Pakistan Appeal No. 01.56/2003 Annual Report

The Federation's mission is to improve the lives of vulnerable people by mobilizing the power of humanity. It is the world's largest humanitarian organization and its millions of volunteers are active in over 181 countries.

In Brief

Appeal No. 01.56/2003; Appeal target: CHF 2,784,097 (USD 2,176,988 or EUR 1,758,680); Appeal coverage: 65% (click here to go directly to the Financial Report).

This Annual Report reflects activities implemented over a one-year period; they form part of, and are based on, longer-term, multi-year planning

Overall analysis of the programme

On the political front, ongoing debates relating to the country's constitution and other matters slowed down the normal process of government. There were numerous security issues related to the war in Iraq, the situation in Afghanistan, as well as sectarian, tribal and other violence. However, the country remained generally calm, with no specific threats to the work of the Federation and the Pakistan Red Crescent Society (PRCS), apart from ongoing security concerns in Baluchistan province.

The PRCS implemented its plan of action as outlined in the Appeal 2003, and responded to the floods in Sindh and Baluchistan mid-year, with funds generated in-country. There was a general slowing down of activities in the second half of the year, partly due to governance and management issues, but most of the objectives for the year were met. A major achievement was the national society's ongoing commitment to the development of its strategic agenda, with numerous documents now in draft, following inclusive and fully participatory processes. These documents include a fully revised constitution, the four-year strategic plan, now in draft, and strategies and policies for health, disaster management, and fundraising. While not yet finalised, these significant developments provide an excellent basis for the new governance and leadership to develop their plans and priorities for the PRCS.

The Federation implemented water/sanitation project in the Baluchistan camps for Afghan refugees was successfully handed over as planned to a local non-governmental organisation (NGO) in the second half of the year. This was undertaken earlier than originally planned due to the increasingly difficult operating environment in that part of the country, but work in the camps has been ongoing.

The key priorities for 2004 very much build on the progress achieved during 2003. They focus mainly on the scaling-up of disaster management capacity and related activities, closely linked with the further development of organisational capacity, especially in the areas of human and financial resource mobilisation and management, and development of capacity and the volunteer base at the district branch level.

1. Health and Care

Goal: The national society continues to build on its existing health activities and experience to improve essential health care services and health of the most vulnerable.

Objective: The capacity of the national society is strengthened to successfully, plan, implement and manage programmes, which have a positive effect on the health of the community in the operational areas.

Expected Results

• Measurably increased health programme management and training capacity within the national society and community capacity to respond to health needs.
  
  
• Raised awareness within the communities in the operational areas of basic health problems to enable community members to take more responsibility for their health.

Progress / Achievements

Strengthening of overall health management: The health policy was drafted in April 2003 through a participatory approach. The draft has gone through several modifications and is now awaiting ratification by the managing board. The health policy provides a foundation for and direction to the health programmes and it is to be circulated to all health units as soon as it is approved.

The health department at national headquarters reviewed its organisational structure. The post of polio coordinator was replaced by health programme coordinator, who has started initiatives for ensuring that the reproductive health needs of the vulnerable , particularly women and children, are met through the health units currently providing primary health care. Thus basic health units (BHUs), mobile health units (MHUs), maternity and maternal and child health centres (MCH centers) and even secondary care hospitals will ensure access for women at "one window" reproductive health integrated primary health care services.

Job descriptions are being revised in a manner that reproductive health related responsibilities for different positions in the primary health care service provision would be incorporated.

BHUs, MHUs and MCH centres are ensuring that comprehensive reproductive health/family planning services are provided within the primary health service provision set-up.

Three health department staff members along with PRCS secretariat staff were trained in Microsoft Office automation, for better understanding of computer applications.

Two district branches in each of the four provinces will be strengthened or established, using health as the entry point: Health activities continue in all branch areas, particularly in Balochistan where MHUs and BHUs are providing both preventive and curative care. The BHU in Noshki has considerably enhanced its sphere of activities mainly related to health care, which serves as an entry point for the newly planned district branch.

Establish/strengthen training centres at national and provincial level to provide first aid/ community-based first aid (CBFA)/other community-based training as per PRCS training policy: As an ongoing activity, the Pakistan Red Crescent first aid training centre continues to conduct first aid training courses for external organisations such as private companies and the police. The income generated through these trainings is used for further development of the training centres.

To enhance the capacity of these centres to improve quality first aid training to meet an ever-increasing demand, a proposal was drafted and approved by ICRC to support these centres in 2004.

In order to update and improve the first aid knowledge and skills for national society staff and volunteers, a three day refresher training was held.

CBFA continues to be a vital part of community-based disaster preparedness (CBDP). The CBFA book was revised and a second edition was printed. It contains information not only on first aid but also on the seven principles and disaster preparedness.

Linkages continue with the Family Planning Association of Pakistan, and staff and volunteers in Lahore, Karachi and Islamabad were trained/re-trained as CBFA trainers.

Increased community capacity to respond to emergencies and save lives by working towards the long-term goal of "A First Aider in Every Home": The curriculum and syllabus of first aid courses are constantly being revised and adapted to meet the needs of the communities. An essential part of all first aid training is information on the Movement and how the seven principles can be applied to first aid. The topics of HIV/AIDS, high risk behaviour and gender equity are also included in the courses.

Negotiations with the Trust for Voluntary Organisations has resulted in the arrangement for approximately 1,100 members of various community-based organisations working throughout Pakistan to be trained in emergency first aid. This training will commence in 2004.

World First Aid Day was combined with the launch of the World Disaster Report for 2003. This emphasised the role of first aid in disaster preparedness.

Greater sustainability of health programmes through increased local resource mobilisation: Income from first aid training courses in the private sector is expected to become a regular source of funds. With the increase of capacity to deliver quality first aid training, there exists the prospect that not only will centres become self-sustainable but will also be able to support the CBFA programme for vulnerable communities.

The strategy for cost recovery of health units through service provision is not very successful as the most vulnerable are only able to pay a token amount.

Contraceptives are being procured at nominal cost and distributed through national society health care facilities providing reproductive health services. Information, education and communication material (IEC) and training through the Ministry of Population Welfare (MoPW) is being provided free of cost for national society health staff. However, other costs of participants are covered through donor funds.

Increased partnerships in relevant sectors of health with other organisations and government departments in Pakistan: Through a collaborative arrangement with MoPW, PRCS health staff are being provided with training in family planning /reproductive health at the Regional Training Institute of MoPW, free of cost.

The PRCS works closely with UNICEF in polio eradication initiatives. Collaboration for developing a children's book in Urdu on first aid and adaptation of topics suitable for children is underway.

The national society is a member of the UNAIDS theme group. New linkages have been developed with other NGOs such as AMAL and New Light, working in the areas of HIV/AIDS. AMAL has undertaken sensitisation of PRCS staff on all aspect of HIV/AIDS with a particular emphasis on stigma reduction and discrimination. New Light works with people living with HIV/AIDS and has been identified for a collaboration activity once the national society Voluntary Counselling and Testing (VCT) pilot project is implemented. Collaboration with the MoPW for providing training in family planning and reproductive health services to national society health staff is underway.

Community health services project - Provision of basic curative and preventive health in existing health facilities, with external support for Balochistan/North West Frontier Province (NWFP) health units:Balochistan province has three working BHUs in Chaman, Quetta, and Muhammad Khel and three MHUs in Mastung, Qilla Saifullah and Quetta. The NWFP has one BHU in Torkhum and two MHUs in Tajabad and Sethi Town. Activities conducted according to plan were as follows:

A total of 38,355 people living in remote areas of Balochistan province benefited from MHUs which continue to provide health care to local communities and refugees through health education, CBFA training and general health care.

Uniform reporting formats for MHUs and BHUs have been prepared and will be shared with the stakeholders for approval thus ensuring uniform reporting by health units in both Balochistan and NWFP. Essential medicines have been procured and supplied to the said provinces.

Both Balochistan and NWFP were visited by the national headquarters monitoring and evaluation teams and the services being provided by the units were found to be satisfactory.

Additional medicines were also provided to Balochistan and NWFP provincial branches for their health outlets. Reproductive health medicines and equipment were also provided.

A health network meeting was held in December which, in addition to assessing progress, also helped in identification of various problems and formulation of strategies for overcoming them. The meeting was attended by national headquarters project managers, provincial secretaries, provincial programme officers and health staff from provincial branches.

Increased provision of reproductive health services in existing health facilities: It is recognised that empowering women is important in itself and is also a key to improving quality of life. Men have an important role in bringing about gender equity and equality, and in fostering women's full participation in development and improving their reproductive health.

The PRCS strategic plan for reproductive health focusses on adoption of the World Health Organization's (WHO) definition of reproductive health. It ensures the health care services are appropriate for the complete life span of both males and females.

A needs assessment for provision of reproductive health services by BHUs, MHUs and selected MCH centres was undertaken by the health programme coordinator , following which a detailed programme was developed in consultation with provincial secretaries, provincial health officers and regional training institutes' representatives. A total of 22 doctors and 37 paramedical support staff have been provided training in family planning counselling and service provision at MoPWs Regional Training Institutes free of cost.

Equipment for reproductive health service provision, along with other essential items required for primary health care, have been procured for all MHUs and BHUs in Balochistan, NWFP and Shah Alam Hospital Lahore.

Increased health education and awareness, using CBFA as the basic approach: The province of Balochistan continues to impart CBFA training through its health outlets. A total of 3,707 men and women have benefited from this training. The NWFP also imparts CBFA training through MHUs/BHUs and MCH centres, though not reflected in the reports.

Efforts are being made to ensure that all volunteers working in CBDP programmes are given training in first aid.

Pakistan Red Crescent Society is recognised as a key player in the prevention of the spread of HIV/AIDS: The HIV/AIDS strategy plan is still in draft form and needs further inputs from branch secretaries and health care providers before it becomes part of the overall national society health policy.

In order to ensure that the PRCS is an effective key player in prevention of HIV/AIDS, a series of workshops was arranged for staff at national headquarters and the Punjab provincial branch for sensitisation on HIV/AIDS and awareness regarding stigma and discrimination. The sensitisation sessions was facilitated by AMAL.

The national society is in the process of setting up a VCT centre in Punjab with support from the Japanese Red Cross society. The location for the centre has been identified and terms of reference for the consultant have also been finalised. Interviews have been held and the final selection is pending. The consultant will start work in early 2004 and will develop a project proposal, and implement and initiate the pilot project. If successful, this pilot project will be replicated in other branches.

The PRCS hosted the third South Asia Red Cross/Red Crescent Network on HIV/AIDS (SARNHA) meeting in August 2003. The meeting was followed by a workshop on the project planning process. A total of 22 participants attended the meeting, which included SARNHA members from Afghanistan, Bangladesh, Nepal and Sri Lanka. Two representatives from a local NGO run by HIV positive people also participated. The observers were from the Asia Regional taskforce on HIV/AIDS, Federation regional delegation Bangkok, South Asia Regional Delegation (SARD) and IFRC Geneva. The objectives of the meeting were to review activities carried out by the national societies and SARNHA coordination office against the action plan developed in the second SARNHA meeting held in December 2002, and also to review the draft of SARNHA's strategic plan document. The strategic plan was discussed and then revised and subsequently finalised and shared with all the network members.

The health programme coordinator attended the 3rd International Refresher Course on Sexual Health in Bangkok, organised by Consortium of Thai Training Institute for STDs and AIDS. The coordinator also visited the VCT centre run by the Thai Red Cross society, providing a valuable update on HIV/AIDS and its management.

The deputy director of health and training attended the 6th International Home and Community Care Conference for People living with HIV/AIDS, held in Dakar, Senegal which provided an opportunity for exchange of experience with other partner organisations.

Polio eradication efforts are continued and other immunisation programmes scaled up: The PRCS continues to be an active member of the National Steering Committee on Polio Eradication and has participated in deliberations with global and national partners in endeavours to make Pakistan polio free by 2005.

Detailed guidelines have been provided to the provincial branches for full coordination and cooperation with the provincial polio committees. The role of district branches in social mobilisation during polio campaigns is to ensure administration of polio drops to all children attending national society health outlets.

Most of the PRCS primary health care units have the basic vaccines available for DPT, BCG and polio drops for routine immunisation of children, while Hepatitis B vaccine is available at subsidised rates at some of the health units.

Maintain programme of recruitment of voluntary non-remunerated blood donors: The blood donor centre at national headquarters held 50 blood camps and collected 1,864 units of blood during 2003.

As part of donor education and motivation activities, lectures and distribution of IEC material to 200,000 beneficiaries were undertaken. Free distribution of 100,000 iron tablets and 1,500 copies of the Holy Quran for health support and for appreciation of voluntary blood donation was undertaken.

An award ceremony was held at national headquarters for recognition of blood donors. A computerised database for registered blood donors is in the process of being developed. A total of 1,445 blood donors were registered during 2003.

Impact

The BHU in Noshki has considerably enhanced its sphere of activities, mainly related to health care, which will serve as an entry point for the planned district branch.

Polio drops were administered to 852,918 children by national society volunteers during the immunisation campaigns. The national society raised awareness about the polio immunisation with the provision of 3,000 banners in districts where polio is still prevalent.

The national training and resource centre and branch centres trained a total of 2,114 people in first aid.

The health outlets of Balochistan and NWFP provinces provided health care to 139,134 people of local communities and refugees. Male and female motivators played an important role in providing health education and CBFA training to the people , bringing about a significant change in their lifestyle. Many of these beneficiaries have little or no access to health care other than that provided by the PRCS.

The society for Awareness of Blood Safety gave lectures to students in 70 schools. 5,000 young children benefited from these lectures on health, nutrition and awareness. This programme is being expanded to an additional 100 schools in Lahore.

Constraints

The absence of an effective human resource policy and standard salary structure has been identified as a major constraint and has resulted in rapid staff turnover.

Despite efforts, no further progress has been made to develop two new district branches in each province. Work is being undertaken to improve coordination between national headquarters and provincial headquarters to achieve this goal.

Construction of a training centre at the Balochistan branch is taking longer than anticipated and its completion is a priority. There is also the need to establish a training centre at Jammu and Kashmir state branch. Due to the increased demand for first aid, more staff are required at all levels.

Security issues continue to affect implementation of activities in Balochistan, particularly where health centres are located in refugee camps.

Scheduled training of 74 doctors, paramedics and support staff in family planning had to be cancelled because of non-availability of funds to cover other costs with concerned branches.

Although the heath capacity building and community health services are separate projects, they complement each other and at times the activities are combined. This leads to a duplication of reporting and new reporting processes will need to be examined.

Due to a combination of activities, particularly where training courses have been combined with monitoring and evaluation visits, or workshops and meetings are being scheduled back-to-back, there was an underspend of funds allocated to these activities.

For further information specifically related to this Annual Appeal please contact:

In Islamabad: Pakistan Red Crescent society, phone +92 51 925 7404, fax +92 41 925 7408

Irja Sandberg, Head of Delegation, email ifrcpk08@ifrc.org , phone +92 51 9257 122, fax +92 51 443 0754.

In Geneva: Jagan Chapagain, Regional Officer, email: jagan.chapagain@ifrc.org , phone +41.22.730.4316, fax +41.22.733.0395

All International Federation assistance seeks to adhere to the Code of Conduct and is committed to the Humanitarian Charter and Minimum Standards in Disaster Response in delivering assistance to the most vulnerable. For support to or for further information concerning Federation programmes or operations in this or other countries, or for a full description of the national society profile, please access the Federation's website at http://www.ifrc.org

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