Adversity to Advocacy

“In a society governed by the archaic “Mata Sata” system, my father’s desperate attempt to secure a son led to unimaginable consequences.”

I am Jaam Zaadi, a resilient 29-year-old woman from the village of Naseer Khan Brohi. My life, marked by trials and triumphs, narrates a story of resilience, education, and empowerment. Born into a family shattered by my parent’s divorce and my father’s callous decisions, I overcame societal norms to become an advocate for education and health, thanks to the transformative impact of HANDS.
In a society governed by the archaic “adla badla” system, my father’s desperate attempt to secure a son led to unimaginable consequences. He sold my 2-year-old sister for PKR 75,000 and me, a 6-month-old infant for PKR 50,000, all without my mother’s knowledge. Yet, my mother’s steadfast refusal to let us go became a pivotal moment that altered the course of our lives. Abandoned by our father, my mother, sister and I faced the scorn of societal prejudice against female education.
Despite the relentless opposition, my mother, a beacon of determination, toiled as a laborer to provide us with basic school necessities. Hiding our books in the jungle, we pursued education stealthily, navigating through societal hindrances. Our journey continued against all odds, and with the help of our teachers, we managed to continue with our education.
The struggle persisted as we completed matriculation. The family’s pressure to marry within our caste reached new heights, with my father claiming us for the elderly man he had sold us to. I stood firm, filing a case against him, refusing to be treated like commodities. The community shunned me for my education, but my mother’s unwavering support prevailed. Eventually, I found solace in marrying outside the family. My husband is very supportive, appreciates my hard work, and encourages me to put my education to good use. In 2013, our lives intersected with HANDS, an organization that would become a catalyst for transformation. Starting as Marvi workers, my sister and I began contributing to our household income. Dr. Tanveer recognized my educational background and encouraged me to pursue a midwifery course. The 2-year CMW course at Civil Hospital, Sanghar, became a turning point.

Our journey with HANDS allowed us to apply our skills to various projects, including WFP, Aga Khan, and mental health initiatives. We became active members of our community, offering assistance in medical care, family planning, NIC and NADRA issues, and legal matters. The attitude of people towards us changed, evolving from reluctance to friendship.
In particular, my role in health advocacy has become significant. Through HANDS, we learned about family planning, the importance of birth spacing, and prenatal care. Our village lacked ultrasound facilities, making healthcare inaccessible and costly. HANDS intervened, providing ultrasound services in the village, and empowering women to discuss their health openly. I play a crucial role in educating women about family planning, contraceptives, and the significance of healthcare.
My association with HANDS has not only empowered me but also impacted my community positively. I am determined to continue this journey, educating women, supporting health initiatives, and breaking barriers. As I dream of securing a job for myself and my sister, I am grateful for HANDS, an organization that not only transformed our lives but empowered us to be agents of change in our community.

HANDS Reshaping FP and MCH services through Marvi model in rural and urban areas:

HANDS has demonstrated the pragmatic approaches to improve access to quality Maternal Child Health, Family Planning and Nutrition information and services in rural and Urban non-LHW areas which are under-served. The community based Marvi workers are the key players in educating their communities through engagement and community mobilization to facilitate behavior change within their communities. Marvi workers are linking the door step community mobilization to the quality MCH and FP services within their village by qualified supervisor LHVs. Each LHV supervised a cluster of 50 Marvi workers for MCH/ FP services and support them in enhancing their skills for community mobilization and improving their social enterprises/BIB. This LHV-Marvi dyad is effectively reshaping the service delivery to ensure accessibility, affordability and quality to maximize the reach of MCH/ FP services. Marvi workers have been sustained and empowered through establishing their social enterprise/ BiB. The Marvi model interventions since 2007 have been scaled up to 7 districts in Sindh and 7 districts of Punjab. These interventions have resulted in many significant changes in the lives of Marvis, their families and communities.

Based on the learnings and results from these projects have proven that the Marvi model (Marvi-LHV dyad) for community-based distribution is an effective model for the delivery of FP information and service delivery to rural and remote populations. Now under new investment by BMGF, HANDS has planned to expand the Marvi model (FP services) to additional non-LHW areas in 11 districts in Sindh. Total existing Marvi workers serving the communities in 7 districts are 2900 in Sindh. Additional 1900 Marvi workers would be added in the network in both rural and Urban areas in Sindh. Then Total Marvi workers in Sindh would be 4800, and 900 Noor workers in 6 districts Punjab.

Marvi model:

Marvi Worker selected in close coordination with the local communities (e.g. in a large community meeting). The communities are informed that the Marvi worker works as community-based health worker just like an LHW and after getting trained by HANDS will be responsible to provide community-based health services especially for women and children. The Marvi workers are selected on following criteria and agreed to defined scope of work as

  • Serving population based on population density as in most of the rural areas they covered a population of 1000-1300 (180-220 Households), in Urban areas (Karachi & Hyderabad) they covered a population of 3000-5000 (550-750 Households)
  • Local resident of target village/ areas, preferably married with educational qualification is at least primary
  • Between the ages of 18 to 45 years (lower age limit of 18 years is due to requirement of CNIC – Computerized National Identity Card)
  • Appropriate communication skills and confidence and socially acceptable to all ethnic communities and recommended by the community
  • Willing and committed to serving the community

After the MoU signing with their communities (which is also endorsed by family of Marvi workers), the selected Marvis are enrolled in HANDS’s community workers MIS system. Then they are trained on:

  • Training on community mobilization and FP: Marvis will be trained on birth spacing, FP methods, community mobilization approaches, communication skills, counseling techniques, use of digital gadget and video applications, and MIS maintenance.
  • Training on Community Leadership and Stewardship: Training manual with defined skills sets that further empower the Marvis will be developed. The formal training sessions will be followed by on-job sessions to enhance skills of Marvi workers as agent of change for leading community-led initiatives such as promotion of girls’ enrollment in schools, promotion of prohibition of early marriages, immunization etc.
  • Referrals for MNCH and FP services as needed

On graduation as per defined skills sets, each Marvi recognized as Community Leader accredited by the HANDS leadership program. This is achieved by frequent formal training sessions for cluster of Marvis and followed by on-the-job structured sessions by supervisor LHVs.

  • Uptake of modern contraceptive method in Marvi workers areas is nearly 59%
  • Method discontinuation in Marvi workers areas is low (only 5.6%) as compared to national figures
  • According to independent consultant study, communities that were mobilized through Marvi workers have higher health seeking behaviors and better health indicators.

Communities feel that their access to healthcare has increased due to the Marvis who provide many of much needed healthcare services at the doorstep and often cheaply. Marvi workers are also trusted to provide quality advice and have helped to improve health awareness