Inclusion of MISP for the protection of maternal women and new born in Disasters and Emergencies .

Rahnuma Family Planning Association of Pakistan (FPAP) in collaboration with Research and Advocacy Fund Pakistan launched a one year advocacy project under the title “Ensuring SH&RH Component in The SOPS of National Disaster Management Plans and Provincial Disaster Management Plans” through the inclusion of MISP (minimum initial services package) for maternal mothers and new born in plans of National Disaster Management Authority and all provincial disaster management authorities including AJK, Gilgat Baltistan and FATA. Rhanuma-FPAP advocacy section undertook a dedicated advocacy and lobbying campaign with all stakeholders including provincial DMAs, Health, and Social Welfare Departments, Media, other disaster mitigations institutions, INGOs, UN system organizations, CSOs, media, academia, Research Institutions etc.


Past experience in recent emergencies in Pakistan has been that relief and rescue efforts were prompt but un-coordinated and unplanned. The overall coordinating agency is the National Disaster Management Authority which liaises with international agencies as well as with several government departments like health, food, transport, local administration etc. The army too played a major role with its own institutional medical and logistical back up. The focus was to rescue people and provide shelter and food in the immediate phase. However the needs of vulnerable groups like women, children, the elderly or disabled were not addressed as these have not been anticipated, planned for or indeed considered any sort of priority. SH&RH needs continue and even increase during crises. In the floods of 2010, according to UNFPA statistics, of the 17.5 million people affected, 70% were women and children. 1.5 million Women were in the reproductive age group and approximately 52000 were going to give birth in the next few months. However SH&RH services which are inadequate even in normal times became severely strained during the crisis resulting in the suffering of women and children.


Overall we were successful in achieving stipulated policy change in NDMPs and PDMPs by incorporating MISP in their SOPs. All provincial governments including AJK and Gilgat Baltistan (GB) and FATA have notified inclusion of MISP in their disaster Management Plans to better protect mother and new born in disaster & emergencies as Women become much more vulnerable during disasters or emergencies. Rahnuma-FPAP advocacy team provided technical expertise to facilitate the revision in policy which include drafting of the SOPs and embedded them with the mainstream disaster response strategy.


Afghan Refugees 2002:
After the Soviet invasion of Afghanistan, two million Afghan flooded to Pakistan. Two decades later, the Afghans left in dusty and sprawling camps were joined by new refugees fleeing their beleaguered country following the US bombing. Aiming to mitigate the suffering of shelter less people especially women and children initially in camps at Kohat, Peshawar, Quetta, and Haripur (funded by IPPF, BMZ, DL&PF and EOJ) FPAP started providing general and reproductive health services to Afghan refugees in 2002. FPAP interventions benefitted more than 100,000 people when the project was snapped in 2003 with Afghan’s repatriation.  Twenty seven FHCs were set up in various camps of the NWFP (now KPK) and Baluchistan. Five camps in Peshawar were covered through mobile camps. Post abortion counseling was provided to 52,000 women. Children and women were immunized against tentnus toxoid and other diseases. Capacity of 600 TBAs were developed to conduct aseptic and safe delivery. The service included ante natal and post natal, infertility counseling, STIs/HIV/AIDS, Lactation and menstruation counseling, clean water supply. 41 non formal schools were established for education of children on the syllabus approved by UNCHR. Skill training of women on surf making, embroidery, stitching and sewing, preserving food, jams and jelly and pickle and juice making was also held.


Victims of AJK/ NWFP Earthquake 2005


Rahnuma-FPAP First Initiative (IPPF)  
Rahnuma-FPAP provided emergency services for victims of earthquake that hit the AJK in 2005. Service provision continued up to March 31, 2006.  Two mobile Units, one static clinic, one medical camp in village tent and one collaborating hospital provided emergency services through this project in AJK and NEFP. Mobile Units in AJK and NWFP covered more than 56 locations and provided comprehensive services for general treatment, RH and lifespan services to 10288 victims of earthquake. Static clinic at Muzaffarabad offered services of FP, RH and general health to 1165 clients. Medical camps established in collaboration with Turkish Red Crescent Society at tent village of H-11 in Islamabad offered comprehensive services of general treatment. FP and RH to 7848 clients. Project also established the linkages with UNFPA for provision of safe delivery kits to TBAs. Mobile teams distributed the 135 kits to trained TBAs already conducting the safe deliveries at grassroots level and oriented them regarding infection prevention during deliveries. In collaboration with UNICEF 293 women and 267 children were vaccinated for DPT, TT, Polio and measles etc. through medical camp in Tent Village. Project also entered in collaboration with AMAR International NGO and Provided one LHV, one female attendant and one RH Counselor for its static clinic AIMS. Rahnuma-FPAP also deputed a male and female doctor for AIMS who provided RH and lifespan services to 3595 clients. They also helped in 202 safe deliveries and 109 pregnancy tests. Project also focused on provision of contraceptives and enrolled 763 new clients during the reporting period


Rahnuma-FPAP Second Initiative (JOICFP)
JOICFP funded project was implemented in AJK and NWFP from April 2006 to October 31, 2006 to provide emergency maternal and child health services for victims of earthquake. Its duration was six months. Two FHCs established in AJK provided MCH services to women and infants in collaboration with other NGOs. These FHCs were assisted by one mobile unit for outreach services. This mobile unit covered NWFP as well and made 64 visits at 42 locations in Manshera and Batgram. The MSU provided emergency mother and child health treatment services to 5990 women and health treatment services to 5990 women and children. Project also focused on provision of FP services, enrolled 2407 clients new to FP and achieved 2046 CYP during the project life. Motivational meetings with community members were held regularly, as a result 5780 people were provided information about importance of FP, breast cancer, hazards of unsafe abortion, infertility, reproductive health and human rights. Motivational meetings with community proved helpful for integration of FP & SH&RH services with emergency child and mother health activities of the project. During the project period some funds remained unutilized and JOICFP allowed the no cost extension of the project for another one year in which the KATO Center AJK was supported to provide health and skill development services to earthquake affectees in Muzaffarabad. A compound wall of KATO Women Center AJK was constructed and electric wiring in rooms of Kato Center was completed. Landscaping of the premises of the Kato Complex outside the building and within the boundary was also undertaken to create parking space for vehicles as well as improve the outlook of the complex.


There is an FHC in KATO Women Centre AJK, which provides FP/SH&RH. For provision of safe deliveries and MCH services to earthquake affected population one incubator and one oven was purchased.


Victims of Rain and Floods 2007


Rahnuma First Initiative (Care International)

In the beginning of July 2007, cyclone/floods/torrential rains caused damage to lives of poor people living in Sindh (costal areas of Badin, Shahdad Kot and Wara) and in Balochistan (in Turbat and Ketch). People in these areas become homeless and there was an outbreak of water born disease due to prevailing unhygienic conditions caused by flood/rains. In Sindh particularly in costal areas of Badin flood caused the death of more than 110 persons while 50,000 people became homeless in Balochistan more than 800,000 people were either rendered homeless or severely affected by the cyclone. Most affected districts in Balochistan were Turbat and Jafferabad.


Responding to immediate needs of victims of flood/rains in Sindh and Balochistan, Rahnuma-FPAP implemented a short project with technical and financial assistance from Care International.


Project provided 293 poor and homeless families with tents as shelter to save them from harsh of weather. Non food items like hygiene kits, mosquito kits, soaps, aqua tablets and kitchen sets were distributed among 967 deserving poor families to save them from further suffering. Health and hygiene sessions were conducted with women, men and adolescents girls. Adopting the participatory approaches, locations in immediate and dire need of health services were identified locations 510 free medical camps were organized, through proper assessment and in consultation with Department of Health, local NGOs, community representatives and local volunteers, and 49742 persons were provided with emergency primary health and RH Services.


Rahnuma-FPAP Second Initiative (IPPF)

During the project life 87 mobile medical camps were conducted at locations identified in consultation with Department of Population Welfare Department. LHWs, TBAs, school teachers, religious leader and volunteers were involved in publicity of mobile camps at identified locations. Counseling services regarding FP, SH&RH and nutrition were provided to 4430 women. 846 women received safe motherhood services while 702 men and 1923 children (1088 girls and 835 boys) received general health services and treatment for water borne diseases.


Rahnuma-FPAP  Third Initiative (Care International)
With support from Care International Rahnuma-FPAP implemented another project in the flood affected areas from July 2007 to February 2008. Under this project, Rahnuma-FPAP provided comprehensive relief and health services to the effected. 90 poor and homeless families were provided with tents as shelter to save them from unfavorable weather. Non-food items like hygiene kits, mosquito kits, soaps, aqua tablets and kitchen sets were distributed among 315 poor deserving families. 20 sessions on Health and hygiene were conducted with (1500) women, men and adolescents girls. The sessions focused on awareness creation among affected population on cleanliness, hygienic food, water, use of aqua tablets for purification of water and personal hygiene. 100 free medical camps were organized with the help of local NGOs and 7500 persons were provided with emergency primary health and RH services.  


Rahnuma-FPAP Fourth Initiative (Care International)
Project was implemented from February 2008 to December 2008. During the implementation of Flood relief project Rahnuma-FPAP team found that a large number of families were badly affected in 3 UCs namely Ahmed Rajo, Khadan and Bugra Memon of district Badin. These families were unable to build their houses due to resource constraint. The women, children and elder persons were exposed to harsh weather of winter and did not have proper winter materials to save themselves from cold. 850 of deserving households were identified through assessment, which was carried out in the first two weeks of the project by using the prescribed assessment format provided by the Care International. To ensure proper and timely implementation of the project a warehouse was hired nearest to the affected area and three distribution points were also established one in each UC. The winterization package comprising 2 Jerry cans, 2 plastic buckets of 20ltrs capacity, 1 family hygiene kit, 1 disposable delivery kit, 2 mosquito nets, 4 pairs of children socks, 3 children woolen caps, 1 shawl for woman, 1 shawl for man and 1 plastic sheet (D/P 4x5 m for shelter), were distributed to 850 households. Rahnuma-FPAP ensured the involvement of local volunteers and community leaders during the assessment and distribution of package. Rahnuma-FPAP Project Manager and Care International Officials closely monitored the activity.


Rain and Floods 2010
Pakistan was grappling with the swelling issues of political instability, terrorism, target killings, and deteriorating economy that the flash flood and heavy rains hit the land in an unprecedented manner in August, 2010 affecting one-fifth of the country, and engulfed large parts of all four provinces—Punjab, Baluchistan, Sindh and Khyber-Pakhtunkhwa.


The vast scope of the damage makes the floods a truly national disaster which affected more than 20.18 million populations in 78 districts of all the four provinces of Pakistan, damaging more than 1.74 million households and destroying more than 2.24 million hectares of crops, leaving 1985 people dead and 2946 injured. Economic reflection of this huge scale loss has been estimated around 40 billion dollars.


Rahnuma-FPAP First Initiative (MISP-IPPF)

With IPPF support Rahnuma-FPAP implemented the MISP in District Muzaffargarh of Punjab and Nowshera, KPK Province of Pakistan.  The MISP is a minimum standard in the 2004 Sphere guidelines and in the 2009 IASC Global Health Cluster Guidance as well as a CERF minimum life-saving criterion eligible for CERF funding. 20, 512 women were provided with ante natal, post natal, family planning, counseling, general health and STIs services including deliveries and referral. 7091 cases of skin infection, malaria, diarrhea and RTIs were treated. Medicines were provided to 8648 persons and 2014 delivery kits, TBA kits, baby kits, mini kits and hygiene kits were provided.  


Rahnuma-FPAP Second Initiative (IPPF)
THE project was implemented in the two districts of KPK; Charsadha and Nowshera. During the period from October 2010 to 14 January 2011. 166 camps were arranged in flood affected areas in District Charsadda & Peshawar. 22196 women were provided with ante natal, post natal, infertility, menopause, breast examination, RTIs, STIs, ARIs services including skin and eye infection, malaria and diarrhea treatment. 16123 condoms, 201 ECP, 758 Oral Pills, 719 injections and 74 IUDs were also distributed. 162 delivery kits were also provided. 667 referrals were made.


Rahnuma-FPAP Third Initiative (Care International)
The main focus was the medical camps. Project staff and local volunteers held meetings with communities and made announcement through loud speakers in the mosque for the medical camp one day earlier the camp was held. Due to the effected coordination between the project staff, health Department, local volunteers and the local communities 305 camps were conducted. The total 38,589 beneficiaries availed the services. To educate the people on Health & Hygiene 178 session were organized for the affected communities. These 178 health & Hygiene sessions were attended by the 4,855 people.  These sessions were jointly organized for men, women and children. Questions and quires of the people were addressed by project staff


Rahnuma-FPAP Fourth Initiative (PPAF):
Some medical camps were conducted in the floods hit areas with support from Pakistan Poverty Alleviation Fund which is currently supporting the functioning of some 50 clinics.


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