The Atlanta Agreement was followed by an initiative taken by the Italian Social Partners for combating child labour in the surgical instruments industry, with the collaboration of the ILO and SIMAP (Surgical Instruments Manufacturers' Association of Pakistan) in Sialkot district. The project, titled Combating Hazardous and Exploitative Child Labour in Surgical Instruments Manufacturing through Prevention, Withdrawal, and Rehabilitation, was launched in 2000.

Over a period of two years, the project has contributed to the reduction of child labour in one of the country's major export industries. Under its direct action programmes, 1,496 children employed in surgical instruments production workshops have been provided non-formal education and pre-vocational training. Attendance in these programmes has resulted in substantially reduced working hours for the children. The education initiative has been complemented with action by the labour groups, particularly the All Pakistan Federation of Trade Unions (APFTU) and the All Pakistan Federation of Labour (APFOL). They have established contact with the target groups and concerned stakeholders and carried out a number of activities aimed at raising awareness about the child labour problem in the surgical instruments industry, and the need to address it. In view of the lessons learned and experience gained so far, the project has been extended into a second phase. In its second phase, the project has been expanded to cover larger numbers of children. Around 1,200 children, aged 14 years and below, working in the surgical instruments industry in Sialkot district, have been targeted to benefit from the project through the provisions of non-formal education, prevocational training and other support services. The second phase of the project was completed in June 2006.