal disorders.

As community development is inter-related to health and a component of comprehensive Primary Health Care, various developmental programs have been established by the Urban Health Programme so as to improve the quality of life of people living in squatter settlements. For example, adult (especially women) and children literacy programs have been organized with the assistance of CMTs. Other initiatives include micro-credit loan schemes, income-generating activities, and development of an adequate sewage system. For these developmental activities, UHP has been networking with various government and non-government organizations.

This program has recently been a first prize recipient of the Talloires Network MacJannet Prize for Global Citizenship on June 6, 2009 at Talloires, France. "The MacJannet Prize for Global Citizenship recognizes exceptional student civic engagement initiatives based in the Talloires Network member universities around the world and contributes financially to their ongoing public service efforts."

After visiting the Rehri Goth site of the Urban Health Program, my colleagues and I came to the realization that this program has achieved noteworthy milestones, especially since it was initiated from scratch with our a previous foundation to work on. Additionally, the cultural and religious barriers that had to be encountered and solved, with the communities of course, was no easy task. Therefore, it is no wonder that further areas of improvement were identified. For example, the immunization program runs only once a week at the health care clinics and once a week on an outreach level. Additionally, only one worker conducts the immunizations but she too has to travel far distances in order to obtain vaccine supplies. A comprehensive model of Primary Health Care would dictate the implementation of a routine vaccination schedule every day of the week. Due to several material, money and manpower resource restrictions, this is difficult to achieve. Community members need to be mobilized and trained as vaccinators in order to increase the human resource power, especially since the catchment population of only one field site is 40,000. Emergency Obstetric and Neonatal Care (EmONC) is not provided and communities rely on the referral system to secondary and tertiary health facilities for emergency care. These facilities are usually far away and families cannot afford transportation. Therefore, it is imperative that we train traditional birth attendants residing in communities so that they can conduct safe delivers and recognize obstetric danger signs so women can seek health care efficiently and effectively.