Geographical Context

The health sector situation in KP and FATA is worse like other least developed regions of the country. Health problem is owed to several factors but due to lack of resources and perhaps the political will they remained unaddressed. The KP government spends more than double as much on security and law enforcement as on health services. The public health health1facilities and quality of health services under the administration of department of health in FATA and in most districts of Khyber Pakhtunkhwa are inadequate and poor, mainly due to the lack of substantial medical resources, unawareness of communities and high population growth rate. The basic health facilities in rural areas are partially functioning, that hinders in meeting the health needs on time and with quality services.

A significant number of deaths in FATA/KP are attributable to communicable (contagious) diseases, which are in turn linked to social and environmental factors such as unsafe drinking water, malnutrition, over-crowding, low vaccine coverage, poverty, and high illiteracy rate that are also frequently encountered in other parts of the country. The lack of trained female staff in primary health care facilities is also responsible for reduced and limited women’s access to health care. In KP province, majority of population (63%) experiences problems in accessing or using healthcare services. The lack of access to quality health services is one of the factors contributing to the high mortality rates for infants and children under five and mothers. There is still a great deal of work remaining in universal immunization, addressing severe malnutrition, disease prevention, health promotion, and curative and rehabilitative services. Morbidity and mortality from diarrheal diseases and acute respiratory infections remain at a very high level among children.

Health Program-An Introduction

The strategic goal of CMDO’s health Program is to work on Improving/Enhancing the health status of the marginalized communities and reducing the infant mortality (IMR), Under Five, and Maternal Mortality Rate (MMR) and morbidity rate in KP and FATA. CMDO’s health interventions being implemented in districts health programePeshawar, Mansehra, Lakki Marwat, Nowshera, Charsadda, Tank, DI Khan and Bannu (KP), and in Kuram, Bajaur, Orakzai, Khyber, Mohmand and North Waziristan Agencies (FATA). Under CMDO’s health program, the interventions include the improving primary/ basic and mother/child health services through life cycle approach at both the facility and community levels.

It also include improving basic health services, mother and child health, imparting awareness and education on health, hygiene and nutrition, control of communicable diseases, provision of vaccination to avoid disability, providing reproductive health services at different levels, capacity-building of health staff etc. The capacity building of health staff for strengthening their service delivery proved helpful in the provision of basic health services and addressing the health needs particularly of the poorer and marginalized segments of society.

Health Program Interventions

Primary Health Care Services

CMDO established six well equipped and appropriately staffed Community Health Centers meant to provide mother child health services are serving the community in Khyber Agency. A well organized and coordinated level Primary Health Care Servicesof activities in the form of a network between the staff of static MCH service providers, outreach health workers, and community based workers also made a range of MCH services available and accessible to communities at their doorsteps. This work has generated positive feedback from the community. The health static and outreach teams successfully treated more than 78,570 patients; provide treatment to 32,326 children including 18,430 under-five years of age and 2,230 laboratory tests conducted whereas 1,064 vaccines provided.

CMDO Health Network

CMDO established a network of TBAs and LHWs, CHWs, both female and male, in 463 villages in district Peshawar, Mansehra, Lakki Marwat and Bannu (KP), and in Kuram, Bajaur, Orakzai, Khyber, Mohmand and North Waziristan Agencies (FATA). This network is working to improve the overall health status of children, especially those <5 through increase in awareness and knowledge at the household level, as well as that of the health service providers, teachers, community members. CMDO’s heath network is serving approximately 450,000 populations. CMDO enhanced and strengthened immunization program and has conducted 64 events in the communities of KP and FATA. It conducted 679 child health days and conducted 1,368 child health care workshops on newborn and child health. To further support the Child health days 595 mobilization/sensitization sessions have been conducted. It has also arranged school based activities, including teacher sensitization on the child health related issues and the distribution of IEC materials in schools. For imparting awareness sessions for improved child/mother health care 463 health committees were formed. Similarly CMDO health network has conducted 1,381 awareness and sensitization related events. CMDO also launched family planning campaign in those areas. About a wide range of issues in mother and child health including immunization, Acute respiratory Infection (ARI), Control of Diarrhoeal Diseases (CDD), Essential Newborn Care (ENC), Nutrition and Micronutrients. The network of workers has been providing preventive and curative services. The TBAs are providing door step services by visiting pregnant women, infants, and under five children. They undertake routine checkups, imparting health hygiene education, either actually provide vaccination/TT shots or referral to facilities, and referral of the pregnant women for consulting qualified doctors in case of any symptoms of any expected   complication in delivery. [/av_toggle] [av_toggle title='Support to the Nutritional Development of Children' tags=''] A detailed assessment of the health status of young children in FATA and a community child health strategy was developed in partnership with stakeholders. Trainings were imparted to health professionals and workers for an Support to the Nutritional Development of Childrenincreased capacity to conduct a nutritional assessment of young children; support breastfeeding and good feeding practices; and impart child health education in local communities. Besides this they were also capacitated to monitor the growth and development of young children; manage common childhood diseases; identify and refer young children with serious health problems; support young children with physical and learning disabilities, and their careers.

Infrastructural and Operational Development of BHUs

11 Basic Health Units were rehabilitated in district Bannu and Lakki Marwat through medicines, medical and office equipments, furniture, rehabilitation of building, water supply (pressure pumps), and electrification. Doctors, Lady Health Workers were made available to provide services.

Infrastructural and Operational Development

2.3.5    Enhancing and Strengthening of Immunization

CMDO together with its health network and local communities identified and registered children for vaccination and extended immunization services in non LHW covered areas in targeted areas of KP and FATA. It registered 4,240 numbers of children, who were issued vaccination cards for immunization. Pregnant women are also identified for TT shots along with the registration of children

Child Health Days

Aimed at the improvement of the health of children, CMDO conducted 679 child health days in KP and FATA primarily to strengthen immunization through the public health system. The activity involved the provision of medicines and vaccines on a designated day to stimulate the people’s confidence in the system. This stimulation is intended to stimulate the system’s response to an increased public demand for services. To support the Child health days 595 mobilization/sensitization sessions have been conducted to attract people to the BHUs on the designated child heath day. This activity benefited 78,570 of population.

Awareness Sessions for Improved Child Health Care

CMDO, besides conducting child health days, numerous sessions on “Improved Child Care” successfully carried in KP and FATA. It also includes orientation of the communities on control of CDD (Control of Diarrheal Diseases), ARI (Acute Respiratory Infection), Warm infestation, Malnutrition and EPI (Extended program for Immunization). For imparting awareness sessions for improved child/mother health care 463 health committees were formed. Similarly CMDO health network has conducted 1,381 awareness and sensitization related events.

Family Planning

When a widening disparity between the needs and resources arises, controlling population through numerous family planning means becomes inevitably crucial. In wake of current recessionary trends and food shortage demands to control the overstretched growth of population. CMDO therefore launched family planning campaign in its operational areas. It was more on awareness on family planning. Unfortunately, the religious leaders have made this issue controversial based on Islamic injunctions.

Health/Hygiene/Sanitation Education

CMDO provided health education on a wide range of health issues such as personal and environmental hygiene, nutrition, vitamins supplementations, and breast feeding etc to the target populations in KP and FATA. CMDO HealthEducationtrained 1,040 teachers, both male and female, to conduct hygiene and sanitation promotion activities in the schools. 6,200 children were thus sensitized on safe hygiene and sanitation practices are expected to disseminate the messages to siblings, peers, and their family and household. This initiative aimed to reduce diarrhea through promoting safe hygiene and sanitation practices, most particularly the habit of hand washing.

Capacity Building of Local Health Institutions

CMDO conducted trainings to the primary health care staff in improving children nutritional status in KP and FATA. Essential capacity building trainings were imparted to more than 400 Primary Health Care Staff of government health facilities and more than 10,000 community members on best nutritional practices, preventive measures for communicable diseases and hygiene education have been given awareness. Similarly, CMDO conducted 10 trainings for the Staff of line departments and local government institutions that included PHED, TMAs (Tehsil Municipal Administration), and tube well operators. These trainings aim at strengthening of the staff capacity in areas as diverse as operation and maintenance of filtration units, planning, finance and monitoring, water sampling, testing and disinfecting, sanitary inspection, participatory planning and monitoring skills, LMST/CMST, and public-private partnership. The overriding purpose of the intervention was the sustainable operations of water supply schemes and filtration plants installed by the Ministry of Environment, Government of Pakistan under its Clean Drinking Water for All (CDWI) initiative.

Formation of Health Committees and Utilization of BHUs and RHCs

CMDO formed 463 village health committees in KP and FATA and trained them to further imparting awareness sessions on improved child/mother health at community level. It conducted 1,381 awareness and health related sensitization that included a wide range of issues in mother and child health including immunization, Acute respiratory Infection (ARI), Control of Diarrhoeal Diseases (CDD), Essential Newborn Care (ENC), Nutrition and Micronutrients. These committees also worked for the enhancements of the vaccination, medications and Polio Drops. The Health Committees were holding meeting with the community elders and male members at the village level in order to advocate and lobby for the use of the BHUs and RHCs by sending their children and women in case of any health issues. One of the purposes of village committees was to bridge-up the gap between the service providers and health facility. They would jointly identified lack of facilities in the concerned RHC/BHU.

Strengthening of Existing Health Facilities

CMDO strengthened and capacitated 07 Tertiary Health Institutions in the Agency Head Quarter Hospitals of all FATA by providing them with essential medical equipments and supplies. The equipments were for the treatment of children and women.


Advocacy for the Promotion of Vaccination

The importance that drive for delivering vaccination to the children less than five years of age can help eradicate life-threatening diseases cannot be denied. Due to the poor level of availability of health infrastructure and services the infant health of the native children can always be at stake. More importantly the active perception present in FATA is against the vaccination campaign. They generally relate vaccination delivery as contrary to the religion. Similarly, they regard this to be probably a hidden agenda of someone else. So on the whole there exist a negative perception of the people regarding vaccination. One the one hand their general behavior is not positive on the other it is a necessity for the health of the children to enable them to be a healthy future and asset of the country. CMDO had undertaking an advocacy program aiming at convincing and moulding the opinion of the decision making members in the family setup as well as schools teachers, Mullahs (Spiritual leaders) and community leaders at village level for enhancing the mass level vaccination of children under five years of age and TT shots to the pregnant women. Second, its purpose was also to stimulate the community to create the demand, built the trust and, more importantly, revitalize the medical services of Basic Health Units (BHUs) and Rural Health Centres (RHCs). Regarding this level of intervention, CMDO has conducted a number of 110 advocacy events in KP and FATA. This advocacy program actually aims at an effort to sensitize the population, create local realization and general community mobilization to assert the right of health services.

CMDO’s Future Health Program

One fundamental strategic objective of CMDO’s health program is to bring improvements in the health of poor people through increased access to affordable and adequate basic public health services. CMDO during the next 5-year would keep working on replicating its previous experiences in the health sector such as providing health services related to child-mother health care, child immunization, family planning, medical camps/mobile units, lady health workers trainings and awareness raising on preventive health measures in relation to the water borne and other infectious diseases. CMDO in coordination with its grass root network and local health institutions should design and undertake awareness raising advocacy campaigns on public health measures on regular basis. The local human resources in the intervened communities should also be given first aid life saving trainings.

CMDO in coordination with concerned district/agency level health departments and its grass root community networks would keep working on upgrading basic health units and public hospitals in the intervened areas in terms of equipping health units with infrastructure/equipments, arrangements for specialist doctors regular visits, and capacity building trainings of basic health unit staff. CMDO in next five years should also plan projects regarding the construction and establishment of small to medium scale health units and hospitals in least developed regions in FATA/KP.