Empowerment of Adolescents:

Rahnuma’s youth program aims to empower youth by building their capacities and skills to access SH&RHR information and services. Youth involvement is as old as the organization itself but project specific interventions came in 1972. The overall purpose of the program is to enable them to make informed choices and decisions regarding their SH&RH and act upon them. Peer education and life skill based education programs are integral part of the youth initiative. The main features include:

 

Girl Child Project:

Empowerment of girl children was one of the major thematic areas of Girl Child Project implemented during 1991-2006 with support from UNICEF. The project’s main purpose was to build the capacity of girl children through skill development training, life skill based education, first aid training, home school training, leadership development and awareness on RH and Rights. During awareness raising activities on RH and Rights the girl children were also exposed to information and practices of various forms of domestic abuse and violence in order for enabling them to protect themselves is case such situations arise. The project started on 10 locations in the beginning but expanded to 730 locations all over the country by 2004. 36,500 Girl Children and 6,900 Boys were the direct beneficiaries of this project whereas 217,000 members of families and peers were accessed indirectly through this project. In the last phase of the program young boys were also included in the program on the demand of the communities. Girls are now the focus of core interventions.

 

Youth Help Lines:

In 2001, 6 youth help lines were established in Lahore, Karachi, Quetta, Peshawar, Islamabad and Gilgit. These Help Lines are adequately equipped to provide counselling to male and female youth on SH&RHR related matters, HIV/AIDS and domestic abuse and violence in a confidential manner. These help lines are being run by professional psychologists and data is recorded on daily basis with respect to the nature of issues taken up with the psychologists and solutions offered or referral made. The Youth Helpline (0800-44488) is being operated through male & female counsellors. The online counselling and referral services are provided from are 9:00am to 5:00pm. During 2010 12690 (M= 11783. F=1907) online calls were responded and 9000 (M=6173, F=2827) face to face counselling carried out.

 

Youth Resource Centres:  
Rahnuma-FPAP is operating 36 Male and 16 Female Youth Resource Centres to provide boys and girl children an opportunity to express themselves independent of their elders and involve themselves in activities ranging from recreation to learning. These centres are run by the youth themselves with community support and are equipped with computers, books etc. It also provides boys and girls a platform to organize events such as debating competitions and celebrate international days and also to discuss SH&RHR and community issues. They study the newspapers together and discuss issues of common interest.   

 

National Youth Network:

As per the constitution of IPPF 20% representation of youth is must in governing bodies of the organization at all levels. This has been achieved. On top of that, national youth network has been established for incorporating youth perspective in the programs. Members of the national youth network are democratically elected. Hence, organization is not only interested in knowing the needs of the youth and making arrangements to cater for their needs but also in the leadership development amongst youth so that they could plan and implement youth focused programs. Constitution of NYN is in place which guides its functioning.

 

Strengthening and Developing Partnerships:
In order to provide a conducive environment for the youth focal persons and youth volunteers to advocate for youth SH&RH rights, needs and services, linkages with the movers and shakers of society were developed and strengthened. These include government ministries such as Ministry of Youth Affairs, Ministry of Education (Secretary), Directorate of Human Rights, Packard Grantee-Punjab PWD Partnership, Population Welfare Department, and many others. Similarly, partnerships with international donors such as UNFPA, UNIFEM, ILO, WPF, WHO, Aus-AID, and INGOs such as Plan International, Care International were strengthened through collaborative programs and interventions. Further, networking with like-minded civil society actors such as NGOs namely Shirkat Gah, Sahil, White Ribbon, HomeNet Pakistan and media were also strengthened through collaborative efforts. Rahnuma-FPAP is part of and actively participating in the National Clusters coordinated by the UN on Child Protection and Gender Based Violence.

 

Youth Friendly Services and LSBE:

In order to make the services youth friendly, special emphasis has been placed in choosing the location of the waiting area that has a separate entry and exit point from the hospital. The waiting area is also equipped with TV&DVD to show documentaries/videos on youth SH&RHR issues. Magazines/ journals, newsletters are also made available for youth. Attractive sign boards about the SH&RH services are placed at the facility to guide the young people to the services. Male and female doctors and youth counselors are available to provide comprehensive SH&RH services. The young people also have access to the voluntary counseling and testing (VCT)  center, HIV /AIDS/STI , post abortion care related services and laboratory services provided at the hospital for both married and unmarried youth. Based on past reflections and lessons, Rahnuma-FPAP has shifted timings of the services for young people to evenings, engaged more actively with young people, increased its outreach to young people through mobile camps in the communities and schools/colleges etc. Services provided through the mobile camps include, primary health care screening, counseling and treatment; Individual counseling sessions on SH&RH & HIV; treatment and/or referral in case of STI complications or VCT requests; emergency contraception, referral to its own hospitals.
Rahuma-FPAP has built the capacity of its FHHs and FHCs and service providers to provide youth friendly services to youth. Similarly, Rahnuma-FPAP took the initiative for Life Skilled Based Education and advocating with relevant ministries to bring it in the curriculum of schools.  
Rahnuma-FPAP is operational areas includes 5 Regional Offices (Lahore, Karachi, Islamabad/Rawalpindi, Quetta and Peshawar) and 8 Program Management Offices (Badin, Faisalabad, Chakwal, Turbat, Azad Jaummu and Kashmir, Gilgit Baltistan, Kohat and Haripur) which helps to reduce the geographical barriers to access of SH&RHR/FP services.

 

At present Rahnuma-FPAP is covering an area of 77910 sq. km. and population of 12,569,000 in areas of its operations.
All the above interventions contribute to the reduction in barriers to access and enhance the acceptability and affordability of services to youth.

 

Reaching out to Displaced Populations:

Rahnuma-FPAP has been always cognizant of the needs of displaced populations whether they are flooding in as a result of conflict outside or leaving their homes and temporarily settling at places inside due to natural disasters and local conflicts.  
Sensitization of stakeholders on GBV

 

With the support of UNFPA in 2006, 5 district level and 3 provincial level workshops were held in which 371 representatives from the civil society, government, law enforcement agencies, media, UNFPA and Rahnuma-FPAP participated. As a result of this series of workshops organizational capacity of Rahnuma-FPAP, UNFPA as well as other stakeholders has been built for advocacy on gender based violence, some appropriate sensitization and advocacy material has been developed, public awareness on gender mainstreaming has increased, there is also increased involvement of media to promote gender mainstreaming and women rights and improved sensitization of service providers, policy and opinion makers on the issue has been achieved. The workshops received media coverage in local newspapers, television and radio. Overall the response from the participants was very encouraging with special emphasis on continuation of this initiative. Focal persons from each representing organizations were identified and in 2007 a national alliance e on Gender related issues was initiated. Also in 2007, 26 staff members received extensive 3-day training on Gender Sensitive Planning and Communication.
With these interventions, women are not only able to participate in electoral process but also well aware of their RH rights and economically empowered to take decisions on their own.

 

Addressing violence amongst Jail inmates:
In 2007 Rahnuma-FPAP decided to participate in the 16 Days of Activism against Gender Violence; an international campaign by reaching out to the marginalized women in Lahore Jail. It is important to note that those who witness or experience domestic violence themselves are often found inflicting it. The intervention was aimed to have a catalytic effect and generate discourse on gender based violence. Looking at the initiatives on domestic violence, most of them deal with the outcomes of the violent relationships such as setting up shelters, crisis centres, counselling centres and legal aid centres. The purpose of the intervention is to make a direct contribution to the prevention of domestic violence.
The project aimed at tackling domestic violence by promoting the respect of human rights, sensitizing the women inmates and management at the Lahore Jail and the public at large to advocate for change and challenge the acceptance of violence and empowering victims of domestic violence through information sharing.

 

Through this intervention 28 male and 9 female of Jail staff and 180 women inmates were sensitized and made aware on Human Rights, SH&RH Rights and Violence against Women. Counselling services were provided to 65 women, medical services to 82 women and legal advice to 124 women.
The project design has a built-in system of multiplication and replication. The staff and peer educators trained, as trainers will build the capacities of other colleagues and inmates in the field of violence against women. The Peer Educators trained from within the target group will continue the process of sensitization after the intervention. The organization will continue to plan and implement interventions with the target audience in order to support the process of women empowerment and linkage development with service provider e.g. Life Skill Based Education, Skill Development Trainings, Face to Face Counselling etc.

 

Gender Based Violence in the forming of Burning:
Rahnuma-FPAP has implemented two projects specifically aiming at the reduction of incidence of domestic violence against women (burning) with financial support from European Commission in 2006 and 2007. The main purpose was the capacity building of doctors, police officers, judges, lawyers, local representatives, religious leaders and media for the effective enforcement of Cr.PC 174-A a new law enacted to punish the culprits of violence against women (burning). In the first phase, the project was implemented in Islamabad Region but in the second phase same activities and methodology was replicated at other locations of Islamabad, Peshawar and AJK (Jhelum, Chakwal, Attock, Haripur and Kotli).
The Family Health Hospital in Islamabad has established a Burns Unit wherein the doctors are now trained to perform reconstructive surgery themselves. The organization has also recently implemented Operation Smile Project, in collaboration within Medicine Du Monde, in five districts with the objective to provide reconstructive surgery for Acid and Stove burn victims. The hospital has also recently entered into collaboration with Smile Again Foundation that helps burn victims through plastic surgery and counselling. The organization has vast experience in research and capacity building. With a focus on rural communities, the organization has its strength in social mobilization. Rahnuma-FPAP has worked with marginalized communities including Jail inmates.  

 

Economic Empowerment of women through micro-credit services:
Rahnuma-FPAP initiated the Poverty Alleviation Program in 1999 on the felt need of the communities. The overall goal of the program is to economically empower women and adolescents through an integrated multi-sectoral intervention.  The program adopted a two pronged approach: Micro Finance Unit in Badin where both the social mobilization and financial service package is provided by the organization and the sector’s first ever NGO-Bank collaboration model with Rahnuma-FPAP role being identified as social mobilizer and Khushhali Bank as the Banker. The project beneficiaries are women (90%) and men (10%) below the poverty line. At present the program is being implemented in 14 locations across Pakistan and has benefited over 30,000 women and men. Poverty alleviation program has a multidimensional affect on the status of women in families and even in communities. The beneficiary surveys and other in-house assessments have shown that the Rahnuma-FPAP’s Poverty Alleviation Program has had a definite positive impact on women empowerment and women & child health care, which holds true for all ages and education groups. Below is the summarized version of the beneficiary survey report;

 

A.    Poverty Alleviation Program contributed towards empowerment of the women beneficiaries through:
•    Increase in self generated income
•    Improved role in house hold decision-making
•    Increased financial independence
•    Reduced dependency on husbands
•    Improved self-confidence
•    Increased mobility without male consent
•    Improved access to health care facilities
•    Improved knowledge of SH&RH&R and family planning
•    Increased use of contraceptives
•    Increased knowledge of HIV/AIDS
•    
B.    The poverty alleviation program also contributed reasonably towards improved child health care especially in terms of immunization.

C.    The program has to some extent helped in improving the access to information and services for health care to women especially in antenatal care and maternal health care.

 

Partnerships with Private Practitioners:
Rahnuma-FPAP involved private practitioners in family planning program in 1972. Private practitioners are qualified medical professionals who enjoy the respect and trust of the community. They are commercial service providers and have their own clinical facilities.  A good number of them have surgical theaters and as such they have the capacity to provide full range of family planning services. In 2010, they contributed 46% to the total CYP achievement of FPAP (501298) and the project was the most economical of all. The project is ongoing.

 

Partnership with NGOs:
Rahnuma-FPAP started this innovative project in 1969 by involving other NGOs and integrating family planning component in the services being offered by them. The purpose was to utilize their infrastructure and trained staff, good reputation, and other resources in a participatory manner. Currently, Rahnuma-FPAP is partnering with 43 NGOs, out of which 25 are being funded by IPPF and 18 are self sustained. In 2010, NGOs enrolled 29205 new acceptors,  and achieved 60089 CYP, contribution to overall CYP being 12%, and provided defined range of 220289 SH&RH services including counseling, Safe motherhood, Reproductive health, general health and diagnostics services. The project is ongoing.

 

Quality of Care Project:
Quality of Care approach is as old as the FHHs (1958) and FHCs (1969). The recruitment of Quality Assurance Doctors started in 1998. However, full fledge project on Quality of Care was launched in 2002 and since then this project is the part of Rahnuma-FPAP Annual Program and Budgets (APBs). The main activities include medical audits, exit interviews, mystery clients and focus group discussion (FDGs). COPE exercises are also carried out to see to what extent the services are client oriented and provider efficient. From 2010, Rahnuma-FPAP is reporting to IPPF on the indicators designed for quality of care in SH&RH services for the purpose to evaluate performance in this area and for allocation of funds for the next year. Under this system quality of care has been defined under six heads/questions having multidimensional approach to quality of services. In view of these parameters Rahnuma-FPAP is making necessary changes in the service delivery system.  

 

Public Partnerships:

 

Partnership with Armed Forces of Pakistan (DL&PF):
Collaboration with Army was one of the most important initiatives taken by FPAP. The project was initiated in 2000 and continued up to 2002. Based on the success of the first phase the project was further extended for another five years up to 2007, moving in 2008.  This male involvement intervention brings about attitudinal and behavioral change among the men with regard to their tradition perception of family planning, women and girl children. The significant intervention in the extended phase was the inclusion of Pakistan Air Force. The project was implemented at 23 Garrisons of the Pakistan Army and 10 based of Pakistan Air Force. With the inclusion of Pakistan Air Force, the project was renamed as ‘Armed Forces Project.

 

The project continued in 2008 on no cost extension basis approved by the donor from January to June 2008 for completion of activities and from July to December as close out phase. During the reporting period the project enrolled 10440 new clients reaching the performance level of 143.36% and achieved 13049 CYP with performance level touching 82.22% of the targets. Maximum contribution in CYP achievement was made by IUCD (65%) followed by sterilization (16%), Norgest (5.6%) and Depo (6%). Condoms and Oral pills contributed 3.7% and 3.1% respectively.  Mean ago of the FP clients was 27.37 years while their average parity was 3.38.

 

Project provided 42443 SH&RH including 25552 counseling services on FP, nutrition and SH&RH to men and women of Armed Forces. This included 4938 lifespan services, 3270 immunization and 1668 general health services.

 

27 paramedics of Pakistan Army and Pakistan Air Force (PAF) was given refreshers on clinical contraception, which helped them in delivery of quality FP/RH services at the centers being managed by Armed Forces. Orientation sessions on FP/SH&RH proved beneficial to sensitize the men and women on effects of over population. Trained Key Unit Trainers of Army and PAF held monthly ‘Darbar’ meetings with more than 215 men that became the basis for institutionalizing small family norm and promotion of SH&RHR in the Army and PAF. Family Life Education helped the officers, Junior Commissioned Officers and soldiers to understand health issues and women rights. Women learnt about RH, FP, safe motherhood, infertility, consequences of unsafe abortion, prevention from STIs and HIV infection, importance of balanced diet, women’s education, social values of women in Islam, small family norm, personal hygiene, gender equality and women’s role in community development.

 

At the expiry of the project for the purpose of sustainability Ministry of Population Welfare took over the program.

 

Partnership with AJK Government:
The AJK Project was outstanding achievement of 2003 for FPAP. It was the first area wise reproductive health and family planning program which was approved in a public sector development program and its implementation was outsourced to an NGO (FPAP). Rahnuma-FPAP struck an agreement under which the government committed to provide 65% share and Rahnuma-FPAP 35% share for four years up to 2007 but the project moved up to 2009. In 2009, the last year of the project, PMO AJK all Health service outlets, 148 total, achieved 53568 CYPs.  CYP achievement against the target set for the year was 76.89%. Method wise maximum contribution in CYP was made by IUCD (68.51%) followed by Depo (12.12%), Norigest (6.65%) and sterilization (10.06%). Contribution of Oral pills and Condoms was only 2.65%. Mean age of client in the project area was 27.35 years and parity was 3.62. Client’s younger age and low parity showed that program focus was on relatively young couples.

 

A total of 1001 counseling services were provided in 2009. 52061 safe motherhood services that included 29963 anti-natal were provided, 5716 cases of safe motherhood were referred to other facilities for advance treatment. 24881 Reproductive health services were provided consisting of 2610 infertility related and 7677 HIV/AIDS, RTIs & STIs related services. 91230 lifespan services including immunization and general treatment were given, 4154 cases were referred to THQ & DHQ for further investigation and treatment. 32550 Diagnostic services were provided including ultrasound, pregnancy tests, semen and blood tests. High level achievement 466% in services was due to effective community awareness/mobilization by the field staff regarding the SH&RH services. Since 2009, the project has been made a part of Rahnuma’s core program.

 

Partnership with City Government Lahore (W&FHF USA):
Project was implemented from April 2002 to December 2003. During 2002, the project achieved 10289 CYPs and in 2003 it achieved 21489 CYPs. In the last year of the project, some 300 prayer leaders/journalists of City District, Lahore were provided RH/FP related orientation/awareness in the light of Islamic injections. Awareness lectures/discussions were conducted in 10 Boys/Girls Schools where information on adverse effects of over-population on quality of life, RH, women’s right and men’s role towards their families was given to 1500 senior students/teachers. As many as 350 women participated in “Happy Home Meetings” in all the six Towns of City District, Lahore

 

Partnership with Pakistan Railways (W&FHF USA):
The project was of one year from October 2002 to December 2003. The project in 2003 achieved  4738 CYPs. Around 77 members of senior management cadre of Pakistan Railways were provided project related orientation which helped identification of staff and strategies for smooth implementation of project. One day workshops were conducted in workshops cum factories for 150 workers with an aim to educate them about RH/FP, quality of life. 50 shopkeepers of Railways residential colonies were made aware of RH/FP needs/rationale and finally convinced them to become sale points for contraceptives & referrals. Approximately 1550 persons (both male/female) were directly intervened through Sukhi Ghar Mehfils (women club meetings), discussions, lectures and declamation contests in schools, industrial centers etc. & they were provided awareness on FP/RH needs, women’s rights and men’s responsibilities

 

HIV & AIDS Research:
FPAP also conducted two Research Studies on HIV/AIDS. The focus of the first study was the Sexual Behavior of Hijras & their Knowledge of HIV /AIDS. Study assessed the risk behavior including number and type of sex partners (commercial, regular, non-paying) and the condom use, the knowledge of STIs, HIV & AIDS and perceptions of related self-risk and Drug and substance use. Focus of the second study was to assess the Prevalence of Depression, Sexual Behavior and Practices among Female Sex Workers. Study analyzed the sexual behavior and practices of female sex workers, assessed their knowledge about STIs, including HIV and AIDS, measured the prevalence of depression and level of self- esteem among female sex workers and assessed the condom use among female sex workers and risk perception to HIV. Apart from these studies FPAP also conducted KAP survey in FPAP areas of operations on

 

HIV/AIDS/STIs and STDs.
FPAP has signed Memorandum of Understanding with Federal Ministry of Health of which the National AIDS Control Program and Provincial AIDS Control Programs are the part, which put the organization in a better position to implement such difficult projects in any part of the country.
Rahnuma-FPAP has also developed partnerships with organizations working on HIV & AIDS at regional level. In Lahore, it has signed agreements with Punjab AIDS Control Program, Sathi Foundation and Sheed Foundation; in Quetta with Legend Society; in Peshawar with Doost Foundation and in Karachi with Isla. All these collaborations provide Rahnuma-FPAP an edge to implement HIV & AIDS related programs at grassroots level as it entails the support of the government departments as well as the NGO sector organizations.  Involvement of PLHIV in the policy, program development and implementation of HIV & AIDS programs also provides Rahnuma-FPAP an edge. One volunteer, who is PLHIV and member of Rahnuma-FPAP, participates in the design and implementation of the program and gives input for policy development with respect to HIV & AIDS. HIV Coordinator, who is PLHIV, regularly visited to DIC for HIGH RISK GROUPs and VCTC in Lahore for monitoring purposes. He is also involved as resource person in trainings for FPAP staff and volunteers on HIV Counseling. HIV Coordinator also liaises with PLHIV Associations and other NGOs/CBOs of key populations through meetings. Rahnuma–FPAP’s HIV & AIDS Work Place Policy is a part of HR manual which also has an affirmative stand on HIV and prohibits discrimination on the basis of HIV status and also guarantees ‘reasonable adjustment’ for PLHIV staff.

 

Participation of target populations and Continuum of care is a hallmark of Rahnuma-FPAP HIV/AIDS Program.  What needs to be planned in terms of activities and how these activities need to be implemented come from the target groups which is further refined with Rahnuma-FPAP expertise? As AIDS was the new priority area for FPAP from 2002 and vulnerable groups were new clients to Rahnuma-FPAP this modality of participation was vigorously followed no matter it was truckers and associated populations, youth or in or out of school children or female sex workers or hijras or PLHIV. Rahnuma-FPAP not only consulted the target groups in the planning phase but also involved them in the implementation, monitoring and evaluation of the project. This participation has been institutionalized in the shape of representation of target populations in the technical advisory committee. As is obvious from the objectives, Continuum of Care will be provided in the area of AIDS. Behavior change communication including adherence counseling, condom promotion, STIs diagnostic and treatment, voluntary counseling and testing, psychosocial support and treatment of opportunistic infections will be an important part of HIV/AIDS service package. Care and support will be ensured through collaboration with NGOs and public sector departments. Involvement of PLHIV in the policy and program development and implementation also enhances the participation of key populations. Peer education strategy also provides an opportunity for the target population to participate in an effective manner in the implementation of the projects and remain in touch with the goals and objectives of the interventions.  

 

Advocacy for STIs and HIV/AIDS Prevention among Youth (JTF), 2003
The project aimed at advocating for STIs and HIV/AIDS for in-school and out school boys and girls at three selected locations of Peshawar, Chakwal and Northern Areas. Male and female teachers of 6 village schools and religious leaders were trained as master trainers. Both the categories of master trainers then trained 144 male and female youth, school and out-of-school, as peer educators on HIV/AIDS and SH&RH. 48 groups of peer educators, formed to carry out peer education activities in schools and communities, reached 1,800 youth through peer education sessions in school and out of school settings.


1.    HIV/AIDS prevention among truckers and associated populations (HIGH RISK GROUPs, MSWs, Hijras, Hotel Boys, Massagers) of Badami Bagh truck terminal Lahore (JTF), 2005

The overall purpose of the project was to promote health seeking behavior and safe sexual practices among truckers and associated populations thereby reducing the risk to HIV infection. 200 peer educators were trained as follows:

Hijras: 20; Massagers: 20; Hotel Boys: 20; HIGH RISK GROUPs: 20; Cleaners: 40’ Truck Drivers: 40; Company staff: 40

The peer educators were provided with IEC material and involved in awareness and referral for diagnostic purposes. Keeping in view the action plan 178 religious & prayer leaders, government & police officials and local service providers were provided comprehensive orientation regarding HIV/ AIDS, its mode of spread and prevention from HIV/AIDS. 55 Community Based Distributors (CBDs) were identified and provided orientation on HIV/AIDS and involved in the distribution of the condoms. One of local NGOs namely SHEED working with sex workers in area adjacent to Badami Bagh truck terminal was approached and their service provider LHVs were trained in family planning and also a group of 20 TBAs was trained in conducting safe deliveries and provided with delivery kits. Four LHV based clinics in truck terminal area Badami Bagh were also involved in the program. Referral system was put in place for referral to VCT centres.

2.    Understanding Social Power and Dynamics among High Risk Groups and Piloting Specific Packages Using Innovative Approaches (UNFPA), 2007-08
The project was implemented in 2007 in Quetta city of Balochistan Province. It was funded by UNFPA. During the project period 432 sex workers at Khoti Khaanas, homes, beauty parlors, street based were oriented on prevention of HIV, safe sex practices, referrals to the DIC for clinical services and condom use as dual protection. The peer educators distributed about 6328 condoms. The low usage of condom was addressed by increasing the counseling sessions with the target group.  700 pieces of IEC material was distributed to HIGH RISK GROUPs during the project period. DIC was established through which services for PHC and STIs management to HIGH RISK GROUPs, their families and adjacent communities were provided.  LHV conducted 48 home visits to the community and provided pills and condoms as well as provide counseling services to 225 beneficiaries with regard to condom use, and prevention of STIs/HIV AIDS at the DIC. 88 referral were made to VCT for HIV screening. Syndromic Management training was also organized.


3.    The Saheli Project: SH&RH and HIV Service for Female Sex Workers (JTF),2009-10

The DIC was established and made fully functional. 1248 HIGH RISK GROUPs were identified and registered.  A large number of Sex Network Operators (pimps, aunties, naikas, beauticians and rickshaw drivers) were registered and sensitized on Hygiene, HIV/AIDS infection & prevention, correct use of condoms, STI symptoms & treatment, stigma and discrimination, SH&RH Rights.  3 Training Manuals “Our Health & HIV/AIDS” “Negotiating Safer Sex guidelines” and “Manual on Peer Education” were reviewed, adapted, pre-tested and printed.  Mobile HIGH RISK GROUPs in an extremely conservative setting like Baluchistan were accessed and awareness rising on SH&RHR was conducted, hence empowering them to exercise their rights and also opportunity for HIGH RISK GROUPs to access non discriminatory HIV services through VCT and DIC at the FHH was instrumental. The project helped to provide/strengthen the outreach services, skill building of staff and value reconstruction/clarifications

7     The HUMJOLI Project: Reaching out to Transgender/Hijras in Lahore and Faisalabad (This    name, meaning ‘A friend’, was suggested by a member of TG/Hijra Community)

The project, of two years duration, has been approved by JTF and implementation would soon start.   The following activities will be carried out under the following three objectives:
Objective 1: To increase the use of HIV prevention and SH&RH services among T    G/Hijras from 6.5 % in Lahore and 8% in Faisalabad to 30% and 28.5% respectively by March 2014. (Baseline data from Round 3 HASP).
Strengthen/Establish mobile camps in Lahore and Faisalabad,  Establish and operate mobile VCT services weekly,  Mapping of TG/Hijras Deras, Sensitization of  Sex Operators (Gurus, Pimps,), Training of Public and Private service providers,

Training of project staff, Development of service provision guidelines for mobile services and VCT and STIs and Client Management, Psycho social counselling (individual and in groups), , Equipment and Commodities (medicine, condoms, water based lubricants, kits, contraceptives, reagents, instruments).
Objective 2: To increase the percentage of TG/Hijras reporting consistent condom use from 28.4% in Lahore and 4.5% in Faisalabad to 40% and 15% respectively by March 2014.
Sensitization sessions with TG/Hijras, Development and Printing of training programs on HIV/AIDS, Safer sex, negotiation skills and peer educations, Training and refresher of community peer educators on Negotiation skills for consistent condom use and safe sex practices, Identification, training and refresher of peer educators on peer education skills, Peer Education group sessions by community peer educators, Meetings of mobile unit Peer Educators with Community Peer Educators, Development and dissemination of IEC/BCC material, Recreational Activity ( educational  theatre /acting programs), Revise and implement data collection, entry and reporting formats.

Objective 3: To decrease the percentage of TG/Hijras reporting harassment by law enforcers and discrimination by health service providers by 20%’.

Bi annual Sensitization sessions with of Police officials, Bi-annual sensitization sessions with  local representatives, Annual attitudinal reconstruction sessions with  public and private sector service providers, Annual attitudinal reconstruction sessions with FPAP staff and volunteers, Networking with  NGOs/CBOs and human rights representatives, Facilitate TG/Hijras to form  Self Help Groups and Registration of a TG/Hijras led CBO in Faisalabad, Roundtable with journalists, law enforcement agencies, TG/Hijras and PACP representatives to promote greater tolerance of diverse groups in society.

 

MA Experience in HIV & AIDS:
To take forward the international understanding reached at ICPD on expanding and converging efforts and resources towards preventing and reducing the incidence of sexually transmitted infections and growing and serious threat of HIV/AIDS, FPAP launched its first awareness project in 1994 simultaneously with the launching of National AIDS Program of the Government of Pakistan. Under the project, two groups of service providers including 25 doctors and 275 paramedics received orientation and 20,000 people received information through IEC material.  A total of 30,000 pieces of condoms were also distributed.
Second initiative, however, came late in 2000, and covered a greater number of staff and population. Under the initiative, 500 staff members and 1600 community functionaries were orientated and the messaged was spread across, capturing the attention of more than 376,000 people. Inter-personal communication, development and distribution of IEC material and audio-visual facilities including three AV Vans were the peculiar characteristics of the campaign.

 

HIV/AIDS Prevention
HIV/AIDS is one of the priority program areas of the organization and Rahnuma-FPAP continues to strive to prevent the spread of HIV & AIDS by integrating HIV & AIDS awareness and services in sexual and reproductive health service delivery systems in its area of operations. Two objectives have been set to achieve this strategic direction. Organization is endeavoring to reduce socio-cultural and economic barriers that make people vulnerable to HIV & AIDS and the purpose of such efforts is to increase the understanding of HIV&AIDS among general populations, especially vulnerable groups and to create supportive environment for HIV & AIDS interventions. On the other side Rahnuma-FPAP is simultaneously engaged in increasing the access to STIs/HIV & AIDS related information and services as part of integrated, gender sensitive SH&RHR services package including access to care, support and treatment for people infected and affected by STIs/HIV & AIDS, leading to enhanced protection against HIV&AIDS.

 

The Association has an experience of working with vulnerable and high risk groups in the field of STI, HIV/AIDS such as truckers, female sex workers, jail inmates and transgender. The Association has also experience of working with associated populations of truck drivers such as massagers, hijras, hotel boys and men having sex with men (MSWs). FPAP program leadership has rich and valuable experience in the prevention of STIs and HIV/AIDS by virtue of its interaction at regional and international level. The Association is providing VCT Services as well through its Center established in Family Health Hospital Johar Town Lahore and DICs in Quetta and Karim Park Lahore and has good networking with NGOs working with PLHIVs.
Sensitization and mobilizing religious leaders and opinion makers;

 

Islam and Family Planning:  Since its inception in 50s, organization faced resistance from men and women against family planning programs. The resistance was based on the perception that family planning is against Islam. At times the head office of the organization was stoned by the mob.
The FPAP in 1972 engaged an eminent lawyer for a study ‘Law and Population’ which examined all major Islamic Schools of Thought. The study brought out the unequivocal conclusion that Islam and family planning were not incompatible and there must be a policy acceptable to the people for controlling the voluntary reproductive behaviour. In 1974 FPAP published a poster based on Quranic Verses at the time of Islamic Summit Conference in Lahore. It was well received. Subsequently, a set of four posters based on Quranic Verses printed over a dozen times in large quantity from 1974 to date. In 1979, the FPAP took the initiative to involve religious scholars and leaders and republish a monograph on ‘Islam and Family Planning’ by the eminent religious scholar, first published in the sixties by the Institute of Islamic Culture Lahore.  This monograph has been printed seven times since then for motivation purposes and sharing with religious institutions and madarris.

 

Later, based on the feedback from the grassroots the FPAP published a booklet entitled ‘Andaishay aur Haqaiq” (Fear and Facts) which contains the commonly voiced doubts and misconceptions and their clarifications by three religious scholars representing different schools of thought. In order to highlight the true Islamic perception of a girl child a booklet containing ‘Ahdit’ (sayings of Holy Prophet PBUH) has been printed again and again. In 1992 work with religious scholars and leaders was started and a dialogues were held with notable leaders from Deobandi, Barelvi, Ahle-e-Hadith and Isna Ashrari schools of thought and seminars were held with religious notables at various locations in Pakistan. The FPAP published ‘Fatwa’ (religious edicts) of various religious authorities in 1992, printed/reprinted six times to date, in Urdu and translated into Sindhi and Pushto in 1993.

 

By 1997, the FPAP put together a strategic nationwide intervention/project, ‘Islam and Family Planning’, which was based on experience gained in the past. Started with the World Bank funding through NATPOW for one year in 1998 the project used two-pronged approach of involving religious leaders for addressing both men and women with the rights perspective and to take forward the RH/FP promotion. Both components of the program women-to-women dialogue and meetings with Khateeb/Paish Imams were well received. On the basis of this project, FPAP initiated another intervention ‘RH/FP interventions in Muslim Society’ in 2000. It was based on three pronged strategy and aims at spreading awareness, dissemination of knowledge about reproductive health and family planning amongst the project audience and using religious leadership as advocates. Through this project information was taken to school and colleges young women and community women with authenticity of its linkage with Islam at all thirteen-program areas of Pakistan in FPAP. Now the project activities have been merged within the core program of Rahnuma-FPAP. This project provides an important link and understanding that is required to implement projects relating to violence against women particularly in forms and shapes that are contoured by the so called socio-cultural norms and practices.
Rahnuma-FPAP is consciously making efforts to work on Gender related issues and has conducted a couple of researches in this regard and developed a strong partnership network. The most recent situation analysis on Child/Early Marriage in Pakistan has been the source of identification of this inhumane practice camouflaged through marriage i.e. Swara. The MA has sound capacity to implement the project due to the following reasons:
•    Over 15 years experience of MA in working in the targeted areas and over 30 years of experience of working in the region
•    Strong network of religious scholars
•    Established capacity of organization in GBV
•    SDPs of the MA in the vicinity.

 

Women Empowerment:
Rahnuma-FPAP is a gender focused organization with a holistic integrated approach towards development. Over the last 50 years the organization has been working on issues related to maternal and neo-natal health, child/early marriages, honour related crimes, violence against women in particular burn cases, economic empowerment of women and sexual and reproductive health needs of women and their families.

 

The Women Empowerment Program with IPPF was started in 1978 as an indirect approach to promote family planning acceptance among women and their families. The strategy attempted to make women conscious of their status and role and to improve their decision-making capacity within the family but by now the program has broadened to include political, economic, social and legal empowerment. The women have also been trained to effectively participate in the electoral process and many of them have been elected as councillors in the last two elections. Skill development and micro credit opportunities and programs are implemented for enhancing their economic status. Since 1978 this program has been an important component of Rahnuma-FPAP core program being implemented at thirteen locations in Pakistan with three KATO Women Development Complexes at Quetta, Haripur and AJK, providing an effective platform for marginalized women of these underserved areas to learn and market their skills leading to enhancement of their economic status in families. Women empowerment has been found effective strategy to coup with the domestic violence /abuse issue in the operational areas of FPAP.

 

Economic Empowerment of women through micro-credit services: Rahnuma-FPAP initiated the Poverty Alleviation Program in 1999 on the felt need of the communities. The overall goal of the program is to economically empower women and adolescents through an integrated multi-sectoral intervention.  The program adopted a two pronged approach: Micro Finance Unit in Badin where both the social mobilization and financial service package is provided by the organization and the sector’s first ever NGO-Bank collaboration model with Rahnuma-FPAP role being identified as social mobilizer and Khushhali Bank as the Banker. The project beneficiaries are women (90%) and men (10%) below the poverty line. At present the program is being implemented in 14 locations across Pakistan and has benefited over 30,000 women and men. Poverty alleviation program has a multidimensional affect on the status of women in families and even in communities. The beneficiary surveys and other in-house assessments have shown that the Rahnuma-FPAP’s Poverty Alleviation Program has had a definite positive impact on women empowerment and women & child health care, which holds true for all ages and education groups. Below is the summarized version of the beneficiary survey report;

 

Poverty Alleviation Program contributed towards empowerment of the women beneficiaries through:
Increase in self generated income
Improved role in house hold decision-making
Increased financial independence
Reduced dependency on husbands
Improved self-confidence
Increased mobility without male consent
Improved access to health care facilities
Improved knowledge of SH&RH&R and family planning
Increased use of contraceptives
Increased knowledge of HIV/AIDS

The poverty alleviation program also contributed reasonably towards improved child health care especially in terms of immunization.

The program has to some extent helped in improving the access to information and services for health care to women especially in antenatal care and maternal health care.
Gender Based Violence in the forming of Burning: Rahnuma-FPAP has implemented two projects specifically aiming at the reduction of incidence of domestic violence against women (burning) with financial support from European Commission in 2006 and 2007. The main purpose was the capacity building of doctors, police officers, judges, lawyers, local representatives, religious leaders and media for the effective enforcement of Cr.PC 174-A a new law enacted to punish the culprits of violence against women (burning). In the first phase, the project was implemented in Islamabad Region but in the second phase same activities and methodology was replicated at other locations of Islamabad, Peshawar and AJK (Jhelum, Chakwal, Attock, Haripur and Kotli).
The Family Health Hospital in Islamabad has established a Burns Unit wherein the doctors are now trained to perform reconstructive surgery themselves. The organization has also recently implemented Operation Smile Project, in collaboration within Medicine Du Monde, in five districts with the objective to provide reconstructive surgery for Acid and Stove burn victims. The hospital has also recently entered into collaboration with SmileAgain Foundation that helps burn victims through plastic surgery and counselling. The organization has vast experience in research and capacity building. With a focus on rural communities, the organization has its strength in social mobilization. Rahnuma-FPAP has worked with marginalized communities including Female Sex Workers and Jail inmates.  

 

Strengthening of Electoral Process through Awareness:
To create mass awareness among women on their civic and political rights and to motivate them for their greater participation in the forth coming general election of 2007, RAHNUMA- FPAP entered into partnership with ECP/UNPD for implementation of one year ( May 06- April 07) project” Strengthening of electoral process through awareness”. This project intended to strengthen the electoral process through increased awareness especially among women of poor and socially excluded community members. Its particular focus was on women in the age group of 18 years and above, who were eligible to vote. Project was implemented in rural and urban slum in five districts i.e. Chakwal, Rawalpindi (Punjab), Badin (Sindh); Turbat (Baluchistan) and Kohat (NWFP).

 

Manual Development:
Major achievements of the project include; development of four training manuals (Civic rights and electoral process, registration of ID Cards, eligibility criteria for contesting the election and Step by Step procedure for vote casting) as guiding tools for project teams and other partner NGOs of ECP/UNDP.
Training of Trainers (TOT) and Relay Trainings:

 

Another achievement was the conduction of four TOTs to train the cadre of 10 master trainers on the basis of content of each training manual; training of 156 women forward leaders and 81 religious leaders for promotion of civic rights and involvement of women in electoral process; awareness session with 9931 women for participation in electoral process; training of 9907 women for making influence-free decisions regarding political rights; training of 9843 women on the process of obtaining and registration of ID Cards; preparation of 45502 ID Cards of women through linkages with NADRA; training of 164 women regarding eligibility criteria to contest the election; training of 111 political leaders for managing the successful canvassing campaign and training of 9843 women on correct procedure for vote casting and formation of volunteers committee to establish the community based mechanism to facilitate the women for making influence-free decisions at polling stations.

 

In the Local Government Elections in 2005 the Rahnuma-FPAP also played an active role in sensitizing women so as to ensure their participation in the election. They were also trained about the importance of vote, and the need and way to cost their votes free from outside influence. The women were also encouraged to participate in the elections and, as a result of its input and support many women were elected to various levels of elected positions in various part of the country.

 

KSM Training of Project:
This is another project which shows the confidence of the donor on FPAP for conducting training program on a large scale. Under this project Rahnuma- FPAP is conducting and managing family planning training of the specified cadres of service providers in the following assigned districts by itself:

 

Punjab:    Bahwalnagar, Chakwal, Faisalabad, Jhelum, Kasur, Khushab, Lahore, Mandi Bahauddin, Multan, Okara, Pakpattan, Rawalpindi, RY Khan, Sargodha, Sheikhupura
Sindh:     Karachi, Nawabshah, Nowsheroferaz, Sukhar, Tharparker
NWFP:     Haripur, Kohat, Lakki Marwat, Peshawar
Balochistan:     Kach, Panjgur, Quetta, Turbat
Northern Areas:     Diamer, Gilgit Town

 

Up to May 2007, beginning from October 2004, Rahnuma-FPAP trained 1083 doctors and 3115 LHVs in Hormonal Contraceptives and 236 Lady Doctors and 216 LHVs have been trained in IUCD insertions. Key Social Marketing (KSM) has subcontracted FPAP for these trainings. The purpose was to support the Government of Pakistan’s (GOP) goals of improving the reproductive health status of women, increase family planning usage and expand involvement of the commercial private sector in the provision of modern contraceptives
There is another important point which is worth mentioning here. It was the FPAP which initially trained the staff of Green Star and Key Social Marketing which have now developed into giant organizations in the area of social marketing.  

 

WFP Project ToT and relay trainings.
This project was implemented during 1998-2001. The purpose was to promote RH information and services in collaboration with 100 NGOs from all provinces. Under this project 200 paramedics and 500 volunteers and outreach workers were trained in the area of service delivery and community mobilization etc.  For the purpose, training of 30 master trainers (ToT) was held in Lahore wherein management staff from the field participated. In the second step these trainers conducted the trainings of 700 service providers and program staff and volunteers of 100 NGOs in five regional offices and 13 focus areas programs all over the country.

 

Gender Training Project of UNFPA:
Gender training was conducted in eight focused districts of UNFPA by Rahuma-FPAP. At the first step, UNFPA oriented the master trainers of FPAP for one day. Five one day workshops on Gender and Reproductive Rights were conducted by FPAP master trainers in eight focused districts of UNFPA including Kotli and Muzzafarabad (combined), Thatha and Jacobabad (combined), Mansehra and Kohat (combined), Muzzafargarh and Chakwal (combined). Then, three day workshops were conducted in Lahore, Peshawar and Karachi. 361 persons from government, NGOs, Media, UNFPA and other groups were trained and their awareness on gender mainstreaming, domestic violence faced by women, role of media in promoting gender was raised. It also aimed at improving the access of women to related information and services and increasing their awareness on basic human right. Enhanced capacity of partner organizations, Rahuman and UNFPA, to advocate gender issues was another main purpose of this training program and gender sensitization of service providers and policy and opinion leaders and development of linkages between them wan another priority which was achieved as a result of this training program.

 

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