Marvi Case study downloadable pdf - HANDS
Marvi Case study downloadable pdf - HANDS
Marvi Case study downloadable pdf - HANDS
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A STORY OF EMPOWERED AND DIGNIFIED WOMAN<br />
Kumari, lives in a remote desert village named Sadoori in district Umarkot, Sindh Pakistan. She<br />
is a housewife with three children. Her husband Mithan is a driver, her family income is so<br />
limited that most of the time they sleep empty stomach.<br />
Her life was limited only to her family and household chores, cooking, fetching water for home<br />
etc and incase get any time, it spends with gossiping with neighborhood women. One day few<br />
NGO workers came into her village they introduced themselves as an NGO worker name<br />
<strong>HANDS</strong> and explained their purpose of visit.<br />
Kumari becomes MARVI worker after getting this training<br />
she feel that Dai Kari and she can bring lot of change in<br />
women’s lives of her village. She started her work as per<br />
assigned job, to register married childbearing age women,<br />
pregnant women, and children under 3 years old of the<br />
village with the assistance of Dai Kari. <strong>HANDS</strong> Lady<br />
Health visitor started visiting her regularly and assisting<br />
her to verify the cases for Contraceptives, high risk women<br />
and malnourished children.<br />
<strong>HANDS</strong> team visited again and initiated the<br />
formal process of formation of men and<br />
women organization. They also asked them<br />
to nominate few women to interview to<br />
work as Health Worker and few Dais.<br />
Finally Kumari was selected by the<br />
committee for this position along with Dai<br />
Kari. Later <strong>HANDS</strong> workers trained her for<br />
the training of Community Health Workers<br />
and Dai Kari in exclusive Trained<br />
Traditional Birth Attendants Training.<br />
One day a relative of the landlord came to her house and asked her husband to stop, as he don’t<br />
like at all, the services Kumari has given and the selling of contraceptives and medicines.<br />
Kumari was shocked and scared to continue her work but times passed away and on a dark night<br />
of winter, someone knocked Kumari’s door, she was surprised to found that the landlord, was<br />
standing at her door with his one year old son in his lap. He showed her the child; the baby had<br />
high fever, so much so that the child was having fits, Kumari given cold sponging and 2 tea
spoons of syrup Paracetamol immediately, after half an hour the condition of the child improved.<br />
Kumari rechecked the fever and ask the father of the child that it was now safe to take the child<br />
to a clinic which she was told is declared as mother/child friendly by <strong>HANDS</strong> Staff.<br />
The next day the landlord came again to Kumari’s<br />
house. He called Kumari and her husband and told<br />
them that the doctor of the clinic had informed him<br />
that the timely first aid to the child in the village<br />
had saved his life. He had tears in his eyes. He said,<br />
"From today, Kumari will hold a place of pride in<br />
this village".<br />
Pakistan with the population of 177 million is at the<br />
verge of population explosion, after 63 years of<br />
independence, 64 million Pakistanis do not have access to health facilities, 276 women die out of<br />
100,00 while giving births. Only 41 percent of women attended by skilled birth attendant, 75<br />
children out of 1000 live births die before their first birthday. Although 95percent Pakistani<br />
Women have knowledge of at least one modern contraceptive but the Contraceptive Prevalence<br />
Rate is only 29 percent. Considering the low literacy among women folk’s, the LHWs program<br />
could cover only 54percent of population. Thus leave huge 46 percent highly marginalized<br />
population vulnerable for ill health and hence deaths.<br />
District Umerkot is the poorest district of the country located in Southern region of Sindh<br />
Province of Pakistan. It consists of barren tracts of sand dunes covered with thorny bushes. The<br />
population of the district is 860,000. The 49percent population is non Muslim that is Hindu, and<br />
most of them (74percent) are low cast, almost 74percent of them are living under the poverty line<br />
with literacy rate of only 6 percent. 53.6 percent of the total population is deprived of Lady<br />
Health Worker Services in District Umerkot.<br />
The Marginalized Areas Reproductive Health and Family Planning Viable Initiatives – MARVI,<br />
aims to pilot a model project for integrated project of community development. Word MARVI<br />
considered as dignity and women empowerment, is adopted from the name of women in folk<br />
stories.<br />
The project linked livelihood with Reproductive health & family planning services in LHW’s<br />
uncovered areas. Health And Nutrition Development Society- <strong>HANDS</strong> implemented this project<br />
with the assistance of Thardeep Rural Development Program – TRDP and collaboration of<br />
district health and population welfare department. The financial assistance to the project is given<br />
by The David and Lucile Packard Foundation.
The first phase of MARVI project initiated from<br />
1st November 2007 with baseline survey and has<br />
concluded on October 2010. The base line <strong>study</strong><br />
was conducted before the start of intervention.<br />
The social mobilization strategy was initiated with<br />
the formation of 700 health committees or<br />
community groups. 1128 members of these<br />
groups trained. One MARVI worker and a Dai<br />
were selected per 700 to 1000 populations per<br />
village and hence 350 villages were identified.<br />
The total population benefitted from the project is<br />
400,000 directly and whole district population of 858000 indirectly MARVI Workers and<br />
Traditional Birth Attendants (TBAs) were trained through 12 training events, which is over all<br />
60 days for each provider.<br />
The Project has trained 350 MARVI Workers and 350 TBAs and has supplied with health<br />
products which include basic medicine, ORS, Safe delivery Kits, sanitary pads, condoms and<br />
contraceptive pills and iodized salt on subsidized cost. Project also supported to MARVI workers<br />
with stipend of rupees 1200 per month and nearly 30 percent subsidy for each supply. Each<br />
<strong>Marvi</strong> Worker has asked to establish a “MARVI HOUSE” in one of the corner of their house.<br />
They are also supported by a record keeping system.<br />
After o3 years of intervention the End line evaluation stated the mean age of MARVI workers<br />
was 30 years. The End line evaluation depicting that majority of 63 percent of the MARVI<br />
workers had attended at least primary schools. Printed material, posters, and flip charts sets were<br />
displayed by 93.3percent MARVI Workers; it was almost same in MTR.<br />
The knowledge of MARVI workers about the<br />
three years was found 90 percent. A referral<br />
strategy has developed by MARVI workers for<br />
their respective villages. The strategy was<br />
comprised of identification of women with danger<br />
signs during Antenatal, Natal and Post Natal<br />
period, identification of readily available vehicle<br />
with the contact number of driver.<br />
The volunteer blood donors have been identified<br />
in all 350 villages and their lists were developed,<br />
the village based telecommunication that is<br />
wireless phone / cell phone and transport sources were available and identified in all villages,<br />
their name and contact numbers were displayed in 74 percent of MARVI houses in end line<br />
findings.<br />
MARVI has referred nearly 54255 women, 8594 children with complications to secondary care<br />
facilities and save their lives. TBA’s conducted 6951 normal deliveries by using 53percent safe<br />
delivery kits while it was used 47 percent in MTR.
End Evaluation verifies that 83 percent of MARVI Workers know the recommended number of<br />
antenatal checkups that is at least 4 antenatal during the pregnancy. 100 percent MARVI workers<br />
reported 02 and more than 02 postnatal checkups necessary during the post partum period. 51<br />
percent of the <strong>Marvi</strong> workers had knowledge of at least 4 danger signs of antenatal, natal and<br />
postnatal period. 41.1% of the TBAs have able to identify at least 04 danger signs during<br />
antenatal, natal and postnatal period.<br />
<strong>HANDS</strong> designed its Behavioral Change Communication strategy on the basis of SMART Chart<br />
communication technique, 17 sets of posters; flip charts and other material were provided to<br />
MWs as health education material. MARVI is conducting health awareness sessions with the<br />
assistance of TBA by using this material. Up till now they have conducted 41316 health<br />
awareness sessions and 42000 women support group meetings during phase I and reached to<br />
659196 participants. As part of advocacy strategy MARVI project organized many mass<br />
mobilization events like MARVI Health and Cultural Mela, Women Festivals, Children Mela<br />
etc. The End Evaluation results revealed that 93 percent women knew about MARVI and 65<br />
percent women knew about availability of Family planning methods with MARVI worker. In<br />
End Evaluation 96 percent women knew about at least one modern method of contraception. In<br />
the End Evaluation current users of Family Planning were 22percent in comparison of 9.3percent<br />
in Baseline.<br />
Women's knowledge of Family Planning Methods<br />
Injectable<br />
Oral Pills<br />
Condom<br />
IUCD<br />
Tubal Ligation<br />
Vasectomy<br />
Others<br />
3<br />
2.1<br />
5<br />
6<br />
12<br />
19.3<br />
23<br />
29.7<br />
33.1<br />
35<br />
39<br />
49.7<br />
50<br />
59<br />
62<br />
73<br />
78<br />
82.8<br />
85.5<br />
0 10 20 30 40 50 60 70 80 90<br />
End Evaluation MTR Baseline<br />
25<br />
20<br />
15<br />
10<br />
5<br />
0<br />
Current Users of Family<br />
Planning Methods<br />
9.3<br />
14.5<br />
22<br />
Baseline MTR End Evaluation<br />
It reflects that there is an increase of 12.7percent<br />
in current user of Family planning from the<br />
baseline. 56.2 percent women identified MARVI<br />
House as a source of Family Planning methods in<br />
comparison of 41percent in MTR. 37percent of<br />
the married women sought antenatal care in their<br />
last pregnancy in End Evaluation, as compare to<br />
31percent in MTR.
According to End line evaluation 93 percent of women knows MARVI house have present<br />
within their villages. 62 percent women mentioned TBAs as their health care provider within<br />
their community/village. 82 percent women identified MARVI workers as health worker within<br />
their Villages.<br />
<strong>HANDS</strong> social marketing department ensured the smooth supply of health products throughout.<br />
MARVI worker were able to sale the health products of amount 2.3 million and earned average<br />
Rupees 1700 per-month.<br />
End Evaluation results showed that 55 percent TBAs had knowledge of three cleans of delivery<br />
i.e cleaning of hands, clean place of delivery, use of safe delivery kit, while it was 31 percent in<br />
Baseline. End Evaluation results also observed that 70 percent TBAs have knowledge about<br />
three delays against 73 percent TBAs in Baseline.<br />
MARVI project also supported 50 public sector health facilities through supplies, equipments,<br />
technical training and developed into women friendly health facilities.<br />
<strong>HANDS</strong> Monitoring Evaluation strategy starts from community based record of MWs, reported<br />
through Health promoters and then district to office web base data base which link to the head<br />
office. There are regular supervisory / Orientation visits by HANDs senior and midlevel<br />
management teams, monthly progress reviews, midterm reviews and annual reviews were<br />
conducted to maintain quality. District Government officials from Health & Population<br />
Department also supported in supervision.<br />
MARIV pilot project model has proved that when there is no lady health worker, a low or no<br />
literate girl if trained as community health worker along with trained TBAs can deliver<br />
Reproductive Health and Family Planning Services with the support of community based groups.<br />
The success of MARVI intervention already took her out of the boundary of District<br />
Umerkot. Million of Pakistani women and children are waiting for her. Let’s help us to<br />
scale MARVI intervention throughout Pakistan<br />
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