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26 year old Chandna from Village Nabisar says: The most beneficial feature of provided medical services is the free of cost treatment by a trained healthcare team and quality medicines given for free. Before Community World Service’s health project, we used to suffer because of the lack of Female Medical Officer in our area and we had to travel long distances for treatment and we also used to spend a lot on medication.

Community World Service Asia is operating three Rural Healthcare Units (RHU) in Hyderfarm Taluka, Nabisar Taluka Kunri and Dhoronaro in district Umerkot in Sindh. These healthcare units provide curative and preventive health services to the communities. The RHUs located in Hyderfarm and Nabisar also consist of an outdoor patient department (OPD) and provides free consultations and essential medicines to patients. Labour rooms are operational at all the three health facilities. The staff at these healthcare units include female medical officers, lady health visitors (LHVs), medical technicians and social mobilizers.

The health services at these RHUs focus primarily on reproductive health of women of child-bearing age. Disease Early Warning System (DEWS) and Health Information System (HIS) have also been established at two of these health facilities.

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Sheherbano belongs to Haji Talib Bijoro, a small village in Thatta district, Sindh, Pakistan. At just 18 years of age, Sheherbano has already been working as an information secretary in her village, facilitating various NGOs who work with the community there. Passionate about working towards the betterment of her village, she spoke about her participation in the recently held three-day disaster risk reduction (DRR) training.

“In the beginning when Community World Service Asia came to our village, they discussed how they were going to work with us for the betterment of our community and our village. We learnt so many things about fires, storms, floods and earthquakes. They informed us about the different measures we could undertake to keep ourselves safe during floods and fires,” she said.

Talking about the precautionary measures to take during disasters, Sheherbano said that while she and her fellow villagers were previously unaware and uninterested, participation in the training had changed their perspective and they had become interested in learning about preventative measures.

“In case of a flood, as soon as we hear about it on the radio news, we should take the elderly and the children of our village to a safer place. I also learnt that we should keep our valuables with ourselves and in case of an emergency, we should find a place which is above the ground level to keep ourselves safe,” she added.

Sheherbano is eager to spread this knowledge with her family and friends in neighbouring villages as well. She said that weddings or other village ceremonies are good opportunities for her to tell her friends about her learning at the training conducted by Community World Service Asia staff in Haji Talib Bijoro.

When a fellow villager told Sheherbano about a fire that broke out in their village, she shared her knowledge on the actions and precautionary measures one should take as she had learnt during the DRR trainings. She shared the causes behind fires breaking out and spreading fast and how to effectively and immediately contain it with her neighbours and community members.

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Shanti, 30, is an artisan from Kharoro Charan village in Umerkot, Sindh.  Embroidery has been a part of her life from a young age. “I learned embroidery skills myself because my mother died when I was just a child,” Shanti proclaims. “I enjoy this work because it is in our culture, and our community is known for this work.”

Traditional handicraft skills are a daily feature in the life of most rural Sindhi communities.  “Embroidery  work is a good source of income for our people and many love to wear embroidered clothes in all seasons in our country,” Shanti believes. “Our handmade craft is demanded in the market, and fortunately we are very rich in this skill.”

Shanti joined Community World Service Asia’s training centre because she wanted to see her embroidery to be used in new and different designs and products which could be sold in the urban market.  She wants to be able to provide for her family and cover the costs of health care and education for her children.  “When my children ask for new clothes for festivals, I am not able to  fulfil their wishes,” Shanti admitted dismally.

Through the project, Shanti has been able to work with design and textile students from Karachi, and learn new skills to further enhance her inborn talent and develop exciting opportunities.  “I did not know about color combination before I met with the students.  They taught me about the usage of color, which colors look better in craft.  Moreover, I got more ideas on new designs, and now I am trying out those designs in my embroidery and stitching”

Shanti enjoyed working with the students and sharing her traditional embroidery skills with them. “The students are very kind and they respect our culture, and have taught us how to work on new designs very well” she says. One of Shanti’s most memorable experiences was visiting Karachi and participating in a design workshop at the Textile Institute of Pakistan campus. “I have never been to any school before, so I was very happy to  visit such a big school,” she added. Shanti hopes to provide better education opportunities to her children  with the additional income she will earn through craft making. “My children will get admission in big schools, and I am already working on orders to be able to achieve that.  Maybe I can start my own enterprise someday!”

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Kanwal, 20, is an artisan from Thatta in rural Sindh.  She is one of eight family members, who struggle to make ends meet with an average monthly household income of around Rs. 7,000 (approximately DKK 448).  Most of her family members work as laborers in the field. “Low income has always remained an issue in our family, and often it caused conflict among family members,” she explains. “Because the income is low and the family is large, it is always difficult to pay for clothes, meals and other things.”

Kanwal is the only member of her family who is learning a new skill to earn an income.  “I feel peace of mind while doing embroidery.  Basic stitches, such as running stitch, I learned from my mother and grandmother.  Right now, I have learned some stitches like mirror work, hormuch and filling stitch at the VTC [Vocational Training Center], and embroidery finishing.”

Traditional Sindhi crafts are extremely important to the people in the region.  Kanwal explains that wearing these traditional handicrafts gives people pride in their identity.  Through her involvement in the project, Kanwal can share this artistic heritage through different designs.  “It is my passion to continue working in this project and improve my skills,” she says.  Working with design students of the Indus Valley School in Karachi, has enabled Kanwal to explore a range of new skills and abilities.  She has learned about product ranges, color palettes, different types of material, measurements, pinning and tracing. “It was a good opportunity for me,” she says.  “I really enjoyed [the students’] company and working with them during the design workshop.  I very much liked the institute, it was big and neat.  It seems like a dream that a visited there.”

Kanwal’s favorite experience from the project so far has been participating in the Danish Embassy’s “Innovative Denmark” event, where she showed visitors how to do traditional stitches and shared her skills.  “It has really helped me in raising my confidence,” she says.

Kanwal’s family is also excited about her participation in the project, and are confident that she will be able to earn an income with her developed skills.  An alternative source of income is vital to these communities, who are so reliant on agriculture, an increasingly fragile sector.  She explains the importance of extra income for her family, who are affected by frequent flooding in the area.  “In crop season, I have to work with my family members for twelve to sixteen hours daily under frequently harsh and unhealthy conditions to earn some money and store something for the following year to survive, which is now becoming challenging because of flooding.”

This project, which is supported by the Danish Centre for Arts and Culture and the Danish Embassy in Pakistan, is supporting artisans like Kanwal to enhance their opportunities and protect themselves from such financial shocks and is empowering them to combat poverty for themselves and their families. Under the project, rural artisans are working in collaboration with design students of renown design institutes in Karachi, Pakistan, to learn contemporary designs and stitching techniques to cater to the trending market demands as well.

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What is the project?

The project aims to support families affected by recurrent floods who have been left with food shortages and minimal income opportunities as agricultural gains have been washed away.

Target groups:

  • Vulnerable households frequently affected by the floods
  • Flood-affected women engaged in kitchen gardening and other income-generation activities
  • Small landowners (who own up to six acres of land) and sharecroppers who have lost their crops during the recent and previous floods
  • Flood-affected landless labourers
  • Socially and religiously marginalized disaster-affected communities
  • Direct Target Groups: 1,535 households (including 625 women-headed households), or 7,675 individuals
  • Indirect Target Groups: 300 households, or 1,860 individuals who will indirectly benefit from the rehabilitated agriculture infrastructure

Achievements so far:

  • Introduction of IRRI-6 rice crop, a saline tolerant crop which will eventually increase resilience of rice planted in saline-affected fields and protect farmers from damage and loss of crops
  • Each family received three 20kg bags of certified rice seed
  • Each family received one 20kg bag of organic fertilizer, sufficient for cultivating two to three acres of land
  • Orientation on integrated crop management techniques and disaster resilient farming techniques for affected farmers
  • 600 women-headed households received kitchen gardening seeds and tool kits
  • Cash grants and disaster risk reduction sessions support local resilience and capacity to effectively cope with the future disasters
  • Promotion of women’s empowerment and food diversity through kitchen gardening

2014

Community World Service Asia is working with communities in rural Sindh to empower women.  With support from UK Aid and Y Care International, we are training women in vocational and literacy skills to improve their opportunities and combat poverty.  However, in order for women to be able to fully realize their potential, their rights need to be recognized, supported and upheld in their homes and throughout the wider community.

We are working to promote gender equality by highlighting some of the key issues which affect women in this area, including domestic violence and child marriage.  Theater is a powerful tool to approach these difficult topics, as it provides entertainment, can reach a large number of people, and can engage an audience in themes which are relevant to them, overcoming limitations such as low levels of literacy.

More than 60 community members, social workers, civil society activists and students came to watch a performance which was organized and held by local gender activists who are being trained and supported to raise awareness of gender issues through the project.

The play followed the story of a character called Neela, who was married at the age of twelve.  Although the legal minimum age for marriage in Pakistan is eighteen for boys and sixteen for girls, poverty and insecurity mean that many girls are married at a young age.  Through Neela’s character, the audience saw the impact of a decision made by her father, without the involvement of Neela herself or any other family members.

Neela was forced to drop out of school before progressing on to grade six, so that she could go and live with her new husband and his family.  In her new home, she experienced domestic abuse, both physically and mentally. When Neela returned to her parents’ home, the performers stopped the play and invited the audience to decide how to address the situation. This kind of interaction is extremely engaging for the audience and helps them to relate the themes of the performance to their own situations.  The audience suggested that Neela should file a case in court under Sindh’s Child Marriage Act.

The play was able to share the reality of gender inequality with the audience, and to highlight the violations of rights that are caused by practices such as child marriage. Ms Lachmi, one of the performers, explained the importance of highlighting issues relating to gender justice in the community.

“We women should be strong. We are not only the machines of producing children, but all women can stand with men shoulder to shoulder.”

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Twenty members of sixteen Village Disaster Management Committees (VDMCs) established by Community World Service Asia in rural Sindh visited the Pakistan Meteorological Department in Karachi this May.  The members of this hazard-prone community, which is regularly and severely affected by seasonal flooding, were able to observe the ways in which the government department processes and responds to information on weather, climate and geophysical phenomena with the aim of ensuring safety in the air, land and sea. They also observed how these measures mitigate the impact of climate change on agriculture, the main source of employment and income in the province of Sindh.

Chief Meteorologist, Abdul Rasheed, and his colleague, Sarfaraz, introduced the visitors to the effects of climate change, weather forecasting and early warning systems for heavy rains, heatwaves and flooding.

“It’s a matter of great pleasure for us that Community World Service Asia is taking such brave steps to educate communities at a grass-root level,”

Rasheed shared. “The role of DDMA [District Disaster Management Authority] should be strengthened to reduce disasters at the local level, however our unconditional support is always there.”

Gul Hassan, a VDMC member, added,

“It is a good opportunity to learn how government machinery works. We would also like to request the Chief Meteorologist and his team to educate us in the villages.” 

Hanif Nooh Waliro, another VDMC member, said,

“We have learnt a lot; although the presentation was quite tricky, visiting observatory stations was very informative.”

With support from Christian Aid, Community World Service Asia is working to empower local communities to take action so that they can protect themselves from the impact of natural disasters.  Activities such as this visit enable community members to learn about the causes of natural disasters and the mechanisms which are in place to anticipate them. Such activities build links between government departments and local organizations which contribute to effective coordination for preparedness.

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Students and teachers participated actively in a walk/rally, in district Sujawal, organized by Community World Service to mark the importance of Global Earth Day.

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Every year, Global Earth Day is celebrated across the globe to call for action against harmful environmental practices and to help spread awareness about protecting the Earth’s natural environment. To mark the importance of this day and the cause it represents, Community World Service Asia, with support from Christian Aid, pledged to plant 4000 trees in various localities of districts Thatta and Sujawal in Sindh. The team collaborated with Plan International, Action for Humanitarian Development (AHD) and Voice of Youth Group to make this possible.

Titled ‘One Family, One Tree,’ the campaign ran for an entire week  (18-22 April) and was inaugurated by chief guest Mr. Abdul Latif Brohi, Assistant Deputy Commissioner , who planted a tree at the DC office in Thatta. Over the five days of the campaign, trees were planted by men, women and children in schools, government offices, roadsides and villages. Youth volunteers and teachers also participated in the activity.

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Children waiting for their turn to be examined by the doctor

The government in Sindh is considered as the main provider of preventive care throughout the province and a major provider of curative services in most of its rural areas. Health services in the public sector are provided through a tiered referral system covering a  range from primary, to secondary and tertiary medical facilities. Primary care facilities include basic health units (BHUs), rural health centers (RHCs), government rural dispensaries (GRDs), mother and child health (MCH) centers and TB centers.

Unfortunately, most of these facilities lack the provision of a broader range of preventive and curative health services. The Taluka (Administrative division) and seventeen district headquarter hospitals in rural Sindh are responsible for providing medical care to the people of these areas. However, many are unable to benefit from these health care institutions due to the lack of technical assistance and the poor infrastructure.

The public health system in Sindh is unable to cope with the mounting health challenges that people are facing in the province. The province’s  district of Umerkot faces the highest national statistics on human and material health care shortages.

Community World Service Asia has been working in the health sector in Pakistan for the past thirty years. Through this experience, the organization has learnt that project interventions must work towards strengthening the existing government structures regardless of its weaknesses. This approach results in a more  sustainable impact instead of working in isolation or parallelly to the system.

Based on a recent rapid assessment carried out by Community World Service Asia, development of  three RHCs in villages Nabi ser, Dhoror Naro and Hyder Farm were proposed and approved. These RHCs aim to benefit a combined population of around 98,341.

To ensure long-term sustainability, the project’s plan is to work in close coordination with the government health department thus aiming to bridge the gaps in services such as provision of human and material resources. This includes working closely with female medical officers and para-medical staff, provision of essential medical supplies/equipment, necessary maintenance and repair of existing medical facilities as most of them have been damaged due to the floods that hit the province  in years 2010 and 2013. Through this project, preventive and curative services will be developed, as well as  the capacity of the government health staff will be enhanced.

In Umerkot, three RHUs in Hyderfarm Taluka Umerkot, Nabisar Taluka Kunri and town committee Dhoronaro have already become operational providing curative and preventive health services to the communities. At the initial stage, the infrastructure of the dilapidated RHCs was worked upon and these units were provided essential equipment required to cater to the health needs of the community. In the health facilities located at Hyderfarm and Nabisar, an outdoor patient departments (OPDs) providing free consultations and essential medicines to patients has also been set up. Additionally, labour rooms have been made operational at all the three health facilities. Medical services are provided by health staff including female medical officers, lady health visitors (LHVs), medical technicians and social mobilizers at these facilities.

These health services are focusing on the reproductive health of women of child-bearing age. Disease Early Warning System (DEWS) and Health Information System (HIS) have also been established at both the health facilities. Information from these centres is regularly shared with the district government and Community World Service Asia’s head offices.

  • 44,341 community members have received preventive and curative healthcare
  • 16,802 patients are provided with general out-patient department (OPD) care
  • 2,184 pregnant women received Antenatal check-ups
  • 560 postnatal check-ups conducted
  • 501 community members practising child spacing
  • 21 Deliveries facilitated
  • 34 delivery kits provided for safer deliveries made at home
  • Labour and Consultations rooms repaired 3 hospitals
  • Six health committees formed (3 for men and 3 for women)
  • District health advocacy forum established
  • Established DEWS and HIS in two health facilities
  • 24,294 individuals participated in health education sessions
  • 4,379 women and children assessed for malnutrition
  • 16,802 patients received free of cost essential medications
  • Proper referral system setup for complicated cases

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    Community World Service Asia, with the support of the ACT Alliance, has been working to respond to the needs of families affected by severe flooding in 2015.  District Sujawal, in the Sindh province of Pakistan, has been faced with many serious health risks in the aftermath of the flooding.  Access to health facilities and services is a major issue for the community, as the nearest government health facility is at least five kilometers away.  With high levels of poverty, unreliable income sources and the losses faced by families as a result of the floods, the cost of transport and treatment can be an insurmountable obstacle.

    Stagnant water and poor shelter conditions result in widespread incidences of malaria, diarrhea, fever, scabies and other skin diseases.  Families who have been displaced by the flooding, as well as young children and the elderly, are especially vulnerable to these illnesses.

    Community World Service Asia has been working directly with communities in the Union Councils of Bello and Bijora in District Sujawal for many years, and has developed strong relationships in these areas.  In order to meet the urgent health needs of these communities, a seven-month project was initiated in August 2015.  Mobile health units enabled vulnerable groups such as women, children, the elderly and persons with disabilities to access health care in their own villages, and have consultations with doctors.  A total of 12,793 patients were examined by doctors in this seven-month period, which enabled health issues to be properly identified and addressed.  Essential medicines were also provided to patients, which eased the financial burden of health needs and ensured that patients were able to receive the treatment they needed.

    In such situations of uncertainty and insecurity, pregnant women in particular are faced with specific risks and challenges.  A Lady Health Visitor and a doctor were also available to provide vital ante- and post-natal care services to 388 women.

    As well as responding to current health needs, 362 awareness-raising sessions on health and hygiene were delivered to 8,378 community members in order to prevent the outbreak of illness through improved knowledge and practices.

    Community World Service Asia is committed to the accountability of all its interventions, and works to ensure that our projects are implemented in a way that is inclusive and participatory.  A key method for engaging and empowering the communities we work with is to form village committees, who play a vital role in liaising between the communities and the project teams, identifying relevant issues and mobilizing the community.  In seven months 24 village health committees were formed in Union Councils.  We are also committed to ensuring that the voices of all affected people are heard, so half of these committees are women’s committees, and are dedicated to highlighting and addressing the needs of women in the area.

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