South Waziristan Agency has been recovering from decade long militancy and the resultant military operation to establish the writ of the government. Prolonged conflict resulted in disruption of the basic services and mass exodus left thousands of families in state of displacement and badly affected the infrastructure for services delivery in different sectors with the inclusion of essential services like the health, education, water and sanitation. The agency was already deficient in terms of health facilities while the conflict resulted in further deterioration of the situation on ground. Inadequate services & professional/technical staff, lack of medicines had been a big issue which needed immediate attention to bring the life to normalcy and support sustainable returns after stabilization of the situation.
The situation in Tehsil Sarwakai of South Waziristan Agency was even worse. The Tehsil head quarter hospital which is category D hospital did not have a single Lady Doctor for providing reproductive health services. The area of Sarwakai was cleared partly in the last half of 2015 and first half of 2016. With return of a significant number of TDPs to these areas the need for basic emergency obstetric care was immense and it was extremely important to save the lives of mothers and new born. In addition to reducing maternal and newborn mortality and morbidity it was also important to reduce the transmission of sexually transmitted infections, HIV and introduce family planning practices. In order to achieve the desired goals, Foundation for Rural Development (FRD) entered an agreement with UNFPA to improve Basic emergency obstetrics care and to provide reproductive health services under the CERF funding.
To achieve the objective of MISP project for reproductive health, FRD selected 4 health facilities (one category D hospital Maula Khan Sarai and three peripheral health facilities i.e. Sarwakai, Barwand & Chagh Malai health facilities). The selected health facilities were provided with the necessary repair and renovation for effective services delivery.
As part of the interventions, the health facilities were reinforced and equipped with medicine, equipment, professional & technical staff comprising female medical doctor, LHVs, Midwives and other staff. The provision of reproductive health services started form April 2016 till June, 2016 (Though FRD voluntarily provided services till 20th July 2016). FRD has been successful to get some commitment for additional funds for continuation of the project on smaller scale. During the period free consultation & medication was provided to 2763 females (2098 women & 665 girls) & 1921 male (940 men & 981 boys) thorough checkups, medical advice, guidelines, medication for ANC & PNC care, Family planning, contraceptives, STIs, referral for vaccination & general diseases. Reproductive health services provided specifically to 413 pregnant women with proper check-ups, guidance, counselling during pregnancy & after delivery, 78 family planning & 266 sexually transmitted infections. Similarly, 62 deliveries facilitated at health facilities while three complicated cases referred to Agency Head Quarter hospital (AHQ) for comprehensive obstetric care. 324 pregnant women facilitated with clean delivery kits for safe deliveries at home & 403 New Born Baby kits to new born babies.
To improve awareness regarding reproductive health among the male & female community, 636 (138 men, 273 women, 76 boys, 149 girls) awareness raising sessions were organized & conducted separately for men, women, boys & girls on proper care, nutrition, sexually transmitted infections, Family Planning, vaccination, menstrual hygiene, etc. For effective communication of information, IEC material was developed considering the need, local culture & language. The relevant information was successfully communicated to 4336 individuals (men=948, women=1930, boys= 425, girls=1033) in the awareness sessions through verbal communication and distribution of IEC material. The campaign had a very positive effect on the community and resulted into the high flow of visiting patients to health facilities.
Keeping in view strict traditional setup and lack of education and awareness in South Waziristan, provision of reproductive health services to females as well as males was challenging task but due to tireless efforts of FRD staff, the target was achieved successfully. The health facilities that were without services and even without single lady doctor is now fully functional and fully equipped with all basic health facilities/services as well as professional staff (male and female). According to survey 70% patient showed satisfaction over health services.
Overall the project brought positive change into the mindset of locals specifically about proper care of expecting mothers & their safe deliveries. Clarified myths and reinforced the need of professional care for mothers and babies, developed relationship of trust with the government line agency of health and sensitized them on the need of collaborating with civil society organizations for improving the quality of services delivery. The endeavors put in by FRD jointly with UNFPA worked well & a good number of people started approaching health facilities for availing reproductive health services. The arrival of 314 pregnant women at health facilities within just two months proved the importance of services & efforts.