Stories

On Day 4, participants were involved in at the refresher training.

Under the “Women economic empowerment through disaster resilience approach, Sindh Province Project, a four days refresher training on “Sexual Reproductive Health(SRH) and Gender Based Violence (GBV)” of a theatre group was conducted in mid-March of this year. The first training of its kind was conducted in the start of the year when project was initiated. The objective of the refresher training was to enhance the group’s performance skills, dramatisation techniques and develop a thorough understanding on the topics of SRH and GBV to better represent them on stage. Exercises to improve confidence levels and adaption of more audience interactive methods were also practiced in the training to increase audience attention and performance impact.  It also aimed at prioritizing and highlighting the topic related issues to further build awareness among rural communities to change rigid mindsets.

Yousuf Dominic, a specialist consultant at Community World Service Asia, facilitated and lead this refresher workshop. Yousuf has an extensive experience of 22 years as a consultant trainer on various capacity building programs including gender equality, social mobilization and sexual reproductive health.

Before the start of this four day workshop, Yousaf had scheduled one whole day visiting the project field sites to observe the existing social and cultural gaps and to take note of field level operational issues. Ways to address the points noted during the field visit were carefully incorporated in the session plans of the workshop.

The training commenced with a brainstorming session in participation with all the theatre performers. At this session, Yousuf shared his findings and gave his feedback on the observations brought back from field. “I was glad to see the hard work and dedication the performers put in their work. However, more work needs to be done on early childhood marriages, health issues and women protection policies through more informative dialogues.” Yousaf emphasized on the importance of conducting social mapping in order to develop a clear understanding on common issues existing in the communities.

Thus, a social mapping exercise was carried out where participants were divided into groups. Each group identified various issues in their respective communities and the reasons behind their being. Each group then developed solutions for the issues identified and shared their proposed strategies with the others. This effective group activity allowed the participants to jointly identify five key issues, which were common among all communities:



  • Women harassment

     

  • Early child Marriage

  • Women ignored in decision-making

  • Girls Education

  • Restrictions on women

Through this training, performers were enabled to write stories and performance scripts on the issues of sexual reproductive health and gender based violence through group exercises and thorough discussions. After evaluating the stories shared by the participants, Yousuf expressed the importance of authenticity in writing stories and representing real life examples. He further elaborated that performers may work on stories through social mapping and prioritize their issues and develop more needs based stories which would have more impact and relativity for audiences.  In addition, Yousaf clarified, “Stories must have a clear introduction to the audience on the basic parameters and a very tangible reason, so that a positive and effective message is conveyed to the crowd.”

A story/show script was fully developed in the four day training through social mapping exercises. The participants wrote their dialogues keeping in mind the sensitivity of the issues. A final theater show was performed on the last day of the refresher training. Participants developed a comprehensive understanding on characterization and role plays during theatre shows.  Their story and script skills were enhanced and specific capacity was built on plot construction and characterization. All participants were then awarded certificates for their contribution, commitment and participation.

A group photo of Community World Service Asia Jhuddo staff with the delegation of Sindh Agricultural University.

A group of 37 students of the Rural Sociology Department, Sindh Univeristy, accompanied by senior professors and chairman of the Rural Sociology Department (RSD), visited Community World Service Asia’s Jhuddo Office this April. The purpose of the study tour was to orient students on the working methodologies and policies of humanitarian organizations and NGOs’ and the role and structure of Community Based Organizations (CBO). Something different from the usual theoretical classroom learnings at the RSD, this exposure tour was designed to familiarize students with the different cultures and living patterns of rural communities and provide them with a practical learning experience.

Ashar Nasir, Project Manager at Community World Service Asia, along with other staff, welcomed the group of students and faculty members at the local office. An introductory session, on the organization and its various projects and thematic areas, kick-started the exposure visit for the eager guests.

The group first visited Fazal Wadho village; one of the targeted villages of Community World Service Asia’s Promoting Sustainable Agriculture project in Badin. Participants were welcomed by members of the Community Based Organization (CBO). Mohammad Hassan, community representative of Fazal Wadho village, gave a detailed presentation on the village profile and its’ previous and existing initiatives with different organizations. He also briefed the participants on the history of the CBO’s  formation, its objectives  and their role in local development. This was followed by a question and answer sessions in which a student asked about the importance of CBOs at a community level. To his response, it was shared that CBOs bridge communication and networking gaps between feudal lords and higher officials and the local community people. The CBOs also amplify the voices of the  village people on local issues and together with concerned departments develop resolutions to those issues.

Community World Service Asia’s role, through their various Food Security and Livelihoods projects in the area, in forming the CBOs and VOs and equipping them with necessary resources and knowledge, was highlighted. The students and their faculty were told about the role the women of the community are playing in being trained on Nutrition and Kitchen Gardening to develop balanced nutritious diets for their families and themselves through the Sustainable Farming project in Badin. Many other field experiences were shared with the group, including the exposure visit to Sindh Agricultural University where the women project participants actively observed the workings of different departments. They also shared their experience of participating in the Farmers Festival which displayed their home grown vegetables on sale stalls and connected them with local retailers.

Dr. Ghulam Mujtaba Khushk, chairman of RSD, appreciated the efforts of the CBO in local development. He appreciated the informative and effective opportunity given to the students and the faculty members; increasing their knowledge and learning in relation to the different practicalities of rural life and how people of various local communities are being involved to build a sustainable livelihood together. The students and faculty members learnt about project implementation, project planning and social mobilization. Concluding the visit, Dr. Ghulam Mujtaba presented an appreciation letter and a shield to Community World Service Asia Team for their commitment and contribution to the communities.

Improving the capacities of education officials on monitoring and evaluation (M&E) skills contributes directly to the quality and accountability in reporting on education. It also impacts the expectations of schools and teachers that are held accountable for sub-professional behaviors, such as absenteeism.  Improved M&E systems would also support better reporting and would lead to improvement in information available to relevant decision-makers. To refine the existing system, a Monitoring and Evaluation (M&E) Training was conducted in Nangarhar Province, Afghanistan end of March this year for Provincial and District level education directorates. A total of 20 participants (men) attended the informative training at the Community World Service Asia office in Jalalabad.

Education officials in Afghanistan undertook joint monitoring visits to schools that are part of Community World Service Asia’s Girls Education Project to observe teacher trainings, classroom instructions and school-based civil education camps. In addition, they received coaching on appropriately utilizing M&E tools and on developing a comparative study of M&E systems run by other professionals in different fields.

The participants were trained on the difference between Monitoring and Evaluation processes and how to conduct an effective monitoring visit to thoroughly observe the teaching process of school teachers and the management system of school principals. During the training, the participants were engaged in various group activities where they developed monitoring and supervision plans and ways of using existing forms and formats of the Education Directorate for monitoring purposes, providing feedback and recommendations. Sessions on conflict resolution further modified the participants’ role in conflict management, if any existed in the schools.

Schools and teaching environments will benefit greatly through the commitment of effective M&E staff provided they are well equipped with knowledge and necessary skills in the said field. The monitors efficiently conduct visits and provide teachers and school management with good and constructive feedbacks and recommendations in order to improve. Furthermore, the regular visits of M & E officers will ensure systematic school management processes. The teachers’ teaching methods are observed to assure that new methods learnt from trainings are implemented rationally; existing gaps are identified and further improved accordingly. These trainings are vital as it enhances monitoring systems in the Ministry of Education and fulfils the aim of ensuring quality education within the targeted schools.

A stall showcasing antiques and cultural shawls which attracted many people at the festivals.

The Sindh Culture and Tourism Department organized a two-day “Thar and Parker Festival” at the historical Umerkot Fort from the 24th – 25th of March. The various arts and crafts of the culturally rich Thar were put on display on a number of stalls at the vibrant festival. Apparel, rillies, handbags, fancy clutches, jewelry and other handmade crafts were on display and for sale. The entertaining event featured cultural activities such as camel and horse races, folk musical concerts and standing stalls of delicious local food.

The festival was inaugurated by Syed Sardar Ali Shah, Minister of Culture and Tourism in Sindh. “This festival will show the more beautiful facets of our rich desert which has formerly remained hidden as the region has predominantly been known for its natural disasters and subsequent deaths of children,” announced Mr. Shah. He added that such events will bring back harmony and a cultural spirit to the region which has suffered consistently in the past. Dost Mohammad Rahimoon, MPA Sindh, also present at the inauguration ceremony added, “The festival will provide a forum to people to showcase their rich culture and traditions for the entire world to see.”

Local artisans of Umerkot, along with Community World Service Asia staff, participated at the event, showcasing and promoting their handicrafts from Umerkot and Thatta. A range of products including casual apparel, jewelry and other home accessories produced under the brand “Taanka” were exhibited for sale at the festival. A large number of people visited the stall and watched the artisans hand make some of the products “live”. Syed Sardar Shah, also paid visited the Taanka stall and appreciated the quality work of the artisans that stood out among the many stalls at the festival.

Women from near and far villages, attended the event and were very happy to see a large variety of cultural apparels and antiques at the stalls. Families enjoyed tableau and the many music and theatre shows being performed by local communities and theater groups. Folk musician sang and entertained audiences at the festival for hours and received much applause and cheers. The festival ended with sparkling, large fireworks on the second day, lightening the lives of the people of Thar with color, happiness and celebration.

A walk was commenced to observe Health Day at Rural Health Center, Hyderfarm.

Community World Service Asia is provides medical care with a focus on maternal, neonatal and child health (MNCH) through supporting three Rural Health Centers (RHC) in Umerkot since 2015. These health centres provide healthcare to the most vulnerable communities affected by recurrent natural disasters, disease and poverty. The primary aim is to provide medical care through curative and preventive services while adopting a community-based approach by ensuring participation of village health committees and government health department.

The MNCH team organized World Health Day on 7th April at the RHCs in Umerkot in participation of a large number of community members from catchment area, government health staff of each RHC and professionals from NGOs and Civil Society Organizations. The main focus of the day was the topic of “Depression” which was the universal theme of this international day globally. Attention was also given to other more common health issues in the area such as heatstroke, diarrhea and anemia.

Depression is one of the many results of poor health, poverty, economic and social injustices and power imbalance prevalent in the rural society. The main purpose of celebrating this day was to raise common public awareness on various health issues and to sensitize the community and paramedic staff on mitigating the health problems common in the community through self-care and knowledge building.

Topics discussed on World Health Day in Umerkot:


  • To increase public awareness regarding various causes and preventive measures of depression

     


  • To provide detail knowledge of getting prevented from various diseases including diarrhea and missiles.

  • To encourage most vulnerable groups of people to frequently and regularly checkup the women during pregnancy in MNCH Centers.

  • To promote self-care among people of rural area.

  • To motivate the paramedic staff to make their efforts in providing health facility to vulnerable community of the catchment area of all three RHCs.

Medical Superintendents (MSs) of each health facility, health committee representatives, community activists and project staff gave orientations to the community members including men, women and children, on the major causes, prevention and mitigation of depression, heatstrokes and diarrhea. They imparted key messages on good health that aimed to enable men, women and children to lead healthy and productive lives and continue being of valuable existence in lives of their families and communities.

Rural healthcare lags in quality, affordability, and accessibility for several reasons. The main problem faced by health authorities in this regard is lack of awareness. One of the major reasons for such a deplorable state of health in these areas is the lack of health facilities. The establishment of health centers is ensuring better health and is supporting an improved standard of living for the people of rural Sindh.

“Daughters have always been preferred in our family, unlike other families in the village. My husband and I have never given priority to our two sons over our two daughters. We love all of them equally,”

said Hurmi, a resident of Haji Chanesar village in Umerkot. Hurmi is the Vice President of the Steering Committee of the village and a gender activist in the area.

“My first child was a daughter. Normally in our community, daughters are considered as burdens and families are not so happy when a girl is born. But the case was different at our home. I am lucky to have a husband who loves daughters more.”

When the skills development center was set up at Haji Chanesar Village, Hurmi helped identify artisans who were most in need of a sustainable livelihood. Later in the project stage, a steering committee was formed for which Hurmi was nominated as Vice President by the unanimous vote of the artisans themselves.

“After the Community Management Skill Training, the Steering Committee was well equipped with knowledge on how to manage communities and resolve their issues and conflicts. As the Vice President, my role was more influential as many expected me to bring change in the rigid traditions we have been following for years.”

“The center brought countless benefits to women and girls in residual and nearby villages. They used to work in the fields in the season of cotton picking. Parents of young girls felt insecure sending their daughters to the fields, as they worked under the scorching sun and the bushes and thorns would tear their clothes or injure them. The center serves as a shadow in their lives. We encouraged the men of our families to send their wives, sisters and daughters to the center without a worry as the environment is safe and secure. Women in our area now work without worrying about traveling long distances while carrying heavy crops on their heads.”

As a dedicated member of the Steering Committee, Hurmi worked actively for the well-being of her fellow villagers. Recognizing her consistent efforts and dedication, Hurmi was selected as a participant of a ToT for Gender Activists.

“When I joined the Gender Group as an activist, my in-laws and neighbors discouraged me saying such activities for women were not part of our culture and it was not right to let women and girls talk so boldly on sensitive issues. My husband on the other hand, supported me strongly. He motivated me to work as a gender activist and change the mind-sets of the people who did not allow their daughters to grow socially and economically,”

reiterated Hurmi with a confident smile.

“When I started working as a gender activist, I realized that the people in these rural communities are still living in a backward world, where caste difference was a firm way of life. One of the reasons for some families to not send their daughters to the skills center was the issue of caste difference. They could not allow their daughters to sit with women belonging to a lower caste than them. They also believed that sending their daughters to the skill building center will bring dishonor to their traditions and cultural values,”

narrated Hurmi disappointedly,

“We conducted gender awareness sessions. We also led sessions to individual households to have a direct impact. Girls in our village started to go to school and early childhood marriages started to decrease.”

“Recently, a 16-year-old girl was getting married in our village. Our gender activist group visited the household and briefed the family about the problems young girls face in early marriages. When the girl’s in-laws (to be) came to schedule the wedding for February 23rd, the father of the 16-year-old refused instantly. The in-laws were furious to see his reaction. The daughter’s family called us to talk to the in-laws and explain the disadvantages of early childhood marriages to them as well. When the in-laws were also enlightened on the subject, they too understood and postponed the marriage to three years later. It is not just about one change in one house. People have started to think over many rigid traditions followed by us for ages as a result of these awareness sessions.”

“There was another instance of a man named Mohan. His wife, Dhai, was very disturbed as Mohan use to drink a lot. He used to waste his earnings on buying alcohol. He did not even spare Dhai’s minimum wage which she earned through stitching and agricultural work. He even hit Dhai when he was drunk. He once hit her with a small axe while he was drunk. He also used to beat his children. We tried to talk to him but he did not listen. So, we went to a doctor to talk about Mohan’s condition. We requested the doctor to scare Mohan by lying to him, stating that his health is weakening. When Mohan fell ill, the doctor came to Mohan and stated that he has cancer. Mohan got so scarred that he stopped consuming alcohol himself. Mohan has not been drinking since three months now. His wife is very relieved as he does not hit her or her children as his mental state has now improved. He does not waste money on drinking now and is more calm and caring towards his family. Yesterday, our steering committee held a meeting with the villagers. At the meeting, Mohan informed us that he has quit smoking as well. His wife is very happy now. Everybody in the village is curious to know how Mohan has changed so much.”

It is important for women to participate proactively for work on gender equality as only women can understand the problems of other women well enough. They will work towards resolving issues in a more realistic and practical manner.

“Women easily communicate their issues to us. I am happy when I help others to live a better life, especially when daughters are treated well. Now that we have been given a chance to live a better life, we must walk forward together to build a progressive society instead of letting each other down. I wish to see an all girls’ educated and equality based society”

Improving teachers’ skills and knowledge is seen as one of the most important investments, of time and resources, that local, state, and civil leaders can make to education.

“The Teachers Training and the Master Teacher Training conducted by Community World Service Asia, was a new experience of professional development for us. With its focus ranging from classroom processes and structures to teachers’ personal and teaching traits, it taught us a lot. It was a learning opportunity for us teachers that was explicitly aimed at enhancing teaching skills and increasing student achievement,”

 expressed Hameeda Memon, a 42 years old teacher at the Government Girls Primary School, Civil Hospital, Thatta.

Hameeda has been teaching for 23 years and has always been passionate about teaching.

“I was not familiar with the various teaching methods I learnt at the training. Our students have mostly been engaged in mindless memorization. The lessons were not properly understood and the students studied enough to achieve passing marks only.  I wanted the students to enjoy their work but was unable to encourage them towards building interest in academic books,” added Hameeda, “In the teachers training, we were taught various theories and methodologies like students. We were the students this time. Morning meeting exercises and role play activities were conducted. We engaged in group activities and learnt how to develop low and cost no learning material. All this involvement through the interactive exercises increased our interest in teaching. That was when I realized how important it is to engage students in practical activities like these to keep their minds and bodies fresh to comprehend lessons better and achieve greater outcomes.”

Sessions on Gender education and Health Hygiene and Environment were the most informative and appealing content for Hameeda.

“It was the first time for me to learnt about these topics. We all were aware of the terms but we never studied them in our context. I now believe that these topics should be included in the curriculum to increase student’s knowledge on it as well. Teachers’ should emphasize on gender education and hygiene like they do on discipline and class work.”

Hameeda feels more confident and prepared about our classes after receiving the training.

“The Master Teacher Training was more about teaching methods and adult learning. It focused on planning and reporting skills of teachers for better class presentation and school management. These trainings have influenced our classroom practices significantly and have lead to improved student achievement. Zia, a student in my class, was very weak in her studies. She rarely spoke in the class and had difficulty in understanding her lessons. After the morning meetings and role plays, she started to speak up and participate in conversations. Today, she sits in the first row of the class and manages the black board and charts displayed in the classroom. Likewise, I have given other students certain responsibilities for classroom management. This ownership has motivated students to be more attentive.”

“Learning is a continuous process; more learning leads to better results. Even as teachers, we have a lot to learn and there is always room for improvement. If we are trained, we will deliver our lessons efficiently and more effectively, with the result being, our students benefiting in the long run. In addition, the reputation of the school will improve and the enrolment of students will increase. It’s a cycle of improvement at every stage. That’s why trainings like these should be an on-going process,”

concluded Hameeda with a positive attitude.

Hasan of village Fazal Wadho, participant, expressed, “We were wasting valuable natural resources, but now I will utilize these resources for sustainable agriculture practices.”

An exposure visit of sixty farmers from Badin, Sindh, to the Central Cotton Research Institute, Agriculture Training Institute and Wheat Research Institute was conducted and facilitated in Sakrand last week of March under the Promoting Sustainable Agriculture Farming project supported by Canadian Foodgrains Bank (CFGB).

Mr. Muhammad Yousaf Channa, coordinator and senior Instructor for the Integrated Pest Management (IPM) unit at Agriculture Training Institute in Sakrand, facilitated the visit along with Community World Service Asia staff. The participants were welcomed by Dr. Abdul Waris Sanjrani, Director,Central Cotton Research Institute (CCRI).

The CCRI is engaged in multidisciplinary researches conducted in the field of Agronomy, Plant Breeding and Genetics, Cytogenetics, Entomology, Plant Pathology, Plant Physiology and a newly established section, Transfer of Technology. Since its inception, the Institute has successfully evolved considerable number of high yielding cotton varieties at required fiber qualities. Abdullah Keerio and Saira Bano, Scientific officers at the Institute, introduced production technology to the participants. Shah Nawaz Khoro, Senior Scientific Officer, explained Cotton Insect pests. A documentary was also screened showing the cotton production technology.

Abdul Wahab Soomro and Vishandas Suthar, also Scientific officers at the Institute, facilitated the participants through their visit of the greenhouse placed with parental genes of cotton plants imported from various countries for development of further progenies. The Glass house was another visiting site in the location where cotton cultivars were planted in winter in controlled environments to save the time required for evaluation of new variety. The participants were amazed to visit the Cold Room where decades old cotton seeds are preserved.

At the Agricultural Training Institute (ATI), the group of visiting farmers was welcomed by Dr. Ghulam Mustafa Jamali, Principal of the Institute (ATI). The farmers were briefed about the integrated crop and pest management process and systems by the coordinator at ATI and experienced new procedures of organic backyard gardening, compost making, optimum use of available waste resources for more productive plantation and innovative methods to measure soil moisture. At the Wheat Research Institute, Dr. Kareem Bux Lagari, briefed the participants regarding the varieties of wheat grown in experimental fields and demonstrated how different strains and wheat are developed. The farmers then visited the demonstration field where production technologies were functioning and lastly to the Wheat Museum where a large variety of wheat was on display.

The Sindhi farming community is very apprehensive about the current cropping season. They are looking for best suitable crop varieties in accordance to the soil composition and the changing climate. Previously they use to purchase any variety of plant to yield but these exposure visits have made the farmers more aware about seed selection and crop management as per changing seasons. Moreover, the farmers are now planning to use waste material for crop and vegetable production. One of the participant has already started making compost from the waste material and is planning to go for ridge sowing in the following wheat season to collect a good yield.

World Health Day provides an opportunity for the global community to come together to focus on interventions and actions that lead to improving human health. Every year an important issue is highlighted. This year WHO says “Depression: Let’s Talk”. Community World Service Asia has been working in Pakistan and Afghanistan’s health sector, providing assistance to the poor and marginalized since 1993. To bring healthcare to the poorest of the poor, Community World Service Asia has become an organization that empowers people and communities to eliminate injustices through integrated efforts in health, education and development. We have provided basic healthcare services that have directly facilitated 99,709 patients. Today in celebration of World Health Day 2017, we tell you a moving story of one of these patients and her recovery from a common, yet most under-estimated, mental illness- depression.

Abida, daughter of Gulajan, is a 35 years old widow from Shamoram village of Alishang district in Laghman Province.

“I am a widow and mother of five children. My eldest daughter is just 17 years old. My husband was a policeman and the sole bread earner for our family. He did not earn much but we were a happily bonded family.”

Abida gets upset even today as she mentions the ill-fated day that turned her blissful life around.

“I was baking bread when I heard a crowd of people moaning outside our house. Some men were carrying a chaarpaai (wooden bed) with a body lying on it draped in a white cloth. It was my husband, Shaihdullah! I fainted instantly when I saw him lying lifeless.”

Her husband died while he was at work where he was killed in a terrorist attack.

Abida now lives with her father-in-law who is an aged man and unable to support their family.

“I lost quite a lot that day; my husband, caregiver, father to my children, a supporting son of an elderly father and the only income bearer of the household.”

Abida’s father provided financial support for healthcare expenses and with purchasing clothes for her children occasionally.

“After my husband’s loss, I was terribly broken. I use to have body pains and felt weak most of the times. I used to spend hours thinking about the future of my children without the support of their father. I was unable to sleep as well which was deteriorating my health.”

Abida’s father-in-law had to take her to Gamba clinic which was at an hour’s distance from their hometown. This was time consuming and expensive.

“The doctors there prescribed painkillers but it was only giving me short term relief. I could not consume painkillers at all times as it was not curing my problem. I was trying very hard to adjust but every passing day was becoming difficult to survive for me.”

“One day, I was very depressed and could not stop crying. My brother then took me to the doctor. After explaining my condition to him, he prescribed some medicines for stress relief and advised me to visit him weekly. But due to financial constraints, I was unable to visit the doctor regularly as it was expensive and I had to travel a long distance for which I needed my father or brother to accompany me. I did not want to worry them again and again as they had their own responsibilities to handle.”

Abida then found out about the MNCH established by Community World Service Asia in Shamoram village. This was quite a relief for her.  She hesitated to discuss her issue when she initially visited the MNCH.

“The female staff at the MNCH was very friendly. Looking at my condition, the midwife knew something was wrong and that I was not telling the whole story.”

Abida shared her troubled story and the anxiety she was experiencing. She elaborated on how her bad health was effecting her children and family.

“The midwives listened to me patiently as I let my heart out to them. The doctor then prescribed stress relief medicines and advised to visit the MNCH on a weekly basis.”

Abida visited the doctor as prescribed as the MNCH was not far and easily accessible. She did not need her brother or father in law to accompany her to make these visits and regularly went on her own.

“The women staff at the MNCH provided good counselling. I continued my treatment for almost seven months on a regular basis as suggested. Now I can confidently say that I am a healthy mother taking care of my children and father-in-law. Bad times come and go; we have to stay strong for the people who are with us today.”

Since her treatment, Abida had visited the MNCH for health assistance for her children. Abida, along with many other community members of Laghman villages have benefitted from the services provided at the health centers established in Pakistan and Afghanistan. Rural communities residing in remote areas are vulnerable and unable to avail healthcare services easily. The establishment of the health centers in remote areas are providing basic healthcare facilities which have turned many lives around for the better.

Health & Hygiene session in the catchment area of RHC Dhoronaro.

According to the Pakistan Demographic and Health Survey (PDHS), 2012-13, maternal and child death remains a major concern in Pakistan. In the provincial public sector, health services are provided through a tiered referral system of health care facilities; with increasing levels of complexity and coverage from primary, to secondary and tertiary health services. Primary care facilities include Basic Health Units (BHUs), Rural Health Centres (RHCs), Government Rural Dispensaries (GRDs), Mother and Child Health (MCH) Centres and TB centres. Most of these public health facilities lack the provision of a broader range of preventive and curative health services.

Community World Service Asia conducted a baseline survey in first year (2015) of its health project inception in Umerkot and these are the major findings of the study:

  • Very few, small private clinics operational in some villages of the targeted Union Councils. These clinics are not affordable for most of the community members (selected in the sample size) as they have low monthly incomes, with an average of only PKR 8733
  • According to 91.7% of the respondents, there are no antenatal services. 99% of respondents replied that there are no postnatal services. 5% reported the absence of delivery services whereas 96.1% reported the absence of family planning services
  • 100% of respondents replied that there are no women medical officers available at the health facility, whereas, 76.5 % reported the absence of Lady Health Visitors (LHVs) in the health facility. A 99.5% and 81.4% responded positively to the presence of male doctors and Medical Technician (MT) respectively
  • 5% respondents raised the need for a presence of medical staff to improve health services in the area
  • 8% respondents raised the need for provision of essential medicines, whereas 37% believed that the provision of 24 hours emergency services were essential to improve the quality of services
  • 2% of the respondents believed better infrastructure and cleanliness of health facilities were key to further improving the overall health services of the area

What is the project doing?

After analysing the results of the baseline survey, three Rural Health Centres (RHCs) were set up by Community World Service Asia, with the support of Act for Peace. All three of these RHCs are functioning with a focus on delivering primary healthcare services in the district of Umerkot.

The health facilities established, have deployed Female Medical Officers (FMOs), LHVs and Medical Technicians in their centres at Hyderfarm and Nabisar Road along with providing medicines. In RHC Dhoronaro, a lady doctor sits in shifts and rotationally visits the centre as well.

The social mobilizers, under the project, have formed two Health Committees in addition to the existing six committees formed last year. An advocacy forum has also been developed at district level to address emerging health issues. The village Health Committees and advocacy forum consists of eight to ten members including both men and women activists from the community, who are responsible to facilitate and support health services provided under the project. The village Health Committees meet monthly, with facilitation of the community mobilizers, and share their committees’ progress, problems and challenges and plan for the next month. A total of eight village Health Committees and a district health advocacy forum are running actively and meet regularly at the health facility. They conduct joint meetings in the villages on a fortnightly or monthly basis to discuss the pertaining issues regarding health and other community based problems. These meetings are properly documented and shared with the project management team. The discussions of these meetings are recorded for further planning, improvement and implementation of the project activities.

Clinical support is also given at these curative and preventive RHCs with focus to Maternal, Newborn and Child Health (MNCH) services. These services are delivered by women health staff comprising of FMOs and LHVs along with two medical technicians and one male and one female social mobilizers. The main focus of the services is on reproductive health of women of childbearing age.

Recognizing maternal, neonatal and child health care as a major component of the health services, the project team provides antenatal and postnatal assistance to local women.  Complicated cases are referred to the secondary level health care facilities in the area. The MNCH services at the RHC focus on continuum of care including family planning, pre-pregnancy, pregnancy, labour and childbirth, postpartum, newborn care, and child health and support high-impact, evidence-based interventions that saves lives.

Health education sessions are being conducted for men, women and children at the health facilities, in the surrounding villages of each RHC and at schools. Major topics on health education, such as Personal Hygiene, Family Planning, Reproductive Health, Hepatitis, HIV/AIDS awareness, Importance of Breastfeeding and Safe Drinking Water, with emphasis to prevalence of the disease, have been included in the IEC materials developed for building the knowledge of the communities.  Through general OPD, patients are treated and facilitated along with being provided necessary medicines.

The project team assessed the nutritional status of women and children under five, of all the three RHCs, through analysing their medical history, physical examination, and height to weight balance and various other parameters. The patients are then referred accordingly to different NGOs, providing nutritional care, based in the district. More complicated cases are referred to District Headquarter Hospitals of Umerkot and Mirpurkhas. Counselling sessions to malnourished, lactating and pregnant women are also provided. Children under the age of five are facilitated with de-worming medicines and family planning services are being provided to women by LHVs across the three healthcare facilities. The LHVs brief the women from these communities on the importance and benefits of family planning and the various, free of cost methods available for family planning at the health facilities.

What have we achieved so far?

The availability of services such as primary care, behavioural health, emergency, and public health services are a basic human right which must be provided to all. The project has worked towards providing this basic right and has achieved the following so far:

  • 12,156 community members provided with curative and preventive healthcare services
  • 11,307 individual have participated in health education sessions
  • 2,414 women provided with antenatal and postnatal services
  • 868 individuals have availed family planning services
  • 5,426 women and children were assessed for nutritional balance
  • 42 baby deliveries conducted at the health facilities
  • 25 delivery kits were provided to women as per criteria
  • Participation in seven coordination meetings with line departments, other NGOs and civil society organizations working at district level.

Community World Service Asia is implementing the project through its own staff, including two lady doctors, three LHVs, two Medical Technicians, two community mobilizers and a manager located in Umerkot. They are implementing the project with equally involving the Health Committees and District Advocacy Forum. The health team continues to maintain regular dialogue with the government line departments at the Federal, Provincial and District levels to ensure the efficacy and implementation of the program. Regular coordination meetings are held between key, district stakeholders including NGOs and civil society organizations.