NRSP has been engaged in promoting community-based health care interventions for the rural poor since its inception in 1991. We have always recognized the need to ensure locally-available health care services for the very poor, who cannot afford to travel to distant centres to receive care. Sometimes care is not available, as health facilities lack staff, medicines and equipment.
As always, the COs, VOs and LSOs function as ‘platforms’ for transmitting information about health care services within communities. Their members also help to identify eligible participants for projects. The social capital acquired by NRSP and the Community based Organisations over many years has been a significant factor in implementing health projects successfully.
In some areas periodic health camps provide diagnostic and curative services in remote village. These are arranged by NRSP and the LSOs. In the domain of training and awareness raising, reproductive health information for community members has been integrated into NRSP’s core programme through Social Mobilization. The COs, VOs and LSOs also contribute to activities such as Situation Analyses, baseline surveys and ‘social marketing’ for the poor. The members also identify Traditional Birth Attendants for training courses where they learn how to utilise modern and hygienic delivery practices.
We have expanded some of our long-standing health interventions in the last 5 years. One example is our pioneering work in community-based ophthalmic care, started in Chakwal in 2007 with the Munawwar Memorial Hospital. We now have links with 2 additional institutions (Shifa Eye Trust and the Layton Rahmatullah Benevolent Trust): now three hospitals are providing vision screening and subsidised cataract surgery.
Since 2004, NRSP has played a key role in community education on malaria prevention and control in areas where the disease is endemic. In Rounds 2 and 7 of the Global Fund for AIDS, TB and Malaria we distributed 496,597 Long-lasting Insecticide Treated Malaria nets. In Round 10 (June 2012 to June 2014) we are working with the Directorate of Malaria Control and Save the Children to prevent malaria in 7 Districts. The goal was to reduce malaria by 75% by 2014.
Another example of ongoing involvement is support of various kinds to provincial and District Governments. We have enhanced the skills of Government Health workers in many Districts as a means of improving community access to good health care. NRSP developed a BHU management model in Lodhran in 1999. This has now been scaled up by the Government of Punjab. That project provided the knowledge and expertise to take on other health management projects. We have recently rehabilitated a Rural Health Centre in Khoski and the 20-bed Kario Medical Centre, both in Badin. The Hospital now has a fully-equipped laboratory amongst other facilities. NRSP has since handed the Hospital over to the District Government. These facilities provided services to close to 90,000 patients while being managed by NRSP.
Quality Reproductive Health care is often not available to poor families in remote areas. NRSP’s efforts to improve this situation include awareness raising on the benefits of birth spacing (funded by the David and Lucille Packard Foundation) and upgrading the skills of Traditional Birth Attendants so they can use modern and hygienic delivery methods. NRSP has established 11 Lady Health Visitor clinics for maternal, neonatal and Child care, funded by PPAF. Each Clinic has a Lady Health Visitor and a Midwife. The clinics provide reproductive and general care. Over 126,000 women, children and men have been treated at these clinics since 2010. NRSP was also a member of the Consortium that implemented a USAID-funded ‘Diversification of Family Planning and Birth Spacing Awareness’ project in 20 Districts between June 2008 and October 2011.
NRSP has a strong platform of Community Organizations, Village Organisations and Local Support Organisations at the grass roots: these are instrumental in disseminating health messages and launching health initiatives locally. NRSP attempts to build the capacity of community members through these local community organizations to improve people’s access to and utilization of the health services available at nearby public or private health facilities.
NRSP has learnt that improving access to health services requires nurturing a large number of community volunteers responsible for educating community members in different areas such as preventing malaria and malnutrition, immunization and the different components of reproductive health and family planning. These health education activities include sessions, puppet shows, focus group discussions and interpersonal communication using flip charts and brochures.
NRSP has developed or adapted IEC materials with appealing graphics and easily understandable messages for educating members of rural and marginalized communities. The IEC material is related to the following:
NRSP had always been responsive during disasters or emergencies and has the mandate to support and rehabilitate the affected communities. NRSP has allocated funds under its disaster management policy for immediate relief activities which include relief health camps and community education for health issues and the rehabilitation of damaged health facilities. Donors have always extended their support to scale up the relief and rehabilitation activities. These initiatives were taken to support the communities in increased access to health services either through the rehabilitation of affected Government facilities and health ‘camps’.
In partnership with PPAF, we restored two Government Health Facilities in AJK to full functionality. We also received funding from the David and Lucile Packard Foundation to restore infrastructure and services in a Basic Health Unit in District Swat. The area had been devastated by militants and massive disruptions in normal life, including the destruction of health care infrastructure and the internal displacement of tens of thousands of people. The BHU was renovated and equipment and medicines were provided. A Lady Health Visitor was hired to provide services. There was a tremendous demand for OPD and RH services for women and children: over 36,000 patients, nearly 20,000 of them women, came for Outpatient care and over 10,000 children were vaccinated. NRSP has now handed over the facility to the People’s Primary Healthcare Initiative.
We established a successful Centre for replacing limbs after the 2005 earthquake, with expertise provided by a UK-based Pakistani orthopaedic Surgeon. The Centre, now located in Sihala (Islamabad) serves patients from all over Pakistan and AJK.
Acute malnutrition is a spectre facing many people in the wake of the floods of 2010 and 2011. We have responded by implementing two large scale projects: one by the Health and Nutrition Sector and the other under the umbrella of Social Protection. The health sector Community-based Management of Acute Malnutrition project has been implemented in two Provinces: in KPK in Districts Swat, Swabi and Mardan until August 2010 and in southern Punjab from Nov 2010 until 2012. In Swat over 51,000 children under 5 and over 20,000 pregnant or lactating women were screened and over 6,500 children and 3,500 women were enrolled in a supplementary feeding programme.
NRSP’s health interventions have taken many forms, ranging from small pilot projects to large and complex interventions covering multiple Districts. NRSP has a strategy which includes:
The following thematic areas are included in NRSP’s health interventions: