“YES, your child is eligible for the measles vaccination. Your information is correct, the vaccine is free, and provided by the government’s immunisation programme. Is there anything else you’d like to know? Take care of yourself. Allah Hafiz.” This was a telephone operator responding to questions on routine immunisation.

In the second booth, another operator was telling a mother from district Khairpur in Sindh that the vaccination team would not visit her at home, as this wasn’t a polio campaign. The mother would have to take her baby herself to a health facility for vaccination. Assembled in a hall, these 20 young boys and girls — referred to as ‘call agents’ — were busy responding in Urdu, English and Pashto to callers’ questions regarding routine immunisation, on the government-run helpline ‘Sehat Tahaffuz’.

Calls are initially answered by first-line agents, who obtain the basic information and handle general queries about vaccines in routine immunisation, campaign dates, complaints and vaccine registration. They then transfer the technical calls to doctors, who answer queries related to vaccine eligibility as well as any complaints of adverse events following immunisation.

A trusted source of information, the ‘Sehat Tahaffuz-1166 Helpline’, functioning under the aegis of the Federal Directorate of Immunisation, is the only national-level platform interacting directly with the public to address emergency concerns and respond to questions. Parents call and seek guidance if their child is showing symptoms of any vaccine-preventable disease. Highly confidential conversations between qualified doctors and parents help promote confidence in the immunisation programme and reduce vaccine hesitancy and refusals.

The call agents go beyond giving remedial advice.

Launched in November 2019, the helpline was originally a part of Pakistan’s Polio Eradication Initiative and was meant to bridge the gap between the public and the vaccine programme by addressing concerns about polio and essential immunisation, sharing basic information and providing medical guidance.

In February 2020, a new health emergency in the form of the Covid-19 pandemic demanded the use of call centre services. It was then that the Ministry of National Health Services, Regulation and Coordination decided that the scope of the helpline would be widened to disseminate information about Covid as well as address callers’ concerns about the infection. The next month, Helpline 1166 was made toll-free to facilitate callers; the volume of calls increased dramatically from approximately 9,000 calls a day in 2019 to over 50,000 calls from March 2020 onwards.

The first two waves of the coronavirus outbreak proved a tough challenge for the helpline operators who attempted to reduce the panic among the public. In those tense days, 1166 was the only public communication channel available to the public vis-à-vis the virus. Agents advised patients experiencing mild symptoms and guided them when it came to testing, isolation, medicine, food, remedies for managing the condition at home, etc.

In some measure, this may have helped reduce the burden on the healthcare delivery system, especially when hospital bed occupancy exceeded capacity and patients were unable to get admitted in a healthcare unit. With medical advice from 1166 doctors, these patients’ caregivers were able to manage their symptoms at home.

After the flattening of the coronavirus epidemiological curve, human resource was rationalised. Today, supported by 85 first-line call agents and eight doctors, working in two shifts, the helpline is operative from 8am till 12 midnight, in three languages — Urdu, English and Pashto.

Mothers from underserved areas, where access to qualified doctors is difficult, call and ask questions related to their own health as well; they are able to speak to a medical doctor completely free of cost as it is a toll-free helpline.

During last summer’s floods, there were calls from affected areas where women and families did not have access to a health facility or qualified doctors, and needed information from a trusted source. However, some don’t call for health reasons. Operators feel these persons just want to be heard. “So we try to be patient listeners.”

An important responsibility of the helpline is to build public trust and address misconceptions. In this regard, the interpersonal communication skills of the call agents are built up in a way so that the public can openly share their concerns.

However, often their role is not so much remedial as soothing — to calm callers’ nerves, whether it is a Covid-19 patient struggling with depression or a worried mother cut off from a functioning health centre. One of the doctors shared that the most rewarding thing is “when callers thank us with heartfelt prayers after they have completely recovered with the help of our advice”.

The writer is a journalist.

Published in Dawn, April 29th, 2023