Misali / Marvi Workers (Community Health Workers)
HANDS has the honor to introduce a cadre of community based outreach health workers in areas where there is no LHW by a piolat project held in 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 underserved 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 LHV for the technical/skill based services. Marvi worker mobilizes the community and provide 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 applications with recorded health education messages. Thus our Marvi/Misali worker is not just a community health worker but a Change Agent for positive behavior change. 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 Health and Hygiene items at their Marvi markaz, make their access easy for those products. Through this model Marvi worker earns around 2-4 thousand /month on average to sustain health services.
3,614 Misali/Marvi Workers in 04 provinces and 20 districts of Pakistan are accessing to a population of approximately 04 million.
The Avon Ladies of Pakistan selling contraception door to door
HANDS introduced the nation to a cadre of Community Health Worker (CHW) in the areas “Where there is no Lady Health Worker (LHW)”. These CHWs are local, literate / low literate / illiterate women selected as per defined selection criteria. The selected women are trained to serve their communities as community based Marvi / Misali worker to provide basic health and development services in their defined target area that is from 100 to 150 households. The job description of Marvi worker includes provision of health services.
So far HANDS has developed about 4000 Marvis, including – around 3500 working in Family Planning and Reproductive Health – FPRH and – nearly 1500 Marvis in Nutrition. Marvi Model intervention is present in 20 districts of Pakistan with 62 Supervisor LHVs and catering to a population of approximately 4 million.
The Marvi workers rendered Family Planning services to around 535,000 Married Women of Reproductive Age – MWRAs, this has led to increase Contraceptive Prevalence Each Marvi worker is provided supportive supervision by a LHV for the technical / skill based health services. Marvi worker mobilizes the community and provide information / knowledge to her community on standard information packages for behavior change.
The LHV supervisors and Marvi Workers are technologically equipped with tablets to deliver standard health education messages to the communities in the form of videos on health issues and real time monitoring (data entry of services). Thus our Marvi/Misali worker is not just a community health worker but a change agent for positive behavior change. The health services are integrated with social mobilization, income generation opportunities, gender empowerment and other program components.
Nearly 4000 Misali / Marvi Workers in 04 provinces and 20 districts of Pakistan are accessing to a population of approximately 04 million.
Rate – CPR in HANDS intervention districts from 17%, to 45% from the baseline. Nutrition services rendered by Marvis during July 2018 – June 2019 include screening of nearly 03 million women and children.
They have provided Nutrition supplements to about 17,200 malnourished Pregnant and Lactating Women and nearly 67,000 acutely malnourished children during the year.
The overall method mix of modern contraceptive methods show that injectables are more prevalent both in intervention and non-intervention areas 30.4% and 29% respectively. The next most prevalent method in intervention areas is IUCD – 25.5% while in non-intervention areas it is 17.2%. This difference is probably due to the presence of skill based / technical services provided by LHV supervisor of Marvi at the doorstep.
The modern Contraceptive Prevalence Rate (mCPR) in our intervention area is 52.8% which is very much improved as compared to non-intervention areas – 28.2% and PDHS figure of 25%. Similarly the unmet need in intervention areas has decreased to 15% as compared to 23.6% in non-intervention areas and PDHS figure of 17.3%.
The identified malnourished under 5 years children are managed as per protocol. The cured under 5 years children was about 65%, the remaining children include under treatment children at the time of data finalization. The identified malnourished PLW 116,009 and 37% were cured, the remaining were under treatment as per protocol at the time of data finalization.
Public Private Partnership
Health department Govt. of Sindh with the intention to improve the overall health care delivery with primary focus on improving the health care delivery at the health facility level 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, 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 a Paramedics Training Institute affiliated with Sindh medical faculty (Department of Health) in which local human resources are being selected and trained on different disciplines like dispenser, OT technician, Lab Technicians etc. So far >70 Paramedics are trained in aforesaid cadres.
Following are the Health Facilities Assessment Findings during December 2016 when HANDS took over management of 34 health facilities of District Malir:
- Attendance of staff was 36.6PC against the 568 filled positions
- There was no operation theatre neither neonatal care unit.
- Legal electricity connection was available with only 08 facilities.
- 06 HFs had pipe water supply and gas connections were available with only two HFs.
- Only 03 HFs had wheel chairs and stretchers.
- Out of 34 health centres, only one facility had functional generator.
- Half of facilities were without any boundary walls.
- Family planning services were available with 05 HFs.
- Half of the facilities didn’t have functional toilets.
- For 34 facilities only 00 ambulances were under operation.
- Ultrasound and X-ray machines were available in only 01 HF.
Sindh Government Hospitals
Rural Health Centeres
Basic Health Units
Maternal And Child Health Centres
HANDS is conducting paramedic training in Sindh Govt. Hospital (SGH) Ibrahim Hyderi and Murad Memon Goth. Currently there are 16 students enrolled in 02 batches for dispenser course at SGH Ibrahim Hydreri and Memon Goth. 25 students are currently enrolled at SGH Ibrahim Hyderi including 05 each in laboratory, dispenser, anesthesia, OT and X-ray technician course. Thus a total number of 35 paramedics are currently registered in different discipline of paramedical training.
Birthing Station Model
HANDS has introduced Birthing Station as a best practice model to focus on the Reproductive Health (RH) needs of rural communities. The Community Midwife (CMW) trained at Community Midwifery Schools of HANDS, is placed at her respective village where a fully equipped birthing station is established to provide antenatal, natal, postnatal and neonatal services. Referral strategy is developed and applied for any high risk/complicated case.
The objectives of this model are to:
- Reduce maternal mortality and morbidity through clean and safe delivery in target population.
- Reduce neonatal mortality in target population.
- Increase contraceptive prevalence in target population.
- Cater to basic reproductive healthcare (antenatal, natal, postnatal, neonatal care, treatment of minor ailments, TT and EPI vaccination etc.).
Community Midwifery (CMW) Training
HANDS established 02 Community Midwifery schools one in Karachi Rural (Jamkanda Hospital) and the other one in Matiari district (THQ Hala). Both schools are registered with PNC and hold a good reputation among the Midwifery schools in the province and country. About 546 CMWs were enrolled, out of which 502 successfully completed their training.
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 the under 5 years’ children.
In Community Based Management of Acute Malnutrition (CMAM), PKR 517.99 Million Nutrition Supplements provided.
Telehealth (Telemedicine) Service Delivery Model
Health services delivery in remote areas of the country is a big issue. Besides long distances, non-availability of quality health care including health facility and health care provider is also a burning issue. Under the distance teaching/learning technology HANDS has introduced telehealth program. Phone Cast Company has played premier role in this regard. The program is run under the management of Health Promotion Program of the organization.
Objectives of this program are to:
- Provide quality health services to distant places where there is either no health facility or health care provider or absence of both.
- Save resources in terms of time and cost
- Improve quality of health care for the poor communities in remote areas
Inclusion based Initiatives for Persons with Disabilities
This is our social responsibility as a society to support disabled persons and boost their morals so that they can lead a normal life as useful citizens. This model focuses on special persons and their needs towards leading a normal life.
Objectives of this program are to:
- Improve the overall quality of life of Persons with Disabilities (PWDs).
- Provide support (assistive devices) to improve the management of daily routines and quality of life.
- Facilitate in making the PWDs as self-reliant individuals of the society through capacity building.
- Identification of persons with disability through screening.
- Assessment of type and severity of disability through medical need assessment camp.
- Awareness raising session for the communities.
- Social and educational inclusion of children with disability.
- Training of family members of the bedridden PWDs, enabling them to attend such persons with special needs.
- Provision of supportive devices e.g. wheel chair, prosthesis etc.
- Enterprise/business development training for PWDs.
- Teachers training on educational inclusion of the Children with Disabilities (CWDs) in main stream school.
- Capacity building of staff for persons with Disability.
Workers Well-being Initiative (WWI)
Under this initiative HANDS has implemented this workers wellbeing initiative with the partnership of local Industry). We have served more than 1500 factory workers including women. They have been empowered through knowledge and awareness about their health priorities and issues that bring the behavior change for adaptation of healthy and positive practice. The factories management especially the human resource management understood the business benefits of workers empowerment and workforce wellbeing programs. The working environment considering the health perspectives have improved. The health services availability has been improved within workplace and through linkages with the other services and care options.
The objectives of Workers Well-being Initiatives are;
- Improve health related knowledge of low-income women and men workers
- Increase uptake of health services and products as a positive behavior change
- Grow the capacity of Factory management to implement effective trainings in the workplace
- Partner supplier will be able to demonstrate business benefits for investing in work force well-being.
Hands Contribution in Sustainable Development Goals
Success Story of Dr. Zaib Taj
Zaib Taj d/o Tufail Ahmed Jumani (Rtd. Secretary Gov. Sindh) started her journey as beneficiary (user) of HANDS-DWA Independent Living Center from 15-April-2019. She was depressed & isolated in her home for 7 years because of her disability and lost her self-confidence completely She became disabled by a gunshot from police mobile which damaged her spinal cord and left her paralyzed. A qualified doctor moving independently suddenly became a totally dependent person which was a big shock along with the shock of getting divorced just after her marriage.