APPNA SEHAT

Preventive Health Project by
APPNA SEHAT

I.     HIGHLIGHTS

  • Immunization coverage for children under five has been raised from 32% to 84% and for women of reproductive age has been increased from 16 to 92%.
  • Health Services Directorate Islamabad withdrew its EPI staff and handed immunization activities in Golra Sharif over to APPNA SEHAT in January 2002.
  • Contraceptive prevalence has been increased from 30% to 46%.
  • Communities are being educated on immunizations; diarrheal disease, dehydration, ORS preparation and administration; importance of growth monitoring for children; importance of antenatal and postnatal examinations; importance of child spacing; importance of drinking potable water and proper disposal of wastes, etc.
  • Men and women Community Organizations have started taking local development initiatives.
  • Field staff participation in APPNA SEHAT inter-regional study tours.
  • Five days staff refresher training.

II.    HEAD LINES – Activities in Brief

  • APPNA SEHAT PROGRAM INTERVENTIONS
    • Children and women were vaccinated and health education on importance of immunization for women and children was continued.
    • Health education on diarrheal disease, dehydration, ORS preparation and administration was continued.
    • Mothers were educated on importance of growth monitoring for children and growth of children under five was monitored.
    • Pregnant women were examined, high risk pregnancies were referred and health education was given on importance of antenatal and postnatal examinations.
    • Health education on importance of child spacing was continued.
    • Health education of parents on importance of drinking potable water and proper disposal of wastes was continued.
    • Health education on ARI was continued.
    • Health education on importance of personal hygiene was continued.
    • Field staff knowledge and skills were monitored on quarterly basis.
    • Field staff met on monthly basis to discuss progress and plan for the future.
       
  • SOCIAL ORGANIZATION AND COMMUNITY DEVELOPMENT
    • A Women Community Organization took initiative to solve mosquito problem in Golra Sharif.
    • Community members constructed Septic Tank on self-help basis.
    • Unit Health Committee was elected by the COs in January 2002.
    • Unit Committee is in process of establishing Computer Literacy Center in Golra Sharif.
  • HUMAN RESOURCE DEVELOPMENT
    • A total of 40 community teams comprising 2 members each were trained by EPI and APPNA SEHAT to participate in National Polio Eradication Campaign.
    • The Supervising Health Assistant participated in training workshop on “Role of NGOs in Development” at NCRD Islamabad.
    • Field staff participated in APPNA SEHAT inter-regional study tours to Sahiwal and Badin regions in January and March 2002, respectively.
    • Five days staff refresher training was conducted in Murree region.
    • TBAs were trained in conducting save deliveries.
       
  • INTERACTION AND COLLABORATION WITH OTHERS
    • Health Services Directorate Islamabad withdrew its EPI staff and handed immunization activities in Golra Sharif over to APPNA SEHAT in January 2002.
    • APPNA SEHAT staff participated in all phases of National Polio Eradication Campaign.
    • Working relationship was established with LHW program.
  • IMPORTANT VISITORS
    • Delegation of Community Uplift Program visited Golra Sharif to explore possibilities of coordination in November 2001.
    • Dr. Taha from UNICEF visited Golra Sharif project in April 2002.

III.   PROGRESS DURING THIS PERIOD

A.   APPNA SEHAT PROGRAM INTERVENTIONS

  • Immunizations

The activities to educate mothers on importance of immunization for children and women of reproductive age and vaccination of these two target groups were started in August 2001.

Prior to initiation of immunization activities, the baseline survey revealed that only 32.7% of children under five against 6 vaccine preventable diseases. Similarly only 15.9% of WRAs were immunized with Tetanus Toxoid.

From November 2001 onward immunization of women and children were carried out on priority basis. In addition to door-to-door health education and vaccination, static camps were also arranged at APPNA SEHAT field office on twice monthly basis. One day prior to the camp days the information was disseminated through loud speakers of the local mosques. It proved to be very effective strategy as the adjacent non-project area communities also brought their kids for immunization. Moreover, TT vaccination was also conducted at the static points. Table 1 gives details of vaccination status for children and women as of April 2002.

Table 1: Immunization coverage for children & women.

Target Group

#

Baseline

%

April 2002

%

Children < 5

676

32.7

84

Women 15-45

1,364

15.93

91.6

  • Control of diarrheal disease

One of the key interventions of APPNA SEHAT is to educate mothers on controlling diarrheal disease. It includes education on diarrhea, recognition of signs of dehydration, preparation and administration of homemade ORS, and recognition of signs of diarrheal complications. It is estimated that more than 50% of mothers in the project area can recognize the signs of dehydration, can prepare and administer ORS.

  • Growth monitoring of Children
  • Growth Monitoring and Promotion activities for children under five were initiated in August 2001. The mothers are educated on importance of growth monitoring, health and weight relationship of children, initiation of breast-feeding soon after birth, weaning and preparation of weaning food. Children less than five years are weighed on monthly basis and all those found to be at risk are to an appropriate source of help.

    • Table 2 gives the nutritional status of children under five in the Golra Sharif project area as of April 2002.

    Table 2: Nutritional status of children under five

     

    CHILDREN

    #

    WEIGHED

    %

    GREEN

    %

    YELLOW

    %

    RED

    %

    GRADE III

    %

    REFERRED

    %

    BASELINE

    599

    -

    58.8

    22.8

    12.1

    6.3

    -

    APRIL 2002

    676

    80.2

    89.6

    7.3

    2.2

    0.9

    3.1

    • Maternal Care
  • Health education is given on importance of antenatal, natal and postnatal care. Pregnant women are registered in the maternal care program and antenatal examinations are conducted on monthly basis. Figure 1 shows that out of all pregnant women examined during the month of April 2002, 92% were found normal whereas 5% had minor and 3% major problems. All those found to be at risk were referred to an appropriate source of help.

    • During April 2002 a total of 5 pregnancies were ended to live-births.

    • Child Spacing
  • After establishing the benchmark for contraceptive prevalence rate, Child Spacing activities were started in Golra Sharif. All the eligible couples are registered with the program, and educated on importance of child spacing. Table 3 below gives status of child spacing activities as of April 2002 in comparison with the baseline. It is encouraging to note that in just a short period of time the CPR is raised from 31 to 46% in Golra Sharif.

    • Table 3: Eligible couples reportedly using any child spacing method of their choice.

    TIME

    ELIGIBLE COUPLES

    #

    USING PERMANENT METHODS

    %

    USING TEMPORARY METHODS

    %

    TOTAL USING ANY METHOD

    %

    BASELINE

    722

    13.7

    17

    30.7

    APRIL 2002

    805

    17

    29.3

    46.3

    • Water & Sanitation
  • The communities are educated on importance of drinking potable water and how to make water potable and on importance of appropriate disposal of wastes. During the period under reporting each household received health education on water and sanitation on monthly basis.
    • ARI
  • The communities are educated on recognition of signs of ARI, when to seek help in case of ARI and making of soothing solution at home. During the period under reporting each household received health education on ARI on monthly basis.
    • Personal Hygiene
  • The communities are educated on importance of observing principles of personal hygiene. During the period under reporting each household received health education on personal hygiene on monthly basis.
    • Monitoring of Field Staff Knowledge & Skills
  • Field staff knowledge and skills were monitored twice during the period under reporting.

    • Knowledge and skills of field workers must be appropriate for effective dissemination of information and counseling, motivation and mobilization of community. To maintain required level of knowledge and skills of the field staff, the monitoring and support is the key to the success of the APPNA SEHAT.

    • Meetings of Field Staff to Discuss Progress and Planning
  • The field staff meets regularly at the end of each month to discuss the progress for the last month and plan for the next month. The APPNA SEHAT Golra Sharif staff met regularly on monthly basis during the period under reporting.

    • B.   SOCIAL ORGANIZATION & COMMUNITY DEVELOPMENT

    • Initiative of Women Community Organization
  • A women CO in Golra Sharif realized the problem of mosquitoes in the area and decided to solve this problem. They formed a committee of 5 women and APPNA SEHAT facilitated their interaction with CDA. A meeting is scheduled between women CO members and CDA officials on 23 May 2002 to discuss the issue with them.
    • Construction of Septic Tank on Self-help Basis
  • The CO of mohalla Bahkra Ku in Golra Sharif realized that improper disposal of wastes is causing damages to health of the people and environment. They discussed the solution at the local level and decided to build a septic tank on self-help basis in April 2002. They developed a project, reviewed their resources and contributed the costs. All the community members took active part in the construction of the septic tank.
    • Formation of First Unit Health Committee
  • APPNA SEHAT organizes the community ensuring maximum representation. Each of the COs already formed in Golra Sharif project area elected its representatives for the Unit Health Committee and Unit Committee was formed on 19 January 2002. Organizing the male community in Golra Sharif was a challenge however, after initial efforts when they understood the advantages of organization and participatory development it was encouraging to note that their involvement was increased with the passage of time. The Unit Committee in its very first meeting discussed the installation of at least four filth depots at four different sites of Golra Sharif.

    • The Unit Committee met again in March and appointed four of its members to interact with CDA for the filth depots. After APPNA SEHAT’s facilitation of the process the CDA has agreed to the request of communities.

    • Process of Establishing Computer Literacy Center
  • In addition to problem of solid waste management, the Unit Committee identified that the immediate needs of the area were a girl’s secondary school, health center, and a computer literacy centre. The Unit Committee has started working on developing the project for computer center and health center.

    • C.   HUMAN RESOURCE DEVELOPMENT

    • Training of 80 Community members by EPI and APPNA SEHAT
  • In order to participate in the National Polio Eradication Campaign 40 teams comprising two members each were trained jointly by APPNA SEHAT and government EPI staff. These training were conducted in March and April 2002.
    • Participation in Workshop on Role of NGOs in Development

    APPNA SEHAT SHA at Golra Sharif Mr. Zia-ur-Rehman participated in training workshop on “Role of NGOs in Development” conducted by NCRD Islamabad from 1 to 6 April 2002. A total of forty five government and NGOs representatives participated in the workshop. The main topics discussed included concept and philosophy of NGOs; organization and management of NGOs; registration procedures of NGOs; constraints, issues and steps in capacity building of NGOs; community based projects; local level planning for community development; role of community and social organizer in partnership concepts; steps in project implementation; participatory monitoring and evaluation; poverty alleviation efforts through NGOs; role of NGOs in gender equity and rural development; and decentralized planning through local government plan. A field visit of Baidari, an NGO working for neglected, deprived and victimized women, was conducted.

    • Participation in APPNA SEHAT Inter-regional study tour to Sahiwal & Badin
  • The Golra Sharif staff participated in inter-regional study tours to APPNA SEHAT Sahiwal and Badin project areas in January and March 2002, respectively. The objectives were to observe and learn from the experiences of other regions in conducting activities in the field. From all other APPNA SEHAT regions the staff participated in this activity.
    • Field staff Refresher Training
  • Field staff refresher training course Community Development and Health Interventions was conducted from 12 to 16 March 2002 at Regional Office Murree. Regional Director Murree and Social Organizer for Sahiwal were the resource persons. The training contents included Preventive Health and Curative Health Keeping in view program’s goals; Role of Health Education as a tool in Preventive Health; field activities like Growth Monitoring and Growth Promotion, Immunization, Maternal care, ORS/ORT, etc; Development and Participatory Development; Support Organization, qualities of a good worker; Counseling; Social Mobilization; Communication Skills; and Group Dynamics.
    • Training of TBAs and LHWs in Conducting Safe Deliveries
  • Three days training was carried out in conducting safe deliveries including antenatal and postnatal care 27 to 31 January 2002. Four TBAs, four HAs, and three LHWs participated in the training course. Madam Bilquis, Supervisor, Rural Area II of Islamabad had personally requested APPNA SEHAT to include three LHWs in the training. The resource person for the training was Miss Nighat Jabeen, Women Health Coordinator from Murree. The training contents included antenatal check-up, natal and post natal care and use of aseptic techniques during delivery. At the end of the training delivery kits were distributed among the participants.

    • D.   INTERACTIONS AND COLLABORATION WITH OTHERS

    • Immunization Activities have been handed over to APPNA SEHAT

    In a meeting held in Islamabad on 30 January with Director Health Services, Islamabad, the government officials requested APPNA SEHAT to take over all immunization activities in Golra Sharif. The request was made on the basis that EPI program had remained unfortunate to increase immunization coverage for children beyond 32% since its inception, whereas after starting immunization activities in Golra Sharif, APPNA SEHAT had almost doubled the coverage in just short period of time. APPNA SEHAT has accepted this challenge.

    It was also decided in the meeting that in the forthcoming Polio Eradication Phases APPNA SEHAT staff would manage the entire Rural Area II of Islamabad. Although it is tough job as it includes about 10,000 households however APPNA SEHAT has accepted this challenge. It was agreed to appoint Mr. Zia-ur-Rehman Supervising Health Assistant APPNA SEHAT as Zonal Supervisor of Rural Area II of Islamabad for these activities.

    APPNA SEHAT achievement in immunization has also inspired WHO officials to plan for joint meeting of NGOs working in Islamabad Capital Territory in order to involve them in immunization activities.

    • Participation in National polio Eradication Campaign

    National Polio eradication Program conducted two rounds of Polio Eradication during the period under reporting. First round was held from 6 to 8 and second from 22 to 25 January 2002. The Health Department Staff conducted training of the APPNA SEHAT field staff. A total of 250 households were allocated to each staff member. Along with the APPNA SEHAT staff, the teachers were also hired by Health Department on daily wages basis. Officials from WHO and Health Department monitored these activities. It is worth mentioning that monitoring and supervising staff highly appreciated the working of APPNA SEHAT staff. APPNA SEHAT field office in Golra Sharif was the static point for Polio eradication activities.

    • Collaboration with LHW Program
  • The Supervisor LHWs Program, Rural area II, Islamabad, visited APPNA SEHAT Golra Sharif on 12 December 2001. She observed field activities being performed by APPNA SEHAT staff. After field visit, discussions were held with Regional Director at the field office. She was inspired by the working methodologies of field staff and instructed LHWs of Golra Sharif to cooperate with APPNA SEHAT staff for provision of child spacing services on priority basis to the individuals referred by APPNA SEHAT staff. She also requested Regional Director to provide TBAs training to LHWs of Golra Sharif. Regional Director acknowledged the request and asked to send the willing candidates in forth coming TBAs training course.

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