Project Completion Report

Project Name : Provision of Healthcare Services to Flood affected Women and Children in two Union Councils of Tehsil D.G. Khan

Funded by : Concern worldwide

Location : Union Councils: Haji Ghazi and Jakhar Imam Shah,

Tehsil and District D G Khan

Implemented by: Al-Asar Development Organization, D.G.Khan

CONTENTS

Page

Background information 1

Project Output 1

Achievements 6

Overall Impact of the Project 11

Case Studies 12

Recommendations 13

Awareness Publications 14

Picture Gallery 17

ANNEXURES A, B & C

Background Information Dera Ghazi Khan (D. G. Khan) District is situated in southwestern part of Pakistan. The district covers an area of 11922 square kilometers. According to the 1998 Census of Pakistan, the district had a population of 1,643,118 persons and estimated current population is 2,165,708. The district is divided into 3 tehsils including main tehsils of D.G Khan and Taunsa. Of 59 total union councils, 51are located in rural, while 8 union councils are located in urban part of the district. Geographically D.G Khan is divided into two regions i.e. the western half of the district is covered by Sulaimain Mountains and other is plane in the east. The cultivation and livestock breeding are main source of income for rural population. Heavy monsoon rains and floods caused devastation on a massive scale in district D.G Khan. The road contact of Dera Ghazi Khan to Multan, Muzaffargarh and the rest of Punjab was suspended as national highway was flooded at various locations and some key bridges collapsed. Flood water caused severe damage to houses, public infrastructures, crops, roads and bridges.

Project Output

Project named “Provision of healthcare services to flood affected women and children in two Union Councils of Tehsil DGKhan” started from November, 01, 2010, in two union councils haji ghazi and jhakar imam shah funded by Concern worldwide and implemented through Al-Asar Development Organization. This project has successfully been completed on 06-02-2011. The strategy of implementation of project was as under.

i. Identification of affected areas through meetings with local peoples following social mobilization process. Finally 22 severe flood affected locations, where disease incidence/ prevalence rate is high, which was determine through conduction of comprehensive baseline survey, were selected for program interventions in each of UC Haji Ghazi and Jakhar Imam Shah.

ii. Identification of village volunteers in these locations through village level meetings by social mobilization teams

iii. Orientation meeting with volunteers for the organization of free medical camps and awareness session

iv. Conducted meetings with the concern health centers for referral cases

1 v. Free medical camps started from November 15, 2010 to February 3, 2011.

List of identified villages and focal presons of Union council Jhakar Imam Shah and Haji Ghazi with maps where camps organized is as under;

List of Villages of U/C Jhakar Imam Shah

Sr. no Union Council Name of Village Focal person/volunteer 1 Jhakar Imam Shah Basti Samandri Khadim Hussain 2 Jhakar Imam Shah Basti Rindan Ghulam Shabbir 3 Jhakar Imam Shah Basti Dhori Ghulam Jaffar Chandia 4 Jhakar Imam Shah Basti Binani wala Hafiz Saeed Ahmad 5 Jhakar Imam Shah Basti Hamsheera Muhammad Shahid 6 Jhakar Imam Shah Basti Shikrey wala Master Iqbal Hussain 7 Jhakar Imam Shah Shairo Jadeed Hafiz Allah Bukhsh 8 Jhakar Imam Shah Kaleem Abad Master Muhammad Ayoub 9 Jhakar Imam Shah Chah Dom wala Muhammad Ansar Laskani 10 Jhakar Imam Shah Basti Dadi wala Bilal Ahmad 11 Jhakar Imam Shah Basti Sahool wala Muhammad Riaz 12 Jhakar Imam Shah Basti Jee wala Dr. Peer Bukhsh 13 Jhakar Imam Shah Basti Madan Wala Ghulam Farid 14 Jhakar Imam Shah Basti Qaim wala Syed Muhammad Akbar 15 Jhakar Imam Shah Huday wala, Mouza Abdul Ghafoor Abreened 16 Jhakar Imam Shah Basti Luarkha Hafiz Ghulam Rasool 17 Jhakar Imam Shah Basti Kumhar wala Muhammad Mujahid Shah 18 Jhakar Imam Shah Basti Mian wala Haji Abdul Kareem 19 Jhakar Imam Shah Basti Malkani Qalandar Muneer Hussain Malkani 20 Jhakar Imam Shah Basti Matam wala Muhammd Asif 21 Jhakar Imam Shah Basti Jaal Wala Muhammad Latif, Muhammad Ayoub 22 Jhakar Imam Shah Basti Mochi wala Muhammd Iqbal Khan

3 U/C Haji Ghazi

Sr. no Union Council Name of Village Focal Person/Volunteer Syed Nadeem Abbas, 1 Haji Ghazi Dari Miro Abdul Rasheed Nutkani 2 Haji Ghazi Basti Peepal wala Syed Ghulam Abbas 3 Haji Ghazi Bait Malana Khalil Ahmad , Malik Wahid Bukhsh Muhammad Yaqoob, Haji Ghulam 4 Haji Ghazi Band Kastori Rasool 5 Haji Ghazi Basti Gopang Saeed Ahmad, Jan Muhammad 6 Haji Ghazi Bhatti wala Ghulam Yasee, Muhammad Ramzan 7 Haji Ghazi Basti Rid wala Fayyaz Ahmad, Muhammad Ijaz 8 Haji Ghazi Rakh Chavni Ghulam Sadiq, Faiz Muhammad 9 Haji Ghazi Basti Makory wala Muhammad Hanif, Iqbal Javed 10 Haji Ghazi Sindh wala/khadim khosa Raiz Hussain 11 Haji Ghazi Haidar Wala/Basti Malkana Hafiz Noor Muhammad, Ashiq Hussain 12 Haji Ghazi Basti Wasti Wala Khalid Mehmood, Muhammad Naveed 13 Haji Ghazi Bait Malana II Ghulam Haidar, Noor Muhammad Hafiz Amir Bukhsh, Muhammad 14 Haji Ghazi Basti Jatt wala Ramzan 15 Haji Ghazi Nasir wala Syed Ibrar Naqvi, Muhammad Jamil 16 Haji Ghazi Rind Wala Malik Ghulam Rasool, Ghulam Asghar 17 Haji Ghazi Pathan wala/Jatti wala Muhammad Bilal 18 Haji Ghazi Basti Darakh Wala Muhammad Amin Basti Darkhan wala/Bhatti 19 Haji Ghazi Munir Ahmad Fauji, Saeed Ahmad wala 20 Haji Ghazi Jattoi wala Muhammad Tanveer , Allah Ditta 21 Haji Ghazi Peer Fatheh Shah Syed Mujahid Hussain 22 Haji Ghazi Mochi wala Sheikh Mehmood, Ahmad Bukhsh

5 Beneficiary Numbers

ADO provided health facilities in the shape of free medical camps to the affectees of flood. In the free medical camp in which doctors male and female, paramedic staff provides the primary health care services to the flood affactees. Data of beneficiaries is as under;

Category No. of Families Age breakdown Male Female Total

Flood 4569 Under 18 7568 7636 15204 Affectees Over 18 4569 15133 19701

Total 3200 Under 18 7568 7636 15402

Over 18 4569 13333 19701

UC AND GENDER-WISE BENEFICIARIES 6000 5318 4977 5000 4188 4329 4000 3380 3307

3000 2494 2600 2238 2075 2000

1000

1 0 Above 18 Under 18 Above 18 Under 18 Pregnant Above 18 Under 18 Above 18 Under 18 Pregnant Yrs Yrs Yrs Yrs Women Yrs Yrs Yrs Yrs Women

Males Females Males Females

UC Haji Ghazi UC Jhakhar Imam Shah

6 Commutative Beneficiaries from Free Medical Camp

GENDER-WISE BENEFICIARIES

12000 10295 10000 7568 7636 8000 6000 4569 4838 4000 2000 0 Above 18 Yrs Under 18 Yrs Above 18 Yrs Under 18 Yrs Pregnant Women Males Females

Males Females

DISEASE PATTERN (N = 34906)

2% 15% 12% 1%

1% Diarrhea 4% Dysentery AWD ARI Malaria/ PUO Skin Eye Infection 31% Maternal 23% Other

11%

7 Final Activities Completed

Free medical camps and awareness session started from November 15, 2010 to February 03, 2011. Main activities during free medical camp were as under;

• Provision of primary health care services by doctors and paramedic staff

• Male and Female health & hygiene awareness session

• Registration of data of pregnant women

• Serious patients were referred to nearest BHU/RHC/DHQ

• Distribution of 3300 Hygiene and safe delivery kits

• Distribution of 1500 Mosquito Nets

• Distribution of Lades pads and Pampers for children

Summary of final activities

Sr. No Name of Activity Target Achieved Remarks

1 Free Medical Camp 132 132 Health and Hygiene Awareness 2 Session 264 264 Mosquito Nets Target was 1100. ADO distributed 1500 Mosquito 3 Nets among the pregnant and 1500 1500 new born baby mothers Safe Delivery Kits ADO distributed 2500 4 3300 3300 Female underwire 5 Hygiene Kits 3300 3300 Serious patient referred to Serious patient were referred 6 BHU/RHC/DHQ to nearest BHU/RHC/DHQ, 600 546 DGkhan

8 Final indicator results

During the baseline survey it was found that in adults, the most common reported ailments were diarrhea, while respiratory diseases , skin diseases, Malaria, Hyper tension, Diabetes and fungal infection were also common. The same disease pattern was noted in children diarrhea was the most common ailment, , and eye infections were frequently reported in children and adults. During survey 3300 pregnant women identified in both union councils Haji Ghazi Ghazi. During the organization of free medical camps and awareness session, pregnant women and child were focused. It was provided them the free medical checkup, free medicines , awareness regarding pregnancy period of pregnant women and awareness about safe delivery, use of ORS for children, use of safe drinking water. It was conducted special session of MOC exercise regarding use of “Pure” to clean the water for safe drinking. It was distributed safe delivery kits, hygiene kits along with mosquito nets and lades pads and pampers for children (donation received from Turkish team and NETPAO).

Coordination

ADO has good coordination with line departments and other partner NGOs/INGOs. During this disaster AADO developed good coordination with Health Department i-e EDO health Office, RHCs/BHUs , Field staff of health departments like LHV, TBAs of DGKhan, WHO, Green Star Social Marketing, NETPAO, Punjab Welfare Trust for disable , pharmaceutical companies , local donors for health services. ADO conducted meeting with EDO health more then three time. The agenda of meetings were;

Ø briefing regarding implementation of project in selected union councils Ø Meeting regarding request for medicines and mosquito nets for flood affected communities Ø Progress sharing on monthly DCM(district coordination meeting)

2- ADO also conducted meeting with WHO team- D.G.Khan and participated in two trainings held at WHO Hub Office Multan. One was on Logistic support System (LSS) for management of medicines and other was on expiry calendar, safe disposal of expiry medicines and management of warehouse.

3- ADO conducted meeting with Regional Manager Marketing for request of “Pure” sachet for flood affected people. Because due to heavy flood affect, affect the ground water of the area. Water level become high and TDS of ground water change. People of the affected area facing the different diseases. . So it was requested to Green star to provide pure sachet for provision of safe and clean water to the affected community.

4- ADO was conducted meeting with Director Programs Punjab welfare trust for disables Lahore for request of medicines for free medical camps. This meeting was held in D.G.Khan when he visited the flood affected area of DGKhan.

9 5- ADO conducted meeting with Regional Field Officer of NETPAO at Multan for request of free medicines, but they apologies to provide medicines, they provide lades pads and pampers for Childs. Detail of facilities provided by above mentioned departments and others is as under;

Sr. No Department/Organization Facilitation for Health services

Health department showed warm cooperation regarding treatment of referral patient at BHU and RHCS level. Provided data of TBA, LHVs 1 Health Department, D.G.Khan and supervisors of concerned union councils. Provided medicines and mosquito nets for flood affected communities

World Health Organization visited the setup of ADO, meeting with doctors and paramedic staff, verify the free medical camps and 2 World Health Organization provided one kit of medicine for affectees and provide trainings on stock management and safe disposal of expiry medicines

Qarshee Pakistan provided medicines for flood affected people that 3 Qarshi Pakistan was, aab-e- Naqra, Saafi and other medicines

A Team of doctors and paramedic staff of brother country TURKI, visited free medical camp and provided medicines and pampers for 4 TEFTIS KURULU BASKANLIGI children, which were distributed in the free medical camps in u/c Haji Ghazi and Jhakar Imam Shah

5 Punjab Welfare Trust for Disable PWTD provided medicine for the affected communities

NEPAO also provided ladies pads for the women of flood affected 6 NETPAO communities as well as pampers for children

Local donations in shape of free medicines received and different pharmaceutical companies coordinate to provide free medicines for the flood affected communities

Operating environment

Al-Asar Development Organization start to implement this project in two union council with the coordination of line departments at district level as well as local level and local activities volunteers, local volunteers guide the road maps of the flood affected area and access to the affected communities of the two union councils of haji ghazi and jhakar Imam Shah. Due to coordination and planned activities ADO face no difficulty to implement the project. Security problem was noted in the beginning of the disaster but during project implementation ADO face no any incident regarding security. Mostly local road was damaged due to heavy flood disaster, ADO faced little bit problem in this regards and solved the

10 help of local community. In the beginning of the flood’s days people migrated to safe places, when water level down they went back to their home places and trying to start their routine activities. Most of the families that were shifted to near native cities/villages shifted to their homes.

Overall impact of the Project

In late July and early August, there has been devastation in large areas of Pakistan due to un-precedent massive floods in district Dera Ghazi Khan. Many people have been affected resulting in large scale population displacement and huge damage to the communications and health infra-structure including maternal services. Considering the imminent risk of diseases to mothers and children, which may have resulted in high rate of morbidities and mortalities, health care interventions were launched, as to avert this significant risk, additional health care activities were imperative in the floods affected area like Haji Ghazi and Jhakhar Imam Shah, being declared severely affected. ADO with technical and financial assistance of implementation partner (Concerned worldwide US) had undertaken health care activities targeting very high risk population i.e pregnant women and children in inaccessible areas. The health care delivery system made practical as immediate response to cover all vulnerable pregnant women and children in the serve flood hit areas, so that the risk of emergencies may be minimized in target group.

The interventions can be categories primarily in four domains, 1) Social Mobilization on Health & Hygiene Promotion and Community Participation for ensuring sustainability. 2) Provision of Health Care Services focusing vulnerable group of pregnant women and children. 3) Establishment of effective and efficient referral system. 4) Distribution of safe delivery kits, hygiene kits, mosquito nets and promotional material for awareness.

These interventions all together made a significant contribution in providing and ensuring good health of flood affected communities. Through health & Hygiene promotion sessions the communities were sensitized about the prevalent health problems pertaining to pregnant women and children. These awareness sessions also helped in involvement and organization of communities to have best of the facilities being provided. The local people owned these camps and their participation was definite level good. These camps aimed at providing quality health services, especially to pregnant women and children and were fully recognized in meeting the desired set of objectives i.e countering health requirements. All the stakeholders were kept in coordination and channelized to ensure maximum health benefit to the communities.

11 Case Studies

During the field activities Al-Asar Development Organization faced some social barriers and provides rescue service for safe delivery of flood affected women. Detail of two different stories is as under;

Reported by: - Social Mobilization team

That day, we organized a one day relief medical camp at Basti rid wala, on Thursday 25-11-10. It was shared for your kind information that it is a scattered area of union council Haji Ghazi that was also affected with recently flood. AL-Asar Development team prearranged the spot before 4 days; announcement messages were delivered through mosques, drum beating & influence persons also used for the success of camp; so that the disease ratio should be minimize. Male & female community mobilizers also informed the surrounding community regarding camp.

It was the challengeable 7 worst issue that was faced by the AL-Asar Development team. In addition, I would like to brief that team unusually found the male & children beneficiaries mostly than women. According to implemented organized relief medical camp’s summary that mostly based on women beneficiaries but unfortunately low number of

women came in this organized relief camp.

Community mobilizers went to surrounding villages to know about this critical matter. Observation brought a summary that due to stick orthodox veil culture system women has no permission to go out for any activity except old women. Another problem was that the most continent of rigid society also not agreed to come for the provision of free check up & medical services from camp. Community passed the comments that area‘s people didn’t love to come in the relief medical camp or agreed to receive the camp medicines.

Most interesting story of the day was that the pregnant woman was present in the host house that was used for the organized relief camp; she did not come in the next room of the lady doctor. Female community moblizer went to meet her and knew the matter she said that I have no permission to go out for this free check up or any other activity.

12 That day, male n female community mobilizers delivered the Al-Aasar development messages regarding pregnant wormen and new born child’s health during the field visit and campaign about health education.

It was the success of the day, which was shared in detailed in about mention paragraph. Actually this surrounding village’s community has a sever need of awareness about health education. Community mobilizers tried for their best to justify the question that was raised by the community during field visit and awareness campaign.

AADO provided rescue service for flood affected community of bait malkani Qalandar reached such village for free medical camp, team identified a pregnant woman which was near to delivery time. Female leady doctor Ms. Robina, LHV Ms. Tahira Nasreen and female social mobilizer miss shakeela provide/assist emergency service. Pregnant female Ms. Amina Bibi came in medical camp for checkups visit. She was feeling pain of delivery. Lady Doctor advised him that their medical team provide you full facilitation and delivery may complete in BHU. But female said, he has no permission from her husband and delivery will be from local TBA. Social mobilization team called up her husband Malik Ibrahim and convinced him regarding safe delivery and provision of medicine and other facilitation at BHU level.

Medicine will provide Al-Asar Team. After long discussion their family agreed to delivery at BHU. Lady Doctor and LHV along with Female social mobilizer pick that women and reached BHU Jhakar Imam Shah. BHU officer/officials already awarded regarding such case and ready for safe delivery. Alhamdulillah malik ibrahim and family blessed by a baby boy. They much pleased and vote of thanks to Al-Asar Team. Al-Asar team success for provision of health service for the flood affected communities.

Recommendations

• Strengthen the BHU in term of time duration of medical staff. It may open till night.

• Eyes specialist and skin specialist should at BHU level for better look after of the affectees

• There should a up gradation of hospital laboratories for medical test of patients

13 • Facility of safe drinking water and hygiene is most important need of the community. A specific program may launch for rehabilitation of the affected people.

• Shelte is another importenat need of the people. This issue may be considered on top priority.

Awareness Publications

Awareness session was the other main component during the organization of free medical camp in different locations. Social mobilization team conducted the session on different health and hygiene related issues. Different pamphlet were distributed and pasted in the villages. Detail of awareness material is as under;

Picture Gallery of the project

Project Team Haji Ghazi Project Team Jhakar Imam Shah