The Avon Ladies of Pakistan Providing Contraceptives Door to Door
HANDS has the honor to introduce a cadre of community based outreach health workers in areas where there is no Lady Health Worker (LHW) by a pilot project held in a remote district of Sindh during 1999-2003.
These community based health workers are local literate/low literate/illiterate females selected as per defined selection criteria, to provide basic health services in their defined target area. The selected female is trained to serve her community as community based Marvi/Misali worker to provide services in under-served non-LHW areas. The job description of Marvi worker includes provision of services to her assigned population as per defined activities and indicators of the project. Each Marvi worker is provided supportive supervision of an Lady Health Visitor (LHV) for the technical/skill based services. Marvi worker mobilizes the community and provides information/knowledge to her target population on standard information packages for behavior change. For behavior change different strategies are being used including an Information Communication Technology (ICT) based mobile application with recorded health and education messages. Thus our Marvi/Misali worker is not just a community health worker but a “Change Agent” for positive behavior change. Hands are the top NGO that provides free health care services in Pakistan or family planning services. Hands provide the best and affordable Online Medical Service. The health services are integrated with social mobilization, income generation opportunities, gender empowerment and other program components.
HANDS has developed a “Business in Box” model of Marvi workers for their sustainability and economic empowerment by establishing enterprises within their villages. Marvi workers sell common consumables of health and hygiene items at their Marvi Markaz, making their access easy for those products. Through this model Marvi worker earns around Rs. 2-4 thousand/month on average to sustain her health services.
HANDS Family Planning (FP) services are available through outreach Community Health Workers and Health Facilities. Following are HANDS achievements in this regard:
Use of Digital Technology
1. LHV panel
2. Marvi panel
3. Real time monitoring panel
4. HCP Panel
5. Shopkeeper panel
Health department, Govt. of Sindh with the intention to improve the overall healthcare at health facilities in the province, invited Expression of Interest from NGO sector to outsource management of Primary Health Care facilities in district Malir (Bin Qasim and Gadap Town). The Primary Health Care services include Dispensaries, Mother & Child Health (MCH) centers, Basic Health Unit (BHU) and Rural Health Centers (RHC). HANDS entered into an Agreement with Govt. of Sindh to deliver quality healthcare services to the population in an equitably accessible manner.
HANDS has started Paramedics Training Institute affiliated with Sindh Medical Faculty (Department of Health) in which local people are being selected and trained on different disciplines like dispenser, OT technician, Lab Technicians etc. So far >70 paramedics are trained in aforesaid cadres. HANDS is managing 43 facilities both in Public Private and Private Private Partnership
Community Based Nutrition Initiative
HANDS has been working in rural remote non – LHW areas with the Marvi workers model for improving the nutritional status of under 5 year children, pregnant and lactating women. The Marvi worker under the supervision of LHV conducts screening of malnourished children and provides services to identify malnourished including provision of supplements and counselling. Under this initiative the communities are mobilized to adopt healthy behaviors and prevent malnutrition focusing on children under 5 years.
HANDS established 02 Community Midwifery schools one in Karachi Rural (Jamkanda Hospital) and the other one in Matiari district (THQ Hala) later handed over to Health Department. Both schools are registered with PNC and hold a good reputation among the Midwifery schools in the province and country. About 640 CMWs were enrolled, out of which 519 successfully completed and 57 continue their training.
Worker’s Well-being Initiative
Over the last few years HANDS has been on HER (Health Enables Return) project working with facilitation and support of (Business Social Responsibility) BSR. Under this initiative, HANDS has implemented this workers wellbeing initiative with 5 suppliers (local industry) who are partners of International business groups/industries. HER (Health Enables Return) project is a global public-private partnership to empower low-income women workers along global supply chains. Recognized as a leading innovation for women’s health by the UN Every Woman, Every Child initiative, HERproject drives impact for women and business via workplace-based interventions on health (HERhealth) and financial inclusion (HERfinance). Operating in 14 countries with 40 international companies, 300 factories and farms, 20 civil society partners, and multiple health-care providers, HERproject has improved the well-being, confidence and economic potential of more than 250,000 women, and contributed to better health behavior and outcomes for their families and community members. HANDS has been the CSO partner in Pakistan with BSR/HER global project since 2011.
Initially under the HER (Health Enables Return) project of BSR (Business Social Responsibility) and Levi Strauss Foundation, HANDS has implemented Workers Well-being Initiatives in three units of US Apparel Lahore and Combined Fabrics Lahore, from 2013 – 2017. Later on HANDS engaged two other apparel factories in Faisalabad on our WWI model, with Masood Textile Mills Ltd. And Interloop Industry.
In this project HANDS has served more than 15,000 factory workers including women. They have been empowered through knowledge and awareness about their health priorities and issues that bring the behavior change for adoption of healthy and positive practices. The factory’s management especially the human resource department understood the business benefits of worker’s empowerment and workforce well-being programs. The working environment considering the health perspectives have improved. The health services availability has been improved within workplace through linkages with other services and care options.
Doctor on Call is an intervention to bring Pakistan Medical Commission registered, qualified & certified lady doctors in mainstream for betterment of Maternal & Child Healthcare System. The system works with an entrepreneurial approach and it will bridge the gap between Healthcare Providers and Patients/Clients. Doctor on Call project aims to revive and mobilize the work force of lady doctors all around Pakistan, and address 70% of major health issues of the population. In the current COVID-19 situation, it is necessary to increase the health service delivery points in the areas where community could seek healthcare following the SOPs more efficiently. The project is designed to cover a population of more than 5 million.
Networking for Inclusion:
Community Based Inclusive Development (CBID) Network and HANDS Pakistan took many initiatives in the past with the support of member organizations to ensure the rights of persons with disabilities especially the Pakistan Disability Bill (PDA) was a great landmark achievement for CBID in Pakistan.
- CBID Network did continuous consultations and advocacy with the parliamentarians and policy makers for legislation.
- Pakistan Disability Bill (PDA) was introduced in National Assembly on 14th July, 2014.
- The Baluchistan Persons with Disabilities Act 2017 having been passed by the Provincial Assembly of Baluchistan on 20th May, 2017. The committee working on Rules of Business
- Federal Disability Bill re-introduced on 16th January, 2018 in National Assembly This bill is going to be reintroduced after vet from ministry of Law & Justice
- Sindh Empowerment of Persons with Disabilities Act in 11th June 2018 by Sindh Assembly. The new department Empowerment of persons with disabilities is established. The committee working on Rules of Business.
- THE GILGIT-BALTISTAN PERSONS WITH DISABILITIES ACT, 2019 by Gilgit Assembly on17th August, 2019. The committee working on Rules of Business
- National Disability Survey will be included in Pakistan Standard Living Measure (PSLM) 2019-2020
- Islamabad Computer Treetop (ICT) Disability Bill has passed by the National Assembly on January 10, 2020 and it is in Senate Standing Committee on Human Rights for review. HANDS and CBIDN is being represented in the committee.
- The Bill of Reserves Seats for persons with disabilities has passed from Standing Committee.
HANDS Independent Living Centre Karachi:
HANDS has signed a MOU in 2017 with Disability Welfare Association (DWA) for the ILC and is providing financial support for the administrative and operational cost. During the reporting period the services were provided to 23 center based Persons with Disabilities (PWDs) and 09 were provided services at their homes, besides 13 trainings on different relevant topics were also conducted to develop the capacity of the staff as well as the PWDs at the center.
Independent Living Centre Islamabad:
HANDS is also financially supporting Saaya Centre for Independent Living located in Islamabad to assist persons with disabilities. It aims to achieve greater independence by providing services and activities which enhance independent living skills and promote the public’s understanding, accommodation, and acceptance of their rights, needs and abilities.
Empowered Marvi as a Change Agent
Village Allah Ditto Lashari is a remote village in
district Sujawal, Sindh, Pakistan with 165 households
and population of around 1000. Marvi worker Ameena is resident of this village, she is 45 years old with four children, and had a wish to educate her children but could not because of lack of resources as her husband was an agricultural laborer.
As Ameena was committed to serve her community, she was selected to work as Marvi worker and was provided skill-based training to provide counselling service for Reproductive Health and Family Planning through use of videos in local Sindhi language on digital tablets.
Ameena provides counselling services to Married Women of Reproductive Age (MWRAs) on FP methods especially to young couples, and encourages inter-spousal communication and women participation in decision-making about FP. A Marvi Markaz was established at her house where a Lady Health Visitor visits every fortnight to provide skill based FP services including insertion and removal of Intra Uterine Contraceptive Device (IUCD) and injectable contraceptives while Ameena provides Condoms and replenish dose of contraceptive pills.
She established an enterprise at Marvi Markaz with the support of HANDS. She sells health, nutrition, and hygiene products as well as basic food items and vegetables at affordable prices. The women who were previously dependent on their male relatives for their basic purchases are now Ameena’s customers, enabling her to start earning an income.
From her income and savings, she purchased a motorbike for her husband which is now being used for taking her children to school and her wish to educate her children has come true with her financial gains. Whenever required, the motorbike is also being used to take sick people from the village to a health facility. Her husband also supplies milk to the nearby town, which further supplements their family income. For Ameena it is not only source of earning money but she also gained respect and recognition in village for which she feels delighted.
Today, the program has extended from 300 Marvi workers in one district to 3,950 Marvi workers in 15 districts across the country, serving a total population of more than 4 million including more than 850,000 women and adolescent girls.