HANDS Health Program offers several tested strategies given below, which contribute in MDG 4 Reduce child mortality and MDG 5 to improve maternal health, MDG 6 to combat HIV/AIDS, malaria and other diseases (Hepatitis) in addition to other MDGs.
STRATEGY I: PROJECT DESIGNING AND IMPLEMENTATION
HANDS has designed and implemented following projects with different public and private organizations last year.
Strategy II: Research
HANDS Health Promotion program conducted many researches last year. Following are the key findings of few of these.
Key Findings of Marginalized Areas Reproductive Health Viable Initiatives (MARVI) Survey
Total maternal deaths are 51 during last two years, 70% occurred in lower income groups. Most of the women (62%) either did not receive any antenatal care or less than the recommended number of antenatal visits. 73% received care from private health care providers, only 22% women sought advice from some government health facility. Most of the respondents (70%) knew about at least one modern method of contraception.
Key Findings of School Health Survey
4484 children were found to have abnormal weight out of total 21247 screened children. 2808 girls were malnourished out of 14158 girls screened and 1676 boys out of total 7089 screened boys were malnourished. The frequency distribution of abnormalities showed highest incidence (43.1%) of Oral / Dental problem category among the total abnormalities.
The frequency distribution of abnormalities in the screened school children in district Umerkot showed frequency of malnourishment as 55.8%, stunting 31.2%, Oral/Dental 40.2%, ENT 25.5%, Eye 27% and skin 36.1%. In district Thatta 2808 girls were malnourished out of 14158 girls screened and 1676 boys out of total 7089 screened boys were malnourished. The frequency distribution of abnormalities shows highest incidence (43.1%) of Oral / Dental problem category among the total abnormalities. The other category of abnormality of significance is malnutrition which is 39.8% and stunting (height for age) which showed and incidence of 31.2% among the total abnormalities. The remaining categories of problem are less than 10% of the total abnormalities in the district.
Key Findings of Sexual and Reproductive Health Services for Adolescents and Youth: Project Survey
Poor knowledge was found about reproductive health among health care providers particularly Traditional Birth Attendances and religious person. Weakness in education system, negative thinking, desire of getting married; Leucorrhoea in women were the SRH identified problems by them. Modern methods of FP were more prevalent compare to traditional methods. It was observed that respondents of all groups were familiar with Sexual diseases such as AIDS, Hepatitis, T.B. Besides that they also acknowledged cancer, secretion from vagina, swelling on womb, menses disorder.
Strategy III: Capacity Development
The program offers several capacity development packages in addition to tailor made trainings. The program offered following trainings during last year.
Program developed the capacity of 654 professional staff through 94 trainings. The health program trained 352 staff through 45 internal training and 71 of them were trained through other NGOs /Public Sectors training institutes. The program has trained 231staff members of partner NGOs / Public Sector who received trainings from other training institutes.
Capacity building of Health Care Providers
HANDS Health Promotion Program in collaboration with Human Resource Program trained nearly 357 health care providers in 45 trainings programs, 34 of them got diploma of 18 months in community midwifery.
Strategy IV: Services
HANDS Community Midwifery Training School
To improve the safe motherhood status and to reduce maternal, infant and neonatal mortality and morbidity, HANDS started Community Midwifery Training Program in 2002 in two schools one in Karachi and the other one in Hala, District Matiari. Both of these schools are attached with functional secondary care facility so that CMW get exposed to clinical practices and community at the same time. These schools are recognized by Pakistan Nursing Council. HANDS is pioneer in the community midwifery training program in Pakistan. HANDS Health program has trained 183 community midwives 21% have been dropped out and 121 have passed out (66%). The trained community midwives later go back to their own villages and established primary health care centers and start midwifery practices. HANDS Health team facilitate them for next two years to establish rational and low cost practices.
Performance of Midwifery School
Primary Health Care Program
Following services are available at the Primary Health Care Centers.
Immunization for women and children, Oral Re-hydration Therapy and Control of Diarrheal Diseases, Nutrition counseling, growth monitoring, Treatment of minor illness, Antenatal, postnatal, delivery services, Treatment of Acute Respiratory Infection and Referral services to secondary care facility
Adopt a Govt. Health Facility
“HANDS adopted a government health facility project” starts with identification of partially/non functional govt. health facility, signing of MoU with district government, formation of Health Management Board, opening of joint account, initiation of user charges, establishing Community Midwifery Training school in hospital premises, establishment of health management information system.
HANDS in 1999 signed an agreement of partnership with District Council Karachi and made Jamkanda Hospital functional. Before this the health facility was not functional . Now this 20 bedded hospital is providing quality health services with special focus on mother and child health to about 2,00,000 population of 84 villages of Bin Qasim and Gadap towns.
HANDS gradually expanded health services and presently this hospital is Providing secondary health care services to more than 300000 people of 70 villages of rural Karachi. 30 bedded hospital (CDG-HANDS Hospital) , 24 Hours Emergency, In & out patients dept., EOC (Emergency Obstetric Care), Operation Theatre, Ambulance, Laboratory, Blood Bank, Ultrasound, X-ray , Gyne Specialist , Vaccination and Family Spacing Services.
Reproductive Health Services
Health Promotion program has benefited nearly 6.4 million population and 55249 clients out of which 54% were female , 26% children and 20% were male. This year 84% antenatal coverage achieved in the target population as compare to 91% previously. Total No of delivery on records are 571 , 90% these were with normal birth weight.
There is significant decline in the MMR (Maternal Mortality Rate) within HANDS intervention areas where its trained community midwives provide health services. 86% women are delivered by skilled birth attendants as compare to national figures of 20%.
Antenatal coverage was 84% in 2006-07.
HANDS Health program is running a large family planning project in all districts with the objective of increasing demand of family planning repositioning birth spacing as a health intervention and to address the unmet need by improving knowledge and access to quality family planning and birth spacing services in all the districts of HANDS. All the concerned staff is trained in reproductive health and family planning. 5 consultation meetings were conducted in this year one at provincial level and five at district level. HANDS also extended its partnership with Rural Support Program Network (RSPN) and their representative National Rural Support Program (NRSP) , Sindh Rural Support Organization (SRSO), Thardeep Rural Development Program (TRDP), Sindh Graduate Association (SGA) in districts Thatta, Sukkur, Umerkot and Sanghar respectively.
Community Based Social Marketing
HANDS Social Marketing plan is consumer focused addressing the elements of "marketing mix.“ "Four Ps" of marketing concept is adopted Product, Price, distribution (Place), and Promotion. HANDS trained community based workers and then established supply chain mechanism. more than 400 providers are engaged with HANDS social marketing team. HANDS market product like safe delivery kit, contraceptives pills & condoms, emergency contraceptives, essential medicine, sanitary pads, oral rehydration salts.
School Health Program
School Health Program objective is to detect primary impairments of children at school, conduct de-worming at schools, develop health monitoring mechanism, establish referral and treatment through secondary care health facility. The initial assessment results show that children are having problems of vision error, hearing problems, dental caries, throat and skin infections like scabies. To detect impairments 63 doctors and LHVs were trained .Health screening of 42310 children from 577 schools of Umerkot and Thatta were carried out for height, weight, ENT examination, oral and dental examination, skin examination, deworming children. 56 trainings of 933 teachers & SMC members in child health and development, corporal punishment, breast feeding, Expended Program on Immunization (EPI), maternal health, nutrition personal hygiene were held. 800 follow-up sessions with mothers on health & hygiene were organized by SMCs and teachers.
Life Skills Base Education (LSBE)
HANDS LSBE Model started with signing of MoU with the district government. Final selection of educators of public sectors was done for training of Govt. High School teachers on life skill based education for classes of VI, VII & VIII. HANDS has trained 8 Master Trainers, 34 schools have adopted LSBE curriculum, 49 Govt. High School teachers trained, 2327 adolescents with improved knowledge, positive attitudes and improved life skills.
Strategy V: Publications
The health program has developed several publications and health education materials for different behavioral change communication strategies in collaboration with Information and Communication Resource Program.
“MARVI GAVE ME SOCIAL STATUS”
Haseena lives in a remote desert village named Sadoori in district Umarkot, Sindh Pakistan. She is a housewife with three children and her husband Mithan is a driver who can barely make both ends meet. She got education up to class five, as there is no further education facility in her village and she is counted among the educated of the village. She said, ‘I didn’t have any aim in my life until TRDP team came in our village. They told us that they wanted to select a woman for training her in the pattern of lady Health Worker. After consultation, the village elders nominated me for MARVI worker training. I cannot explain my feelings when I was nominated as MARVI Worker, I had a wish to see the world beyond my village. My joy knew no bound, but at the same time I was afraid that how will I learn from the training and would I be able to work in my village as a health care provider? At last the day came when we went to Umerkot to attend the training. During the six days training conducted by a very polite and learned lady from HANDS, I was taught how to work in villages, how to motivate people to adopt healthy habits, how to measure weight of pregnant ladies and why it is necessary to check them and recognize the danger signs. The training was conducted in my mother tongue. I was issued a MARVI Kit, which contained some basic medicines family planning items and instruments for measuring weight, BP, temperature.
I returned to my village after completing the training and started my work. After going around the village for many days, I felt that the villagers were not ready to accept me as a health care provider. They said that how can we believe that you learned things during your training. I was taunted and I started losing interest in work. I came to know that the local landlord does not approve of women stepping out of the house and has thus alienated me.
One day in the winter, about three months after my training there was a knock at my door. I found that the landlord was standing at my door with his one year old son in his lap. He showed me the child; the baby had high fever, so much so that the child was going into convulsions. I had been taught in the class that in such situations, the child is to be given cold sponging and 2 tea spoons of syrup paracetamol immediately. I did that and after half an hour the condition of the child improved. I checked the temperature, which was 990 and I told the father that it was now safe to take the child to a clinic which I was told is declared mother/child friendly by MARVI Project Staff.
The next day the landlord came to our house. He called me and my husband and told us that the doctor in the clinic had informed him that the timely first aid to the child in the village had saved his life. He had tears in his eyes. He said, “From today, MARVI WORKER will hold a place of pride in this village”.
Now, all the people respect me as MARVI Worker, and I try to help as many people as possible. I arrange weekly gathering in my hut, in which health and other social issues are discussed. My financial status has also improved as I charge nominally for my services, and sell family planning products and selected medicines with some profit. My family is very happy now. MARVI has certainly given me a place of honor in my village’.
LETS WORK TOGETHER
Ghagher and Darsano Chanoo are the most deprived Union Councils of the City District Government Karachi. Despite the fact that these UCs are situated at the distance of 40-45 km from the down-town, but are not benefited with the facilities of this mega city. This is astonishing fact that just a few years back UC Darsano Chano was the richest UC of the country. However the dragons of corruption, looting, bribery, fraud, dishonesty finally ruined this UC to a completely desolate one.
Once UC Ghaghar was a part of Darsano Chanoo, however after devolution plan the UC Ghagher came into being as a separate entity. Total population of both the UCs is 67,593 most of them are destitute. The UCs are deprived of basic civic facilities and the people of the area are forced to live in a hideous environment. The dwellers mostly engaged with the agriculture are despondent due to dry and barren miles spread fields. The scarcity of water and heavy billing of electricity made their lives miserable. The health and the education scenario are no different than overall Pakistan. There were only one Basic Health Unit (at Haji Muhammad Jokhio Village UC Ghagher) in the two UCs and that was without doctors and medicines, practically non-functional. The morbidity and mortality figures were alarming. Similar situation was seen in education sector; schools without teachers and sitting facilities.
In the year 2004, M/s. Nestle Pakistan Pvt. Ltd. established its company manufacturing unit at link road UC Darsano Channo. HANDS contacted with the officials of Nestle and convinced them to serve to the poorest communities which are living around the vicinity of the company. In fact it was Nestle’s social responsibility to spend a certain percentage of their income on the development of the area around them. They realized their social responsibility and agreed upon the idea of HANDS and asked to submit a comprehensive proposal. HANDS conducted the socio-economic study and prioritize the problems of the area. HANDS after conducting the study and meeting with the local people assessed that there are three major problems; Health, Education and Poverty. HANDS drew a strategy to upgrade the services of BHU to provide the quality health facility to the inhabitant, planed to renovate the building and recruited teachers to provide the education to the children of the locality, besides set up an entrepreneur center at village Khair Muhammad Khaskheli Village for alleviation the poverty and empower the women.
Nestle Pakistan Pvt. Ltd. approved the proposal and HANDS started serving the community. An agreement was signed on 15th September 2005 among different stakeholders; Nazim UC Darsano Chano, Nazim UC Ghaghr, Town Nazim Gadap, Town Nazim Bin Qasim Town, EDO Health, EDO Education, HANDS and Nestle. It was first agreement ever in the history of HANDS where different authorities were the part of the project with their assigned roles. Renovation work of BHU Haji Ahmed Jokhio UC Ghagher, entrepreneur Center and school of Khair Muhammad Khaskheli village UC Darsano Channo started in the month of December 2005. During this period, project team selected 6 girls of the village for textile training in order to establish an entrepreneur center in the village. The girls got trained at HANDS Technical Training Center (HTTC) Murad Memon Goth. To provide good laboratory facilitate at BHU; a lab technician was trained in CDG-HANDS Hospital Karachi. After the completion of trainings and construction work of all projects (health, education and entrepreneur) HANDS provided required equipments. Nazims of both UCs played active role in this regard. Till 20th April 2005 renovation work of Labor Room and laboratory in BHU has been completed. Repair work of School has been finished and Entrepreneur Center has been established. A vehicle for pick and drop of doctors especially lady doctor has been arranged. At the moment BHU is in functional position. Lady Doctor is providing services of antenatal and postnatal checkups to the pregnant women of the area. Before this facility, there was not a single health facility available in the area. Incharge Medical Officer and the staff of the BHU are regularly attending their duties. The facility is benefiting 650-750 male, 300-400 children and 500-600 women every month. Vaccination facility to women and immunization to children is being provided on regular basis by the Lady Health Workers. HANDS had established a health committee to supervise and monitor the BHU services. Now this health committee has become a register organization under CCBs Act. Community representatives and influential personalities are the members of the committee.
To provide quality education to the students of the village HANDS trained teachers in different teaching methodologies. SMC members were also trained to run the school affairs smoothly. School is now satisfactorily imparting education under the supervision of Community Organization of the village and School Management Committee. Five trained teachers are imparting education to the students. In the school 113 students are enjoying quality education, more importantly, in their own village.
In Entrepreneur Center all trained girls are working and generating income. This project is playing a key role to empower the women. The girls who are working in the center are now empowered and are models for others girls in the village. HANDS formed a Women Organization to look after the center’s affairs. The trained girls though earning handful money, however, as the demand of their work is growing, it is expected that they will earn double or even more.
HANDS is playing a supervisory and monitoring role in the project and its team regularly visits to project supervise different activities and monitor the different indicators. Regular meeting are held where all project incharges share the project progress and discuss the problems. Nazims of both UCs, CCB (Health committee) members, community organizations attend meetings.