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Experiences
September 4, 2025
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1. Introduction:

Health is among the core areas of interest of AWARE. Here is brief about the experience and some innovative work done since 2003 by AWARE in southern districts of Sindh, Pakistan especially in Thar Desert.

AWARE started the health intervention in Tharparkar, Umerkot, Mirpurkhas and Sanghar districts and one of the main objectives of intervention is to improve health and hygiene conditions of women and children in the target area and reduce the mortality rate in both mothers as well as infants. Furthermore, for improving health and hygiene conditions in the area, community mobilization and capacity building of traditional birth attendants has also been initiated which also contributed in to reduce the new born mortality and improve the health of mother and children. One health related some examples are set and being advocated.

2. Collaborative Engagement with Health Department:

2.1 X-ray Machine & Incubators for THQ Chachro 2011

Since September 16, 2011 the X-Ray machine of THQH was out of order and patients had to go to Mithi (DHQ) which is 94KMs away from Chachro for X-ray DHO Tharparkar requested AWARE to support in getting the non-functional X-ray machine repaired. But the machine was beyond repair. Thereafter AWARE was successful in getting resources mobilized from Action Aid Pakistan for new X-ray Machine. Thus one 100 ma new X-ray machine was purchased and installed at THQH Chachro.

Two Incubators were given to THQ Chachro by AWARE

2.2 CBC Analyzer Machine to the THQ Chachro 2021

AWARE believes that our Govt institution be supported in improving their service delivery. THQ Chachro had been supported on different times. AWARE with the support of TDH provided CBC analyzer machine. so, for 47,148 tests are done and this and this is big relief for the common people of area. https://m.facebook.com/story.php?story_fbid=pfbid02dGcYP7Kz2VcFBFth5WS9M9E4SMm2q4Z5xzyNNjSyVQ41Wygq48vy3yQXuuEVM1zel&id=100068645631746&mibextid=9R9pXO

2.3 WHO supported centers:

Two Diarrhea Treatment Center and two Acute Respiratory Infection Treatment Center in THQ Jhudo, Naukot, Digri, Sanghar and Chachro were established during flood 2011.

2.4 Support in DEWS:

The collaboration meeting conducted with DHO and district Focal person of vertical programs for strong planning reduce the overlapping activities among government agencies. District Focal person of DEWS was supported in identifying cases in field.

2.5 Support in EPI Outreach:

AWARE signed agreement with health department and provided support in effective vaccination and follow-ups under EPI drives in district Tharparkar. AWARE is also contributed in polio campaign by providing mobility support to field workers in remote areas to contribute in eradication of polio virus from the country. AWARE staff also created awareness among the communities on the importance of vaccination and mobilized and motivated the communities to make the vaccination campaign success.

Moreover, with the providence of vehicles by AWARE children vaccinating staff reached the children relatively with ease and on time. Otherwise in the shortage or absence of transport the government staff faced difficulties in reaching out the far-flung areas with difficult terrain.

3. Health and Hygiene Awareness:

To increase the health awareness among women in target areas, AWARE Team forms health clubs and which are run by the members of these health clubs. Health staff professional has to thoroughly orient health club members on the health and hygiene conditions. The members also are sensitized regarding personal health and hygiene condition, about the causes and consequences of diseases. Professional health experts (Male/female) are engaged to provide information on the preventive measure and treatment. It is integral part of our approach and for that different methods are used; including theatre, awareness sessions, video shows, village cleaning campaigns through school children etc. For women separate sessions are held on menstrual hygiene. Some of pics of such activities can be viewed here https://www.facebook.com/photo.php?fbid=322292797947686&set=a.322292734614359.1073741846.100005009049443&type=1&theater

4. Mother and child health care services:

Healthcare of mothers and new born were arranged in tehsil Chachro in which 750 mothers participated. Mothers were made aware about the problems of mothers and their new-borns, root causes of complicated health problems of mothers and possible solutions in given circumstances were discussed. Earlier LHV along with health team regularly visited the mothers and after seeking information about the problems of mothers provided authentic consultation.

5. Referral Mechanism and Regular Checkup of Pregnant women:

AWARE worked for Mother and child health care to contribute reduction in maternal and neonatal mortality ratio, ensure safe motherhood practices through health education. AWARE experienced in both curative and preventive side component. In curative side provide the services of mother and child health care through referral mechanism. AWARE team identify the pregnant women at target location of district, issue the referral card for maternal health care in which antenatal care checkup, lab test, delivery services (Normal and C-Section), postnatal care and nursery care included. In this process many taboos, myths, traditions and costumes regarding health care faces as the barriers. All health services have been provided by Love & Trust Hospital; a good health facility managed by Korean team in Chachro town. At this moment, 409 pregnant women have been benefitted from this service and about 80% mortality rate of children & mother have been decreased so far. According to the collected data by LHV and file team, a good impact is observed after the capacity building of TBAs. As per record, 210 babies have been safely delivered at home by TBAs and 278 PW were referred to Love and Trust Hospital at Chachro for ANC, and 54 women were delivered babies in hospital. https://web.facebook.com/pg/AWARE-tdh 154136231753968/photos/?tab=album&album_id=289304464903810
https://web.facebook.com/pg/AWARE-tdh 154136231753968/photos/?tab=album&album_id=277670049400585

6. Menstrual Hygiene & Health

AWARE provided 3500 sanitary pads for the adolescent girls. This practice was not common in the area. Team also oriented the community to develop these sanitary pads locally.
https://m.facebook.com/story.php?story_fbid=pfbid02XGtWy3tfwQ8NCvD9aDaGJQaEXchxZaudYhFnHTRiSJUDEARnKL6E1SaZ1gumwij7l&id=154136231753968&mibextid=Nif5oz

7. Health – Nutrition Link:

In arid area, water availability and access are big issues so, community have no or less opportunity to grow vegetables. So, AWARE experienced that where water is made available there community has grown vegetables/done kitchen gardening even waster water has been used for the good health

8. TBAs Capacity Building:

AWARE trained the local TBAs on necessary topic of maternal child health care & assign the task for ensured the safe deliveries, safe practices regard mother and child health care. They played their role well manner, educate to local communities. Trainings for TBAs are organized and professional health consultants conduct the trainings and TBAs are equipped with practical knowledge and awareness on observing hygiene and care of pregnant women and new born babies. For proper initiation of work, further information and clarity with respect to the change taken place for delivery procedures like use of hand gloves during delivery and ensuring safe delivery kits, proper care of the baby and proper breast feeding with key messages.

As the result, about 80% TBAs are using safe delivery kits and about 70% women are delivering babies in safe hygienic condition in project areas. TBA’s shared that at the time of selection for capacity building, they refused AWARE team to participate because they were scared off about safe delivery and might be a difficult for them but AWARE team encouraged for training, and we participated in training, consequently, we are delivering baby successfully as well as safely and we are very much thankful to AWARE team for giving us chance to enhance our capacity, knowledge and skill. We are now using safe delivery kit.

9. Mobile Health Camps

Mobile camps were organized among the community for provide the primary health care services and mother and child health care services. Trained staff planed and organized at faraway far flung areas of targeted union councils.

10. School Health:

During reporting period 10 health and hygiene sessions were held in 10 schools and total 1233 students were orient ed. The nail cutting and self-hygiene was focused. During these sessions de-worming syrups were given to 2000 children and the result is very positive and encouraging. Children besides being educated on be set and simple health and hygienic practice s were also given hygiene kits containing nail cutters, combs and bath soaps etc. The children in school practically utilized the hygienic kits which created better cleanliness and hygienic conditions in school environment as well as they were urged to take the hygiene kits to their homes and get thenails of their family members cut and motivate them to apply the same practices in home as it was done in schools.

11. Health in Emergencies:

11.1 Floods

AWARE organized 350 hygiene promotion sessions with 8,323 IDPs 3,220 male and 5103 female participants. Hand washing with soap was also the focus of the hygiene promotion activities. Hygiene kits containing bath soaps, cloth washing soaps, female sanitary cloths, towels, torches, comb, toothpowder, nail cutters and jerry cans were distributed. Tokens were issued to the verified beneficiary’s venue and date of the distribution point was also communicated to the beneficiaries well ahead.

11.2 Droughts

  • Health access to 600 pregnant women (referral mechanism)
  • Organize 75 Awareness and capacity building sessions on personal general health and hygiene
  • Organize 100 awareness sessions on mother and child health care
  • Organize 100 awareness sessions on reproductive health
  • Sign MoU with Government Health department for healthy spacing and health child and mother campaign
  • Orientation of project staff and AWARE key staff regarding MISP in detail with a focus on referrals.
  • Close coordination with district health department to raise the awareness of community on harmful effects of early marriage on child and mother.

12. Setting examples:

AWARE under TDH funded project supported 13 patients of 10 project villages. These patients were facing different disease like TB, epilepsy etc. AWARE was aimed to set the example and mobilize the communities that diseases are curable and by proper treatment patients can be cured. Hhere are ssomem examples of patients who were supported and they got recovered their health https://fb.watch/nl2Cm46-iZ/?mibextid=9R9pXO and before treatment community was hopeless and taking such diseases as a curse.

13. Mental Health:

Due low literacy level and unawareness, community in rural areas found less aware and sensitized about mental health and its consequences. AWARE Team set some models and then mobilizes community around the issue, cause and effects; i.e. there were two brothers of village Rohal Wai district Umerkot suffering from mental illness and they were chained at their homes for more than seven years. AWARE with the support of psychiatrist Lakesh Khatri supported them in treatment and now they are spending normal life. AWARE also supported Mushtaq Ali in establishment of small shop now he has his own shop; https://m.facebook.com/story.php?story_fbid=pfbid06obU5AcgSZE3vbxwspqVwCWMqAaZqVEwhhhzVpLy5YBMrJyFHMntsKnbgr7LjUgpl&id=100010550467237&mibextid=Nif5oz

In this way so many other examples set and then guided the community for proper treatment.

14. One Health:

AWARE started a project in May 2016 for 14 villages of 02 Union Councils; Charnore and Heerar Taluka Chachro of district Tharparkar. There are three main components of project; 1. Education (strength Govt primary schools; solar PV systems, WASH, computer education, trainings of teachers and SMCs etc) 2. Livelihood (alternate; rural poultry, kitchen gardening, trees plantation; moringa, date palm and grafted beer, vocational skills – drivers, cook, electricians and auto mechanics,) and 3. Health (mother and child focused; preventative and curative), TBAs trainings and kits provision for safe deliveries, safe drinking water provision through mobile RO and solar powered water supply schemes with water metering

Reduced MMR & IMR: At the time of project initiating, the base line was conducted and the data of previous year May 2015- April 2016 shows high rate of MMR & IMR and after the intervention of AWARE, MMR & IMR decreased. The following graph is self-explanatory.

According to data from May 2015 –May 2015 Mother Mortality is 4 and Child Mortality is 55, the from May 2016 – April 2017 Mother Mortality is one and child Mortality is 19, from June 2017- October 2018, Mother Mortality Rate is zero while Child Mortality is 09 and from June 2018- October 2018 Mother Mortality reduced to zero and child mortality was five. This is one of the example of one health and some extent proved effective in context of Tharparkar.

15. Community health groups interaction with health experts:

The situation of District Tharparkar is varies from the other districts of Pakistan; geographic position, terrain, population settlement pattern and density, communication network, literacy rate etc. There are different issues being faced by people of Thar and health is one of them. AWARE under TDH supported project organized community level sessions to address the issues, its causes and affects. Health expert was hired to build the capacity of health club members and community around the health issues. Prevention of diseases, awareness on cosmetic diseases, pre and post pregnancy complications, ANC& PNC, child nutrition, health education and first 1000 days mother and child support program by government of Sindh were part of discussions made during the mentioned sessions https://m.facebook.com/story.php?story_fbid=pfbid035BnHJdVx7FUjfHWwZtfyvYHjbByBazJbyu7SY29kPtL97diNdoAmanzkdd9KMah4l&id=100068645631746&mibextid=9R9pXO

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16. Collaboration with academia:

AWARE has experience of working with different universities and institutions, working on health associated issues. Study conducted with Dow University of Health Sciences on fluoride effects on health of Thari people. Liaquat University of Medical Sciences (LUMS) delegations had been visiting the areas and AWARE team facilitated the teams in carrying out different health camps.

Community medicines department of Agha Khan university set students to conduct research on affects of presence of nitrate in underground water of Thar.

17. Documentaries about AWARE’s work in health sector:

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