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

Saba, 25, resides with her eight-member family in Mohallah Railway station at Pithoro Taluka[1]. Her home is three kilometers away from Community World Service Asia’s health center in Pithoro of Umerkot District. Saba was in her third trimester in November 2020.

“My husband worked in a textile company as part of the skilled labor before he lost his job amid COVID-19 and was earning PKR-15,000/month. In August 2020, he was diagnosed with Hepatitis. It has been difficult to make ends meet, as my husband was the sole bread earner. We had to take loan from relative to keep our livelihoods going.”

Diarrhea, Tuberculosis (TB), Hepatitis, skin infections and malnutrition are some of the more common health problems reported among communities in Pithoro. During Covid-19 it was very difficult for these rural communities to access medicine and other health services as most humanitarian organisations were unable to operate due to strict restrictions or closures of offices.

“I was able to visit the health facility for checkups as the women medical staff at the Mother Neonatal Child Health Centre is very comforting and efficient in healthcare delivery.”

Saba visited CWSA’s health facility with her sister-in-law for the first time in her first trimester.

“I was so pleased with the health services. The medical doctor conducted a thorough check-up and prescribed some medicines, which I easily got from the pharmacy free of cost. The medical team also gave a health session to maintain a healthy diet and shared a diet plan for me to follow. I strictly follow the plan and it has been very beneficial in terms of health. I did not feel weak or tired throughout my pregnancy period.”

Saba has to face some challenges due to the unavailability of laboratory services in the health facility.

“We have to travel to Mirpurkhas for blood tests, Ultrasound, Hepatitis, Urine-DR and blood CP. Moreover, the tests can be expensive with one blood test costing up to PKR 1500 (Approx. USD 9) in the district’s laboratory. People in my neighborhood do not have sufficient income to manage their household expenses. For this reason, we cannot afford additional expenses of healthcare at quality medical facilities.”

ⁱ A tehsil (of taluka) is an administrative division in some countries of the Indian subcontinent that is usually translated to “township”.

“For years, I have been chopping wood and selling it in the local market known as Pithoro Market. The COVID-19 lead lockdown imposed in our district minimised work opportunities for many of us. Market places had been shut down and people stayed indoors with no opportunity for businesses to operate or grow. Consequently, I was also unable to sell the wood and earn any sort of income. To further add to our worries, we also lost our home during the heavy rains in August (2020). Our house was made of mud and was fragile. We were forced to move out of the village as most of the village was flooded with rainwater. To survive, we built a tent near the main road on a nearby higher ground as a temporary shelter. We have been living here for weeks now. We plan to rebuild our home as soon as the land dries out and return to our village.”

Jarviz is a father to five children and belongs to a remote village named Saint John Colony, located in Talka[1] Pithoro in district Umerkot of Sindh. He is the sole breadwinner for his family despite being physically disabled due to polio at a very young age. Before COVID-19 hit the country, Jarviz earned PKR 200 daily (approx. USD 1) which was not quite sufficient to cover all the needs and expenses of his family of seven (including himself) but the family stayed together and lived on a day to day basis. Jarviz has been a strong man and always helpful towards everyone he knew and is therefore an inspirational member of the community’s Village Committee for over a year now.

“I have been a member of Saint John Colony’s Village Committee (VC) since its formation in August 2019. We are ten members in total with equal numbers of both genders. The committee is formed to ensure community participation and facilitate Community World Service Asia’s (CWSA) health project team in project planning, implementation, and coordination with government line departments and other NGOs. The main objective is to address the problems and needs of the community together. As an active member, I have been involved in conducting health sessions and organising free medical health camps with the project team in remote villages in the area,” shared Jarviz Masih. 

Jarviz also remotely took part in the health sessions conducted by CWSA’s health team on COVID-19 safety in May and June 2020, under its health program.

The sessions sensitised me on social distancing, hand washing, using protective gear and avoiding public gathering to eliminate the transmission of the virus. In addition, the team held sessions on family planning and health and hygiene. One of the key purposes of these sessions were for VC members to replicate the teachings in our communities to make communities aware on COVID-19 preventive and safety measures as much as possible. I myself delivered sessions sensitising 157 people in my village in the following two months. The health team has been continuously providing remote counselling and educating us on accessing Taluka hospitals in case of emergency or other general health issues.”

“In one instance, a woman in our neighborhood delivered a baby at home in an emergency. After her delivery, due to high blood pressure, she suffered from fits. I immediately contacted the health team and they advised us to immediately head towards the THQ[2] Pithoro, as the medical staff of the government was available there. The paramedic in Pithoro referred the women to the Female Medical Officer in Mirpurkhas hospital. The timely counselling and consultations benefitted and the woman was safely and immediately admitted to the hospital and is being treated well,” narrated Jarviz.

As a humanitarian response to the COVID-19 crisis, Community World Service Asia (CWSA), with support of United Methodist Committee on Relief (UMCOR), implemented a project addressing the immediate needs of affected communities in Umerkot district in Sindh province of Pakistan. Jarviz was selected as a participant of this project.

“A cash assistance of PKR 24,000 was provided to me and my family in two installments in the months of August and September 2020. With the money received, I purchased groceries for my family to put food on the table. In addition, I bought some clothes and crockery items for my daughter as her wedding is planned in a month’s time. The assistance was very beneficial and timely for me and my family.”

[1] A tehsil (of taluka) is an administrative division in some countries of the Indian subcontinent that is usually translated to “township”.

[2] Taluka Headquarters

Under the Enhancing disaster resilience against droughts in Sindh Province project, supported by the Ministry of Foreign Affairs, Japan,[1]  eight Disaster Risk Reduction (DRR) committees have been set up in eight villages, with fifteen members in each. Established in April 2019, the committees work towards strengthening the local community’s capacity to manage emergencies and collaborate with government agencies and relevant authorities to reduce risks during emergencies. These DRR committees play a pivotal role in facilitating the implementation and oversight of the project and to ensure community ownership and inclusion to maintain its long-term sustainability.

As physical interaction and implementation of any kind was not possible after the nation-wide lockdown imposed due to the COVID-19 pandemic in the country since March, Community World Service Asia’s DRR team got in touch with the members of the committees through mobile phones. Together they discussed ways of raising community awareness on COVID-19 symptoms and how to stay safe from it. Upon agreement, training sessions with the DRR committees were planned and conducted in April 2020.

Haji Chanesar village in Umerkot district was one of the selected areas and five members of its DRR Committee were part of the remote training session. They were informed about what communities should be doing to be prepared to respond to a case, how to identify a case once it occurs, and how to properly implement the preventive measures to ensure there is no further transmission of the virus.

Prem, 28, is married and a father to three children. After completing his intermediate, he was engaged in different volunteer work as he had grave interest in helping others. As a member of the DRR Committee, he looks after and operates the RO plant established in the village and also supports in the implementation of the project activities. Prem, who is an active member of the DRR Committee of Haji Chanesar village was one of the participants in this training.

The trained members of the committee then replicated the learnings separately in a number of neighbouring villages. Over two hundred local community members were introduced to information on COVID-19 and learnt basic hygiene measures to protect against the infection. By the end of these awareness sessions, communities were able to identify basic symptoms of coronavirus, common transmission channels, how to assess the risk of infection and key preventive measures.

An isolation room was established in Haji Chanesar, in case anyone is infected or is suspicious of being infected. The sessions alerted the villagers and they followed all SOPs[2] strictly especially at homes.

“In my home, none of my children go out to play nor does my wife socialize with her friends or family. We have limited our external activities, and we only go out when food or important household commodities need to be purchased. We have been fortunate till date as no case of coronavirus has come up. To prevent the spread of the virus in our area, we remain secure at home and maintain physical distance,” Prem concluded positively.

[1] Disaster Risk Reduction
[2] Standard of Procedures

Mohan Maghwar, 35, lives with his wife and three children of seven & five years while little one is of three months old, in the remote village of Rantnor, located in the Thar Desertⁱ in the south of Pakistan. All kinds of natural life here is dependent on the annual rainwater. Rantnor is deprived of most basic survival facilities including healthcare, electricity, clean drinking water or sufficient livelihood sources.

Earning an income through traditional Sindhi cap weaving and manufacturing, Mohan was the sole breadwinner for his growing family. His wife would also help him with the weaving. He would receive many orders from the local markets and neighbouring buyers for which Mohan would buy raw materials and work on a fortnightly basis and then sell the finished product providing him a comfortable means to sustain his family. However, as COVID-19 struck the country, he soon lost his only source of livelihood.

Our lives were going fine before the coronavirus came in the country and the national lockdown was imposed. Before the pandemic, I was earning up to PKR 600 (approx. USD 4) on every cap my wife and I produced. Sadly, our work was suspended because of closure of markets and restrictions on gatherings. There were no orders to work on and no money to earn due to limited or no work opportunities. I was worried about making ends meet without any source of income.”

As a humanitarian response to the COVID-19 crisis, Community World Service Asia (CWSA), with support of United Methodist Committee on Relief (UMCOR), is implementing a project addressing the immediate needs of drought affected communities in Umerkot. Through the project, 1,206 families will be provided with two cash grants, each of PKR 12,000 (approx. USD $ 75/-) in September through mobile cash transfer services. This cash assistance is aimed at addressing the food insecurity caused by drought, repeated locust-attacks and the economic implications of COVID-19 on the most vulnerable communities in remote areas of Sindh.

Rantnor was among the project’s target villages due as the family’s livelihoods was severely affected by the lockdown amid COVID-19 and drought. CWSA’s team identified Mohan and his family as project pariticpant of this humanitarian response as they were most affected by not only COVID-19 but other natural and climate induced crises as well.  Mohan received two rounds of cash assistances of PKR 12000 each (Approx. USD 75) in August and October 2020.

“With the money received, I purchased groceries and invested some money in a business and established a small enterprise shop at home, as I have marketing experience and utilized the cash assistance in creating a livelihood opportunity.”

ⁱ 55kilometers from Pakistan’s Umerkot District

“I earn PKR 300 everyday (Approx. USD 3) working at a brick kiln. I also own ten acres of farmland; however, the cultivation is far less due to lack of rainfall and proper irrigation in the area. This year I was only able to grow Guar[1] on the field as the cash assistance provided by Community World Service Asia was consumed for tillage on the land. I purchased Guar seeds from a loan I took from a local seller. I am confident that I will be able to pay off the loan after the harvest season,” shares Mangal, a resident of Vickloker village, located in Umerkot. He lives with five other members of his family. Before the locust attacks they all lived a comfortable and content life together.

In 2019, Mangal cultivated Guar on his land, but the locust invasions completely destroyed the crops. The attacks proved to be catastrophic for the local crops in most parts of Southern Pakistan. Lack of harvest in the area affected the livelihoods of many farmers.

“The earnings we received after selling the crops helped us fulfil our family needs and household expenses. Sadly, this year we had nothing to sell or earn. The local farmers have followed conventional approaches to combat the attack of the locusts. These techniques included making noise and the use of fire smoke. Unfortunately, these attempts did not help much and most of the fields were left bare and eaten. As a result there was no harvest season.”

As part of an Emergency Response project, Community World Service Asia (CWSA), supported by Japan Platform, provided cash assistance to 1600 agrarian families this August. Rural families whose livelihoods were most affected by locust attacks and COVID-19 received conditional cash grants that helped farmers to plough lands to eradicate locust eggs before hatching.

“If effective steps to stop the hatching of new eggs are not taken, existing crops will be destroyed and this will eventually have a significant impact on farmers’ food security and welfare. However, the support we got this year saved us.”

Mangal’s family was among families that received a cash grant of PKR 13500/- (Approx. USD 86) under the emergency response project in Umerkot.

Mangal plans to save some of the harvested crops for household use and sell the rest in the local market as a means of livelihood.

“The money is going to help me repay the loan I took earlier to manage household expenses and to help me buy food for my family.”

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

Chothay is a 26 year old mother of three who lives with her husband, Kapil and children in Haji Chanesar village of Umerkot.

“My husband teaches at a nearby private primary school. We also grow cotton and wheat as joint croppers on a 5-acre field close to our house. Together with my husband’s salary and our earnings from the field, we bring home an income of PKR 15,000/- (Approx. USD 91) every month.”

Most of Chothay and Kapil’s income is spent on household utilities and ensuring to provide three meals for their children. The couple’s elder daughter attends a private school in the locality for which they pay a monthly fee of PKR 1000/- (Approx. USD 6).

“We are used to cooking on conventional mud-made stoves, which have one burner that results in contiguous smoke emissions. This meant more fuel consumption and the fire was hard to manage. The intense fire also damaged cooking utensils and left dark stains on all our crockery and cutlery. With the fire being unmanageable due to high winds, there have been many cases of houses burning down or women’s hands being burned or lungs being affected due to spending long hours in the kitchen. It even took longer to cook the food,” explained Chothay.

Gathering wood for the fire was also a laborious job often shouldered by the women in the house.

“Most of us would have bruised hands and legs when we return from fetching firewood due to the difficulty in breaking the branches and shrubs from trees and bigger plants.” 

In October 2019, Community World Service Asia conducted a training on making and using fuel-efficient stoves for twenty-five women in Haji Chanesar. The participants of the training were taught how to construct the stoves and were sensitised on its health and environmental benefits, including reduction of smoke emissions and decreased deforestation with lesser wood consumption. These trained women then replicated the same training in more than five hundred households in over sixty villages in the last ten months.

“We witnessed multiple fire flaring-up incidents in Haji Chanesar in the months of May and June last year, resulting in burnt hands, depreciated kitchen utensils and increased air pollution due to the smoke. Whereas, ever since we have started using fuel-efficient stoves, such accidents have minimised. Lesser shrubs and branches are used and cut down now which has also resulted in increased forestry and greenery,” said Chothay.

Chothay and many housewives of rural Umerkot now consume less fuel to cook as compared to when using traditional stoves.

“We are now saving time as well as energy while cooking our meals. We are coughing less and cooking more all while using two burners simultaneously. It has also reduced health risks as we do not burn our hands and less smoke is generated. We are using lesser wood which has reduced deforestation in our area and we now see more greenery in our area which is refreshing.”

Ratni is a 70-year-old widow who lives with her son and his family in Senate John Colony, located in Pithoro of Umerkot district in Sindh, Pakistan. They all live together in a cob house made of mud and straw.

“My son, Khemchand, is a teacher at a local private school. He used to earn a reasonable monthly income of PKR 8000 before COVID-19 forced all schools in the region to shut down. The school administration discontinued paying its teachers as the school was not equipped to carry out online classes and there were no incoming student fees that could cover teachers’ salaries. However, the recent monsoons brought some relief to us agrarian communities. The rains have revived the agricultural activities and have given us opportunities to work on the fields. My son and daughter-in-law started working on the fields and were able to bring home some income through that. It was not much but was better than nothing. Sometimes, I would also assist them on the field to earn a bit more to make ends meets.”

The harvest season lasts three months in rain-fed areas of Umerkot and until the next monsoon season arrives, there will be less or no opportunities to work on the fields. Therefore, Ratni, Khemchand and his wife had no work to do once the three-month period ended in August.

“We had no livelihood by then and were forced to sell some of our household possessions to buy essential food supplies for the house and particularly for my four young grand-children. We also had to take some loan from our neighbours when there was nothing left to sell.”

Community World Service Asia (CWSA), with support of United Methodist Committee on Relief (UMCOR), is implementing a Humanitarian Assistance project responding to the immediate needs of drought affected Communities in Umerkot. As part of the project, 1, 206 families will be provided with two cash grants, each of PKR 12,000 in September through mobile cash transfer services to address food insecurity caused by drought, repeated locust-attacks and the economic implications of COVID-19.

Senate John Colony’s Village Committeeⁱ provided a list of families living in the area who were most affected by the COVID-19 pandemic and other natural disasters to be supported through the project. As a result, CWSA’s emergency response team contacted Ratni as a project participant and she received the first cash assistance of PKR 12000 (Approx. USD 72).

“Through the money I received, I paid back the loans I had taken from neigbhours to survive in the last months and bought some food essentials for home. I have also saved some money to buy school books for my grandchildren for when the schools resume.”

ⁱ Village Committees are voluntary associations established for local administration. They are extra constitutional authorities comprised of 7-8 members including male and female from different caste in the village.