Health Annual Report 2011

HANDS-HEALTH

PROGRAM

Annual Report

2011-2012

HANDS – A Brief Profile

HANDS started its life cycle from a public sector hospital in Karachi as Health and Nutrition Project in 1979 lead by then head of department of the Pediatrics Prof. A. G. Billoo (Sitara-e-Imtiaz). He was seriously concern about the poor patients coming from Karachi rural in miserable conditions.

Health and Nutrition project started working in 1979 under the guidance of Professor and 1st Primary Health Care center established in a village 40 kilometers away from city center. The interns of professor following his vision to develop "Healthy Educated Prosperous Pakistan". The vision started taking shape by 1993 and gradually project transform in to the organization called Health and Nutrition development Society commonly called as “HANDS”.

After 33 years HANDS has evolved now as one of the largest Non Profit Organization of the country and show case an excellent integrated development model comprised of key program on HANDS is a nonprofit organization working in Pakistan, with key programs health, education and poverty alleviation. Cross cutting program Social Mobilization, Disaster Management, Gender & Development, Human Resource & Institutional Development, Information & Communication Advocacy, Monitoring Evaluation & Research, and Social Marketing. HANDS has reach in to more than 13 million population of 16182 villages in 24 districts of Pakistan. Considering HANDS started

Management Structure: HANDS is governed by a 14 members elected "Governing Board" lead by Chairman. The Senior Executive Committee comprised of 04 senior executives follow organization critically to keep on the right direction. Steering committee runs daily affairs of the organization under the leadership of Chief Executive with the support of core team of 11 General Managers - Specialists of respective sectors. 2064 full time staff and more 100,000 community based volunteers are the strength of HANDS.

Management Certification: HANDS is certified by Pakistan Center for Philanthropy (PCP) and tax exempted by Income tax department of government of Pakistan. HANDS has also successfully completed the Institutional management and certification Program of USAID for management standards. HANDS is also registered with European Union. We are in process to get ISO Certification. HANDS has developed 17 policy manuals namely Finance, HRM, Social Marketing, Health, Monitoring Evaluation & Research, Poverty Alleviation Program, Gender and Development, Information Technology, Information Communication Resource and advocacy, Infrastructure Education, Human & Institutional D, Social Mobilization, Disaster Management, Child protection, and Resource Mobilization.

HANDS experience in project/administrative and financial management: HANDS has undertaken 152 projects during last 5 years in the key areas of health, education and poverty alleviation with cross cutting theme of social mobilization, gender and development, resource mobilization, monitoring evaluation, information & communication, disaster management and human resource development. HANDS is working with 8522 medium and small size organizations. Finance Department is equipped with qualified personnel working in a web based Finanacial Management Information System (on line linked all districts) through Sidat Hyder Financials. HANDS is currently managing a budget of Rs. 1800 million approx. for 2011-2012. HANDS is also equipped with Hr payroll, Operation supply chain and all program web based software management Information System. HANDS manage 24 office excluding head office Karachi and enjoy services of >1350 full time staff members, along with more than 100,000 volunteers.

HANDS major funding partners: HANDS has partnering with almost with all the donors working in Pakistan. These are Population Council/USAID, PAIMAN/USAID, The David & Lucile Packard Foundation, Save the Children US & UK, The Aga Khan Foundation, UNICEF, Embassy of the Kingdom of Netherlands, The Aga Khan University, Khushhali Bank/ Asian Development Bank, Pakistan Poverty Alleviation Fund/World Bank, The Asia Foundation, World Population

Foundation/European Union, Ministry of Women Development Pakistan, National Commission for Human Development, John Hopkins University-USA, UNFPA, Care International, GOAL International, Medico International, DFID/UKAID, UNDP, WHO, UNHCR, Unicef and all District Governments, different departments & ministries of Government of Pakistan.

HANDS Public Private, Private Partnership: HANDS has been working with federal, provincial and district government education department. Most of HANDS projects are in Public Private Partnership. HANDS has trained / benefited large number of men and women of these departments. HANDS had several agreement and MOUs signed with many Provincial Department like Health, Education, women Development and planning and Development. We have agreements with all district governments wherever HANDS works.

HANDS- Health Strategy 2020:

Health Program

HANDS health program is evolved to the extent that its service are recognized and sought by

international agencies.

HANDS Health Program's include the integration of health interventions with the other social

development initiatives Health services are provided to the community under the supervision of

Health Program with local community organization.

HANDS HEALTH PROGRAMS

5.1 Maternal and child health

5.1.1 Primary Health care:

MARVI (primary maternal and child health/RH Birth spacing)

5.1.2 Traditional Birth Attendants (TBAs)

5.1.3 Community Midwifery training program (CMW)

5.1.4 HANDS NARI Model

5.1.5 Secondary Health Care

Secondary Health care units

5.2 Nutrition

5.2.1 CMAM (Community Based Management of Acute Malnutrition)

5.3 Emergency Relief

5.3.1 Health Programs/Projects in Disaster

Mobile Medical Camp

Acute Respiratory Infection Center (ARI center)

Diarrhoea Treatment Center (DTC)

5.4 SRHR

5.4.1 LSBE/MUMKIN

5.5 Disability

5.5.1 Disability rehabilitation

(Physical and mental disability)

Health Projects/Programs during 2011-12

1. MARVI Project

2. PPAF Health

3. PPAF Disability

4. PPAF Education

5. Acute Respiratory Infection Centers (ARI Centers)

6. Diarrhoea Treatment Centers (DTC)

7. GAVI Project

8. Community Midwifery School

9. CDGK HANDS Hospital Jamkanda

10. Aman Community Health Initiative (ACHI) Project

11. Shamil Project

12. Reproductive Health Initiative for Adolescent (RHIA) Project

13. Community Management of Acute Malnutrition (UNICEF)

14. Community Management of Acute Malnutrition (WFP)

15. Hamara Kal, Life Skill Based Education (LSBE) Project

16. Mobile Medical Camps

17. Mobile Service Units

HANDS Best Practices Models: HANDS offers to hundreds of public, private institution

and organizations the following specialized services in Health service sector; Community Health

Workers (MARVI), Rehabilitation of Disables, Output Based Aid (OBA) voucher

scheme(NARI), Adopt A Hospital, Community based Management of Acute Malnutrition

(CMAM) and Establishment of Birthing Station.

Training best practices;

Community Midwifery Training school, Training of Traditional Births Attendants (TBAs),

Psycho Social Wellbeing Training, IUCD Training, Community Health Workers (MARVI)

Training, Sexual Reproductive Health(SRH) Trainings, Client Centered Approach Training for

Health Care Providers

1. Community Health Workers Model for the areas where there is no LHWs

Introduction

HANDS evolved a CHW model for non LHW areas are through monthly home visits and static

health house established within her residence. She is supported by a health committee and

women' group that are voluntary boards formulated by her for assisting to provide health services

as required.

Objective

To improve Reproductive Health and Family Planning status in marginalized communities of the

country.

Methodology

The following process is followed in the selection and training of Community Based Health

Workers (MARVI) selection process.

Identification of MARVI by Community Based organization

Signing of Memorandum of Understanding with Community Based organization and

MARVI.

Training of MARVI (group of 20-25)

Identification of MARVI Health Houses

Supplies to MARVI -Equipments and essential medicines and social marketing products

Initiation of Health services including the health awareness sessions

Monitoring by Monitoring Evaluation and Research and health team

Reporting to stake holders

Services Provided by MARVI

Mobilization of pregnant women for Antenatal Services

Mobilization of pregnant women for Post Natal Services

Demand creation and sale of Social Marketing Products, Family Planning methods, safe delivery

kit iodise salt, oral rehydration salt, basic medicine

Treatment of common ailments

a. Acute Respiratory Infection (ARI)

b. Diarrhea

c. Malaria

d. Common Skin Diseases

Growth Monitoring of Under three Children

Refer normal Delivery to trained Traditional

Birth Attended (TBA)

Referrals for complicated cases to near Health Facility

Facilitation for Expanded program on Immunization (EPI )

Health Awareness Session through community visits

Finding of endline Evaluation

83 % of MARVI Workers know the recommended number of 04 antenatal checkups.

100% MARVI workers know recommended number of 02 postnatal checkups.

51% MARVI workers had knowledge of at least 4 danger signs of antenatal, natal and

postnatal period.

87% of the MARVI workers were able to identify the three delays. 83% could identify

the first delay, 93% identified second delay and 83.3% identified the third delay.

100% MARVI workers had knowledge about Family Planning and all of these had

knowledge about Pills and Condoms while 93% knew about Injectables, 80% knew about

TL & Vasectomy, 70% knew about IUCD and 30% MARVI workers have knowledge

about other methods too.

100% MARVI workers were supplied RH-FP products of about 2.3 million and 70%

were able to generate some profit. Average income of MARVI's from the sale of RH-FP

products was Rupees 1700 per-month.

MARVI workers had referred nearly 54255 women, 8594 children with complications to

secondary care facilities and save their lives.

MARVI project also supported 25 public sector health facilities through supplies,

equipments, technical training and developed into women friendly health facilities.

2. Rehabilitation of Disables

Objectives

To improve the livelihood of persons with disabilities (PWDs) and make them self reliant

Methodology

Identification of persons with disability through baseline

survey.

Assessment of type and severity of disability through medical

need assessment camp.

Awareness rising session for the communities.

Social and educational inclusion of children with disability.

Attendant ship training for family members of the severely

disable bedridden persons with disability.

Provision of supportive devices, live wheel chair, prosthesis

Enterprise development training and business incubation for physical PWDs.

Teachers training on educational inclusion for the Children with Disabilities (CWDs) in

main stream school.

Capacity building of staff for disabled persons organization (DPOs)

119 Family members of the bedridden Person with Disabilities PWD's were trained for attendant

ship training in three union councils.

Teachers training on inclusive education

provided to 150 teachers of Bin Qasim town

Person with Disabilities of three union

councils were trained for Enterprise

development training and business

incubation. 83 Person with Disabilities were

give support to establish their enterprise

77 Awareness raising sessions given to the

community, Person with 64354 Disabilities

and their family members on genetically

transmitted disease, family marriages, health

and hygiene, reproductive health, care during

pregnancy, vaccination, family planning and

breast feeding etc.

3. Voucher redeeming model for referrals

HANDS Health Program introduced an innovative model of Output Based Aid (OBA) Voucher

Scheme for pregnant women in rural/remote areas IDP Camps and flood affected areas.

Objective

To mobilize communities to use identified emergency obstetrical neonatal care services

in Public / Private health facilities

To provide health care facilities to pregnant women/neonate through Output Based Aid

(OBA) voucher scheme

To strengthen referrals mechanism from Relief

Methodology

Partnership agreement signing between the service provider (Public/Private health

facilities) and HANDS. The project support only out of pocket expenses in case of

public sector has the facilities.

HANDS responsible to administer specific aspects of the model such as

To provide counseling on Safe

Motherhood motivation of the IDPs to

utilize selected health services.

Identify voucher recipients based on

developed eligibility criteria.

Public and Private Health Care facilities

responsible to ensure quality EmONC

services

HANDS redeem the cost against voucher

for the pre determined service to the provider after verification from Public and Private

service

Services Provided

Appraisal and final selection of referral health facilities for Emergency Obstetric Care

(Public and Private)

Registration of all Pregnant women in camps

Antenatal Screening

Introduction of Output Based Aid Voucher Scheme to every pregnant women and

family

Mass media promotion of Output Based Aid Voucher Scheme

Redeem Output Based Aid Voucher Scheme at first care health facility level to facility

Management of pregnant women with danger signs at selected referral health facility

Verification and reimbursement

Achievement till date

Total

9 public and private secondary health care facilities were identified through a screening

process.

3244 NARI Referral Forms (Output Based Aid Voucher) and thousands of Posters and

brochures were distributed.

Providing 894 counseling's on Safe motherhood.

Performing 1333 antenatal checkups and 488 post natal checkups.

Dissemination seminar was organized in Northern Hub (Sukkur) and Southern Hub

(Hyderabad) for awareness rising of project, participated by more than 500 stakeholders.

A comprehensive communication strategy was designed with the focus to introduce

Output Based Aid Voucher Scheme and its mechanism and to promote public/private

health facilities among communities for their maximum utilization.

FM Radio message was relayed to introduce NARI referral voucher (12 times per day) on

FM 92 Nooriabad for District Thatta, FM 98 for Jacobabad and FM 104 for kashmore

district.

Cumulative Target for Health Facilities

Conduction of high risk deliveries 1000

Conduction of complicated deliveries 168

Including caesarian sections 740

Treatment of neonatal cases 500

Total Amount of Reimbursement 1,47,800

4. Secondary care services

Objective

To provide quality health care services (primary and Secondary) to marginalized communities.

To provide comprehensive emergency obstetric and neonatal services.

Methodology

The following Services are provided at the hospital:

Round the clock Out Patient Department and

Emergency services.

Labor Room.

Operation Theatre

Emergency Obstetric Care

Indoor Patient Services

Family Planning services.

Laboratory

Ultrasound facilities

X-ray facility

Blood bank facility

Ambulance Service

Achievement

Besides these, the following services were provided during last 10 years at HANDS CDGK

hospital Jam Kanda.

5. Psycho Social Wellbeing Training

Introduction

Children are particularly vulnerable during emergencies. It is essential to address their emotional

and social needs through psychosocial support activities conducted within a safe, protective

environment.

Objective

To understand the concept of Psycho Social

Wellbeing

To learn about theories of Psycho Social Wellbeing.

To differentiate the components of Psycho Social

Wellbeing

To learn how to promote Psycho Social Wellbeing

To understand concept of Child Rights in

Educational Setting

How to involve communities in the design and implementation of Education In Emergencies

Methodology

Group Work

Individual work

Pair work

Presentations

Role play

Lecture

Demonstration

Duration of the training

07 Days

Training Contents

What is mental health

Post traumatic stress disorder

Schizophrenia

Basic helping skills

Psychosocial competencies

Community consultation

Social animation

6. Medical Camp

Medical Camps are the only way in emergencies to provide basic health facility. HANDS

Provides primary health services in disaster and emergencies through its staff and with

Partnership of different stake holders. We conduct rapid need assessment in prospect health

needs of IDPs and than plans medical mobile camps.

Objective

The Main Objective of medical camps in emergency is to provide basic health services.

Services

Antenatal, Post natal, Diarrhoea, Acute respiratory infection, Skin infection, Eye infection &

Measles

Other Services

Mobile medical teams also conduct health awareness sessions on pertinent topics like, Hand

washing; breast feeding, Diarrhoea, Health and Hygiene, Pneumonia, Antenatal care, Postnatal

Care, Malaria, Safe drinking water, vaccination etc.

Methodology

All teams develop weekly and monthly work plan, and inform the resource person in the

community and share the schedule of their visit and conduct mobile medical camps as per

schedule, after conduction of mobile medical camps and health awareness sessions teams share

the report with concern on daily basis.

Pre Camp Preparations:

Team Member (Health Care Providers - HCPs) comprises of Male/Female Doctor,

LHV/ Dispenser, Vaccinator, Social Mobilizer (Vehicle & Driver) as per need

Adequate medicine for daily camps as per list of medicines (Annex)

Daily and weekly plan of the medical camps available.

Daily requisition of Medicines. (Stock register of medicines, requisition slips,

Medicines will be stored at optimal condition i.e. at room temperature, avoid direct

sunlight. Check the Batch # and expiry date.)

Equipments and necessary items available, (Apron , BP Apparatus, stethoscope,

thermometer, needle cutter, adult and baby weighing scale, safety box, disposable

gloves, stitching material )

All the MIS (OPD Register, prescription slips and reporting format) record kept

carefully.

HCP will submit the report on daily basis to DEM/DPM or in charge.

At Medical Camp:

HCP will take the history of the patients and record it in OPD slip and register.

HCPs will prescribe rational medicines,

Unnecessary medicines/injections to be avoided.

Health session and counseling of the patients will be done with the support of IEC

Material as per defined protocol.

AN and PN checkups will be conducted and for natal services

Complicated cases will be referred to secondary and tertiary health care facilities.

Privacy and confidentially will be ensured as much as possible.

Banners should be placed at appropriate place for visibility.

Safety box /needle cutters to be used for used syringes and properly disposed.

Outreach Services:

HCPs will Provide the outreach services through door to door or tent to tent services

and try to reach where no one accessed.

HCPs will provide rest of services as static camps.

Post Camp:

Reports of the camp submitted on daily basis on given MIS.

DEM/DPM, in charge after compilation, will share the reports on daily basis with

SGM Health and with HANDS M E&R Focal Person

SGM Health will share the reports with stake holders on periodic basis.

Guide Line For Conduction Of Health Education Session

Health education sessions are conducted to create awareness among the communities

regarding healthy behaviors. these sessions are conducted in routine health programs and with

the IDPs as well. Health sessions are conducted on pertinent health topics/issues like health and

hygiene, exclusive breast feeding, weaning, growth monitoring, hand washing, ARI, Diarrhea,

Vaccination, Malaria, safe mother hood etc.

Pre Session:

Selection of participants (10 -15 Participants per session)

Finalization of date & time

Identification of Venue for Session (Well ventilated, well lighted)

Selection of Health education Material/Topic

(Malaria, Classification of Dehydration & Management , Preparation of ORS,TT Vaccine Schedule, EPI

Schedule, Hepatitis, Safe Motherhood 3 Delays, Hygiene and Hand washing)

Pre inform to participants

Make list for attendance of Participants.

During Session:

Team should reach at the venue on time

Sitting Arrangement of Participants should be proper as per situation.

Attendance of Participants/Photo graphics

Recitation of Holy Quran

Welcome to the participants

Share objectives of Session

Conduct session in local Language

Conduct session with the help of IEC material

Voice of Health Educator should be clear & loud

Eye contact with all Participants

Should avoid from noise

Respect to participant (encourage participants on positive Behaviors and encourage to ask questions

for better understanding of the subject)

Conclude session with Key/take home messages

Post Session

Reporting of session with Photo graphics

7. Community Midwives (CMW) School

Introduction

The Community Midwifery is 18 months duration

program after that successful student is prepared to

be a safe practitioner of the midwifery profession

in Pakistan. This course is for female. All

community midwifery education is to take place in

PNC (Pakistan Nursing Council) approved school

of midwifery and the community training will be

conducted in their catchment area of the school.

Pakistan Nursing Council Registration

Pakistan Nursing Council Act. In accordance with the PNC Act 1973(Item 15) registration of

community midwives with PNC is compulsory.

Requirement of community midwifery school

Community midwifery school required following things which are fulfill the PNC rules and

regulations, these are as follows;

Infrastructure of Institute As Prescribed By PNC Rules and Regulation

Faculty staff of Community Midwifery school of 25 Students with 50 Beds

Teaching Staff

Community Midwifery

Following PART A: PTS

Anatomy Physiology

First Aid

Microbiology

Pharmacology

Fundamental Of Nursing

Following PART B. MIDWIFERY

Anatomy Physiology (Female & Male

Reproductive System)

Pregnancy

Normal Labour

Puerperium

Newborn

Abnormalities Of Pregnancy

Community Midwifery & Health Education

Clinical Training

1. In hospital under supervision

(Log book for assessment of practical skill supervised by instructor/ Doctor of procedures.)

(Case book for assessment of practical skill supervised by instructor)

Labor Room

Observation of normal deliveries

Assisted normal delivery

Independent normal deliveries

Deliveries in midwifery care book / journal

Field Training

1. The selected community

(Family Register for assessment of field work supervised by Community Supervisor)

8. Community Based Management of Acute Malnutrition (CMAM)

Introduction

Worldwide nearly 20 Million children under five

are estimated to be suffering from severe acute

malnutrition at any given time. The recently

published Lancet Series on Maternal and Child

Undernutrition recognise SAM as one of the top

three nutrition-related causes of death in children

under-five. However, as SAM is rarely recorded

as a cause of death and data on mortality of

untreated severely malnourished children is

scarce, estimating the proportion of deaths

associated with SAM worldwide is problematic.

Objective

To address the malnutrition in vulnerable groups (<5 children and in pregnant and lactating

women PLWs).

Management of SAM

Community-based management of SAM (CMSAM) is a relatively new, evidence-based

approach which decentralizes the management of SAM and in this way provides the potential to

reach and treat the majority of these children. Combined with inpatient care for the sickest

children and effective management of children with moderate acute malnutrition where possible,

the approach allows the adoption of a comprehensive strategy to treat acute malnutrition. The

approach also fits into a wider programming context that should include interventions and

initiatives for the prevention of malnutrition (fig.1)

Community Level Approach

To engage communities and tapping into

existing community health and nutrition

systems as well as community-level networks

(such as community leaders, religious

authorities and women's groups).

To ensure that children are identified with the

help of communication before the

development of the severe medical

complications.

To identify children with SAM at community level.

Developed soft foods specifically with the right mix of nutrients to treat a child over six

months of age with SAM.

Rehabilitation children to treat of their diseases.

To motivate community-level health and nutrition staff and volunteers involved in the

programme to ensure sustainability.

Implementation

To address the malnutrition in vulnerable groups (<5 children and in pregnant and lactating

women PLWs) the assessment is done by nutrition team at Fix or mobile OTP (Out patient

therapeutic Program) through MUAC (Mid upper Arm Circumference )

The Moderate Acute Mal nutrient (MAM, MUAC 11.5 12.4 cm ) will be identified. They will

be admitted at SFP (Supplementary Feeding Program) They will be given plumpy

supplementary till two months. High energy biscuits will be given to Siblings to prevent

malnutrition and sharing of the plumpy supplementary.

Severe Acute Mal nutrient (SAM MAUC < 11.5 cm without medical complications ) will be

admitted at OTP according to the criteria and plumpy nuts will be given to them and they will be

reassessed after two weeks. And they will be transferred after two months when their MAUC is

more then 11.5 cm to the SFP, Height weight and vitals are checked by team for all identified

SAM children and PLWs.

The SAM children with medical complication (edema, vomiting, persistent diarrhea loss of

appetite will be referred to Stabilizing Center. WHO Standardized treatment is given to these

children.

The pregnant and lactating women ( PLW) less than 21 cm MUAC will be admitted at SFP and

will be provided the 2.25 kg vegetable oil and soya blended flour one in a month till 2 months.

They will be reassessed after two months and if MAUC is more than 21 cm then they will be

discharged. And if MAUC is less than 21 cm after two months treatment they will be

reassessed/observed for two weeks at SFP. If no improvement then they will be referred to

secondary/ tertiary care facility.

All the data is shared with stake holders in Nutrition Information System (NIS).

Strategies

Human Resources: Having a sufficient and productive workforce.

Service Delivery: Improving planning, organisation, management and quality of services.

Stewardship/Governance/Leadership: Defining sector strategies, clarifying roles,

managing competing demands.

Health Financing: Ensuring fair and sustainable financing with financial protection.

Information and Knowledge: Ensuring the generation and use of information, including

for monitoring and evaluation.

Technology and Infrastructure: Ensuring adequate supplies, equipment and infrastructure.

Annexure:

Project Reports.