APWA HEALTH CENTRES IN PUNJAB, PAKISTAN
APWA is currently managing and sustaining 14 Family Planning Health Centres in various cities and towns sprinkled within the province of Punjab. The APWA Health Centres continue to function, both for family planning and general patients since 1985. They have been working under the direction of Mrs. Farrukh Nisar – ul – Haque, Senior Executive Member of APWA and the Lady Supervisor Health Centres, Mrs. Munawar Sultana. The Health Centres are run on single or double shifts daily by Lady Health Visitors, commonly known as the LHV. The latter are trained Health practitioners who continue to be updated in better practices and new products at regular intervals by Green Star and DTI training programs. They are supported by motivators who have played a vital role in informing the local women of the need for family planning. They are semi autonomous, where APWA is paying for a few costs and the rest are recovered by the LHV. Over a period of time, the statistics show clearly that there has been a change in the trend of thinking. The locals now believe that it is better to have few children and to provide them with a better quality of life. Every area has a running school where the local children are now being educated. More dispensaries, clinics and in some places hospitals have been set up close to the Health Centres. Some continue to attend to up to 300 patients a month. The reason is the trust that APWA has engendered in the respective communities. Patients come to Centres seeking other advice and support also. They are also given regular talks to inform them on varying issues that concern them.
The idea of setting up Family Welfare Centres in the province of Punjab, to help women plan better parenthood, was conceived in the year 1985 by the then, Chairman Coordinating Council, Zeba Zubair. APWA was approached and requested to open 6 Centres in Punjab with the specific purpose of providing population control advice, devices for woman and also general health medication.
The Coordinating Council arranged the funding, which included fixed and some variable costs while APWA approached pharmaceutical companies to donate necessary medication. The pirchi system was introduced – a nominal amount was charged to ensure that locals did not become completely depended. This continues to present day.
It was expected that the concept of family planning would not be well received. Therefore, the Health Centres were set up as general health clinics where woman were gradually introduced to the need and way of family planning. The Lady Health visitor recall occasions when they had to face harsh criticism, much skepticism and even defamation from the local residents in pioneering the cause.
The success of the 6 projects was very encouraging and gradually more centres were set up. In all, 14 centres mushroomed in the various cities and towns dispersed around the province of Punjab over some time.
However, with the death of the Chairman, the project lost favor and funding discontinued. NATPOW, seeing the overall success of the project became the donors in 1996. However, on the 26th of December 1999, APWA was given an apologetic 4 day notice and NATPOW withdrew its support.
An emergency meeting was called. After discussion, it was clear that both, the LHV and the patients were eager to continue the centres. Therefore, APWA decided in consultation with the Health practitioners to take alternative measures. These were as follows:
- The Centre were privatized and the monthly salary of LHV was discontinued (as a good will they were given a month’s salary)
- Pirchi fee was increased. The money was to go to the LHV.
- APWA continued to pay the Lady Motivator a fixed nominal salary.
- The LHV was given a nominal rent for the Clinic premises.
- A nominal amount for emergency medication was given to each Centre per month.
Hence, the Centre’s became semi autonomous Family Planning and Health Clinics, running under the direction of APWA Executive to ensure complete compliance to standard and select practices. The cost of running the project was reduced drastically while giving the LHV more authority to run the clinic and generate income.
Regular visits by a Lady Supervisor were set in place to ensure that meticulous records were maintained and no illegal abortions or false medication was being administered. The LHV were encouraged to take refresher trainings and courses to stay abreast of current research and practices.
Monthly visits to APWA headquarters in Lahore are regularly monitored. The LHV have to maintain strict records of patients. These are then scrutinized and concerns are discussed. The LHV get to meet and share information and experiences with each other. Usually, a talk is organized at these monthly meetings to motivate and guide the LHV.
The project has sustained itself since 1985 and the system in place has ensured that the Family Planning Health Centres function in strict accord to the principle and purpose propagated by APWA. The results over the 2 decades are tantamount to that. The family planning trend has decreased from the typical 8-9 children to 4-5 children per family. In some cases, it is even lower. APWA has been able to engender trust and reliance within these communities. Monthly talks on various subjects are organized in these venues for the local resident woman. The Centers are APWA strongholds that can be used as springboards to launch other initiatives as well.
APWA HEALTH CENTERS – VISIT FEBRUARY/MARCH 2016
There are 14 Health Centres dispersed in the Province of Punjab. Mrs. Amina Syed, Executive Member, APWA Punjab accompanied the Lady Supervisor Health projects, Mrs. Munawar during the routine inspection to Centres in and around Lahore. The purpose was not only to check the facilities and records but also to give the new Executive an overview of some projects on ground; to engage with the LHV and where possible community members to guage changing trends and needs for future initiatives.
THE GOOD LIFE APWA HEALTH CENTRE:
The LHV, Naema Akhtar, has been serving APWA since 1985. She is the pioneer health Practitioner. Her Clinic is the model Centre. During the course of the campaign for awareness, her experiences and journey are worth recording. Naema began her career when the mention of family planning was taboo – it was seen as a contravention to shariah. Working in several villages during the course of her career, she was an easy target for much criticism. Though not married at the time, Naema stoically promoted the need for family planning as essential to the health of the mother and well being of the child. It was vital to good parenthood and the development of healthy society. Her Clinic is located presently in Mansura off the Multan road in Lahore. Access to the area was a rough ride owing to the construction of the orange line. The Centre was situated in a narrow but clean paved lane with a signboard on top. Somewhat faded it marks the clinic. The clean entrance porch led to a room adjacent the main house. The room is designated clinic premises.
Widowed at an early age, Naema is a well versed in her field. Having served for so long she has not only a lot of knowledge of general ailments and family planning but has been taking refresher courses to keep herself abreast of current practices. Her experience at handling patients is also invaluable. However, Naema feels she is ready to retire. Her daughter has been formally trained by Green Star and also doing her Masters in Gender and Development. Her mention is important because she shares her mother’s passion and more than that is determined to serve APWA. Her association with APWA since her childhood when she visited the headquarters on the monthly visits with her mother is very strong.
Naema is highly regarded in the vicinity. Some of her older patients from other areas also come to her for treatment and purchase of the contraceptive devices. People have a long association with her. They have built a trust through her for APWA. Her patients come in the morning but mostly in the afternoon when they dropped children for tuition. Naema keeps a stock of medication, and devices that are promoted by Green Star. In a month she estimates that around she attends to some 50 family planning patients. The rest around 300 come with complaints of general ailments.
The Lady Motivator serves the Centre in informing younger married girls, and reminding regular patients of their upcoming appointments. Green Star also puts up advertising camps to inform and encourage woman in the area. The records are meticulously kept.
APWA HEALTH CENTRE – HUNJARWAL
The Centre is located on a roughly paved narrow lane. The car cannot go to the doorstep. Again the area is now restricted owing to the construction of the Orange line on Multan Road. The Clinic is located in an area where the residents are known to engage in illegal drug trafficking. Both women and men are involved. Nabila is the local LHV who has been serving APWA since 1995. She has hired a room on a residential street to attend the patients – woman and children. Centre in Parnawa was shifted here. The clinic is open from 9am to 2pm daily except Sunday.
The clinic is a small but kept clean. A makeshift curtain on the main door lends some privacy. A cupboard, a single hospital bed, a desk and some chairs crowded the room. The sheet was noticeably clean.
Nabila is given refresher trainings periodically. She maintains meticulous records, which are checked monthly by the Lady supervisor. She gets around 50 family planning patients and around 150 patients with general ailment complaints. These include primarily Anemia and Virginal discharge. Serious complaints requiring investigation are referred to the Government hospitals. Nabila does not handle any illegal drug addicts. APWA maintains and upholds certain key principles that have earned the Centre a repute of fair practice.
The Lady motivator was a local resident who also belonged to the respectable Syed family. This gave her easy access into homes. She also carried an APWA identification card. She set dates of regular visits on the patient calendar and played an important role in encouraging women to seek help as well as reminding the regulars of their impending appointment.
KALA KATAI – JAMIL PARK
The Health Centre is located near Shadhara. We drove over the River Ravi to travel to the Centre. The almost dry riverbed is home to nomads in makeshift houses and wandering cattle. The area of Kala Khatai is along the railway line and the roads were not paved and uneven. The people in the area are grocers and small business holders. The wives prefer to work from home – usually they make artificial jewelry. Since the means of the local residents are restricted they prefer smaller families. All the children go to school nearby. There are other small clinics and a nearby hospital but the local residents still come to APWA Health Centre for advice and general treatment. The sense of reliability is all – pervasive here also.
Rubina is the local LHV. Her mother, who has served APWA for a long time as a Lady Motivator, served to inspire her to be an LHV. She is well qualified and keeps abreast of current practices and new research with regular trainings. The local residents often come together and are given general information and motivational talks on varying subjects like food and nutrition, prevention of diseases etc.
The small clinic was in need of treatment. Marks of water seepage were obvious and a recurrent nuisance. The desk had rusted completely. Rubina had taken over in 2001 from another LHV who practiced in the same vicinity. Furniture and some essential medical equipment need to be replaced, namely the desk, sterilizer and weight machine.
The record is meticulously maintained. The patients who visit are around 150 per month, both general and family planning patients. Night – time emergency is referred to the nearby hospital. The trend is very clearly recorded here. In the last 2 decades, people have learnt to value small family and quality life.
APWA FAMILY PLANNING HEALTH CENTRE – MANGA MANDI:
The Centre has been recently housed within new premises, which has a primary school as well as a skill training Centre. The drive to the Centre is through an established town. The local residents work on the agricultural farmland, pine peeling and wool/stitching-manufacturing units.
Shamim Javed is one of the most experienced LHV who has been APWA for the last 20 years. She boasts of having successfully trained a 100 midwifes in 2001. The training organized under the aegis of APWA extended over 6 months. Shamim recalls that encouraging people to consider family planning was very difficult in the initial days. However, over the years the trend has changed and the use of family planning methods is no longer questioned.
The records are maintained regularly. The Clinic has been moved to the morning shift. The new building was clean and multi purpose. The family planning patients were recorded as 50 per month while the general patients with complaints of common ailments ranged to about a 100 a month.
Note: There had been a complaint that the Centre had been closed without notice on a weekday. According to the APWA code, an LHV must inform the Centre incase of an unscheduled closure. The Lady Supervisor was persistent in reminding the LHV of the infringement.
GREEN TOWN HEALTH CENTRE:
The Centre is located in the Green Town, which is near the Quaid –e – Azam industrial town. It is on the outskirts of the Lahore city. It is situated on a busy road among other shops. Dr Rehana Faiz manages the Centre. She took over from the last LHV, when she left for Canada. Dr Rehana has been a health Practitioner for 17-18 years. The Clinic runs from 2pm to 9pm.
General patients visiting the clinic are around 150 while the family planning patient’s range to around 121. The common ailments treated at the clinic are primarily Malaria and the Common cold. Litigation and more serious cases are referred to nearby Clinic. The area has other medical facilities but APWA is maintained its client base. Training was given by Dr Rehana to 100 midwifes under the aegis of APWA who are awaiting completion certificates.
The Centre organizes regular talks on various subjects to educate the local resident women on various issues. A gathering had been arranged on the visit. It was obvious that the LHV was regarded very highly among the resident women. She has been also helping them with personal issues at home and at work.
I was told that the Government school in the area had improved greatly owing to the efforts of the local MNA. The local resident women work in the factories. However, some with young children requested skill training in order to earn incomes while working from home.
The team visited 5 Centres in and around the city of Lahore over a period of 5 weeks. Inspection visit to the remaining 2 Centres in Lahore was canceled due to a close bereavement in the LHV’s family, and inclement weather. The monthly meeting has been organized on the 13th of April at APWA headquarters to meet the LHV from all Health Centres, including from other districts of Punjab.
These visits were part of the routine visits to check facilities and maintained records for the Family Planning Health Centres. There was an added purpose of gauging the trend in family planning pattern over the years and obtain an overview of APWA work on ground.
The APWA family planning health Centres are a testament to the strength and commited that is the hallmark of APWA. They are hubs serving the communities with integrity. They are stronghold serving at the grassroots levels, which are potential springboards for new initiatives.
A comprehensive plan must be drafted in consultation with all stakeholders before designing any training to be conducted in the Centres for resident women. Each area has specific features and needs, which must be considered in planning training and courses. For example, NARC provides training in growing organic kitchen gardens, and starting a nursery of vegetable saplings. These are sold to farmers. In wider areas the land can be used (Example Manga Mandi) but in urban dwelling where space is limited vertical gardens or verge cultivation can be introduced (Green Town). The Tetra Pak in Lahore have a training project to help people recycle waste as part of its Corporate Social Responsibility. All the Centres can benefit form the latter.
Courses in Nutrition and Hygiene, First aid, Ethics and Civics, Better parenthood, Psychological therapy, trauma therapy and legal aid would be beneficial in these communities. Training in growing vertical/ verge kitchen gardens as well as encouraging better cooking practices are essential for prevention of disease. The women patients at Centres had indicated that they need Skill training to generate incomes within the confines of their homes.
During one of the visits there was an unscheduled stop at Talab Sarai. It was most unsightly locality which needed a major cleanup. The visit incited the much needed waste sorting and management in our homes. This could be a key training leading to control, sort and raise income from selling the solid waste and developing alternates to the hazardous waste, for example making of the brown bags. There is a suggestion to ask the founder of the Aabroo initiative to address the LHV on one of their monthly visit. Aabroo runs a street school funded by income generated from selling sorted solid waste donated by donors.
In a country where reliability and integrity are rare to see, APWA has been able to convey them to the grass roots. The project is a model case history, which needs to be documented. The Centres have been able to sustain themselves in the face of changing paradigms and trends, with and without substantial funding.