FPHC Concludes CIHR Grant with PAR Workshop

More than 9 years ago, staff of FPHC reviewed their Strategic Plan. They thought long and hard about how to make a bigger impact in their inaccessible corner of KhyberPushtunKhwa region of Pakistan. They determined then to start doing participatory research to help document what worked and what didn’t in primary health care especially in maternal and child health.

In 2009 a grant was obtained from Canadian Institutes of Health Research to begin the process. An extensive environmental scan was undertaken in six communities. Then two floods, a humanitarian crisis in internally displaced people and ongoing insecurity intervened. Finally in 2012, the final training workshop in Participatory Action Research was finally held. 22 participants (8 women) attended over three weekends. FPHC field staff, government health workers, students, social mobilizers, medical doctors, lady health visitors and administrators. Participants were pleased with the new skills and tools they learned. One participant attended a Situation Analysis for Afghan Refugee camps and found he had provided the majority of the ideas for how to go about it. Government health workers said they were attending their first training in more than a decade.

Participants learned the advantages and disadvantages of participatory research in communities. They undertook exercises on grounded theory, PAR cycle and Focus groups. This was followed by analysis tools such as card sorting, pair wise ranking, direct matrix ranking, problem & solution trees, fishbone diagrams, time lines, seasonal calenders, transect walks and Venn diagrams. The training proved a great success with participants anxious to be able to use the skills as soon as possible.

FPHC Begins Reconstruction in Flood Areas

Sorry for the delay in communicating with you. We have been really overburdened and it continues. even now. The staff is working longer hours than routine, even the office staff..

Because our geographical area is prone to emergencies and we have needed to respond quickly in the past to earthquakes, floods and massive IDP migration, this past January, we opened a special bank account to create an emergency response fund. This also has helped us to track the emergency funds we received better. We had a small amount in this account when the floods hit that allowed us to jump right into relief services at the end of July, 2010 when the floods hit.

The need for medicine and supplies, even at the beginning, however was very big as whole families and communities had run from their flooded homes with only the clothes on their back. So we were very glad that you were able to raise and send funds to us so quickly.

Our early and effective emergency response was acknowledged by the government authorities, who put us on their official list. This helped as we then received some local donations from philanthropists and organizations. International groups such as UNICEF, WHO and UNHCR also came forward to assist us with supplies. In addition, we had realized some unspent funding in ongoing projects in the tribal areas and got approval from UNICEF for utilization of those savings in flood affected areas.

Along with the donations sent by Society of Rural Physicians of Canada, Hillman Medical Education Fund and Rose Charities we have been able to continue actively in our work since the floods began.

Recently we have been chosen by UNHCR for an emergency grant to set up two static health care centres in government health facilities in Nowshera and Charsadda districts for the flood-affected people. Each of the static centers supports six mobile teams. The static centre consists of 1 LHV, 1 MCH Assistant and 1 Male Social Mobiliser. Each of the six mobile teams supporting the static centre consists of 2 Medical Doctors, 1 Medical Technician, 1 Laboratory Technician, 2 LHVs, 2 MCH Assistants, 2 EPI Technicians and support staff. So this totals more than 50 additional staff members as well as the necessary medical and non-medical equipment, rented vehicles and medicine. As part of this UNHCR project we are also rehabilitating 12 health facilities, including several FPHC centers, that have been affected by the heavy rains and floods.

We expect to hear shortly from UNICEF regarding a possible six month Nutrition Project for flood affected people that is planned to start middle of October. Under this project FPHC will be providing Nutrition Services (specifically provision of ready to use micronutrients and nutritional information) to women and children in at least 10 Union Councils . A Union Council is an administrative unit like a big village.

In recognition of our activities, FPHC is now an established part of the the Nutrition Cluster at Country level and coordinate regularly with UN Office for the Coordination of Humanitarian Affairs (UNOCHA) and National Disaster Management Authorities. Thank you to all our generous donors for helping not only flood-affected people here in Pakistan but also for assisting Frontier Primary Health Care to build capacity in responding to these humanitarian emergencies.

from Dr. Emel Khan and FPHC.

Photos: Flood relief 2010

FPHC Contine Pakistan Flood Relief

Since late July, 2010 more than 10 million children have been affected by the Pakistan floods, including 2.8 million under five-year-olds. 1.2 million people still live in 6300 camps all across the country many in KPK.

Although progress is being made, many flood-affected families still have limited access to health facilities. In some areas, service delivery has been totally disrupted as up to 80% of the homes and facilities were affected. With

more than 200 health units destroyed completely or only partially functional, attention has now turned to repairing them.

The majority of private sector health providers in the area have also been disrupted by the floods. Luckily, most of Frontier Primary Health Care health units remained functional so they have been able to assist in areas where facilities have been destroyed.

Surveillance information from the affected flood areas of Pakistan is available on the WHO site. http://www.who.int/hac/crises/pak/en/index.html

In summary in the four districts of KPK, Punjab, Sindh and Baluchistan a total of 80 health facilities were affrected, almost half (38) of them in KPK (Northwest Frontier Province). WHO has 20 health partners assisting in the flood relief in KPK including Frontier Primary Health Care, which is active in both nutrition and health in flood affected areas in Mardan district and a refugee camp.

So far it has proved difficult to track activities of FPHC on the WHO website, which better captures activities of the large international organizations likely due to their better access to the internet. It was not possible, for example, to identify any of the FPHC health centers on the WHO maps which detailed health facilitiy status following the flood nor was FPHC mentioned as a partner in earlier WHO documents despite the fact that their daily medical contacts exceed that of many of the other organizations that are mentioned and despite the fact that they were in the field earlier than most of the other partner organizations.

However, in early Sept, 14 staff from the Frontier Primary Health Care (FPHC) mobile health teams were trained on the WHO Disease Early Warning System so hopefully their activities will be better tracked now.

The efforts of FPHC continue in assisting provision of emergency health assistance including high impact, critical life-saving services for men, women and children in communities of flood-affected areas of Mardan, Khyber Pakhtunkhwa through strengthening, providing and maintaining essential health services.

We have managed to send more than $8000 in flood relief to FPHC to date through Rose Charities. As many other organizations are now finding, direct contributions to effective local groups with a known, trusted reputation in the field appear one of the most cost-effective ways to assist.

Several large international organizations such as Hesperian, the distributors of Where There is No Doctor and Grassroots International are also recommending this approach. A wonderful side effect of this process is that local know-how and expertise in responding to such crises also increases.

It appears that Astarte, a grassroots organization linked to John Snow International at Johns Hopkins University is also raising funds for FPHC as is a Malaysian NGO called Campioning Sara.

A very big thank you to all our generous contributors and hard working volunteers, who make this kind of support possible.

Photos: FPHC Flood relief 2010

FPHC Responding to the 2010 Pakistani Floods

Frontier Primary Health Care is a small, effective Pakistani NGO operating for more than 20 years in the Khyber Pukhtoonkhwa (KPK) region, formerly called Northwest Frontier Province. They provide primary health care to more than 250,000 Afghan refugees and local Pakistanis in 4 rural districts and one of the federally administered tribal areas near the Afghanistan border.

They provide the complete range of PHC at a cost of less than $2 USD per person annually. While minimal in terms of cost, this PHC has increased the health status of the populations they serve enormously, with many of the parameters in their communities much higher than elsewhere in the region. They have accomplished this remarkable achievement by using an army of both male and female local volunteers and a committed group of staff paid local wages.

Over the past five years they have also responded to four humanitarian crises in their region. The earthquakes on the Kashmiri border; the deluge of Internally Displaced People (IDPs) as a result of violence in Northern Pakistan and floods in Mardan in 2009 and now a Pakistan-wide flood of 2010. Their expertise and efforts have been recognized by UNICEF and they have in the past been contracted to provide medical care and nutrition feeding centers.

In the current crisis more than 20 million people, almost 1/5 of the population of Pakistan, have been displaced and in the area where Frontier Primary Health Care operates, flood waters more than 20 feet deep flow over the roads, destroy homes and inundate the fields.

Nowsherra and Charsadda districts have been among those worst hit.FPHC is providing assistance to the flood-affected at their health units in those districts. Additionally Frontier has been deploying two mobile medical teams consisting of medical doctors, medical technicians, Lady Health Visitors, social mobilisers, EPI technicians and support staff equipped with ambulance, medicine and equipment daily. The mobile teams focus mainly on emergency services and MCH services. The major diseases reported are water related such as skin infections, diarrhoea and also respiratory infections.

The mobile teams are also distributing food and clothing donated locally; micronutrients and vaccines supplied by UNICEF and occasionally cooked food and utensils. Each morning the mobile teams report to the District Health Officer to be sent to the hardest hit areas. As the need is so great and the resources few, the teams rarely return to the same area. The threat of cholera and dysentery, because of the difficulty in obtaining drinkable water, increases daily with nutrition of the many displaced children and pregnant women an ongoing need.

FPHC has been in contact with UNICEF and UNHCR but so far international organizations have been experiencing difficulty in moving supplies and people in place in the rural areas. I notice that several of the humanitarian sites such as Hesperian and Grassroots International are suggesting donations be sent to appropriate, reliable local Pakistani NGOs to circumnavigate the difficulties the larger international NGOs are experiencing, in the same way SRPC is doing.

The Society of Rural Physicians of Canada has partnered with Frontier Primary Health Care for more than four years. During that time we have worked with FPHC to improve the management of sexually transmitted diseases, trained traditional birth attendants and are currently developing participatory research, conflict resolution and training projects. Money sent to FPHC will be appropriately and well spent. Along with the Hillman Medical Education Fund and Rose Charities Canada, Society of Rural Physicians proudly supports their work and have found secure reliable ways to send funds. Your generous donations have allowed us to send $6000 to date. Rose Charities is a volunteer-based organization with low overhead.

You can donate online at the rose Charities Canada website.

https://www.canadahelps.org/DonationDetails.aspx?cookieCheck=true

Click on Donate Now button.

On the Fund Destination list scroll down to Pakistan Flood Relief.

Tax Deductible receipts are provided for donations over $20. Every bit helps. We can make a difference.

Photos: FPHC in 2010 flood.

Scenes from NW Pakistan: FPHC Relief

Frontier Primary Health Care is supported by the Rose Charities Canada 'Hillman Fund' Rose Charities flood relief support is being carried out through them and through close partners AMDA Canada / AMDA International. If you wish to donate please see www.rosecharities.info/donate.htm

Images from Jan 2010 ETAT Training Couse Kenya

Training of Traditional Birth Attendants, Pakistan

Traditional birth attendant training Pakistan: Swabi and Wadaga Districts.

(click on pages below to enlarge)