In the bustling, often overlooked urban slum settlements of Karachi, change is taking place. Children who once faced the dual threats of vaccine-preventable diseases and malnutrition are now being reached by the Engaging Private Providers for Immunization-Integrated Services project—an innovative initiative that blends routine
immunization and nutrition services. Funded by the Gates Foundation, this project is made possible through a collaboration between the Expanded Program on Immunization (EPI) Pakistan, Government of Sindh Health Department, Aga Khan University (AKU) and local communities.
In 2022, the project was born out of necessity. Rapid increase in the mobile and migrant population in Karachi has led to an increase in densely populated underserved slum areas with lack of access to health care – especially preventive services such as childhood routine vaccination.
In 10 High Risk and five Super High Risk Union Councils (designated by the Pakistan polio program) across three Karachi districts where health care access was scarce and trust in the system low, families struggled to protect their children. This included four Union Councils in District East, one Union Council in Malir and 10 Union Councils in District West. However, by December 2024, the numbers told a new story: 144,563 children under two vaccinated, 68,861 screened for malnutrition, and a 76% drop in zero-dose children. Behind these figures lie countless small victories: a mother no longer fearing measles, a toddler regaining strength after malnutrition treatment and a community trusting health care workers.
The project’s success hinged on its dual approach. On one front, 33 service centers brought care closer to homes, with extended hours and trained private providers ensuring quality. On the other, local women—trusted voices in their neighborhoods—became champions for sharing information about immunization and dispelling myths. Digital campaigns and WhatsApp broadcasts amplified the messages,
delivering EPI information to caregivers. Nutrition services are part of this effort casting a lifeline for families. Screenings identified 4,629 moderately malnourished and 1,593 severely malnourished children. Through timely interventions, 568 children graduated to healthy weight, and 177 improved from severe to moderate malnutrition.
Dr Azra Pechuho, Sindh’s Health Minister, reflected on the project’s potential saying, “We hope to expand these efforts beyond Karachi to the rest of Sindh. Karachi was meant to serve as a pilot to generate data that could inform scale-up across other districts.” Dr Zahid Memon, Associate Professor from the Community Health Sciences Department at AKU and Project Lead believes that “This initiative proves that when the public and private sectors unite with communities, we can dismantle barriers to health care. By integrating immunization and nutrition services we’re building a resilient health ecosystem.”
At the recent Primary Health care Symposium at AKU, Dr Mukhtar Bharat, Minister of State, Ministry of National Health Services Regulations and Coordination, Government of Pakistan, referred to this project and praised partners such as the Gates Foundation for their provision of technical assistance and innovations for health systems strengthening: “The health sector cannot [alone] resolve the challenges it is facing.
There is a need for multi-sectoral collaboration to address the determinants of health for which multi-sectoral policies must be implemented.”
The project’s lessons are now part of Sindh’s Provincial and National Immunization Strategies (2025–2030), offering a roadmap to scale the model. For Karachi’s families living in urban slums, it’s more than policy—it’s a promise that their children’s health matters.
District Union Councils
East
Gulzar e Hijri
Safoora
Pehlwan Goth
Gujro 04
Malir Malir Cantt
West
Qasba Colony
Frontier Colony
Baloch Goth
Maymarabad
Yousuf Goth
Chisti Nagar 07
Islamia Colony 09
Mangophir 08
Songal 05
Moominabad
Districts and areas covered by this campaign
