GCACI Plus initiative is envisaged and later implemented to extend Family Planning (FP), Menstrual Regulation and (PAC) services including post abortion contraception, post-partum contraception and standalone contraception through 10 existing FPAP doctor based service delivery points. Unsafe abortions by back street providers have been rampant which alone account for mounting death toll of pregnant women in Pakistan. So much so, abortion is taken for a family planning method instead. Against this backdrop of high fertility, high maternal and infant mortality rate, and the inaccessibility of FP services in the country, there has been a pressing need for quality interventions in Family planning and menstruation regulation (MR) services. In addition to this, the lack of integration of family planning and natal services is a lost opportunity for post-partum and post abortion contraceptive uptake. With 60% of Pakistan’s population below 24 years and early marriages being common, there is a need to respond to the child spacing needs of this group through promoting modern contraceptives.
During 2014 all 10 clinics were upgraded, service providers trained and equipment supplies maintained. Capacity building of service providers focusing on MR, TIA, Medical Abortion, FP Methods including LTPM and counseling skills were undertaken during the reporting period. All health facilities have basic essential equipment to provide services; 100% of facilities reported no stock out of IUDs, Implants and MVAs. Furthermore Integrating FP services with other health services such as immunization, new born or child care services and hands-on training for service providers on technical skills were conducted on MA, FP and integrated counseling. Under this initiative Value clarification training (VCAT) was held in collaboration with Ipas which was attended by GCACI Plus concern staff, core staff and volunteers. This helped in clarifying the biases and Country’s law on abortion services. All Quality Assurance Doctors (QADs) are regularly visiting all project locations to assess the level and quality of service provision. On job supervision has improved the Quality of care as well as clientele at all SDPs.
This four year programme is empowering adolescents and young people to make informed choices about their sexual and reproductive health and is placing young people’s sexual rights on the political agenda in fourteen countries. The objectives of the Choices programme are to increase the number of young people with access to an essential package of youth-friendly services, to increase access to comprehensive, gender-sensitive, rights-based sexuality education and to influence policy change that prioritizes the sexual and reproductive health needs of young people within national health systems. The Choices programme is being implemented at three locations (Chakwal, Mardan and Muzaffarabad) to increase young people’s access to a comprehensive package of youth-friendly services, as well as a standardized age-specific, comprehensive, gender-sensitive, rights-based sexuality education.
The project has a specific focus on young married girls. To date, the project has made a huge impact on the lives of young people by not only increasing access to sexual and reproductive health (SRH) services and comprehensive health and rights education but by steadily creating an enabling environment by shifting attitudes and behaviors in different social, cultural and political contexts through strategic interventions.
We have formulated a Taskforce on comprehensive health and rights education with key organizations working on youth SRHR in the country and developed a framework and a training manual (based on the framework) for teachers and gender-segregated handbooks for students in Urdu and English. These are piloting four schools and using them to provide CSE to out of school youth. We also conducted quarterly sensitization sessions on youth SRHR and gender equity with parents and in-laws in project sites. We have formed an Alliance of key partner organizations, government officials from different ministries and their national youth network members to advocate for this education at national and provincial level. At provincial level we got a letter of support from governments in the provinces of AJK and Mardan to provide health and rights awareness and education sessions in schools.
The ASK program is aimed to contribute to achieve MDG 3 (gender equality), MDG 5 (reduce maternal mortality and universal access to Reproductive Health (RH)), MDG 6 (stop the spread of HIV, malaria and TB). The mandate of ASK project is to provide Integrated Package of Essential Services to the young people and ensuring that promotion of sexual rights of clients. This includes reducing stigma and discrimination around SRHR for young people. The overall objective of the project is to improve the SRHR of young people including underserved groups (10-24 years) by increasing young people’s uptake of SRH services. The project is being implemented in Lahore, Karachi, Islamabad, Peshawar, Quetta, Gilgit Chakwal, Kohat and Faisalabad.
Youth Friendly Services, an integral part of the project, are being provided at selected Rahnuma-FPAP clinics (youth friendly spaces). Building the capacity of service providers on the entire range of the essential package of SRH services, including abortion and working with vulnerable groups has remained very effective. Furthermore Mobile SRH Services Camps has remained very successful as these attracted a large number of young people and grass root community groups. These mobile camps were mostly conducted in remote and rural areas around the clinics (Youth Resource Centers) to facilitate access to SRHR services and information to marginalized groups such as young mothers, out of school youth and LGBT group. To further strengthen the ASK services at Youth Friendly Centers referral linkages were developed with private practitioners around the locations, almost 10-15 Private practitioners were registered at each of the project location. Furthermore MOUs with these Private Practitioners (PPs) were signed for expanding the outreach of young people. Peer Educators who remained an essential part of the project as these Peer Educators among in school/out of school, PMSEU and LGBT group of young people provided valuable information and counseling to young people. As young people remain reluctant to walk into SRH clinics, the experience of Youth Resource Centers (YRCs) and Mobile Camps remains quite successful in providing the information and services to the young people. Privacy and Confidentiality is the most important aspect of the service package for young people. It has been learned that Peer educators are very instrumental in reaching out to young people and needs to be strengthened as part of the project.
During this year, the project has complemented the overall goal in terms of bringing ownership of Health and Rights education curriculum by school management and teachers as essential component of student’s personal development. It also improved the health seeking behavior of registered families especially among young girls and women. Eventually it encouraged the independence of trained women and girls by translating their skills into income generation resources. The project connects three on-going initiatives related to SRH education, services and empowerment of women through skill development. Availing the platform of schools, the project reached out to adolescents and their families to increase knowledge and information regarding SRHR issues. The easy to access service delivery mechanism of mobile camps increased the outreach and access to SRH services for young people and their families. Moreover skill development and provision of micro credit empowered women and their families for income generation.
The component of Comprehensive Health and Rights Education was progressively implemented at the Rahnuma Star Schools in targeted locations. The teachers of these schools were trained on Comprehensive Health and Rights Education and were well capacitated with accurate knowledge on the subject. The school teachers provided Comprehensive Health and Rights Education as per the developed lesson plans and assessed the students using developed tools. This process took a significant amount of time and effort beyond their school responsibilities. These teachers carried out these activities with the spirit of volunteerism. To acknowledge their efforts and to bring a sense of ownership of the project in the teachers, a comprehensive health package and a certificate of accreditation as a “star teacher” was provided to them. A total of 59 male and 100 female teachers in 50 schools are accredited.
3419 registered students and their family member (both male and female) were provided with comprehensive information on SRH and family health and women empowerment. In addition to the enhanced knowledge, 54% of woman and young girls shared that they feel more confident about themselves and they also started to take independent decisions about their lives. They are also accessing the health services by their own decisions and mobility in mobile camps and static clinics. An extensive number of women and girls 1887 reported that they are taking the independent decisions regarding their health matters. 60 skilled women and young girls received the micro credit facility and established their home based/ small scale businesses. They have made noteworthy contribution to increase the average monthly income of their families. A considerable increase in income is observed during the year. A total number of 281 women and young girls reported that they are generating and controlling their own income. These women and young girls also reported that they are taking independent decisions regarding financial matters. Moreover these women and young girls also built linkages with local employers and vendors for the future sustainability of their businesses.
The Healthy Mother, Healthy Baby Project improved the delivery of maternal, neonatal and child health services in nine family health clinics in Gilgit-Baltistan. Many women in this mountainous and rural part of Pakistan face difficulties in accessing quality health services and education. This is partly due to the lack of quality MNCH services, but also a result of limited decision making power by the (young) pregnant women to access the services available. This project targeted communities to understand the importance of antenatal, natal and post-natal care, as well as child health services, and seek to improve the decision making role of the expectant mothers. In line with Japan’s Global Health Strategy 2011-2015, the project used the EMBRACE model to ensure the delivery of a continuum of care from pre-pregnancy to early childhood. The overall goal of the project was to improve the maternal neonatal and child health in the communities around nine Family Health Clinics of Gilgit-Baltistan, by strengthening the facility based service delivery, outreach, and community involvement. Its specific objectives were to provide comprehensive MNCH services to women and children in the catchment area of 9 service delivery points through involving the community in promoting health seeking behaviour, improving the quality of services and taking concrete steps towards better MNCH and to involve the community and promote health seeking behaviour of women of reproductive age, particularly those at risk of HIV to access to MNCH services.
The main achievements under this project were 418 mobile camps that provided MNCH, FP and SRH services at the doorsteps of marginalized communities in Gilgit Baltistan. The capacity of the service providers and staff was built on EMBRACE, FP,USG, HIV and AIDS and MNCH. A total of nine well equipped baby health centres were established in the Family Health Clinics for MNCH services. Provided 28785 antenatal check-ups and 18925 pregnant women with Birth Plans registered at the family health clinic. The skilled birth attendants delivered 5819 babies and their neonatal check-ups were carried out. A total of 5800 children were immunized. Post abortion care services were provided to 964 clients along with post abortion contraceptive uptake. In the reported period 35306 clients were provided other family planning services and 37674 condoms were distributed through this project alone.
216 Birth preparedness and emergency planning sessions were conducted with 2808 expected mothers and families. 3024 mothers-in-law and husbands were sensitized on MNCH issues.3050 mothers were counseled on MNCH including FP through during the sessions. A total of 12000 IEC materials were distributed during these sessions as well.
Rahnuma-FPAP launched SPRINT II initiative to improve health outcomes of crisis affected populations by reducing preventable sexual and reproductive health mortality and morbidity as it is an effective way to save lives if implemented at the onset of an emergency. Neglecting sexual and reproductive health (SRH) in emergencies has serious consequences such as preventable maternal and infant deaths unwanted pregnancies and subsequent unsafe abortions. The MISP is a set of priority activities designed to prevent excess maternal and neonatal mortality and morbidity, reduce HIV transmission, prevent and manage the consequences of sexual violence and plan for comprehensive SRH services. The MISP includes kits of equipment and supplies to complement a set of priority activities that must be implemented at the onset of an emergency in a coordinated manner by trained staff. The MISP can be implemented without a new needs assessment because documented evidence already justifies its use. The components of the MISP form a minimum requirement and it is expected that comprehensive SRH services will be provided as soon as the situation allows. The MISP is a minimum standard in the 2004 Sphere guidelines and in the 2009 IASC Global Health Cluster Guidance.
The goal of the project was to improve health outcomes of crisis affected populations by reducing preventable sexual and reproductive health mortality and morbidity. It specific objectives were to create policy & funding environment, increasingly support of SRH in crisis settings and to increase national capacity to coordinate the implementation of the MISP in humanitarian settings.
Rahnuma-FPAP played an important role to integrate MISP RH Support to SPRINT implementation and provide technical assistance/capacity building to integrate the MISP in national policies. We conduct meetings at national and provincial levels with NDMA and PDMAs. Four days ToTs were organized in which participants from public sector. NGOs, INGOs and UN agencies were trained. These trainings were intended for SRH coordinators from local and international organizations including UN agencies and government representatives working in the area of health, SRH, emergency preparedness, disaster management and situations of forced displacement. These sessions included class room lectures brainstorming and group work including practical exercises. Five training for trainers were conducted in collaboration with UNFPA, NHEPRN and Health Services Academy at Islamabad and Peshawar attended by 122 participants from NHEPREN, HSA, UNICEF, UNFPA, NATPOW, Save the Children, and different NGOs. The overall goal of the trainings was to increase the coordination and implementation skills of Sexual and Reproductive Health (SRH) Coordinators and managers. The skills and evidences delivered through these trainings has the capacity to be used as advocacy tool to mainstream SRH into emergency preparedness plans and humanitarian responses.
Under SPRINT project Rahnuma-FPAP Baluchistan region provided counseling sessions, EMoC services, SRH services and sensitized earthquake affected people of Awaran and Kech Districts in Baluchistan. In the reported year Rahnuma-FPAP successfully conducted 422 medical camps in the four affected Union Councils of the two earthquakes affected districts. Medical services such as RH and Lifespan were provided to 51216 people out of whom the total numbers of male and female beneficiaries were 14365 and 36851 respectively.
Counseling sessions were provided to male and female population during the course of medical camps and contraceptives (Condoms) were distributed for prevention of HIV and STIs transmission to affected population.
Most importantly 2000 of delivery kits were provided to the local TBAs and pregnant women to promote clean home deliveries and to reduce the maternal morbidity and mortality rates in the affected areas.
Severe drought that occurred in the Thar Desert of Sindh Arid Zone due to failure of monsoon resulted in severe shortage of food, fodder and water. A large number of people including children died in Mithi hospital. Mostly of them were from Diplo, Mithi, Nagarparkar and Chahro tehsils of Tharparkar district. In three-month time the death rate among children went up to 151 and the district was put on high alert for famine.
Rahnuma-FPAP reached the disaster hit Tharparkar with medical and nutritional assistance with a project that aimed at improving the nutrition of the community especially mothers and children; immunizing them against disease; promote breast feeding; monitor growth of children; provide preventive medication to women especially in the antenatal period and provide family planning services. The other objective was to control communicable diseases common in drought hit areas such as malaria, diarrhea, acute respiratory infections, typhoid, viral hepatitis, cholera and other similar ailments.