midwifery project report idsp-pakistan

Annual Report of Midwifery Project 2012

Annual Report of

Midwifery Project [MAA]

A LEARNING INSTITUTE ENABLING PEOPLE TO CHANGE POWER

STRUCTURES

Figure 1 Batch of 2012 to 2014

2012

Naheed Hassan

Fellow of IDSP Sindh-Pakistan 9/30/2012

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Figure 2 : By Rozina Kanwal , Midwife from Quetta

No woman should die giving life.

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List of Acronyms

CMW Community Midwife

HANDS Health, Nutrition and Development Society

RTI Regional Training Institute of Quetta

IDSP Institute for Development Studies & Practices

TDSP Trust for Development Studies & Practices

L.H.V Lady Health Visitor

CGF Charitable Gift Fund

AKU Agha Khan Hospital

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Director: Dr. Quratulain Bakhteari

Author of the report: Ms. Naheed Hassan & Rubina Usman

Editor of the report: Ms. Asma Zafar

Mr. Saeed Shah

Composing & designing: Asma Zafar

Naheed Hassan

Rubina Usman

Muhammad Yaseen

Financial Reporting: Mr. Muneer Shaikh

Supported by: Ms. Naheed Hassan

Muhammad Yaseen

Correspondence: Institute for Development Studies & Practices (IDSP - Pakistan)

7-A, Al-Mashriq Street, Arbab Karam Khan Road | Quetta, Pakistan

Email: [email protected], [email protected]

Ph: 0092-81-2470243 - 2471776

Fax: 0092-81-2447285

Trust for Development Studies & Practices (TDSP - Pakistan)

House No.56-R Mahmood Ghznavi Road,

56-R, Block-2, P.E.C.H.S | Karachi, Pakistan

Email: [email protected], [email protected]

Ph: 0092-21-34549009

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Table of Contents

Acknowledgement………………………………………………………………………….

Glossary of Acronyms……………………………………………………………………..

1. Message from the Founding Director IDSP-Pakistan

2. Executive Summery

3. Introduction of IDSP/TDSP

4. Introduction of Partner Institute HANDS

5. Background

• Pakistan Maternal Health Indicators

• Referral System

• Scope of Practice Midwifery

6. Affiliation with the existing courses of the HANDS ,CMW School

7. Midwifery Training Program Continuing Medical Education(CME)

(2 Months Refresher Course)

8. The Project

9. Project Planning

10. Project Objectives

11. Project Implementation

12. Selection of Training Institute

13. Overall Course contents

14. Faculty of Course

15. Project Location of CME Course

16. Midwives’ Selection Criteria

17. Partnership with HANDS

18. Criteria for Training

19. Learning Facilities

20. Identification and Selection of Suitable Candidates

• Selection Committee

• Selection Criteria for Midwives

• Orientation Phase

• Selection Process

• Project location in Sindh & Balochistan Provinces

• List of Selected IDSP CMW

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Table of Contents

Admission Criteria:

21. Overall Course Quarters

• Details of each Quarter

• Result of PTS Examination

• Medical Checkups of IDSP CMW

• Result Hepatitis B & TT Vaccination of All CMW Students

22. Challenges of Changing World

1. APPENDICES

Appendix A: Pictures of Midwives

Appendix B: News Clips

Appendix C: Agreement of Midwives for training

Appendix D: Flyer of the Course

Appendix E: Test & Interview Sheet

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Acknowledgement

The process of designing and conducting this project, collecting information and

analysing the training institutions and initiating a new concept of developing midwives

was very challenging .The consultation meetings & field visits during the inception of this

innovative project provided sound basis to determine the focus of this initiative.

We are greatly indebted to the blessings of Almighty God we are able to compile this

report of the Project. It is a matter of immense pleasure and pride that we accomplished

this task within scheduled time and with required quality.

We value the efforts of Ms. Joan Kagle, whose generous support, understanding and her

exceptional intellect for human being suffering on our challenges is exceptional .It was

not possible to make reality of midwifery training in the remote areas of Baluchistan and

Sind; without Ms. Kagle’s kind cooperation. Her gift will help us create midwives’ network

in communities across the provinces of Baluchistan and Sind, thus help to save mothers

and deliver their babies with love, respect and professional support.

We are very thankful to MS. McArdle, Alison from Fidelity, Charity Gift fund, for helping

us in preparing in our contract and guiding us regarding management and operation of the

project.

We are deeply obliged to Dr. Qurat-ul-ain Bakhteari, Founding Director of IDSP-Pakistan

and the Trustees as we as the Team Leader of Midwifery training project for trusting the

capabilities & providing leadership and encouragement to project’s team at all levels.

We are thankful to the Training Institution HANDS, particularly Mr.Khalid Pervaz -Senior

General Manager-Health Promotion Program HANDS ,Mr. Tanveer Shaikh- Chief

Executive HANDS and Ms .Musarrat Rani- Principal Community Midwifery School of

HANDS Jamkanda,Karachi,Mr. Mir. Mumtaz Khaskheli Chief HID Executive of HANDS and

Mr.Ahmad Jan- Provincial Manager of HANDS Quetta, Balochistan for their support.

We deeply acknowledge the genuine support of Dr. Samina Hussain from Regional

Training Institute Quetta, Asia Mangel-L.H.V from Khuzdar ,L.H.V Shreen from Mustung

&Najma- L.H.V from Sibi for identifying committed young women for midwifery training

from Balochistan.

We highly acknowledge the teaching and training staff from Agha Khan Hospital for their

training and assistance, Dr. Kaneez Fatima, Dr.Naresh Kumar Gowalani, Dr.Rifat, Ms.

Kauser Saeed Khan, Pharmacist- Afshan Naz,Ms.Farzana & Mr.Syed Ali Bilgrami .

We highly appreciate the support of Mr.Safder Hussain- Associate Director of IDSP

Quetta, Saeed Shah-Project Director Academic Development Program and Ms. Kamal Jan-

Associate Director Women Leadership Program and its Team.We also acknowledge the

support of Mr.Hubdar Ali Project Manager of ZAANT district campuses.We appreciate the

effort of Mr. Khalil Ronjha- Coordinator IDSP campus in Hub in selection of potential

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midwives from Hub .We are also thankful to Taraki Foundation and Individuals who

supported us during selection process of potential midwives in Sindh and Balochistan .

The excellent professional efforts of Ms Robina Usman Coordinator of Midwifery project

are highly appreciated. Ms. Usman’s technical guidance and supervision was excellent in

post training assessment and we got good results. It is due to Ms. Rubina’s efforts and

leadership that we are able to present the achievement of first phase in this report. It is

highly important to recognize the excellent leadership role played by Ms.Sajida Khir

Mohmmad- coordinator of Midwifery Project ,Balochistan.It was Ms. Saijda’s effort and

co-ordination that we were able to enrol more than 15 women from Balochistan.To

satisfy the families of the girls was a great challenge that Ms. Sajida faced and solved

very professionally .

We are thankful to the Mr.Muhammad Yasin -Admin and Finance Manager TDSP, TDSP

team, Ms.Sadaf Younas - Accounts Assistant, Mr.Mehmood Ahmad-Admin Assistant and

Mr.Hameedullah- Admin and HR Manager IDSP who provided administrative and

financial management support & facilitation throughout the project activities. We highly

acknowledge Mr. Muneer Shaikh- Chief Financial Officer of TDSP Karachi & Mr. Sayed

Asher Ali- Program Manager of TDSP Karachi .We are thankful to Ms. Asma Zafar -

Manager Institutional Support of TDSP/IDSP-Pakistan for providing great support to

achieve the project goals.

We want to acknowledge the contributions of Fidelity Charity Grant Funds and

Ms.Alison’s efficient support in guiding us to follow the agreement.

The last but not the least, we appreciate the efforts made by the families of the selected

young women for Midwifery Training .Their efforts demonstrated the commitment and

will of the poor ,struggling rural families, who accompanied their young daughters ,

sisters ,wives & relatives to ensure the safety and meaningfulness of leaving them for two

years in Karachi’s training hostel .

Ms. Naheed Hassan

Lead Faculty Member

Midwifery Project

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Executive Summary

The present report covers Oct. 2011 to Sept. 2012 project period.

The project was conceived in view of the acute need for the rural women for their

maternal health care for safe deliveries. The encouragement and support from Ms .Joane

Kagle made the concept real. The excellent funding support from Fidelity Charity Gift

Funds, the institutional infrastructure and the excellent women graduates in the rural

Balochistan created by IDSP’s Women Leadership Program, with overall support of the

Trust for Development Studies and Practices Pakistan, made it all happen.

The report gives an overview of the status of maternal mortality rate of Pakistan in

general, focusing Sindh and Balochistan particularly. Pakistan has one of the highest rates

of maternal, pre-natal and child mortality recorded internationally. Research indicates

that 40 per cent of all deaths in Pakistan are preventable.

Some the major areas covered in the present report is the mobilization of more than fifty

families and communities in 20 or 25 districts of Balochistan and Sindh. About 100 men

and women to Karachi to ensure that all that we had claimed in our motivation and

community education processes is true and real, and their women will be safe and there

is not influence of men in the whole environment. The project management team did an

excellent job of hosting the families in the IDSP hostel in Karachi, gave them full

orientation, with food and bedding, arranging their travel to the training institute. A

detailed orientation was given again on the training institute and the living space as for

the under training women. Then they participated in the inauguration ceremony of

midwifes training course. The whole event went on for a week, before all sent beak

happy and satisfied.

The other major breakthrough that helped was the purchase of a building for midwifes

hostel and IDSP’s office in a very modest and safe middle class locality in Karachi. The

establishment of the hostel was one of the fundamental part of midwifes project. The

IDSP’s midwifes do not go home on weekends, they all come to IDSP hostel and relax, go

to sea side, to entertainment parks, zoo and market places, films, theaters, they take

gender and women empowerment classes for leadership training. Their families come to

meet them, and they can call their families.

Another achievement is IDSP and HARD partnership for midwifes training. HARD is a very

practical and relevant training institution. It not only teaches and training midwifes but

also has a very well designed health program for the women student of midwifes

training.

Besides the launching of a two years midwifes training program, refreshers, for the

previously trained midwifes was also held. It was also a very great opportunity for

midwifes to learn about medicine, herbal treatment, communication skills, gender

relation and dynamic, plus their own health care as women.

One very fundamental outcome is the pre midwifes training cost for two years courses

and for start three month refreshers (see the financial report). The report also explains

the technical aspects of the course in details.

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Introduction of IDSP/TDSP

A lot has been done - Much remains to be done still:

Institute for Development Studies and Practices IDSP-Pakistan, is an emerging national

research and practice based national institution based in Balochistan & is working under

the umbrella of Trust for Development Studies & Practices (TDSP). It is committed since

its inception in 1998 ,to its mission of creating, nurturing and engaging adolescents,

youths and young women and men in to professional cadres of community development

with a connection to national and international opportunities. Its major focus is on

excluded adolescents, youths and young population from the national mainstream of

formal education, life as a citizen and from decent, dignified and meaningful livelihood.

(Especially for women)

IDSP today, is managed and operated by its young graduates and fellows who were its

learners in its courses or who joined to create it as part of their practice based learning

since 1998.Since its inception IDSP has launched 12 development courses, 5

mainstreaming gender in development courses, three course cycles of reflective learning

for adolescents & one community development course. These are some of the major

courses that have engaged more than 5000 youth and young numbers of youth across

the country.

Today IDSP'S young managers, program directors, faculty members as fellows of IDSP are

engaged in nurturing and developing directly full time 37 fellows who are working with

more than 70 + communities across Baluchistan and Sindh. While more than 2000

graduates are engaged in social, economic and political activities and programs. Many of

them are on leading position in public and private sectors, from community to

international levels.

The idea of IDSP stemmed out of a critical need- to create a learning space for the

development and intellectual bolstering of the different groups of the motivated

individuals from various fields of research and development. IDSP has been conducting

theory and practice based courses on the themes of development studies, Gender

mainstreaming and community development. The hub of IDSP activities is Quetta. IDSP

mainly engages the excluded adolescents, young people from various parts of Pakistan in

a stimulating learning process in which they share, learn and create together practices

for people-cantered development and sustainable community partnerships.

Introduction of Partner Institute: HANDS

Organization Name: Health And Nutrition Development Society

Acronym: HANDS

Website Address: http://www.hands.org.pk

HANDS registered tax exempted and PCP certified, European Union Accredited, not for

profit organization, working since 1979 with key programs of Health, Education, Poverty

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Alleviation, and cross cutting programs of Social Mobilization, Gender, Human and

Institutional Development, Disaster Management, Information and Communication,

Monitoring, Evaluation, Research and Social Marketing. HANDS are benefiting more than

13 million people of 16,703 villages in 24 Districts of Pakistan.

The participatory approach of HANDS makes it popular among communities and

transparent its decisions and activities that perpetuate its partnership with the

community and government. HANDS was formally registered in 1993 and has undertaken

many projects during last 16 years (1993 – 2011). These projects reflect HANDS expertise

in many sectors, such as health, education, poverty infrastructure training (capacity

building), gender & development, social mobilization, public awareness and early

childhood development.

Background: Overview

Increasing women’s access to quality health service to have the best possible health care

during pregnancy and childbirth is a basic right of every woman. There is much that

needs to be done. Every year approximately 350,000 women die while pregnant or giving

birth, up to 2 million new borne die within the first 24 hours of life, and there are 2.6

million still births. The overwhelming majority of these deaths occur in low-income

countries and most of them could have been prevented. This happens because of no

access to functioning health facilities or to qualified health professionals.

Pakistan has the highest mortality ratio in South East Asia. As per available statistics 80%

of females deliveries at home by unskilled workers called by basic name (Dai). Only

trained persons can save motherhood in the communities and avert maternal mortality.

Pakistan Maternal Health Indicators

� Pregnant women receiving prenatal care: 61%

� Births attended by skilled personnel: 39%

� Births in Health Facilities: 35%

� Women receiving postpartum care: 22%

Figure 3- National Nutrition Survey Report 2011- Aga Khan

IDSP conducts two types of courses regarding midwives trainings which include three

months practice based course for those women who are already trained in the field of

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midwifery but only require practice. After the oral assessment of selected midwives they

are provided 3 months in-house training with practices. IDSP bears cost of all trainees

including boarding, lodging, transportation, and resource material. IDSP has already

conducted 2 months training with support of Quttar Hospital and one (1) refresher

course with support of Aga Khan Hospital. IDSP has affiliated trainings with HANDS CMW

School which is registered by Nursing Counsel Pakistan. The IDSP program model is

comprised of 3- month training courses. During practical session these midwives trainees

have dealt more than 1150 delivery cases in Quttar Hospital Karachi.

Secondly IDSP includes fresh girls/ women for the two year theory and practice based

courses which are being implemented with the collaboration of HANDS training

organization in Karachi. This course is held in IDSP Sindh Campus and 25 learners are

enrolled from Sindh and Balochistan.

A referral based system had been introduced to enable them to link up with secondary

health outlets public sector. In addition, a network of midwives has been devised as per

their geographical areas. This network serves as a platform to share experiences and

provides help where needed. The network is linked with the Doctors, Pharmacists,

Teachers and Midwives, providing health facilities to community whenever required.

Referral System

Figure 4- Referral system

Scope of Practice-Midwifery

o The midwife works in partnership with women, on her own professional

responsibility, to give women the necessary support, care and advice during

pregnancy, labour and the postpartum period up to six weeks, to facilitate births and

to provide care for the new-born.

o The midwife understands, promotes and facilitates the counselling processes of

pregnancy and childbirth, identifies complications that may arise in mother and baby,

accesses appropriate medical assistance, and implements emergency measures as

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Figure 5- Skype Meeting

with Director of IDSP

necessary. When women require referral, midwives provide midwifery care in

collaboration with other health professionals.

o The midwife may practise in any setting, including the home, the community,

hospitals, or in any other maternity service. In all settings, the midwife remains

responsible and accountable for the care she provides.

The Project: “MAA”

IDSP is focusing all interventions to build capacity of youth and women in Baluchistan.

The province has least health facilities especially for Mother and Child care because of

less accessible areas and lack of human resources. Based on previous experiences and

utilizing existing human and technical resources, IDSP has designed a project for rural

women and children for mother & child health care. The project, called “MAA”, is

designed in a way to establish capacity of local women in Midwifery and extend their

access to far flung areas so as to provide Mother and Child care and reduce mortality

among pregnant women and new-borns.

Project Planning

The planning phase consisted of consultative meetings,

selection of training venue, course guidelines, selection

criteria of Trainer & Trainees and suggestions for training

points as an important part of planning. The consultative

meetings gave ideas to develop partnership with training

Institutes and developed support mechanism for midwives.

Midwifery Hostel

To facilitate the midwives during their stay at Karachi, IDSP

has purchased a building that serves as a hostel for Midwifes.

Due to it the family members and relatives of midwives can

easily meet them when the midwives feel homesickness due

to being away from their families for long .The administration

of the hostel also provides them entertainment opportunities

by taking them to picnics, dinners, etc.

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Figure 6. IDSP's Midwifery Hostel, Karachi

Figure 7. Inauguration Ceremony of Midwifery Hostel by the midwifes themselves

Figure 8. Cake Cutting Ceremony by midwifes to celebrate their own hostel newly purchased

Figure 9. Well come to Midwives’ Families in IDSPs Midwifery Hostel

Inauguration (18 months course) and 5th

Graduation Ceremony of CME course

From March 30th

to April 3rd

,2012 the ceremony Inauguration (18 months course) and

5th

Graduation Ceremony of CME course was celebrated at IDSP’s Midwifery Hostel.150

people had participated from Sind and Balochistan including Midwives, their family

members,relatives,friends IDSP Learners,Fellows,IDSP Quetta Team and HANDS

Team.IDSP provided all sort of assistance in organizing boarding,lodging,logistics,etc to

the participants.

Project Objectives

o Develop a new professional cadre of Midwives in Sindh & Balochistan.

o Develop physical bases for capacity building of women in Balochistan in Midwifery.

o Develop a network of midwives in Balochistan

o Bring Behaviour Change to procure Services of Midwives

o Provide refreshers and further institutional and community support.

Project Implementation

The project was designed with the consultation of faculty and training institutions. A

detailed discussion was held to conduct training and find out trainers for refresher

course study with the coordination of faculty of Aga Khan Hospital Karachi.

Selection of Training Institute

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Following institutions were visited and selected during the planning phase of the project:

1. Koi Goth Hospital Karachi: Dr. Shershah’s training institute

There was a problem of safety and security and also there was no practical space in

hospital. Moreover, the tutor of the training institute did not satisfy the Midwifes with

their behaviour, while attitude of Dr. Sher Shah & his team was extremely humiliating

and discouraging.

2. Aga Khan Hospital Karachi (Kharadar)

Aga Khan Medical University School of Midwife and Nursing has comprehensive training

program. But the assessment of their graduate revealed that they have less practical

training. Training of midwifery was started and AKU midwives completed 1st quarter of

training.

3. HANDS Community Midwifes (CMw) Training School Karachi

HANDS CMW training program at CMW School: this training Institute is located at Malir,

Karachi. The hospital has residential facility and well trained and professional staff to

build capacity of selected trainees in midwifery.

Affiliation with the existing courses of the HANDS - CMW School

IDSP affiliated its 3 months’ refresher course and the 18 months course with HANDS-

CMW school. Midwifery Basic Training duration is 18 months with the technical training

support of HANDS.IDSP’s program model comprises of 3 months training and refresher

courses. Before the course content was prepared in consultation with the trainers and

midwives ,it was agreed that after the oral assessment of selected midwifes they would

be provided 3 months for refresher course and 18 months in house training with

practices. IDSP bears cost of all trainees including boarding, lodging, transportation,

shoes, and resource material.

Midwifery Training Program Continuing Medical Education CME (3 Months Refresher

Course)

A comprehensive training program was designed for 35 selected midwives of Balochistan

for 3 months course. Following themes have been selected for refresher course:

Overall Course contents

1. Women Leadership

• Concept of Gender

• Violence against women

• Women & civilization

• Media roll and issues

• Health & Nutrition

• Self Awareness

2. Reproductive Health of Women

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• Antenatal care & Medicine (PIH,APH, Abortion, ,Partograph ,Pre-term labor)

• Postnatal care & Medicine

• PPH

• Infertility

• Stis

• Lab Reports

• Menstrual Cycle pelvis

3. Women and Motherhood

Child Care & Medicine , IUGR,Perpullum,Breast Feeding

A: First Month

� Concept of Gender

� Violence against women

� Women & civilization

� Menstrual Cycle pelvis

� Unani and Herbal Medicine

� Health & Nutrition

B: Second Month

� Media roll and issues

� Self Awareness

� Antenatal care & Medicine (PIH,APH, Abortion, IUGH,Partograph ,Pre-termlbor)

� Postnatal care & Medicine

C: Third Month

� PPH

� Child Care & Medicine

� General Medicine

� First Aid

� Infertility

� Stis

� Lab Reports

� Recitation of Holy Quran

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Faculty

Mr. Ali Ms. Raheela Dr. Sara Dr. Kaneez

Dr. Nareesh Pharmacist Afshan Naz Dr. Rifat & Kausar S.K

• DR: NARESH KUMAR GOWALANI

M.B.B.S from Chandaka Medical College (University of Sindh, Jamshoro)

• Dr. Kaneez Fatima

Resident Medical Officer AKU

• ASHAN NAZ

Pharm D from Federal Urdu University.

• Muhammad Ali Bilgrami

M.Phil

• Ms.Raeela

Master in Herbal Medicine

Project Location of CME Course

In its Refresher course IDSP identified midwives from Balochistan province for practical

training. During the planning phase IDSP selected 28 midwives from 8 districts of

Balochistan and provided practical training at Sindh Government Quttar Hospital,

Karachi.

Midwifes’ Selection Criteria (CME COURSE)

o Midwives from the villages of Balochistan

o Midwives who have completed their theoretical training

o Willing to serve their communities in maternal and child health care

o Having creditability in their communities

o Ages between 20-3

o

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Figure 10- Partnership with HANDS

Figure 11. Midwives in Class Room

Midwifery Training Program (Basic 18 Months Training )

A comprehensive training program was designed with

collaboration of HANDS CMW School.This is basic

training of midwifery which has a duration of 18

months and is divided in 6 quarters. IDSP selected 25

midwives from Sindh & Balochistan for 18 months

course. Following are the details of overall process

from advertisement to 2nd

quarter of training because

this training will be completed in September 2013.

Partnership with HANDS

1. Improving access to the safe maternal & new born

Health Care services in rural areas of Sindh &

Balochistan through developing skilled local

community midwives.

2. Enhancing women empowerment & leadership

through the CMW training program

Criteria for Training

o Recognize training Institute

o Availability of trainers

o Infrastructure

o Equipped facilities

o Labor room condition

o Operation theater

o Classroom facility

o Residential facility available

o Facility of community work

o Facility of antenatal & post natal care

Learning facilities

o Midwife training Center

o Practical Room

o Library

o Para medical staff ready to facilitate

Identification and selection of suitable candidates

Selection Committee

� Regional Training Institute (RTI) Quetta Team

� Leady Health workers (LHW) in Balochistan Team

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� Institute for Development Studies & practices (IDSP-PAK) Balochistan Team

� Health & Nutration Development Socity (HANDS-PAK) Sindh Team

Selection Criteria for Midwifes

� Willing to serve their communities in maternal and child health care

� Female preferably young and not restricted from home.

� Permanent resident of the area from which she is applying

� Qualification: 10th

grade preferably science background

� Age: 18 – 25 Years

Orientation Phase

1. Adds in 2-3 most popular local newspapers in local and national languages ( KAWISH

,MASHRIQ ,JUNG IKHBAR. )

2. Developed pamphlets & distributed them through personal contacts, Lady Health

Workers and IDSP learners / graduates.

3. NGOs (Taraqi Foundation ,RDO ,Aurat Foundation,)

4. Line Department (RTI, Women university, Balochistan University, girls collage ,

Islamia collage ,vocational centers , Health centers )

5. CBOs , Community and personal contacts

Selection Process

• Target of midwives was 30 from Balochistan & Sindh.

• Balochistan (Sibi ,Quetta , Mustung ,Khuzdar Lasbela , Panjgur ,Turbat, Kalat

,Kharan ,Noshki,Bolan ,Nasirabad, Pishin,Gawadar ) 14 districts

• Sindh ( Larkana ,Khirpur ,Mirpur Khas , Dadu , Karachi ,Hyderabad ,Hala

,NawabShah , Shahdad Kot ,Jamshoro)

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Project location in Sindh & Balochistan Provinces

1. Karachi

2. Dadu

3. Larkana

4. Khairpur

5. Hyderabad

1. Zhob

2. Naseraad

3. Sibi

4. Quetta

5. Kharan

6. Mustung

7. Khuzdar

8. Lasbala

9. Pangur

10. Kech

11. Gwadar

Balochistan

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List of Selected IDSP Community Midwives

S/NO Pictures IDSP CMW Province

1

Arifa D/OAbdul Samad

Balochistan

2

Asia D/O Abdul Rauf

Sindh

3

Atia D/O Amanulla

Balochistan

4

Azra D/O Nazir Ahmed Mir Khan

Sindh

5

Bakhtawar D/O Ahmed Khan

Sindh

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6

Farzana D/O Nawaz Ali

Balochistan

7

Fauzia D/O Mola Buksh

Balochistan

8

Gulnaz D/O Raaza Muhammad Khan

Sindh

9

Muniza D/O Muhammad Hussain

Balochistan

10

Nayta D/O Amir Hamza

Balochistan

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11

Nargis Malik D/O Pir Jan

Balochistan

12

Reema D/O Abdul Qadir

Sindh

13

Saima HashimD/O Muhammad Hashim

Sindh

14

Safia D/O Abdul Jabbar

Sindh

15

Salma Hassan D/O Hassan

Balochistan

16

Salam Sultana D/O Muhammad Panah

Sindh

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17

Samreen Akber D/O Muhammad Akber

Sindh

18

Shahida Parveen D/O Moula Bukhsh

Balochistan

19

Shaheen D/O Ghulam Sarwar

Sindh

20 Sultana D/O Abdul Qadir

Sindh

21

Sajida Parveen D/O Muhammad Essa

Balochistan

22

Sunober D/O Muhammad Juman

Sindh

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23

Surya D/O Safdar

Sindh

24

Rubina D/O Muhammad Ibrahim

Sindh

25

Zahra D/O Noor Buksh

Sindh

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Admission Criteria:

Documents required for selection are following

• Matriculation (10th

grade) Certificate.

• Matriculation Mark Sheet.

• Domicile Certificate.

• Character Certificate.

• Citizen National Identity Cards (C.N.I.C)

• Two Photograph.

Training is divided in 6 quarters and each quarter is based on 13 weeks .After every 13

weeks exams are due .The details of quarters are as follows:

Overall Course Quarters

1st

quarter P.T.S Examinations------------ after 13 Weeks

2nd

quarter-------------------------------------after 13 Weeks

3rd

quarter -------------------------------------after 13 Weeks

4th

quarter -------------------------------------after 13 Weeks

5th


6th


Weekly Class test = 4 total, per month

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Details of each Quarter

Quarter: 01

Week 1 Week 2 Week 3 Week 4 Week 5

Orientation Orientation General anatomy

and physiology

General anatomy

and physiology

Microbiology


Microbiology Pharmacology Pharmacology First Aid First Aid

Week 11 Week 12 Week 13

Basic nursing care Basic nursing care Basic nursing care

Quarter: 02


Basic nursing

care Basic nursing care Basic nursing care Review exam Break


Introduction to

midwifery

Reproductive

system:

female pelvis

Reproductive

system:

female pelvis

Fetal Skull

Female external

genitalia

Female

external

genitalia

Male

reproductive

system


Physiology of

reproduction:

Fertilization

Preparing for

pregnancy

Infertility

Physiological

changes of

pregnancy

Quarter: 03


Antenatal care

Hands on

training in ANC

Antenatal care

Hands on training

in ANC

Antenatal care

Hands on training

in ANC

Antenatal care

Hands on training

in ANC

Management

of first stage of

Labour

Hands on

training in LR


Management of

first stage of

Labour

Hands on

training in LR

Management of

first stage of

Labour

Hands on training

in LR

Management of

first stage of

Labour

Hands on training

in LR

Physiology and

management of

second stage of

labor

Hands on training

in LR

Physiology and

management

of second

stage of labor

Hands on

training in LR

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Physiology and

management of

second stage of

labor

Hands on

training in LR

Physiology and

management of

second stage of

labor

Hands on training

in LR

Physiology and

management of

second stage of

labor

Hands on training

in LR

Quarter: 04


Physiology and

management of

third stage of

labor

Hands on

training in LR

Physiology and

management of

third stage of

labor

Hands on training

in LR

Physiology and

management of

third stage of

labor

Hands on training

in LR

Management of

Puerperium

Hands on training

in post partum

ward

Management

of Puerperium

Hands on

training in post

partum ward


Family planning

Hands on

training in FP

clinic

Family planning

Hands on training

in FP clinic

Abnormalities of

early pregnancy

Hands on training

in Gynecology

clinic

Sexually

transmissible

diseases in

pregnancy

Hands on training

in Gynecology

clinic

Disorders

caused by

pregnancy

Hands on

training in

Gynecology

clinic


Disorders caused

by pregnancy

Hands on

training in

Gynecology

clinic

Diseases

associated with

pregnancy

Hands on training

in ANC clinic

Multiple

pregnancy

Hands on training

in ANC clinic

Quarter: 05


Prolonged

pregnancy and

disorders of

uterine action

Hands on training

in LR

Malpositions and

malpresentations

Hands on training

in LR

Obstetric

emergencies Hands

on training in LR

Complications of

third stage of labour

Hands on training in

LR

Complications of

third stage of

labor

Hands on

training in LR

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Care of the

newborn

Hands on training

in Newborn

Nursery

Care of the

newborn

Hands on training

in Newborn

Nursery

Care of the newborn


Newborn Nursery

Care of the newborn


Newborn Nursery

Breast feeding

Hands on

training in Breast

Feeding Clinic


Breast feeding

Hands on training

in Breast Feeding

Clinic

Health Education

Practical training in

HE classes

Health Education

Practical training in

HE classes

Quarter: 06


Health Education

Practical training

in HE classes

Health Education

Practical training

in HE classes

Community

Midwifery

Home visits and

community work

Community

Midwifery

Home visits and

community work

Community

Midwifery

Home visits

and

community

work


Community

Midwifery

Home visits and

community work

Community

Midwifery

Home visits and

community work

Community

Midwifery

Home visits and

community work

Community

Midwifery

Home visits and

community work

Community

Midwifery

Home visits

and

community

work


Preparation

leave

Preparation leave Final Assessment

Examinations

Result of PTS Examination-CMW School HANDS Jamkanda

Roll

NO

Name of CMW Anatomy

&

Physiolo

gy(100)

FON

(100)

First

Aid

(50)

Micro

biolo

gy

(50)

Phar

ma

(50)

First

Aid

(Viva)

(25)

A/P

(Viva)

(100)

Micro

(Viva)

25

Phar

m

(Viva)

(50)

FON

(Viva)

(100)

Total

(650)

1

Arifa D/O Abdul

Samad 74 78 44 43 37 20 65 22 43 63 489

2 Asia D/O Abdul Rauf 64.5 65 36 38 31.5 17 53 16 28 74 423

3 Atia D/O Amanulla 52 72 40 41 36 20 54 22 44 54 435

4

Azra D/O Nazir

Ahmed Mir Khan 77 90 42 43 35 18 56 17 36 63 477

5

Bakhtawar D/O

Ahmed Khan 32.5 60 26 30 16.5 13 50 15 8 16 267

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6

Farzana D/O Nawaz

Ali 52 66 37 26 32 16 60 18 26 35 368

7

Fauzia D/O Mola

Buksh 38 69 34 34 20 16 54 19 32 52 368

8

Gulnaz D/O Raaza

Muhammad 80 74 45 44 27 20 90 23 39 72 514

9

Muniza D/O

Muhammad Hussain 83 95 47 46 32 21 83 24 44 84 559

10

Nayta D/O Amir

Hamza 89.5 81 48 34 36 20 78 23 40 56

505.

5

11

Nargis Malik D/O Pir

Jan 73 90 40 46 32 10 65 22 43 66 487

12

Reema D/O Abdul

Qadir 75 69 33 43 31.5 21 56 23 37 69

457.

5

13

Saima HashimD/O M

Hashim 67 85 42 39 28 20 76 23 40 69 489

14

Safia D/O Abdul

Jabbar 87.5 86 43 40 32 21 68 23 35 78

513.

5

15

Salma Hassan D/O

Hassan 71 82 43 39 29.5 20 72 20 44 79

499.

5

16

Salam Sultana D/O M

Panah Malah 19 30 30 25 30 13 10 15 16 19 207

17

Samreen Akber D/O

M Akber 39 65 37 39 33 17 55 18 39 69 411

18

Shahida Parveen D/O

Moula Bukhsh 82 A 40 46 27.5 19 71 24 42 77

428.

5

19 Shaheen 81 82 45 44 36.5 18 70 22 39 63

500.

5

20

Sultana D/O Abdul

Qadir 76 71 32 41 29 19 78 22 38 52 458

21

Sajida Parveen D/O

M Essa 78.5 71 43 43 32 18 68 23 39 64

479.

5

22

Sunober D/O

Muhammad Juman 52 71 40 33 34 16 50 18 35 34 383

23 Surya D/O Safdar 63 78 39 41 21 17 56 22 28 73 438

24

RubinaD/OMuhamm

ad Ibrahim 65 68.5 40 29 25 20 55 20 32 75

429.

5

25

Afshan KhanD/O

Meer Muhammad 86 89 44 48 34 21 60 23 45 86 536

Medical Checkup of IDSP’s Under Training CMW

The medical check-up was done in two phases. 19 CMWs’ were checked in first phase in April,2012.5 CMWs’ had medical check-up in

May,2012.These Tests include: 1. CBC

2. Blood glucose

3. Urine D/R

4. Hepatitis B antigen

5. Hepatitis C

6. Chest X- Ray

7. ESR

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Results

1. Treatment has been started according to the needs of students.

2. CMW treated according to their problems.

3. Ms. Bakhtawar is Hep C positive case but at a very initial phase and with no

problematic symptoms, her treatment is in process.

Hepatitis B & TT Vaccination of ALLCMW Students

Activities:

1. Gathering of CMWs.

2. Introduction of Hepatitis

3. vaccination& TT

4. Vaccination done

IDSP has provided financial assistance and helped

midwives in fulfilling the following requirements:

• Domicile

• National Identity card

• Bank Accounts

• Use of Bank Cards

Challenges of Changing World

o Social & cultural barriers for residential course

o Law & order condition generally in Karachi and

Baluchistan specifically for girls.

o Bringing behavior change to allow girls out of

province & out of city, hostel living.

o One interesting lesson was that unmarried young

women who were not exposed to any kind of

medical setting related to child birth; it was too

over whelming for the women without any

exposure of maternity related work or

environment.

o Too much use of cell phone

o Home sickness

o Missing the family celebration occasions

o Knowledge of English language in medical

writings in books.

It is a very major achievement that we addressed all

the above mentioned challenges with excellent

result, except one challenge and that is law and

order situation in the city of Karachi and Balochistan.

Figure 11. Midwives during Vaccination

Figure 3Midwife during TT Vaccination

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Way Foreword

• Conduct 3 CME Refresher courses in which we have to graduate 75 midwives

(25 midwives in each course) by September, 2013.

• Organize Certificate Distribution ceremony in September 2013.

• Get partnership with government health departments in Sind and Baluchistan

• Monitor and evaluate the needs of midwives.

• Give awareness t midwives on Women Leadership and Self (particularly on

counseling)

Figure 4 Traditional welcome with AJRAK (Shall) Figure 5. Midwives' Selection Process in SINDH

Figure 15 Midwives’ Selection in BALOCHISTAN Figure 16 Lamp lighting Ceremony

Figure 17 Certificate Ceremony of CME Course

Figure 18 Labour room

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Figure 19 Midwives’ during Examination

Figure 20 Midwifes hostel in CMW school

Figure 21 Midwives dormitories

Daily Kawish is a local being published in Sindhi language in Sindh province of Pakistan

Advertisements in Local News Papers

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This pledge was taken by the Midwifes on the start of the course with candle lights.

International Pledge for Midwifes

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Figure 22 Back view of CME course Certificate

Figure 6Front View of CME Course Certificate

Figure 7Front View of Brochure Figure 8 Back View of Brochure

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Reading Material given to Midwives for the support