SAVING CHILDREN’S LIVES IN SINDH PROVINCE, … the Children Supported Child Survival Project District ... Kharorro Syed, Atta Mohammad ... Marvi workers was carried out on a questionnaire

SAVING CHILDREN’S LIVES IN SINDH PROVINCE, PAKISTAN

Save the Children Supported Child Survival Project

District Umerkot, Sindh

Thardeep Rural Development Programme

Project End Report August 2012

10-Aug-12 Monitoring & Evaluation Section, TRDP

1 Project End Report of ‘Child Survival Project’.

Abbreviations

MNCH Maternal and Neonatal Child Health EMNC Essential Maternal and Neonatal Care HCP Health Care Provider PDQ Partnership Defined Quality WSG Women Support Group BCC Behaviour Change Communication QIT Quality Improvement Team CIMNCI Community Integrated Management Neonatal

Childhood illness LHS Lady Health Supervisor WHO World Health Organization Antenatal Before Delivery Postnatal After Delivery Newborn /Neonatal New born baby up to 28 days Infant Child up to one year age HWDQ Health worker Defined Quality CDQ Community defined Quality IMR Infant Mortality Rate NMR Newborn Mortality Rate MMR Maternal Mortality Rate ANC Antenatal Check-up PNC Postnatal Check-up EPI Expanded Program on Immunization TT Tetanus Toxoid KAP Knowledge, Attitude & Practice CBA Child Bearing Age CSO Civil Society Organizations LMP Last Menstrual Period EDD Expected Date of Delivery AMTSL Active Management of Third Stage Labour APH Ante partum Haemorrhage PPH Post-Partum Haemorrhage MMC Mother Mortality Conference FLCF First Level Care Facility DPIU District Program Implementation Unit BHU Basi Health Unit RHC Rural Health Centre LHV Lady Health Visitor LHS Lady Health Supervisor

Project Name: Child Survival Project Project Duration: 3 years ( 2010-2013) Project Area: Union Councils Kharorro Syed, Atta Mohammad Palli & Mir

Wali Mohammad Talpur of District Umerkot, Sindh, Pakistan Donor: Save the Children Implementing Partner:

Thardeep Rural Development Programme (TRDP)


Country overview: In the period under review there has not been any accident that affected the project except the torrential rainfalls. Owing to a continuous rainfall, the project interventions suspended for a while, however later on the activities initiated but took some time to come in full swing as water receding was slow, infrastructure was severely damaged and people took some time to get back to the project area. Nevertheless in rest of the months the project activities were top priority and target achieved as per plan. Executive Summary: During the period under review TRDP completed all of the targets, part of its project plan (the progress in detail is highlighted against the object from page number 03). However the summary of the project achievements is as: Beneficiaries reached in the project Period:

Refresher training to 153 TBAs and community volunteers Trained 17 facility based staff including 7 medical Doctors (5 male doctors and 2 female

medical doctors) and 10 LHVs of the project area 57 LHWs of the project area visited 704 new born babies 1175 clean delivery kits were provided to pregnant ladies having pregnancy period of 8 to

9 months 1385 support group meetings were conducted by the LHWs in which women 3217

participation is recorded 208 supervisory meetings by female social organizers 546 health committees meeting were conducted in which 488 members participated. 198 health awareness raising session with 5892 community members were conducted Trained 58 LHWs and 58 male volunteers in support group methodology to conduct

support group and health committee meeting effectively. Trained 139 Support group members and 65 Health committee members on health

practices and exclusive breast feeding. Provided 500 mosquito nets to pregnant ladies and lactating mothers in target

Following table shows the month wise increasing beneficiaries number owing to this project: Activity Jan Feb March April May June July

Family Planning services at BHU 36 20 116 156 201 805 852 Vaccination to Pregnant Women TT1 104 187 178 394 721 487 549 Deliveries at BHUs 7 13 13 12 14 7 8 ANC check-ups of Pregnant ladies at BHU 53 43 212 254 490 462 324 PNC Check-up lactating mothers 6 1 20 38 89 76 70

Total 206 264 539 854 1515 1837 180

3 Project Goal: “Maternal health and child survival is improved in target union councils of district Umerkot, Sindh Province to reduce child mortality by 30%”.


Objectives:

1. Increase the utilisation of maternal, new-born and child health (MNCH) services by 30%. 2. Improve knowledge and practices of mothers and primary carers on key maternal, new-

born and child health practices and danger signs of life threatening childhood illnesses. 3. Advocate for the placement of key health staff and availability of essential lifesaving

supplies and equipment at all target public healthcare facilities

Progress against objectives: Objective one: Increase the utilisation of maternal, new-born and child health

(MNCH) services by 30%. Activity 1.1: Capacity building of IP or project staff In the month of August the detailed training was imparted to 8 members of the project staff in Umerkot. Mr. Masood Abbasi from Save the Children gave the first project orientation to the 8 project staff on August 8, 2011 at TRDP district office Umerkot. Task2: Training of 02 project staff on EMNC (Essential maternal and neonatal care) with IKEA project in Sangahar As Dr. Ali Raza Qadri provincial coordinator SC Sind was the part of child survivial project that was mututally agreed to be excluded from the annual plan. Task3:- Training of 08 project staff on support group methodology (with IKEA project in Sangahar) Eight project staff members were imparted the support group methodology trainings in the month of November, 2011. The training was focused on behaviour change communication tools and danger signs in pregnant ladies, neonates and three delays. The four days training was held separately for male and female project staff. Task 4:- Training of 08 project staff on PDQ (with IKEA project in Sanghar) Seven project staff members and project coordinator from Save the children received the four days training on Partnership Define quality (PDQ) approach in the month of February. The training was implemented in the field as highlighted in the activity 3.5 of objective 3. Activity 1.2:- Midline Survey/health facility assessments Midline survey was initiated in the first week of May by the consultants through Save the Children. The survey methodology includes project methodology development, orientation to staff on methodology and data collection from field. In the month of July the dissemination seminar was also organized in District Umerkot participated by all the stakeholders. It is also planned that the sharing of the mid lines survey would be disseminated at provincial level among government health authorities. Activity 1.3:-Two-day refreshers orientation of TBAs & Marvi workers


Task1 Follow-up meetings and training need assessment of TBAs and Marvi workers trained in year 01 Training need assessment of 44 Marvi workers was carried out on a questionnaire designed from training curriculum, imparted during year one of the projects. Later on the format was amended on the suggestion of provincial coordinator, Save the Children and applied for the TNA of remaining 78 TBAs. Task 2 Finalization of two days refresher training/ session plan, training schedule and materials Based on the results on TNA two days refresher was designed mutually (i.e. TRDP and Save the Children) in the month of March, 2012. Task 3 Conduct training for TBA and Marvi workers on clean delivery practices (140 participants/ 7 batches) In the reporting period two days refresher trainings were organized in target three union councils i.e. Kharoro Syed, Atta Muhammad Pali and Mir Wali Talpur (Gapno). In these trainings 153 (92 TBAs and 61 Community Volunteers) participated and benefited. The Module included following sessions:

The refresher training of two days had the following major sessions Behaviour change of mothers and community Basic knowledge on MMR, IMR Use of Clean delivery kits Danger signs in new born Three delays

Activity 1.4 Refresher Training of female health workers on essential new born and child care Task 1:-Follow-up meetings and training need assessment of female health workers trained in year 01 The follow up meetings and training need assessment (TNA) of health workers trained in first year of the year of the project implementation was conducted in October 2011. Task 2:- Finalization of training/ session plan, training schedule and materials Based on the training need assessments the training modules were designed and four resources persons were taken on board to impart this training in the targeted three union councils i.e. Kharoro Syed, Atta Muhammad Pali and Mir Wali Talpur (Gapno). Task 3:- Conduct refresher trainings (100 participants / 5 batches) The refresher trainings were imparted as per plan in the month of June 2012. The training benefited to 58 lady health workers in the targeted U.Cs. Activity 1.5 Refresher training health facility based staff Task 1:-Follow-up meetings and training need assessment of health facility staff trained in year 01


Following up meetings and Training need assessment of heatlh facility staff trained in the first year of the project implementation was conducted as per schedule. Task 2 Finalization of training/ session plan, training schedule and materials The training need assessment provided basis for the finalization of training module. It was a six days training on EMNC. In order to impart the training four trainers were hired, the sessions were focused on Gynaecology and neonatal care. Task 3 Conduct refresher EMNC Trainings of facility based staff In the month of February 17 health facility staff (7 doctors and 10 LHVs) from the targeted U.Cs received EMNC training. The sessions include: communication and counselling, antenatal care, APH and virginal bleeding, its causes and precautionary measures. The other sessions include: Normal/unsatisfactory labour, post partum haemorrhage/care, pyrexia and postnatal care. Given the sensitive topics the services of Trained trainers were hired for different session. Activity 1.6 New born assessment by LHW on 1, 3,7,14 and 28th day of birth Task 1 Orientation of LHWs on assessment tools The female staff of the project at BHUs of the targeted U.Cs conducted orientation session in the month of October, 2011 in which 58 LHWs participated. Task 2 Postnatal care visit to assess new born by LHWs (05 visits of 02 new borns per LHW per months) 57 LHWs paid postnatal care visits and assessed 704 new born in the targeted U.Cs. These newborn were visited 5 times after the birth. In order to timely identify the danger signs and symptoms and referring the sick infant to health facilities. The data of these infants were collected on a prescribed format. Task 3 Compilation of Monthly assessment reports The monthly assessment report of the postnatal care visits are compiled and are in finalization. In the reporting period the data of all 704 new born babies is updated and available at project office Umerkot. Activity 1.7 Provision of clean delivery kit to female health workers / TBAs The pregnant ladies with a pregnancy period of 8 to 9 months were given the 1175 clean delivery kits through trained LHWs, 92 TBAs and 61 community volunteers. Objective two: Improve knowledge and practices of mothers and primary carers on

key maternal, new-born and child health practices and danger signs of life threatening childhood illnesses.

Activity 2.1 Women's Support Group Meetings Task 1: Conduction of support group meetings by LHWs and MARVI workers (02 meetings per LHW/ Marvi worker per month)


During the period under review 1385 support group meetings were conducted by 57 LHWs. In these meetings 14542 women participated. The meetings are aimed to discuss common health issues and impart knowledge and guidance on two P&LWs and child bearing age women through counselling card by adopting participatory methods. For a better comprehension prior to the meeting the one topic is selected for the meeting to discuss on. Task 2 Monitoring / participation of female social organizer in 6 support group meetings per month The female social organizers prepared their plans to participate and monitor the supervisory meetings in the targeted Union councils. In the period under review 208 such visits were conducted by the social organizers. The process of monitoring these meetings was to collect the information through a check list and based on giving guidance to LHWs in order to improve the quality and effectives of the meetings. . Activity 2.2 Men Group Meetings Task 1: Conduction of male group meetings by volunteers (One meeting per volunteers per month) During the period under review 546 health committees meetings were held. In these meetings 488 members of the health committees participated in the targeted union councils. The meetings were organized by the male volunteers from the community with the support of LHWs. Task 2 Monitoring / participation of male social organizer in 6 male group meetings per month The men social organizers prepared their plans to participate and monitor the health committee meetings. In the period under review 188 such visits were conducted by the social organizers. The process of monitoring these meetings was to collect the information through a check list and based on giving suggestion for the improvement Activity 2.3 Participate in FLCF (first level of care facility) meetings of LHW program at targeted Health Facilities In the period under review project staff participated in 41 meeting at BHUs in targeted 3 union councils. FLCF meetings are routine meetings conducted at BHUs in order to know the progress of LHWs. Thus, TRDP staff attended these meetings as per plan in the first week of the every new month. The staff uses formats to collect the data from responsible health officials at BHU. Activity 2.4 Participate in monthly MMC meeting of LHW Program The maternal mortality conferences were attended by TRDP staff regularly (Total 6), these meetings used to be held on monthly basis at district level. The major issues discussed during these meetings were related to ANC, PNC, MMR, IMR and field level problem regarding immunization in MMC. Activity 2.5 Awareness raising session in communities In targeted union councils men and women were focused to raise awareness and in this context with the support of LHWs 198 sessions were conducted. In the targeted area, U.C level health sessions were also held. The session were mainly focusing on best health practices and reinforcing the message delivered by LHWs during here visits. Activity 2.6 Celebrate new born and child health week annually to highlight MNCH issues


Two new born and child health weeks were celebrated during the project period i.e. one from 14-19 November 2011 in collaboration with all stakeholders and second week from May 7-12, 2012 in collaboration with the district health department/government. Theses weeks covered the topics i.e. Nutrition, health and hygiene, Immunization, TT vaccine, Antenatal care, postnatal care and Community led total sanitation. Objective three: Advocate for the placement of key health staff and availability of

essential lifesaving supplies and equipment at all target public healthcare facilities.

Activity 3.1 Formation of a coalition at district level of civil society organization TRDP has successfully managed to bring the entire stakeholder on one common plate form and in this context a civil society network comprising on all stakeholders had been formed at the district level. Under the umbrella of the network 4 meetings were also held on the issues related to MNCH services in Umerkot. . Task 1:- Bi Monthly meetings to review progress In order to review the progress more critically and keep the project activities on target monthly meeting instead of bi-monthly approach was adopted. These monthly meeting were held in the first week of every month. Besides these monthly meeting one special review meeting was also conducted during the project implementation. Activity 3.2 Coordination / Advocacy with district health department Task 1 Participate in DHMT meetings to share the progress and get support The project coordinator and district manager would regularly attend the DHMT meetings (Total 4). These meetings were used participated by responsible district health officials; all the doctors would share the progress and health related issues in these meetings. TRDP in these meetings took opportunity to share the progress of the project regularly. On the platform of these meetings TRDP extended the support of 4x4 vehicles in order to assess the children for polio vaccination in remote areas. This gesture of TRDP was highly appreciated by the government and helped to create congenial relations with the district health department. Task 2 Joint monitoring field visits by district health authorities & coalition

partners to observe interventions TRDP took district government health authorities on board took under the joint field monitoring visit in the project period. DHO Umerkot Dr. Abdul Aziz Kumbhar and DCO national programme Dr. Syed Anwar Ali Shah Bukhari conducted time to time visits in the targeted project area with TRDP staff and Save the Children coordinator. In the visit they gave their valuable input to TRDP for the effective implementation. Activity 3.3 Hold quarterly Review meetings among our partner organizations and health department In the project period under review the review meetings were held as per plan. In which various project related activities were shared and discussion were conducted in order improve the project intervention. Activity 3.4 Arrange district level Seminar to share Mid-term assessment report


District level seminar was organized in Umerkot in which various stakeholders and district level government health officials participated. Activity 3.5 Implement PDQ in target facilities (one in each UC) In the period under review, TRDP successfully implemented PDQs in targeted UCs. Prior to it preliminary discussions and follow up meetings were also held with the district health departments. Task 1 .Identify health facilities in each UC As per the plan three basic health facilities were identified for the implementation of PDQs in the target three union councils i.e. Mir Wali Mohammad (Gapno), Kharoro Syed and Khan Sahib Atta Moahmmad Palli. Task 2.Building the support meetings at district/ tehsil and health facility level The activity was carried out as per the plan it includes the orientation of PDQs to PPHI staff at district level. For the orientation the platform of monthly review was used. Task 3.Bridging the gap meeting in two Union councils In the period under review three “Bridging the Gap” meetings were held in all targeted union councils. QIT teams are formed in these union councils and their action plan are prepared and implemented.

Summary of Project Activities Timeline

Month Activity Description

February 2012

1. EMNC training of health facility based staff/health care providers

2. Training of 08 project staff on Partnership defined quality-PDQ

Six days trainings were conducted at TRDP district office Umerkot. There was total 17 facility based staff including 7 Doctors (5 male doctors and 2 female doctors) and 10 LHVs of the project area. The four day training on Partnership Defined Quality (PDQ) approach was conducted from 1st to 4th February 2012 at DevCon office Sanghar. Three female staff and four male project staff of TRDP and one provincial coordinator Save the Children got the training.


March 2012

1. Training need assessment of TBAs and Marvi workers trained in year 01

2. Conduct TBA and Marvi workers on clean delivery practices (140 participants/ 7 batches)

3. Participate in monthly MMC meeting of LHW Program

4. Participate in DHMT meetings to share the progress and get support

Training need assessment of 44 Marvi workers was carried out to on a questionnaire designed from training curriculum imparted during year one of the projects. Total 153 TBAs (92) and community volunteers (61) have been trained. MMC is a maternal mortality conference at district level arranged by LHW program once in each month. It is participated by Lady Health Supervisors (LHSs) and District Coordinator of LHW program. Each LHSs submits the monthly report of LHWs. Project coordinator and District Manager TRDP had participated in DHMT meeting.

April 1. Building the support meetings at district/ tehsil and health facility level



We conducted the orientation of PDQ to PPHI staff at District level in the MRM (Monthly Review meeting) of PPHI Umerkot on the 10 April. Project coordinator participated in this meeting at National Program office Umerkot. Project coordinator and District Manager TRDP had participated in DHMT meeting.

May 1. Midline Survey/health facility assessments



4. Meeting of civil society organization- CSO

5. PDQ Process

6. MCH Week

Midline survey was started in the first week of May, 2012. Project coordinator participated in this meeting at National Program office Umerkot. Project coordinator and District Manager TRDP had participated in DHMT meeting. Meeting was held on the issues of MNCH services in Umerkot. Exploring the qualities and Bridging the gap meeting in community and at BHU level MCH week celebrated in 3 targeted UCs.

June 1. ENC training of LHWs

2. PDQ Process

The trainings were conducted from June 25 to June 29, 2012. And in these trainings total 58 LHWs had been trained. Bridging the gap meeting at BHU Fateh Mohd Rajar


July 1. Dissemination Seminar on Midline Survey report

2. UC level Seminar



5. Meeting of civil society organization- CSO

6. PDQ Process

Dissemination Seminar on midline survey report was held in July 2012 at Sorrihia Badshah complex Umerkot. 3 UC level seminars were conducted on health awareness and DHO and DCO LHW Program participated. Project coordinator participated in this meeting at National Program office Umerkot. Project coordinator and District Manager TRDP had participated in DHMT meeting. Meeting was held on the issues of MNCH services in Umerkot. Bridging the gap meeting at BHU Kharoro Syed


OUTCOMES THAT HAVE BEEN ACHIEVED - Qualitative (such as increased willingness to use health facilities, increased satisfaction with health services etc.) Due to raise in awareness among the communities regarding the health issues that project was specifically was focusing on there has been a substantial change. It is evident from following graph in which numbers of cases are increased immensely month wise. These results are verified by the midterm evaluation is well. . Health Facility Attendance increased after Jan 2012 to July 2012 at BHU Level

- Qualitative (such as child/maternal mortality rate changes, increased use of health services etc). There has been a substantial change since the time project is implemented in the field. Though the project activities were hampered due to torrential rain yet there is a substantial change in the indicators. It is also verified by the Mid –term evaluation results in the following: Antenatal care and care providers: The midterm review results show that over 87% of mothers had ANC check-up as compared to 70% during the baseline survey, which is a an improvement of 17% as compared to the baseline. Out of those 87% mothers who had ANC visits, 33% mothers had 02 ANC visits as compared to baseline (23%). Further to this, an increase has been seen for 03 and 04 visits. ANC Service Providers: MTR results show that most of the respondents (61%) had TBA as their birth attendant and 39% reported skilled birth attendant (private doctor (30%), public sector doctors (7%), private nurse/ midwife (1%) and LHV (1%).

36 20116 156 201

805 852

104187 178

394

721

487 549

53 43212 254

490 462324

206 264

539

854

1515

1837 1803

0

200

400

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800

1000

1200

1400

1600

1800

2000

January February March April May June July

Family Planning services at BHU

Vaccination to Pregnant Women TT1

Deliveries at BHUs

ANC checkups of Pregnant ladies atBHU


Tetanus Vaccine during last pregnancy:

92% respondents were vaccinated twice as compared to baseline results of 64%. During the baseline, 26% respondents were not vaccinated and only 2% respondents during the midterm said that they were not vaccinated. Skilled birth attendant MTR results show that most of the respondents (61%) had TBA as their birth attendant followed by private doctor (30%) and an increase in women choosing public sector doctors/ facilities as birth attendants (7%).

Post natal Care:

Majority of respondents (93%) reported that they had postnatal checkup after their last delivery. Out of those who had postnatal checkup, 56% respondents visited TBAs, while 35% visited skilled healthcare providers and 09% visited others. Complications during Last Pregnancy/ Child Birth/Postpartum 28% of the respondents had complications during the last pregnancy/ child birth/ postpartum. While the baseline findings were 66%, which shows a decline in cases of complications Family planning methods Results show that 86% of respondents knew about the family planning methods during the midterm review, while this finding was 89% at the time of baseline. Among those who knew about methods, 96% preferred pills as contraceptive method. Public Sector Health Facilities (BHUs) Assessment All the 05 BHUs were providing EPI services at the time of MTR. All 5 BHUs have 01 trained staff on HMIS at each health facility and 100% facilities have submitted their report of following month. CHALLENGES AND LEARNINGS: Challenge Mitigation The qualification of Lady health workers remained a continuous concern as they are mostly primary pass

A comprehensive training programme was designed especially keeping this concern in mind.

PPHI was not part of the MoU signed only with the district health department.

Separate meetings were held with PPHI staff and they were taking into confidence time to time and shared established a proper information mechanism

Prior to the project health committees were comprised of influential members for example: MPA, land lord etc.

TRDP restructured the committees after proper orientation and awareness in the communities through mutual agreement.

Good Practices: Owing to project activities there is rise in awareness related to health issue. TRDP, with the support of save the children transformed this awareness in to a joint voice and brough the community in dialogue with the government. Resultantly the second shift in a BHU and the well-equipped labour room service is also initiated in the targeted Union Councilsd. Likewise, with the support of save the children, under the project, various health facilities are provided different equipment. This support has helped these centers to provide services with quality in district Umerkot.


List of Equipment S# Item PPHI For 03

Centers (Qty) THQ Hospital Samaro (Qty)

Rural Health Centre Nabisar (Qty)

01 Delivery Table 03 01 01

02 Foot Stand 03 01 01

03 Drip Stand 03 01 01

04 Examination Table 03 01 01

05 Nebulizer 03 01 01

06 Autoclave 03 01 01

07 Suction Pump 03 01 01 08 Cord Clamp 700 200 200 09 Disposable Gloves 500 200 200

10 MVA Set with 3 cannulas 03 01 01 Quotes:

Name: Shardha LHW, BHU Kharoro Syed: I was not much aware about Antenatal and Post natal check up of Pregnant & lactating mothers because of I was engaged in medical store to give medicine only on doctor’s prescription paper at BHU. But after EMNC training, now I am able to check Pregnant & lactating mothers on given indicators. Name: Rasheeda Saand LHW, UC Kharoro Syed The concepts were vague for me and I was unable to deliver complete session in community. Some times community women used to ask me question regarding the health issues but I was unable to entertain their question. However after the ENC and support group methodology training I am now able to deliver the sessions confidently but also feel confident on my job. Name: Dr. Devi WMO, MNCH centre Shivani Mohalla Umerkot I am very thankful to TRDP for providing such opportunity of capacity building. Though I was already aware about EMNC yet there were some ambiguities and now after EMNC training I think I

feel sound.

An image from TRDP publication covering case study of child survival project


Case studies

I. Rashida Sand

Rashida Saand is LHW and has been working in UC Kharoro Syed since 1998. She is married and have five children, two boys and three girls. Her husband is peasant and is working on the landlord land. Her husband earns such amounts that they can hardly both hands meet. Rashida has lot of family responsibilities to help economically and socially as well .Socially she is playing vital role in rights awareness for women in whole district Umerkot. Her house is the centre of all social activities .She also supports women in CNIC cards and Watan Cards. All these activities she does voluntarily. Despite of all these busy activities and problems of her home she has never ever ignored the work of LHW.

Her education is Matric but level of knowledge of health and social work and her confidence is very high. Due to Her firm determination and commitment to duty and cause she never thinks of being tired. She always comes with smiling face. She says that she has been working as LHW in that area since long but I did not get such type of training as HANDS and TRDP provided .These trainings are not only interesting, provides refresher but also increase the level of Knowledge . In her catchment area there is 1000 population. She has all records of pregnant ladies, lactating mothers, neonatal. She also has knowledge of expected dates of deliveries of their areas. Socially she has been linked with people closely. If any problem occurs in her area regarding delivery or other complications in antenatal or postnatal visit they immediately call her .She says : I get up early in the morning and do whole work of my home and then prepare food for her children and other family members and then she send all children to school. Approximately I leave for work of LHW at 9 am .In the field I visit I see all the activities of National programme like use of contraceptives, family planning, vaccination , conducting meeting with Women Support group, Health committee, and socially as well. She also helps the other LHWs to do such type of work. She keeps all the record accordingly .She feels pleasure when she gives knowledge of danger signs during pregnancy and in neonatal and about health related issues in communities .If she sees any complication in any patient she refers immediately because referral mechanism is available. Really she is role model of women.


II. Fareeda Pathan

Background: Fareeda W/O Sarfraz by cast pathan Female of 30 years old is working as LHV on BHU Digoo Farm. Actually she belonged to Kunri Town but after her marriage which in 2006, she settled in the Digoo Farm with her husband .She has been working as LHV in PPHI at this BHU Digoo Farm since 2009. She got married in 2006 but had no children yet so she adopted the baby girl. There are five members of her family and her mother in law is Trained TBA working on the same BHU. life and environment. The pathans are very strict in their customs and religious bent of mind. So they are in pardah and can’t do anything except this job. She gets up early in the morning and prays then she goes to centre for duty .Her husband Sarfraz does not allow him to go outside her home that is why she could not go for training. . She does her household work in her home rest of time gives to her adopted baby girl. She performed her duty very honestly at BHU from 9: 00 AM to 3:00 PM .Then she came back to her home gave time to her family and baby girl. If there is delivery at BHU before sunset, then she gives her personal time to conduct delivery. She prays five times a day. First time with struggle of her mother in law and MO in charge she attended the EMNC training of six days which was conducted by the TRDP. This training not only refreshes our knowledge but also changed my behavior towards community women and men. Story in her own words She said that I have learnt following things Knowledge has been increased ,revision of things which were forgotten due to time ,understood the child survival project which is on mothers and neonatal ,know about the issues of mothers and neonatal ,behaviors with mothers and children .How to promote knowledge and create demand of MNCH Services at BHU level .This training helped how to bring the community to BHU ,social mobilization tools and techniques to motivate the women for deliveries at BHU . Programme summary . After the six years of marriage she has become pregnant first time. She got antenatal checkup from Dr of BHU .I also realized that no one will come to improve the services of BHU and serve our people .For this I have to do for our people .This EMNC training turned my life also .First of all I started myself then people created trust on services of BHU. Now I focused on the family planning ,immunization ,Delivery at BHU ,use of delivery kits ,ANC and PNC at my BHU level service . This is the progress of my hard work Activity Jan Feb March April May FP 10 5 32 54 40 Vaccination 10 63 93 181 184 Delivery 6 3 3 7 6 ANC 10 5 42 55 42 PNC 5 0 1 5 6


Theory of change This is all after the training of EMNC which was conducted by TRDP .Before this she used to do

the job for the sake of salary only ,she used to play with adopted the girl all the day at BHU and home also . Here are so many problems of children like diarrhea, pneumonia, nutritional deficiency, low weight birth .So I always highlighted these things in general discussions also. With the grace of God now whatever I think for myself as PREGNANT I also think for the community. I will be vaccinated in third trimester will obey all the instruction of Dr. I would like to suggest all the pregnant women and TBAs to do so .Now I am

satisfied from my job .I have changed the behavior of community members regarding the antenatal checkup and immunization. Able to advocate for children: Through this program I have been able to say something for children and for mothers at plate form. Now I became the member of QIT team to improve the quality of services of our BHU. Key message: She said that sincere services and small efforts can bring change in the community. Second message for our community members that if you save mother from death it means you save your family. If you save child it means you save your future.

Financial Report

Attached as separate sheet


SAVING CHILDREN’S LIVES IN SINDH PROVINCE, … the Children Supported Child Survival Project District ... Kharorro Syed, Atta Mohammad ... Marvi workers was carried out on a questionnaire

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