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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

    2112

    Community World Service Asia is working to empower young women in rural Sindh through improved earning opportunities, literacy skills, and enhanced awareness of gender equality.  Kaveeta is eighteen years old and lives in Walhar village in Umerkot, where the project is being implemented in partnership with Y Care International and UK Aid.

    She is engaged in the project as an artisan and an instructor at the Adult Literacy Center.  Currently, her entire household subsists on around Rs. 6,000 (approximately US$57) a month. “Lack of income means doing everything the hard way,” she explains. “We are struggling to get food.”  For Kaveeta and her family, meeting the basic needs of nutrition, health and education is a constant challenge.

    When Community World Service Asia initiated the project in her village, a local steering committee was formed and the members met with the community to tell them about the project and encourage them to participate.  Kaveeta was already experienced in appliqué work, and wanted the opportunity to polish her skills.  At the Vocational Training Center, she has learned about working in a group to improve the quality, as well as about different color combinations, finishing and packing products, pricing, and how to negotiate with suppliers.

    Due to Kaveeta’s skills, she was selected to produce handicrafts to be displayed and sold at the Daachi Foundation Exhibition in Lahore in November 2015.

    “That was a great experience,” she shares. “Our trainer told us that we have to prepare quilts for the exhibition and we had just fifteen days to complete this order.  At first I was nervous and thought, ‘How can this order be completed in just two weeks?’ But when I started to work in the group, we completed the order on time and realized the importance of group work. That was the first time we prepared quilts with modern designs, that’s why I was very excited.”

    Kaveeta received payment from Community World Service for her contributions to the exhibition.  As she continues to earn an income, she hopes to one day open her own center where she will teach others what she has learned through her participation in the project.

    “Teaching adults is special for me,” she says. Kaveeta’s affinity for teaching motivated her to volunteer as an instructor at the Adult Literacy Center, where she helps her fellow artisans to develop literacy skills. “I enjoy this work because I want to teach all the women of my village.  They are interested in learning.  It is a big achievement that artisans learned to write their names.”

    Through her participation, Kaveeta is building not only her handicraft skills, but her confidence as well.  She has high hopes for her future and for the future of the women in her village.  Community World Service Asia looks forward to continuing to work with her and to realize those hopes.

    2932
    Students and artisans look through design ideas together 01
    Students and artisans look through design ideas together
    Students and artisans look through design ideas together
    Students share new creative patterns for embroidery 02
    Students share new creative patterns for embroidery
    Students share new creative patterns for embroidery
    Students examine embroidery samples 03
    Students examine embroidery samples
    Students examine embroidery samples
    The artisans and students had fun getting know one another 04
    The artisans and students had fun getting know one another
    The artisans and students had fun getting know one another
    The artisans demonstrate their embroidery skills 05
    The artisans demonstrate their embroidery skills
    The artisans demonstrate their embroidery skills
    Artisans were enthusiastic about learning new designs from the students 06
    Artisans were enthusiastic about learning new designs from the students
    Artisans were enthusiastic about learning new designs from the students
    The artisans impressed the students with their traditional skills, including this appliqué work 07
    The artisans impressed the students with their traditional skills, including this appliqué work
    The artisans impressed the students with their traditional skills, including this appliqué work
    The workshop provides a space for women to come together 08
    The workshop provides a space for women to come together
    The workshop provides a space for women to come together
    The students and artisans worked productively together to produce samples 09
    The students and artisans worked productively together to produce samples
    The students and artisans worked productively together to produce samples
    Handicraft skills have the potential to be a reliable source of income for these women 10
    Handicraft skills have the potential to be a reliable source of income for these women
    Handicraft skills have the potential to be a reliable source of income for these women

     

    With support from the Danish Center for Culture and Development, Community World Service Asia is bringing together rural artisans from Thatta and Umerkot in Sindh, and design students from Karachi.  Through their collaboration, traditional skills will be combined with marketable designs, enabling these women to connect to the urban market and earn a sustainable income from their craft.  This month, students from the Indus Valley School of Art and Architecture (IVS) and the Textile Institute of Pakistan (TIP) visited Umerkot and Thatta respectively, in order to meet the artisans with whom they will be working, and gain some insight into their way of life and conditions of work.

    2313

    Kamla is a resident of Surto Oad village in District Umerkot.  Kamla’s father, Mr. Mukesh Kumar, is the sole earner for her family, and was scarcely able to earn enough to support his household of eight people.  Women in these villages in rural Sindh are largely dependent on male family members for financial and social support.  It is extremely difficult for them to overcome cultural and social barriers to earn an income.  For Kamla, who is living with a disability, those barriers are especially difficult: “A I’m a physically disabled woman, I can’t go out for labor in agricultural fields as most of the women do.”

    In spite of these difficulties, Kamla is resolved to support her family and help them to build a resilient future free of any financial worries.  “I have the art of embroidery. I can do embroidery work at my home also, and I can help my family to reduce financial burden.”

    She believes that lack of education, ignorance of health issues and gender discrimination are the major obstacles to women’s empowerment in her community. She stated that when she was informed that an NGO (Community World Service Asia) was establishing an embroidery center at her village, a ray of hope was rekindled for her. She already knew the art of embroidery, but her work was never acknowledged and she did not receive due wages for her laborious work.

    Despite having no formal vocational training, she is very skilled in embroidery and produces high quality work.  However, as she has been unable to properly market her products, her work remained underpaid.  “After taking the artisans’ skill test, I was informed that I have qualified the test and team selected me for the embroidery learning center. I was really glad to hear this news and was highly excited that now my skill will be improved and my work will be recognized with fair wages.”

    Kamla explained how participating in the project will support her to earn a real income from her work: “After a three-month course on embroidery, and then an additional three months for production, I will be able to get an idea about marketing those products and what are the rates of market.  Then I can assist my father in terms of contributing income.”

    Her father will also be engaged in the project activities as a gender activist.  Kamla shared how he is working to promote gender equality in the community after participating in Community World Service Asia’s TOT workshop for gender activists: “Since the training, he is delivering lectures on a regular basis with my neighbors and my relatives and motivates them to educate their daughters as well.” She is quite hopeful that the difference between male and female which society has created will now be reduced; women are now talking about their health issues with their male counterparts.

    For Kamla, the most important impact of the project has been that she is now empowered to support her family.  “Around the clock, I remained in tension, wondering when I would be able to do something for my family. Now I have trust in myself that I can also help my family financially. Despite my physical disability, I can also be independent and can contribute my due share for the betterment of both my family and my community as well.”

    2541
    DurationApr 01, 2015 — Mar 31, 2018
    LocationDistrict Umerkot, Thatta, Sindh Province
    Key Activities
    • Developing women’s skills in embroidery, dying, block printing and quilting through vocational training;
    • Formation of Women’s Enterprise Groups;
    • Training of women with basic literacy and numeracy skills as Sales and Marketing Agents;
    • Training of skilled women as Quality Assurance Supervisors;
    • Gender awareness activities to sensitize communities on gender discrimination and encourage support of women’s income-generation, control over resources and household decision-making;
    • Formation of Household Gender Action Groups
    Participants700 women in vocational training
    3,080 immediate and 7,560 extended household members benefitting from increased income
    1,400 men and community members benefitting directly from gender sensitization activities
    3,450 community members sensitized on gender issues through Gender Action Groups
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