SRSP Health Programme was started in 1996 by training existing Dias1 in the communities through a 15-days UNICEF training module for Dias training. The topics covered in the training courses were communication skills, antenatal and post natal care and problem cases, care and nutrition of new born and infants, birth spacing, diarrhoea and ORS, immunization, personal and environmental hygiene, safe drinking water and sanitation practices.
Uptill March 2003, 869 dias have been trained and are named as Female Health Workers (FHWs). Their activities have remained focused mostly on delivery care and dissemination of knowledge about general health care principles and family planning (FP). These workers have received fee for delivery services in cash or kind from the community people, but not for other activities. Besides FHWs, over 97 Male Health Workers (MHWs) have also been trained.
Similarly Health Field days have been carried out in all the Five Regions i.e Peshawar, Mansehra, Abbottabad, Kohat and Charssada. WCOs have been linked with the FPAP and PWD. Expanded Immunization Campaigns have been carried out in the selected programme areas. Medical Camps have also been arranged for the benefit of rural poor.
SRSP has also hired the services of consultants to conduct a survey to develop health strategy for future interventions. In this regard a survey was carried out in Peshawar District to identify the gaps in Health Sector.
Following are the findings of the survey carried out:
People want affordable, accessible and quality health care but unfortunately the existing system is unable to fulfill the desired need. The existing system lacks appropriate equipment, skilled technicians, paramedics and qualified doctors and invariably low stock in medicines, therefore the local communities do not have much faith in these health facilities. They prefer either private practitioners or local paramedics who are willing to give them time and sometimes provide treatment on credit basis.
Local service providers like Lady Health Workers, TBAs, Male Health Motivators and any other Community Health Workers may be effective in delivery of certain aspects of health care if provided proper training.
People avail treatment on credit basis or take loans from family or friend. This is being experimented by the local NGOs that provide health cover to its participants on installment basis.
It was concluded from the survey that there are three key stakeholders in health sector:
The Government, which does offer a spectrum of services through its health facilities, though substandard; The communities who have genuine needs, but have to be mobilized to move on from the mindset of “government should provide”, and the NGOs who have adopted different models of intervention. Thus a partnership should evolve between all three key stakeholders for the accessibility of health facilities in an effective manner.
II.4 Progress of SRSP’s Health Sector during April-June 2003
Currently health activities are being carried out in three Regions of SRSP i.e:
- Kohat Region
- Abbottabad Region
- Mansehra Region
As already mentioned SRSP’s health Strategy is working for the improvement of three major areas i.e. is capacity building of Health workers, Awareness raising campaigns and establishing linkages with other organization.
Field Health Workers
Under capacity building programme of Health workers about 310 FHWs have been trained and follow up visits of about 43 FHWs have been carried out. During the quarter no basic training or refresher was conducted due to unavailability of funds. Similarly, no advance level training is conducted during this quarter due to lack of funds. According to the feed back, the need has been felt that FHWs require more information about the communicable diseases, complexities of pregnancy, blood tests like eclampsia, preclampisia, hypertension, sugar, R H factor tests and albumin blood sugar.
Family Planning Camps
These camps play vital role in providing Family Planning services, awareness and motivation in areas where health facilities are unavailable and people are not aware about Family Planning practices. Family Planning camps in collaboration with Population Welfare department and family planning center were arranged in WCOs Kashtara, Phore, Ghoray Phair and Zameeri.
Free Medical Camps
A free medical camp was held at village Bradarr on May 14,03, with the assistance of PWD and health personnel from District Headquarters Hospital. About 200 patients were treated with the ratio of 125 men and 50 women while 35 were children.
Diseases identified were low blood pressure, general weakness, Fatigue, cough, allergy (skin diseases) while the eye diseases were common amongst the communities. Patients diagnosed with eye diseases were referred to District hospital for detailed checkups.
Majority of the women complaint about general weakness and body pain due to heavy workload. The patients were provided free medicines for general sickness and contraceptives under family planning programme.
Health & Hygiene
As the health policy of SRSP focuses on primary health care, therefore the emphasis is more on the health awareness campaigns. In this regard, 8 health field days and 3 health and hygiene camps were arranged in collaboration with PWD. Along with the health awareness, free medicines were also provided to the women communities.
As already mentioned, SRSP is striving to bridge the gaps between public and government line agencies. It is evident from the support provided by SRSP in the Women Health Project initiated by GoNWFP (Health Department) in collaboration with the Asian Development Bank (ADB) in the four districts of NWFP. Kohat District being one of the selected districts for WHP, has undertaken a number of activities to strengthen Public-Private partnerships, which includes the improvement of service delivery mechanism through the active participation of communities at grass –root level.
SRSP being the partner organization of WHP arranged a meeting with PWD Kohat, LPRP Lachi, FPAP Kohat and National Program for FP&PHC. It was an effort to strengthen partnerships between all the stakeholders of the selected area.
Under WHP, GoNWFP has initiated following three major activities with the assistance of SRSP :
Training of TBAs
As per commitment with GoNWFP, SRSP has provided a list of 28 community members (from 10 WCOs) for the above-mentioned training to the District Health department.
A six-day training was imparted to 28 community members of district Kohat. The training was held at Liaqat Memorial Hospital-Nursing school Kohat on June 16-21, 2003. Resource persons of the nursing school and LMH Kohat delivered the sessions to the participants. SRSP facilitated the arrangements for accommodation and TA/DA for the community members.
Revolving fund for avoiding maternity delays
In rural areas of NWFP it has been perceived that high rate of mortality amongst women is also due to maternity delays caused by lack of proper transportation system. Similarly, most of the women due to poverty cannot afford transportation cost for visiting hospital. This calls for an active role of community to arrange a Community Based Emergency Transport System. In this regard the most feasible way is to establish revolving funds to be utilized on emergency bases by the patients which would be returned after the fulfillment of his/her medical urgency.
To implement the same idea, WHP has offered a revolving fund of Rs. 8000/- to the community, initially at five locations.
SRSP provided the list of five locations according to the criteria set forth by the district health department to the District Health Office along with the tentative dates for visiting/ meeting the same communities and signing ToP for the award of revolving fund.
SRSP team arranged the meetings with the selected communities according to the plan. The communities were briefed about the purpose of the revolving fund and the criteria for availing the award. The team also conveyed that the fund is not restricted for the WCO members, but all the villagers, who are poor, can avail the fund. However, the women availing the fund would be responsible to return it within the period of one year either in installments or lump sum. It was also emphasized that the entire fund is free of interest.
After meeting ToPs were signed by the WCOs and members from the five WCOs were selected for Revolving fund management committee comprised of four persons i.e. the President, Secretary, a member and Men activists. The committee would be responsible to ensure the eligibility of the applicant and the timely repayments within the mentioned time period.
Health festivals (Health days)
Free medical camps were held on field days i.e. on June 19 and 25th 03 in UC Khushal Garh. SRSP arranged the maximum participation of women in these health days also contributed 75% for the free medicine and arranged accommodation for the said activity. While 25% of the medicines were provided by the district health department and also arranged tents and stalls for different agencies. FPAP arranged medical consultants for these health days and provided free medical consultation.
These health days not only benefited the community members at large scale in a short time span but also provided an opportunity for all the stakeholders to build/strengthen their partnership to identify joint working areas, which avoids duplication of efforts/resources. Similarly such activities also help in establishing linkages of the communities with the other organization working in the same area.
Refresher for FHWs
Two days refresher was held in SOU Hangu with the participation of 18 community members. The refresher was helpful in recalling all the lessons learnt during the training and the WCO members get an opportunity to share their experiences and find solutions for their problems they face while attending the patients.
As mentioned earlier, these camps serve as an awareness-raising medium about the primary health care and contraceptives used for family planning. During the quarter four FPAP camps were held in Hangu and Kohat (2 per SOU). Sixty members from 8 WCOs participated in the activity.
Follow-ups of FHWs
During the quarter, 13 follow-up visits were carried out in District Karak, Kohat and Hangu. During the follow-up visits it has been observed that the FHWs have dealt with 23 delivery cases, during which they have earned Rs. 4600.
The Health Programme of SRSP in Abbottabad Region began in February 1998; it was joint venture of SRSP with Barani Area Development Project. The Region under the capacity building programme of health workers has trained about 99 Female Health workers.
Due to lack of funds none of the advance level trainings have so far been conducted during the quarter. These trainings are considered to be very important in enhancing the knowledge of the trained health workers. These trainings would add to their information about communicable diseases like diarrhea, typhoid, malaria and other tests like eclampsia, preclampisia, hypertension, sugar, RH Factor tests and albumin blood sugar.
Health Field days
Health field days are the part of awareness raising campaigns amongst the rural communities about health and hygiene. The Region carried out about 82 health field days in 45 WCOs while about 44 family planning days have been carried out in 47 WCOs. During the quarter i.e April-June 2003 no health days have been arranged due to non-availability of funds.
FHWs conferences are the part of capacity building programme of SRSP, up till now 100 conferences have been arranged in 40 WCOs. These conferences not only provide exposure to the FHWs but it also provides them the opportunity of experience sharing.
One of the major constraint faced by SRSP in launching its health programme is the non-availability of adequate funds. To resolve this problem to some extent, linkages of the WCOs have been developed with the following:
1) District Health Department.
2) District Population Welfare Department.
3) Family Planning Association of Pakistan & Kato Women center Haripur.
4) Green Star Social Marketing Islamabad.
5) Rehmat Memorial Complex Hospital Abbottabad. Save the Children Reproductive Health Programme Haripur.
6) National Health Programme in the both District Haripur & Abbottabad.
7) Sungi Development Foundation Haripur & Abbottabad.
8) NRCP Abbottabad.
§ Non-availability of vehicle due to credit recovery.
§ Inadequate funds for health related activities.
§ Proper guidance from SS&GI Section Head Office.
Less cooperation from women community in family planning specially Batagram, Allie and Oghi..
Workers No follow-up of Male Health:
Due to non-availability of the Male Health Officer at Region the status of Male Health Workers is dormant which needs to be closely monitored. Social Organizers are also under huge burden of credit recovery and they find less or no time to keep a check on the activities of MHWs.
SRSP health sector is striving to explore new avenues for the improvement of health status in its programme area. It also aims to significantly lower morbidity and mortality, especially among women, children and men of productive age to improve health and support in poverty alleviation. As Health issue lies at the broad spectrum, it needs lots of resources and efforts but SRSP so far has not been fortunate enough to receive funds for its health programme. Both Public and Private Sectors needs to identify joint working areas to find solutions for the health problems.
Keeping in view the efforts and issues related to health activities following are some suggestions to improve the present situation:
§ It has been observed from the efforts initiated for the improvement of primary health care in the programme area that although a lot has been done but so far less/no visible impact has been noticed. This calls for a planned set of activities keeping in view the impact, criteria for selecting the area, focus/approach of the health campaigns, proper follow-up and research.
§ In view of the past experiences and practices, it has been found that SRSP is facing the problem of inadequate allocation of funds for health sector. The need is to find more partnerships and linkages for financial resources required for the health related activities so as to implement health programme more efficiently and effectively.
§ Focus on the areas where the health situation is more vulnerable and people do not have any access to avail the health facilities.
§ Trained cadre should be given refresher and advance level trainings to further enhance their skills i.e. more emphasis should be given on quality rather quantity of Trained Health Workers. It is further suggested that the capacity of all health workers should be build at same level.
§ Similarly Health Officers appointed at the Regional Level should also be given trainings to build their capacity in the field of health related problems, thus making the monitoring process more effective and efficient.
§ More coordination between Health Officers and health workers.
§ Appointment of Health focal Person at Head office with expertise in health sector thus to voice the health issues/problems more effectively.
§ Keeping in view the financial status of communities and affordability, health insurance schemes could also be effective in the present situation.
1 “Dias”, are traditional birth attendants working in the communities but they have not availed any formal trainings.