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The Community-based Management of Acute Malnutrition (CMAM) Surge Approach is designed to enable health systems to effectively treat children diagnosed with acute malnutrition. The CMAM approach relies on the assumption that the number of children with acute malnutrition increases drastically at certain times of the year in many places. Low birth weight owing to poor maternal nutrition, protein-energy malnutrition, anaemia, and iodine deficiency are all major nutritional issues in Pakistan. Since 2013, Pakistan has been a part of the worldwide Scaling Up Nutrition (SUN) effort to address these nutritional issues. Sindh is severely affected by intensifying malnutrition and stunting indicators. As many as 48 percent children under the age of five are stunted while 35pc of them are severely stunted[1].

Aware of the rising rates of acute malnutrition among remote and impoverished communities of rural Sindh, the People’s Primary Healthcare Initiative (PPHI)[2] of Sindh, in collaboration with Community World Service Asia, conducted orientation sessions on CMAM Surge Approach for community-level implementation for early diagnosis and referral of malnourished children in Umerkot district of Sindh.

In June, awareness and orientation sessions on CMAM Surge approach were held in two villages of Umerkot where forty members (both men and women) of village level Health Management Committees (HMC) participated

The sessions focused on the CMAM Surge Model that seeks to improve the resilience of health systems to be able to deliver more efficient and effective medical and preventive treatment for acute malnutrition over time. The focus was on providing the best care during times when cases are at a peak and the need for health services to address these cases is the highest. The potential to save maximum lives is at its greatest then, while ensuring that the capacity and accountability of the public health sector is not undermined.

The CMAM Surge applies an eight step approach to assist health teams in responding to rapid changes in capacity and caseloads. The scaling up of CMAM Surge has resulted in additional learning and adjustments to the methodology that are context-specific. The sessions were facilitated by PPHI and along with thorough learning on the CMAM, nutritional plans, relevant reading material, referral slips and brochures were shared with participants.

In the last six months, 45 cases of malnutrition have been recorded at the MNCHs of Samaro and Pithoro as a result of insufficient food and an absence of a balanced diet. Participants learned about the prevalence of malnutrition and its causes, particularly among children. During the sessions, participants were made aware of the many different forms of malnutrition and how to prevent it. The importance of breastfeeding and consuming a well-balanced diet were stressed upon with participants. A practical exercise was also conducted where participants learned how to measure lactating and pregnant women and children using the Mid-upper Arm Circumference (MUAC) tape.

Learnings of HMC Members:

“I knew very little about malnutrition and the services provided by PPHI to alleviate malnutrition in Sindh. We learned a lot about identifying cases of malnutrition and when and how to refer them to doctors. I will now be able to check children for malnutrition and, if necessary, refer them to the nearest PPHI centre. I also learned that malnutrition is not a disease, but rather a result of human negligence, poverty, unsanitary conditions, and food insecurity. I will sensitise people in my community to maintain hygiene at home and their neighbourhood and provide a healthy diet to their children to avoid malnutrition.”

Chetan Kumar, member of Health Management Committee in Samaro

“The CMAM Surge Model approach is a great way to assist health systems offer treatments to children with acute malnutrition more effectively. Members of the HMC will be able to predict when seasonal caseload surges are likely to occur and will use this information to better prepare themselves for management of services during times of high demand. We were able to gain a thorough understanding of malnutrition, its causes, and how to prevent it. We are now better equipped to refer malnourished children to the nearest PPHI centre for treatment.”

Nabi Bux Solangi, member of Health Management Committee in Samaro

“We discovered that the MUAC is utilised to determine nutritional status of women and children. Because it is simple and inexpensive to use, we can efficiently apply it for active case finding. MUAC is an effective indicator of mortality risk associated with malnutrition, it is therefore a better measure to identify children most in need of treatment. The use of MUAC tape will allow me to immediately refer children with acute malnutrition to doctors in a timely manner.”

Lachmi, member of Health Management Committee in Samaro

“It was my first nutrition training session, and it was a great learning experience. Malnutrition awareness is critical in our community, and individuals must understand how to prevent it. The knowledge on malnutrition, its prevention, and the usage of MUAC tape will help in the mitigation of malnutrition in our village, Mirashah.”

Shanti, member of Health Management Committee in Pithoro

“We were not aware of PPHI’s nutrition program being operated in our vicinity. This session improved our knowledge of malnutrition and its many forms, as well as the use of MUAC tape and the referral of suspicious cases to the PPHI health centre for treatment.”

Sisliya, member of Health Management Committee in Pithoro


[1] https://www.dawn.com/news/1426604

[2] Footnote: PPHI Sindh is a not-for-profit company setup under section 42 of The Companies Act 2017. PPHI Sindh has focused on mother and child health and has continuously improved delivery coverage all over Sindh.

World Environment Day 2021

For too long, we have been exploiting and destroying our planet’s ecosystems. Ecosystem loss is depriving the world of carbon sinks, like forests and peatlands, at a time humanity can least afford it. Global greenhouse gas emissions have grown for three consecutive years and the planet is at one pace for potentially catastrophic climate change.

The emergence of COVID-19 has also shown just how disastrous the consequences of ecosystem loss can be. By shrinking the area of natural habitat for animals, we have created ideal conditions for pathogens – including coronaviruses – to spread. Considering all these challenges, this World Environment Day focuses on the restoration of our ecosystem, with the theme “Reimagine. Recreate. Restore.”

Only in a healthy ecosystem can we sustain people’s livelihoods, counteract climate change impacts and reduce the degradation of biodiversity. A recent German Watch Report of the Long-term Global Climate Risk Index 2020, a global think-tank working on climate change, had rated Pakistan number 8th most affected country due to adverse impacts of climate change. Community World Service Asia continues to encourage and build awareness on environment conservation with communities on the ground that are most affected by climate change and pollution.  We are continuing to invest in preservation, prevention and preparedness, together with the communities, as a necessary part of all systematic efforts to increase resilience to climate change and disaster risks and protect the environment.

Growing Sustainable Kitchen Gardens

Sustainable farming and kitchen gardening impacts everything from the air we breathe to the carbon footprints we leave behind. Community World Service Asia has been working with the most vulnerable, flood and drought affected rural communities by promoting sustainable agriculture among them to improve their food security, health and nutrition. These activities are allowing community members to sustain livelihoods, ensure good well-being and be an active part of preserving their environment.

Growing your own food allows you to stop relying solely on traditional methods of purchasing your produce from a grocery store. When you buy foods from these shops, you should take into consideration the sad, but true, fact that these foods travel several miles before ever being consumed. Not only does this impact the freshness and flavor of the food, but more importantly, this emits dangerous amounts of carbon emissions and waste associated with air freight and other transportation methods into the atmosphere. The concept of kitchen gardening is helping to reduce the high amounts of burning fossil fuels that fill our environment as a direct result of importing foods from commercial farmers. This initiative is also reducing waste from food packaging materials such as man-made plastics and cardboard, that also travel hundreds and thousands of miles. Women in Sindh feel safer and satisfied knowing what they are eating and what has gone into producing their food.

Under its Livelihoods portfolio, CWSA has conducted 291 workshops for more than five thousand people, a majority of these rural women, on kitchen gardening since 2015. Through these trainings, rural communities, especially women, have started growing kitchen gardens in their homes and have applied low-cost irrigation methods in their agrarian farming.

Introducing Eco-Friendly Farming

Most local communities in interior Sindh rely heavily on agriculture, but farmers in this region have struggled to cultivate bountiful harvests in the vicinity due to extreme water scarcity, harsh weather conditions and limited knowledge and resources on sustainable farming.

Under its food security projects, CWSA promotes sustainable farming and agri-based enterprises and provides continuous technical support and guidance on business development to rural farmers to enable them to achieve high quality agricultural produce. To further strengthen the skills and expertise of these agrarian communities, CWSA facilitated six exposure visits of 476 farmers, including men and women from twenty-five villages, to renowned agricultural research institutes in Sindh. During these visits, the community members observed multiple ongoing researches and agricultural activities. Some of these included kitchen gardening activities using drip irrigation systems, pitcher gardening schemes, solar desalination units and hydroponic cultivation systems. They were also familiarised with the use of bio fertilisers as one of the most important components of integrated nutrient management, being cost effective as well as being a renewable source of nutrients to supplement chemical fertilisers.

Through workshops on sustainable farming, 13,125 farmers, more than 50% women, from ninety villages in Sindh have been trained on sustainable agriculture. Communities have learned about crop production sustainability and productivity in changing climatic conditions. Most of these trainings focused on increasing productivity in agriculture and the level of economic prosperity among target communities while working on resource and environment conservation.

Improving ecosystems by restoring natural balance

Afforestation is key to sustaining the ecosystem and accelerating socio-economic development. Trees have remained a main contributor for sustaining resources including food, fiber, livelihood resources and water. Community World Service Asia has launched aeroculture[1] campaigns with farming communities in Sindh. These campaigns have promoted and enhanced biodiversity and mitigated adverse impacts of climate change in the areas that we work. One of the more long-term outcomes of the campaigns has been to provide an alternative livelihood source to water-deprived farming communities in the area. Tree Plantation activities have strengthened peoples’ bond with nature and helped purify the environment.

A variety of fruit and plant saplings such as Sapota, Lemon, Azarirachta indica (neem), Moringa, Falsa, Jujube and Guava, have been distributed among 690 targeted agrarian families of Badin and Umerkot. As many as 34,192 samplings were given out during the campaign that chanted the slogan Let’s make a promise to grow more trees.”

Ensuring human wellbeing and environmental health through Fuel-Efficient Stoves

To reduce smoke emissions and decrease deforestation, CWSA, under its Climate Action and Risk Reduction portfolio, is training women on effectively using and adopting a new technology of fuel-efficient stoves in their homes. The fuel-efficient stove is an energy system that has a positive impact on the ecosystem while providing basic cooking needs. The stoves are made of mud and straw enabling caretakers in the house to cook on two burners simultaneously while being able to control the flame at a required temperature. As a result, it reduces smoke emission and fuelwood consumption. A total of forty-seven trainings have been conducted by women community mobilizers for almost a thousand rural women on the use of the stoves and raising awareness among them on its environment-friendly nature. A cleaner environment and reduction in kitchen expenses has been seen as a direct impact of these trainings. More than three thousand stoves have been effectively installed in 2002 households in 16 villages of Umerkot district of Sindh province since 2019.

Ecosystem restoration can take many forms: Growing trees, making cities greener, rewilding gardens, changing diets or cleaning up rivers and coasts. This is the generation that can make peace with nature so let us all join hands to play an active role in Reimagining, Recreating & Restoring our precious ecosystem.


[1] A method of growing plants without soil by suspending them above sprays that constantly moisten the roots with water and nutrients.

To effectively empower women socially and economically and reduce economic inequality, it is critical to encourage women in rural entrepreneurship. Rural women’s entrepreneurship is a relatively recent phenomenon in Pakistan, and policy efforts to encourage rural women’s interest in entrepreneurship need more work in well-targeted ways. The absence of or lack of awareness of entrepreneurial processes is having a significant impact on the enterprising capability of aspiring rural women entrepreneurs in the country. Furthermore, their lack of experience or expertise in formal enterprises’ management and marketing affairs further impacts their potential for business expansion and profitability.

Community World Service Asia (CWSA) has worked with rural women artisans on enhancing their skills, providing them exposure and promoted their craftsmanship in the national and regional market for more than a decade. CWSA has worked with over a thousand women artisans through its livelihoods programme, giving them a platform to enhance their embroidery and stitching skills and become economically empowered. We have particularly worked towards creating and establishing many market linkages for these artisans to expand their clientele and increase demand for their products. We believe that by establishing sustainable links and maintaining partnership models that are tangible in their deliverables and outcomes, we can provide a critical platform for changing rural women’s position from one of vulnerability to one of decision makers and successful change makers.

By creating or participating in a formal Chamber of Commerce, women entrepreneurs can avail more opportunities to prove their economic clout and convince the government and large corporations to pay attention to specific requirements of women in the workplace and in the enterprise sector. The establishment of an active association specifically focused on women will ensure mentoring, information sharing, simplification of processes and support to rural businesses through policy lobbying.

To develop a pertinent platform, an Association of Rural Women Entrepreneurs is in the process of being registered with the Women Chambers of Commerce and Industry of Pakistan, which will ensure representation of thirty rural artisans as members. CWSA’s team supported the women artisans to prepare and submit all required documents for the registration of the association, including SIM cards, national identification cards and complete profiles of each artisan. Shaiyanne Malik, CWSA’s consultant on women’s skill building and empowerment projects, is in close coordination with the Women Chambers of Commerce and Industry of Pakistan to process and complete the registration of the association successfully. The association will promote entrepreneurship of rural artisans and help rural women connect with business hubs and institutes that will further help them achieve social and economic empowerment.

The primary goal of this association is to give technical assistance and coaching to women who are starting businesses, as well as to promote initiatives from the Export Development Funds (EDF) that are specially targeted for women. It will provide women economic liberty as well as an effective voice to echo their issues, challenges and needs. The chamber will assist rural women in building and operating successful and secure businesses and careers, along with gaining access to government contracts and developing their leadership skills.

This association will be dedicated to changing the economics of business and labour markets, as well as removing impediments to long-term business and economic growth of women in rural regions. In the future, the association will look at funding and capacity-building options, along with promoting the work and products of these rural artisans on a global scale.

Sodho is the President of the Village Management Committee and Disaster Risk Reduction (DRR) Committee of Male Jo Par Village in Umerkot, Pakistan. He has actively been working to promote sustainable farming practices and build community awareness on DRR to enhance community resilience on recurrent hazards and climate change impacts. The Village Management and the DRR Committees[1] were established in September 2020 under Community World Service Asia’s emergency response project[2], supported by the Ministry of Foreign Affairs, Japan.

“I have coordinated and helped the project team conduct 19 trainings focused on kitchen gardening, fuel efficient stoves, sustainable agricultural practices and DRR since last year. It is a relief to see that our people have the knowledge and skills to protect themselves from natural hazards.”

On September 24th, 2020, an orientation for VMC members was organised to share project objectives and to familiarise members with the role of the committee and as individual members.

“All 15 members, seven women and eight men, were explained their responsibilities as VMC members. We were taught on how and when to coordinate with the project team and how we can contribute in organising project activities. By the end of the training I was also elected as the President of the committee.” 

Sodho, along with fifteen other community members, participated in a training on DRR held in October 2020. All training participants shared and learned about common natural and man-made hazards such as earthquakes, floods and fire, experienced in the region.

“The knowledge on DRR was new to the community members. They now know of and are well aware of the different disasters that their people are faced with and have identified ways of alleviating and lessening its effects. Through the training, communities were provided technical knowledge on all kinds of hazards, developing disaster prevention plans and the importance and methods of raising community awareness on DRR.”

Sodho shared a recent accident where a fire broke out at a house in a nearby village. The family was saved but they suffered a massive loss as all their essential belongings and household items were burnt.

“As an active member of the VMC, I immediately called for a meeting to discuss how we can collect donations and help the family recover from the loss. We were able to collect some clothes, food items and essential household items for the family. Through the immediate help, the family found some relief and were hopeful to recover from the monetary and infrastructural loss sooner.”

“VMC members also organised a lesson learning session for their local communities on what they had learned at the DRR training to further enhance community knowledge and capacity on preparedness and mitigation. To overcome natural and man-made disasters, the participants were told about the different disasters and how to minimize the destruction they bring to affected areas. We also shared the story of the house-fire as an example and conducted drills to show what items to save first in the case of a fire and how to prevent the damage caused by such disasters.”

Kitchen gardening, primarily engaging women in the target villages, is another key component of the project. Sodho was personally quite interested in this initiative as having an opportunity to grow healthy vegetables at home seemed like a blessing and was a new concept introduced in the village.

“I saw the benefits of kitchen gardening immediately when the team shared the concept. Growing healthy vegetables at home can bring good health to families and save money as well which was otherwise mostly consumed on purchasing vegetables from the market.”

“I encouraged all women in the village including my own wife to participate in the kitchen gardening trainings. In the last winter season, my wife grew white radish, carrots, spinach, lady fingers and pumpkin in her new kitchen garden. I could see how much she enjoyed working and bringing seeds of different vegetables and fruits from the market to grow in her garden. She is now growing watermelon, guar[3], pumpkins, bottle gourd and lady fingers.”

Sodho further added that their village, Male Jo Par, has existed for the past hundred years and in these many years no-one had ever thought of starting kitchen gardening.

“We reside in the remote areas of Umerkot. The agriculture fields are faced by severe water scarcity. The land has low productivity due to unfertile soil and lack of water. We never thought of growing vegetables in our homes so conveniently with the help of home-made fertilisers and compost. Today, families in Male Jo Par grow garden-fresh vegetables on a daily basis, improving the quality and quantity of their food consumption, nutrition and well-being.”

Sodho also participated in a training session focused on sustainable agricultural practices for farmers, conducted in December 2020 under the project. Ten other small-scale farmers took part in this training.

“Before we took the training, all of us farmers stocked all seeds together in plastic containers and could not differentiate good ones from the bad ones. We would plough the land and sow all the seeds. Consequently, not all crops would grow well. The money that we spent ploughing and harvesting the land would be wasted as the produce would not be as fruitful as expected. This year was different. We stocked the seeds in Stoneware Pots (Matka) and before sowing them, we dried the seeds for at least three days under the sun. As a result, we had a good harvest this year.”

Our village has seen a positive change since the initiation of the DRR project. There has always been severe water scarcity in our area. The RO plant[4], which is being constructed in our village, will also help our people and those of surrounding villages to a great extent. It will provide clean drinking water at a walking distance. Our wives and daughters will not have to travel far places to collect water.”


[1] These are community based structures, members consisting of community people, who are responsible to coordinate project activities and awareness building. They are the key for sustainability and viability of project activities and mobilization of available local resource.

[2] Enhancing disaster resilience against droughts in Sindh Province

[3] Guar is an important legume crop. It is cultivated for fodder as well as for grain purpose.

[4] A reverse osmosis plant is a manufacturing plant where the process of reverse osmosis takes place. Reverse osmosis is a common process to purify or desalinate contaminated water by forcing water through a membrane.

A depression formed due to strong convective clouds over the south east of the Arabian Sea intensified into a severe cyclone storm named Cyclone TAUKTAE on May 15th. Centered at a distance of approximately 1640 km south-southeast of Karachi, the cyclone posed a potential catastrophic threat to parts of India and Pakistan. On May 16th however, the Pakistan Meteorological Department reported that the cyclone will not make a landfall along Pakistan’s coastal belt and has in fact further intensified into a Very Severe Cyclone Storm (VSCS), centering at a distance of 1210 km south-southeast of Karachi. Latest reports suggest that even though the storm will not directly hit Pakistan, widespread rains, dust/thunderstorms with heavy to very heavy falls and gusty winds of 70-90Km/h are likely to occur in Thatta, Badin, Tharparkar, Mirpurkhas, Sanghar and Umerkot districts of Sindh province in Pakistan from May 17th to 20th May 2021. The same weather conditions are likely to impact Karachi, Hyderabad, Jamshoro, Shaheed Bainazirabad, Sukkur, Larkana, Shikarpur, Jacobabad and Dadu districts from May 18th till May 20th.

The Government of Sindh has declared an emergency in all districts located at the coastal belt of the province. It has ordered to remove all bill boards in the area, cleared choking points of storm water drains and restricted fishermen from going into the sea or rivers until May 20th as part of preparatory measures.

Expected heavy rains in the mentioned districts may be life threatening, causing floods, severe damage to property and infrastructure and could leave affected-communities in need of Shelter, Food, NFIs[1] and WASH support.

Community World Service Asia Response:

Community World Service Asia is closely monitoring the situation. Its emergency response team is in close coordination and contact with the Provincial Disaster Management Authority (PDMA) Sindh and other relevant district offices of the Deputy Commissioners. The teams are on standby and will start relief operations immediately if required.

Contacts:

Shama Mall
Deputy Regional Director
Programs & Organisational Development
Email: hi2shama@cyber.net.pk
Tele: 92-21-34390541-4

Palwashay Arbab
Head of Communications
Email: palwashay.arbab@communityworldservice.asia
Tele: +92 42 35865338

Sources:
www.pmd.gov.pk
www.tribune.com.pk


[1] Non-Food Items

by Bonaventure Sokpoh

Senior Advisor on CHS & Outreach, CHS Alliance

“We need to look at localisation in a broader sense in terms of exchange of knowledge & having our own philosophy, and not just in an operational context.” Themrise Khan told an online audience of 75 aid workers mostly based in Pakistan. “Localisation will mean much more if we use our own existing resources and build them further.”

Themrise Khan, an independent development professional and researcher based in Karachi in Pakistan, was speaking at CHS Alliance’s first in-county workshop on “Bringing the CHS closer to the people we serve”, which was virtually held in Pakistan and co-hosted with CHS Alliance member Community World Service Asia (CWSA).

We were also honoured to hear from Marvin Parvez, Regional Director, CWSA. Both speakers talked about seeing the “localisation” process as an opportunity for knowledge exchange between international and national actors and encouraged Pakistani organisations engaging in the global aid sector to use their own philosophies and values.

I was pleased to see the level of interest and engagement in this national workshop. We had 75 participants including representatives from national, international NGOs and networks as well national disaster management authorities, research join us for this interactive session.

A group of Pakistani women in a rural community raising their hands during a leadership skill training session in Sindh © Community World Service Asia

Participants heard some experiences of using the CHS and being members of CHS Alliance from Mr Shahid Ali, Executive Director at Fast Rural Development Program and Aamir Malik, Director RAPID Fund, Concern Worldwide – Pakistan. The opportunity to increase accountability to people we serve through engaging with the CHS was shared. Other benefits highlighted were improving an organisation’s own systems as well as partners’ systems, including community-based organisations.

My main take-aways for how CHS Alliance can support national organisations in Pakistan based on the vibrant discussions with participants are:

  • Intensify awareness on the CHS with national NGOs, community-based organisations and people to amplify the already visible interest and curiosity on the CHS among these actors.
  • Inform organisations of the existing options to address resource and cost barriers for CHS verification for national organisations (e.g. the new CHS self-assessment tools and the Humanitarian Quality Assurance Initiative’s subsidy fund for Independent Verification and Certification) while continuing efforts to increase accessibility to the CHS and CHS verification including availability in local languages and user-friendly tools.
  • Continue exploring and advocating for the potential of CHS verification to contribute optimising the resources for multiple funding partners’ due diligence and capacity assessment, including requirements from national governments.

The atmosphere of the workshop was energising and encouraged the Alliance to continue the conversation with national and local actors. Stay tuned for more as this important work progresses!

Let me know if you have any questions or would like to get more involved: bsokpoh@chsalliance.org.

This article is extracted from a recent issue of South Asia Disasters on ‘Accountability to Affected Populations in Times of the Pandemic.” You can read the full study here: http://www.aidmi.org/publications.aspx

By Shama Mall, Community World Service Asia, Pakistan

At the onset of COVID-19, guidance put forth by Sphere and the CHS Alliance reminded us about the importance of ensuring human dignity, rights of affected people, as well as principled and people-centered approaches in our response and adaptation to COVID-191. There are many lessons to be learnt from experiences of organisations during COVID-19 in this respect.

Localised approaches and ownership are crucial in shaping the degree of access, inclusion and relevance of assistance. Some of the operational challenges of COVID-19 could not have been addressed without the engagement of local and community level structures (village groups, steering committees, community leadership, local govt. Line departments, etc.). Their involvement in decision making processes and implementation is helping to ensure assistance is relevant to the needs of and access to some of the most vulnerable groups – such as people with disabilities, women, children, the elderly and minorities.

Supporting local capacity and engaging community structures, including trust-building is essential to accountability and must be a long-term approach, not only during a pandemic. Organisations that have invested in such processes over the past many years are relying on such structures and continue programming to meet the needs of affected communities. There needs to be a more consistent effort to strengthen and scale up localised approaches and make such processes more meaningful.

Community level capacity must be strengthened to hold each other to account in order to avoid conflict of interest and exploitation of any kind. Remote management has resulted in an increased level of responsibilities and reliance placed upon the community level structures, without necessarily involving a due process or factoring in power-imbalances within such structures. It has increased prospects of individual interests taking precedence and even financial exploitation of affected communities by some individuals in community structures, causing negative consequences. Besides discourse on such issues with community level structures, organisations must support affected communities with strong remote monitoring, verification and complaints processes to ensure that they are not misled in any way, especially when assistance is in the form of any resource transfer.

The risks organisations perceive for affected communities and those communities perceive for themselves vary, so the engagement process must include sufficient dialogue to develop mutual understanding. For affected communities, risks are often defined by context, needs and day to day challenges. For instance, the health implications of COVID-19 for many are relatively insignificant compared to loss of livelihoods, providing for their families or meeting other immediate/long-term healthcare needs. This is affecting social and behavioral changes to limit the spread. Community engagement needs to involve listening to as well as addressing the concerns and on-going needs of communities, whilst supporting them in making informed choices and decisions in risk mitigation. Local organisations and community level structures are best positioned to achieve this.

COVID-19 has exposed the in-ward looking bureaucratic systems of funding partners/Governments. Some local organisations are left in a difficult position owing to immediate suspension of on-going projects by funding partners re-directing funds for their own needs. This is depriving local communities of life-saving services at a time when they need it most. Such action undermines the principles of partnership – by putting own needs before the needs of affected people without due consultation or a dignified exit process.

Though some funding partners are demonstrating flexibility by allowing their partners to adapt existing projects or use reserved funds to meet the needs of people affected by COVID-19.

Conclusion

The current operating context is going to be the new normal, experts predicting more global pandemics, increasing in size and impact. The humanitarian and development sector must take concrete actions based on the learnings of COVID-19 and scale up people-centred and localised approaches to be truly accountable to those most affected.


  1. https://www.chsalliance.org/get-support/article/covid-19-and-the-chs
    https://spherestandards.org/wp-content/uploads/Coronavirus-guidance-2020.pdf

Inequalities have always existed. Despite improvements in health outcomes globally and in the Asia region, these gains have not been shared equally across different countries or communities. The COVID-19 pandemic has had grave consequences for people already experiencing inequalities and has disproportionately impacted communities that were already socially, economically, or geographically disadvantaged.

Working to tackle the causes of equality, Community World Service Asia continues to work towards achieving health equality and provide basic health services in remote communities of Sindh in Pakistan. The health team initiated awareness raising sessions on prevention and safety from COVID-19 and other vital health issues in relation to Mother Neonatal and Child Health (MNCH) for the communities that they work with in the region. These sessions were planned and conducted in coordination with local government health departments, Community Health Management and Village Health committees. A total of thirty-six awareness sessions with staff, health workers and communities have so far been conducted by our health teams.

“The Village Health Committee came to me when I was expecting my first child. They advised me to avail Antenatal Care services provided at the Taluka hospital Samaro by the health team of CWSA. The close vicinity, affordable consultation and free medicines allowed me to regularly visit the health centre during the nine months of my pregnancy and get vaccinated timely. On February 5th this year, I delivered a healthy baby girl at the THQ hospital Samaro without suffering any complications. The health staff has been efficient and responsive in every consultation. My husband and I now visit the health centre for postnatal care and health sessions on family planning and maintaining a hygienic lifestyle,” shared twenty year old Baby, wife of Kishor, living in a remote village in Umerkot.

Baby visiting the THQ for postnatal care.

“We were totally unaware about health issues. In fact, most people here never took health issues seriously.  Ever since the health centres have been set up here and we received health awareness sessions, many people of our community have become health conscious and visit the health centres whenever needed,” shared Meera, who is a 52-year-old village resident in Umerkot and a core member of the Village Health Committee (VHC). She joined the committee in 2019 and has since participated in a number of trainings, include on management skills and Traditional Birth Attendant (TBA).

To ensure progress in tackling health disparities during the pandemic, a WhatsApp group was set up with the Health Management and Village Health Committees[1] based in remote villages to conduct virtual health sessions on awareness on COVID-19 symptoms and precautionary measures. The members of the committees replicated the sessions within their communities to build mass awareness on COVID-19 and how to best protect against it.

Meera participated in the virtual trainings on health education with CWSA’s health team and then shared the same learnings with the communities through community sessions.

“I have been attending the COVID-19 sessions held by HMC and VHC members in our village since last year. Before participating in these sessions, I had firmly believed that COVID-19 did not exist and was something made up.  I was not serious and neither was I following any Sops or wearing a mask. But ever since I have learnt more about the virus, its symptoms, and its fatal impact, I was at first astonished but also careful. Now I wear a mask whenever I am leaving my home and I avoid public gatherings. I also make sure I wash my hands after returning from town. I am also ensuring that my family follows the same practice,” expressed Behari who is a 35-year-old resident of village Major Pali in Umerkot. He has been a regular participant of the various health and hygiene sessions conducted in their village.

The awareness sessions included discussions on other vital health topics such as family planning, importance of breastfeeding, recurrent curable diseases, HIV/AIDs and other communal diseases as well. Special health sessions have also been conducted in schools in coordination with the School Management Committees, for teachers and students to ensure they follow Covid-19 SoPs in school premises and at home. School Hygiene Clubs have been formed by bringing together students who lead in building awareness on various WASH lessons and COVID-19 prevention for fellow students and parents. These clubs have played a pivotal role in increasing the adoption of COVID-19 Sops among children and local communities.

“I am Hera Lal and a student of 5th class. I go to a government primary school in a village in the Umerkot district and am a member of the Health and Hygiene Club set up in our school in February (2021). My primary responsibilities are to keep my school clean and to educate students of my school about health and hygiene. I also inform my family members and siblings about what we learnt in the health hygiene club and what they should do to keep safe from viruses and diseases. I feel very happy to be part of this club.”

In consultation and coordination with the local health departments and district administration, Community World Service Asia’s health centres in Sindh are providing essential healthcare services to help local, impoverished communities live a healthy life regardless of their age, gender, ethnicity, disability, economic situation or livelihood. These centres have been established under our health portfolio supported by Australian Aid and Act for Peace. It is actively providing health services and clinical support in two THQs[2] in district Umerkot, equipped with trained health staff including medical officers, lady health visitors, medical technicians and community mobilizers. Community participation is ensured from the inception of the project through their representation in Village Health Committees and Health Management Committees and district advocacy forums.


[1] Community-level structures formed to ensure community participation in project implementation. The members consisting of key persons from the community coordinate with the project team in terms of organising and coordinating project activities, awareness raising and sensitizing communities.

[2]  Taluka’s Health Quarters

Under its Education portfolio, Community World Service Asia is supporting fifteen public schools in Pakistan’s Sindh province to promote and facilitate inclusive and good quality education while promoting a safe learning environment to disadvantaged children amid COVID risks looming in the country.

WASH services such as hand-washing stations and water filters have been set up in these schools to reduce the risk of transmission of the virus among students. Hygiene kits including soaps and disinfection supplies have also been distributed among these schools for effective prevention and safety from COVID-19. Through our support, we are focusing on creating awareness on implementing COVID-19 SOPS and providing a safe learning environment to students and teachers.

Hygiene Promotion sessions sharing thorough hand-washing techniques and hygiene practices have been conducted with students, teachers and parents. Information, Education and Communication (IEC) material has also been provided to these fifteen schools to raise knowledge among stakeholders on safety protocols and measures against the spread of the virus.

This video, published by a local media news channel, shows one of the schools supported with water supply system installations by Community World Service Asia. Shahida Parveen, the head teacher of a school in Umerkot, shares how the school has benefited through the WASH services and teachers’ training on COVID-19 SoPs and Early Childhood Care and Education. The school is also utilising the water supply services to water trees and plants in the school’s vicinity and surroundings, therefore also ensuring a greener and healthier environment.


Living with her seven children, Shaibaan is constantly multi-tasking to meet the everyday needs of her family. The children demand attention and unconditional care.

“All day long I am busy taking care of the children, engage in household chores and in cooking meals. My husband, Karshan, is a labourer, earning a monthly income of PKR 7500 (Approx. USD 46). My five younger children go to school but my two elder son and daughter don’t because we cannot afford to pay the fees of all seven.”

Shaibaan and her family live in the remote village of Ratan Bheel in Umerkot district of Sindh. Though many households depend on local vegetation in the area, Shaibaan never thought about growing a kitchen garden in her front yard.

“I had no experience of growing crops before and it was not very common to grow crops at home. We purchased vegetables to cook. When we did not have money to buy vegetables or any other food item, we ate red chilies with rotiⁱ,” said Shaibaan.

Selected alongside thirty other women from Ratan Bheel and nearby villages, Shaibaan was trained on kitchen gardening techniques in March 2019. The group of women were familiarised on the concept of kitchen gardening and how it improves food security of households. They were taught different vegetable sowing and pest control techniques. Shaibaan and other participants were also trained on how to conduct seed germination tests which would help them save time, energy and resources when cultivating difficult to grow seeds. Germinationⁱⁱ tests measure the resilience of seeds, thus allowing farmers the option to decide on how many to plant or whether to plant at all.

Shaibaan replicated the training in fourteen other households in her village.

“I did not think of growing a kitchen garden in this desert area. When Shaibaan came to my house with this initiative, I was amazed to know how we can grow clean and healthy vegetables in our yards for our daily consumption when cooking food. We now have the pleasure of eating homemade nutritious vegetables of various kinds. The garden in the kitchen is now a means of food diversification and food conservation for us,” said Saleemat, another Ratan Bheel kitchen gardener.

“Today, my family supports in maintaining the kitchen garden with me. My two elder children take keen interest in taking care of the garden and growing new vegetables and plants in it. It has been a year now since we have been growing vegetables in our green garden. We are now growing cluster bean, lady finger, ridge gourd and brinjal. Moreover, we are also able to save PKR 500 (Approx. USD 3) every week, which we previously consumed in purchasing vegetables from the market. We use the money we are saving to buy other household essentials such as linens, bed sheets and curtains.”

Shaibaan prepared grounds for sowing vegetables in the recent winter season.

“I prepared half an acre of land in my garden to plant spinach, mustard leaves, coriander, radish and fenugreek. I plan to sell the surplus in the local markets and support my family financially.”


ⁱ Roti is a round flatbread native to the Indian subcontinent made from stoneground wholemeal flour and water that is combined into a dough.

ⁱⁱ Germination is the process by which plants, fungi and bacteria emerge from seeds and spores, and begin growth

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