First Progress Report of Midwifery Project

Dec 2009- August 2010

Submitted by: Institute for Development Studies and Practices (IDSPPakistan) Submitted to:

Email: idsp@idsp.org.pk

Website: www.idsp.org.pk

Acknowledgement
The process of designing and conducting this pro ect! collecting information and analy"ing the training institutions and initiating a ne# concept of developing mid#ifes is a very challenging #ork$ The consultation meetings! field visits during the inception of this innovative pro ect provided sound basis to determine the focus of this initiative$ %e are thankful to the head of training institutions particularly! reno#ned &s$ 'sia &angle from (TI! Dr$ Sher Shah, in Qatar hospital, has large number of patients for mid wife training and practice . Dr$ Sara! Dr$ Shaista and )aider Sahab from *atar )ospital for training and assistants! Dr$ Setna! Dr$ 'shraf *amurdin! Dr$ 'sad +aheer from ,ady Different )ospital and &s$ &all Principle of &id#ifery School! &r$ -adir .ull /araych! &s$ 0ausar S$0! &s$ Samina director school of mid#ifery and nursing and the teaching and training staff of 'gha 0han maternity home kharadar! Director school of Public )ealth Sindh &s$ 'bbasi! Drr$ 1aseen of District /ela )ospital for their professional contribution in processing and analy"ing the training institutions of /alochistan$ IDSP highly ackno#ledge the support and encouragement of fello#s2mid#ifes families for encouraging their young daughters for initiating this innovative pro ect in /alochistan$ %e are thankful to all the efforts made by &r$ 0halil for facilitating IDSP in selection of potential mid#ifes at )ub and also in conduction of orientation sessions for mid#ifes at respective district$ %e deeply ackno#ledge the support and encouraging participation of &s$ +ara Shahid )ussain! -oureen ,ehri! &s$ Shakira! &s$ Shahida 1ousaf! &s$ (a"ia! &s$ 0a#ish! &s$ -oor /ano! &s$ 'smat! &s$ Shena"! and &s$ -a eeba from districts in developing the feasibility of pro ect$ %e sincerely hope that through launching this pro ect IDSP #ill be able to enhance the capacity of young mid#ifes but also it #ill be a practical step of overcoming the maternal death ratio in the region$

Dr$ *uratulain /akhtiari 3ounding Director IDSP-Pakistan

Executive Summery

IDSP is a human resource development organization that believes in change by individuals. In this report IDSP highlighting the issue of women maternity and its reasons by consulting the trained midwifes. The report carried out the details of the inception of a new project around midwifes in Balochistan. The report also provides the details of the project feasibility, its processes of inception and some key findings of the maternal issues. Section one is focusing the introduction part of IDSP and project while it also provide the details of meetings and consultation during the field visits at Sawat Internal Displaced People (IDPS). While in section Two the details of designing project feasibility for training midwives in Balochistan. The report disrobes the picture of issues and possible solutions around existing potential midwives. The report is aimed to facilitate in understanding the meetings and consultation processes of developing human resource, its detail steps of engaging with its communities. The report also presents the picture of midwifery training institutions of Pakistan particularly in Sindh (Karachi and Balochistan, the methodology, the gapes and the potentials of training institutions. During the project designing and its implementations some challenges and outcomes are part of this report. While project future sustainability and its next phase is also described at the end.

A) Institute for development studies and Practices IDSP-Pakistan! is an emerging research and practice based national institution based in /alochistan$ It is committed since its inception in 4556 !to its mission of creating! nurturing and engaging adolescents! youths and young #omen and men in to professional cadres of community development #ith a connection to national and international opportunities$ Its ma or focus is on e7cluded adolescents! youths and young population from the national mainstream of formal education! life as a citi"en and from decent! dignified and meaningful livelihood$ IDSP today! is managed and operated by its young graduates and fello#s #ho #ere its learners in its courses or #ho oined to create it as part of their practice based learning8s since 4556 and still continues$ Since 4556 IDSP has launched 5 development courses! 9 mainstreaming gender in development courses! three course cycles of reflective learning8s for adolescents! one community development course! these are some of the ma or courses that engaged large numbers across /alochistan and Pakistan$ 's of today IDSP:S young managers! program directors! program directors! faculty members as fello#s of IDSP are engaged in nurturing and developing directly full time more than ;< fello#s! and these fello#s are #orking #ith more than appro7 =< communities across /alochistan$ %hile it more than ><<< graduates are 4<< percent engaged in social and economic management and decision making positions in public and private sectors! from community to international levels$ The effective of these ><<< graduates goes in to appro7$ directly on 4<<!<<< and indirectly on ;<<!<<<$ To name some of IDSP fello#:s engagements these are on important and immediate social and economic issues! concerns gender mainstreaming! peace and pluralism and youth activism! child labor and child protection! health and maternity and child! literacy! education and sustainable livelihood! democracy! disaster! child ! youth! adolescents! #omen rights of indigenous people and human rights in general$ In si7 districts IDSP graduates have established centers! campuses! net #orks and partnerships to practice organi"ation and institutional building processes$ 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$ Since its inception (4556) IDSP has been conducting theory and practice based courses on the themes of development studies! .ender mainstreaming and community development$ /ased in *uetta IDSP mainly engages the e7cluded adolescents! young people from various parts of Pakistan in a stimulating learning process! #here they share! learn! create

Section One Introduction Introduction of IDSP:

1.

together practices for people centered development and sustainable community partnerships$ (Third party evaluation by Dr$ 0aramat 'li ><<5! &r$ %asif (i"vi 4555! internal evaluations by academic program ><<?)$ B) Introduction/Background of Project: IDSP is a human resource development Institution created in 1998 in Baluchistan. The creator of IDSP Quratulain Bakhteari is a Skoll awarded of 2006. It all started when the army operations in SWAT against the Taliban occupation of Swat started in 2008 or 2009.Dr. Quratulain Bakhteari went over to Mardan and Peshawar and had meetings with the effected people and come up with some ideas that how IDSP can support them. She met the internally displaced people living in camps, in schools, in the homes of the people who offered everything they had. During the visits she got good support by Mohammad Ali a fellow of Ashoka, who is the founder of an orphanage in Swat. She also got support of Ms. Shad Begum, an activist of women organization from Dir, and Mr. Shaukat Sharar who is also a Ashoka fellow working on the mapping out the area and demographic of IDPS. During the meetings and visits Mr. Hussain Ali Sina played a vital role through his guidance and Mr. Mubashar Naqvi IDSPs AJK fellow also supported in this process. It was a very painful situation that women expecting babies in camps while the campus had no such facilities for these expectant mothers. According to a rough estimate some 60,000 women were pregnant and will be delivering babies with three to eight months, many needed immediate medical support. The women had no prior experience of hospitals and midwifes or lady doctors, they all had babies at home like a natural process assisted by knowledgeable women in the families or tradition birth attendant in the communities. Thereby the issues has been discussed amongst the group of individuals (mentioned as above) .After exploring several possibilities the team came up with this resolution that Establish Maternity Centers in the camps. Establishing the Maternal Centers: Dr. Bakkhtiari and Shad Begum with the support of local midwife established three maternity centers in three different school based camps. They hired midwifes, the midwives guided them to purchase the matter and instruments and the medicines needed, and within two days the maternity centers were functioning. Some of the tradition birth attendants and wise women from the camps also included in the team and together a base line designed and conducted inside and outside the camps. Team learnt that midwifes also treated out ailments as well for women and children. When Dr. Quratulain witnessed the effectiveness of midwife as a leader in womens health care, she decided to initiate a process of trainings for midwife from IDSPs plate form as an approach for womens leadership.

Course Designing for Midwifes:

For creating the bases of training midwifes some potential hospitals visited by Dr.Quratulain Bakhtiari , She had a meeting with an old and very well know Gynecologist Dr. Setna who is the founder of first midwife school Lady different hospital in Karachi. In the meeting the concept of training midwives shared in detail. He immediately agreed and offered all possible support along with free boarding and lodging, and a stipend of Rs. 300 per month. 2.

Section Two

Project Feasibility
IDSP runs courses for women leadership since 2003 and to date 300 young women from rural Balochistan. Semi literate or poor quality of high school graduate enrolled in IDSP courses on gender mainstreaming courses and graduated after 9 months. The concept shared with the faculty of IDSPs core program women leadership and its principal coordinator Ms. Noreen Lehri. As a result of this sharing it has been resolved that since its a new idea so the IDSP senior needs to get an orientation on the midwifery training and its whole concept. Thereby a study trip around this concept designed and a group of seven to eight women faculty members of IDSPs women courses traveled to Karachi and visited Lady Different Hospital in Karachi. We examined the possibilities of initiating a midwifery training program as a means for women leadership in community health. IDSP has been trying to start a maternal health care program as part of its mainstreaming gender courses. They stayed in the hostel, for two nights, and got detail orientation on the midwifery course, the length and requirements. They visited the Operation Theater, labor rooms, class rooms and library. All were very excited, and seemed to be motivated. The group analyzed the visit, and all were keen to work on the training for midwife in Karachi. The experiences of SAWAT and concerns of women maternity shared in detail and finally after several detail discussions, over eight or ten months a project designed and developed on midwifery training project to learn and understand the challenges as first step. Later, on lessons learnt we will keep adapting, learning and growing the project in to a viable midwifery training program of IDSP. There were bit of concerns, the requirement was at least 12 grade graduates, knowledge of English language, and live in the hostel in Karachi for 18 months. These were seen as a bit of an obstacle by IDSP women faculty. But however we all agreed that we will try to see if we find some women who will qualify. I also realized that there is also a need of fellowship for the trainee and at that time IDSP did not have funds to initiate this as a project, but we started the search for young women interested in the midwifery training. The best would have been that some of the senior women get enrolled and take the trainings this would have broken the inhibition.

Initiating the Project with Support of Fidelity Charitable Grant:

As a Skoll Awarders Dr.Quratulain attend Skoll World Forum each year in Oxford England. It was one of these forums that she and Ms. Joane met and discussed how to further support women in Pakistan. Sometimes in early 2009 IDSP got a very encouraging call from Joanne asking if IDSP is interested in midwifery training project. Dr. Quratulain recommended to Joanne by Bridget in Skoll based on Dr. Quratulain work establishing maternity homes in IDPS of swat. The fidelity charitable grant funds agreed to grant funds US$ 75000.00 to Trust for IDSP and Dr. Quratulain Bakhteari will be the key responsible person as director IDSP on behalf of the Trust for IDSP. Dr. Quratulain Bakhtiari was supported by Skoll as one of its fellows with US $10000 for the support of IDPS of swat. Meanwhile Dr. Baktiari also initiated the fund rising from INFAQ Foundation of Karachi, individuals, friends and families of Karachi. So the practical implementation of establishing the maternity centers initiated with these donations. Meetings and Visits: Working in close association with Ms. Noreen Lehri, and MS. Zara Shahid hussain, initiated the process of further understanding more deeply the trainings of midwifes and the study the institutions that conduct these trainings at Hub As the potential candidates for midwifery training being identified from the two above mentioned district. Simultaneously team was visiting the training institutions for midwifery training in Balochistan and Sindh. Following institutions of two provinces were visited and its principles or directors were met and discussions were held. 1) 1. 2. 3. 4. Balochistan: Quetta, Regional training Institute (RTI) for Lady Health visitors training Balochistan. Provincial Government Public health and school of midwifery training Quetta. Lady Different Hospital Quetta had a midwifery training program. Balochistan Rural Support Program, Government of Balochistan to establish Basic Health Units where there is a trained midwife in any community across Balochistan. Sindh: Karachi, Lady Different hospital school of midwifery training. Public Health school of midwifery training. Agha Khan Medical University School of Nursing and midwifery DR. Shear Shahs program of midwifery training in Qatar Hospital.

2) 1. 2. 3. 4.

Basic Information and findings of Training Institutions: 1) Quetta. 1.1 RTI focuses on family planning, and were using midwifery training with a family planning view. It is a federal institution and does not have its own practice based teaching facilities. 1.2 The provincial public health school of midwifery training is carried out in civil hospital of Quetta. This hospital has no proper and organized midwifery training spaces for young women coming fresh from communities.

1.3 Lady different was not visited by then, it was planned but due to sudden violence and killing on the streets of Quetta. Sindh. Karachi. 1. Lady different hospital, has a very strong program of midwifery training and is well recognized but they opposed to giving fellowships to the trainees, the justification was that it will affect their other trainees who will not get more then 300 Rs. IDSP proposed that we can help raise their stipend too, but there was a concern that how will they pay every year the increased stipend. 2. Most of the both districts of Balochistan could not identify women for 18 months training nor they want to leave there communities and go to Karachi, reasons were terror against women in Mustung and Khuzdar. 3. Government public health school of midwifery training, this institution only takes women from Sindh and not from any other province. On detail information we came to know that they too send their trainees to civil hospital Karachi, where the medical students of Dow medical college do not let midwifes trainees to work in the labor room theater, as they also have to do their own practices as part of their internship. 4. The midwifes are considered lower and unprofessional training by the medical students, so almost no space for rural women for midwifery training in teaching hospitals institutions. Besides, we needed especial permission from secretary health Sindh to enrolled women from Balochistan, this was a very long and tiring process, and would have left little time for actual implementation of the project. 5. Agha Khan Medical University School of midwife and nursing, after getting a detail orientation from the key persons of the training program Dr. Quratulain Bakhtiar visited their training center in Khuzdar. Then she met midwifes trained by Agha Khan Program in Lasbela. Although it is a very comprehensive program of midwifery training but it lacked connection with the actual application of its training. Here too since AHGA Khan is a medical teaching hospital the medical students has more access to the practice opportunities in birth deliveries then the under training midwives. On the other hand the Agha Khan training Program was the only program did not have these limitations of English language, or 12 grade graduates. They also focused community based midwifery training and practices. This made me very interested to meet midwifes trained by Agha Khan 6. One major limitation was that they asked about who is our funder they wanted their overall institutional cost if we engaged them for the training. This was a bit difficult was us to agree. We agree for the fee and all the related cost, but to pay institutional cost on top of all these costs was asking too much. In any case we resolved that after meeting with Agha Khan trained Midwifes.

7. Dr.Shear Shahs training program has been engaged in training midwives in Qatar hospital in Aorangi town Karachi, and in Landhi an area our side urban Karachi with clusters of small semi rural and poor and illiterate communities in the East of Karachi. While Aorangi town one of the largest squatter settlements of Karachi and in Pakistan. Now over the years the huge community is a small town in itself in Landhi. 8. Dr. Shear Shah is also treating women with fistula, and also training doctors on it as well as he has a great community education and promotion program on treating Fistula. After visiting both the hospitals in great detail and could see an obvious difference between Dr. Shear Shahs training and his midwifery training program and in other institutions in Quetta and Karachi. 9. One fundamental difference has been that the hospitals he works in and has the midwifery training schools did not have a medical teaching hospital attached to it. 10. The hospital does not give access to medical doctors as interns. While it did not attracts huge number of patients for maternity services. All case are handled by midwifes, for any complications there is a team of trained doctors to supervise and support. 11. This was the institution that truly belied and focused on empowering midwifes in their professions and supported them in all possible manners. Dr. Shear Shah training programs had hostel facilities, with food and boarding, library, computer training, library and books. Orientation and Consultation Session with IDSP Team: In South West of Karachi Balochistan has its provincial boarders with Karachi, the district of Balochistan that boarders with Karachi is called Lasbela, IDSP has its campus in Lasbela this campus is working on creating alternative education and learning spaces for excluded adolescents from formal government school system. An orientation meeting on midwife training project was planned in Lasbela campus. The IDSPs women faculty was invited and all the team of the Lasbela campus was also present. The midwifery training project was presented by Dr. Quratulain Bakhteari after presentation a consultation process started. The coordinator of the campus Mr. Khalil Ronjha is a graduate of IDSPs Development Course of 2002. Mr. Khalil Ronjha explained that, before he joined IDSP as district Coordinator, he was coordinating for a midwifery training project for Lasbela. This project was funded by USAID and implemented by an Islamabad based NGO Mercy Crops Pakistan initiative a PAIMAN project on mother and new born health. The project ended after training several thousand midwifes across Pakistan. Khalil also informed that the Mercy Crops subcontracted Agha Khan Medical University for the midwife training of this project. Around 40 young women were selected from Lasbela district and sent to Agha Khan School of Midwife Training and Nursing in Karachi. After getting orientation IDSP team asked Khalil to arrange a visit of IDSP women faculty members participating in the consultation to meet these midwifes at their work place so the IDSP women faculty can understand the whole process of their training and their practice in the communities. Khalil could locate seven midwifes in two union councils who were still working after the training

and had their own maternity centers, while two were employed by an organization called Mercy corps in their own community. After two hours visit to midwifes centers all IDSP members returned back to IDSP campus. With detail consultation with midwifes at their work places. The project for midwifery training was discussed in detail with the existing faculty and team members of IDSPs women and leadership program and with all women in IDSP. The outcome of these discussions was that the project has all the potential for opening up more opportunities for young women in Balochstan and Sindh. It was agreed that four women will be selected from Khuzdar district and four from Mustung district. Both are Balochistan districts. The management and coordination can be either from Quetta or Karachi depending upon the training institution selected for the training. The selection of the eight young women will be made by the relevant district campuses.

Project Location

7 Fellows ( idwifes! are from District Bela Pro"ince Baloc#istan and attending t#e $#ree mont#s $raining from %atar &os'ital (rangi $own )arac#i Pro"ince Sind#

Project Objectives:
Develop a ne# professional carder of &id#ifes in /alochistan To develop physical bases for practicing their profession To initiate a process of overcoming the maternal ratio in /alochistan

Establish community support for midwifes. Refreshers and further institutional and community support.

3.

Section Three
Progress

Project Team and Institutions Selection: The project first phase was to identify and select the project team. Thereby IDSP first developed the selection criterias and selected the followings: Project Advisory Team Project Manager Fellows/Midwives Potential Training Institutions A) Selection Criteria of Project Manager: A project manager will be hired through news paper advertisement and will be based in Karachi office of IDSP. Process of Selection: Ads in two leading national news papers was given to hire project manager to work from Karachi. The response was not very encouraging, women applied , and had conditions of not really going in the communities, had no orientation of women and their lives in rural Pakistan, and most of all their major concern was financial and benefits. There is several midwifery training projects are going on funded by USAID, and it is giving huge financial packages, we are also mistaken to be the same kind of project. Thereby experiencing these limitations the institutional arrangements based on IDSPs approach of developing people from within IDSP made by Dr. Quratulain Bakhtiari. The Idea is to give the leadership role. In the process the individual will come up and take the responsibility. Its fellows do not negotiate money and benefits before hand, they take learning opportunities and work on it, they learn and grow, and then it is their own growth that brings resources for them. Therefore a senior fellow of womens leadership program of IDSP Ms. Shahida Yousaf who is with IDSP for last seven years, Shahida belongs to a small town in Sibi district of Balochistan and has gone through very rough time since her childhood to her tenth grade her story is a very inspiring one. She joined MGD course 2003, after completing her nine months education and training, she remained an intern of Ms. Noreen Lehri, who mentored Shahida and helped her in all possible manner to come out of her insecurities. Shahida became a lead mentor of Sibi campus and thus practiced her leadership skills. She later became a focal faculty member for MGDC for all Balochistan women lead campuses. And has practical experience of managing courses and mentoring young

women, and is now ready for an independent leadership role on her own. IDSP uses its projects to create leadership spaces for young women and men. Therefore she offered herself to manage the midwifery training project from Karachi. Shahidas new learning contract is developed as fellow of IDSP. (See Annex 1 her learning contract). Shahida is selected in a one year course in Karachis organization of therapy works. Shahida Yousaf will be learning humanistic counseling and therapy; her classes are once a week for three hours. To participate in this course Shahida has shifted to Karachi from Quetta, and is living in IDSPs Karachi hostel, that also has office too. This office support has come to IDSP from SKOLL FOUNDATION. B) Fellows/midwifes Selection Criteria: These selected midwifes will be enrolled as IDSP fellows, and will get Rs 8000.00 per month for a maximum of three months. Their training cost, living and boarding cost, food cost, uniform and shoes, computer training cost, books and related expenses will paid by the project. The Institution for the training will give enough spaces that each midwife can practice at least 50 births while in the training; also a supervised training program is needed. The project will be in three phases. IDSP selects eight young women from any of the two provinces Balochistan or Sindh. Fellows/ midwifes will attend the 18 months training course. Each enrolled fellow will receive a fellowship of 8000 RS per month. IDSP can also take trained midwifes in case they need more support and refreshers for confidence and more mentoring based practices. The potential midwifes new or semi trained or trained midwifes for refresher courses will be enrolled in a midwife training institution selected by midwifes /fellows by themselves with support of IDSP. The potential midwifes can be fresh trainees or already existing and trained midwifes who need more support to perform better. Selection Process of Midwifes: Mr Khalil Ronjha coordinator of IDSP campus Lasbela became very supportive of the whole project and suggested that we must talk to the trained midwifes from Agha Khan. His view was very valid that these midwives are not really working and are not able to establish themselves well enough. (See Annex 2 His CV). A one day workshop was organized by Khalil and Dr. Quratulain Bakhtiari traveled from Karachi and selected seven potential young midwifes. The same seven midwifes were invited as they were the ones who has not given up and were struggling to make their training useful for the community. Seven midwifes are selected from two union councils in District Lasbela, following is the brief profile of each enrolled midwife.
S# Name 1 Hanifa Qadir Bakhsh Address Akram Colony U/C Berot 2 Hub Lasbela contacts 03422784058 Age 27 Year 1983 formal education F.A 2005 midwifery training status 1 2 Midwifery Training (CMW Training. Worked on Polio Day.

3 4

Worked in Zahid Medical. Attended the Trainings on Infection prevention and Manual Vacuum aspiration. Midwifery Training. Training From Green Star. Attended Training on Pure Water as Social Work From APWA. Midwifery Training (CMW). Work With DR. Yasmeen 2 Months. Attended The Training From Green Star. Worked on Polio Days. 1. Midwifery Training in Public Health School Karachi. 2. Months job in Sapna Hospital Hub. 3. Months Job in Marie Stop Hub. 4. Attended training from Green Star. 1. Midwifery Training (CMW Training. 2. Attended the Training From Green Star. 3. Attended the X-ray Technician Training. 4. Worked Asif Clinic and Maryam Clinic. 1. Midwifery Training (CMW Training. 2. Attended the Training From Green Star. 3. Worked on Polio Day.

Rubina Daino Cplony Court 03072232379 Mohammad Road TCF School Usman Baloch Colony Hub Lasbela

24 Year 1986

Metric 2002

1 2 3

Soniya Somer Khan

Ala Abad Town 03012291055 Magsi Mohalla Hub Lasbela

22 Year 1988

Metric 2008

1 2 3 4

Sumaia Salam

Alla Abad Town Hub, Baldia Road Near National Cambridge School Hub Lasbela

03328057413

20 Year 1990

Under Second Year

Shazia Yousaf

Charente Colony Hub Lasbela

03422517906

22 Year 1988

F.A

Najma Qadia Bakhsh

Haji Ibrahim Shekh 033212487453 Goth Mamodi More Alaabad Hub Lasbela

22 Year 1988

Metric

Sumera Haji Ibrahim Shekh 03333828020 Mohammad Goth Mamodi More Amin Alaabad Hub Lasbela

22 Year 1988

Metric 2006

1. Midwifery Training (CMW Training. 2. Attended the training from Green Star. 3. Worked in Sapna Medica 2 Yearsl. 4. Worked in IRFAN clinic. 5. Worked on Polio Day.

A) Selection Criteria of Training Institution: The second main factor of the project will be to identify an appropriate and effective midwife training institution that is: Close to the idea of taking in young women from the rural communities and empower them as a confident young professional in her own community. The training institution will be paid training fee, cost of boarding and lodging, uniform, books, and any other support required. A program that ensures opportunities to each midwife to deliver 50 babies in three months of their training. Supervision that gives them confidence and trust that they can deliver babies on their own. Train then as a professionally strong midwifes. Selection Process of Training Institution: All the selected midwifes were spend two days in visiting Karachis training institutes mentioned in above chapters. They visited all the institutions mentioned in this report. The met the directors, trainers, and lead doctors. They looked at all the training facilities, and hostel facilities, the quality of instructors etc. It was after two days they selected Dr. Shear Shahs program of midwifery training. They selected this institution because they dialogued directly with Shear Shah and got satisfied by the fact that his program do not talk medical students and interns in his program, his program is only for midwives. This means that all opportunities will be for midwifes and the medical colleges intern will not push them out of the theater. (See Annex 3 Training structure and process, MIDWIFE TRAINING PROGRAM details).

B) Project Advisory Team: A project advisory team will be made by taking members from the training institute, IDSP, community representatives, and professional individuals.

Team Leader

Dr. Quratulain Bakhtiari IDSP-Pakistan

Advisory Group

Noreen Lehri

Dr. Shair Shah

Kausar S. Khan

Kahlil Ronjha

Project Management Team

Shahida Yousaf Project Manager IDSP-Karachi

Dr. Shaista Supervisor Qatar Hospital Karachi

Dr. Sara Supervisor Qatar Hospital Karachi

Haidar Sahab Administrator Qatar Hospital Karachi

M. Yaseen / Sumera Finance Managers IDSP-Karachi/ Quettaa

7 Fellows of IDSP-Pakistan

Hanifa

Rubina

Soniya

Sumaia

Shazia

Najma

Sumera

4.

Section Four

Consultation Workshop of Need Assessment of Selected Midwifes. IDSP organized one day orientation session for the selected midwifes. The key objective was to develop their understanding about IDSP and around this project. The workshop was attended by all seven midwives, Khalil and Dr. Yasmeen from Lasbella district government hospital. A detailed orientation session on IDSP and the concept of midwifery training project conducted by Khalil Ronjha. Then each midwife gave her detail introduction of her work, her training at AGHA KHAN, understanding and actual practices in the communities. They shared in detail about their doubts, concerns and future unclear directions. After detail consultations and documentation of the discussions some important areas has been discussed as under: Experience Sharing of Training at AGHA Khan,

The midwifes shared about Agha Khan training method that it was a very useful training and well conducted, they were well look after and cared but the training lacked empowering and confidence building within the young women as community midwives. They hardly did any deliveries on their own, no space for experiencing the real practices of midwifery in the theater or labor room. There was always someone to take over the process and the trainees were made to observe then to do it themselves, This lack of practice has obstructed the process of breaking down the inhibitions in the young midwifes. After almost one year, none of the mid wives has done more than ten or fifteen deliveries, and hardly anyone paid them for their job. This lack of confidence continued after their training in the communities, the traditional birth attendants could see a threat and further obstructed their path in reach women in need. On the other hand the government doctors do private practice and were not very supportive that midwifes should succeed. The AGHA Khan trainers never came and asked how they are doing and what they need further. The USAID project gave they all the equipment to set up their maternity services from their own homes, or from a hired place and earn their income as midwife. But originally they were promised jobs in government hospitals which were later denied. When they were selected for training they were never told that they will be midwifes and what is a midwife, it was only later when they were taken to the deliver rooms that they realized what is expected from them. They did not make a big deal out of this miscommunication as they were getting good stipend and lot of care. Lack of Understanding the Community Support The community does not know what is the difference between a midwife and traditional birth attendants (TBAS). The TBAS are part of the communities ever since and all have confidence on her. These are experienced and always available in the communities. They charge 1000 to 2000 Rs per deliver and people have no problems in paying them. In case of trained midwife the assumption is that they are paid by the government so why should community pay them. Also because these are unmarried young girls they are not trusted by the women and their older family women. The community expects medicines to be given free by the midwives; there is a perception that they have free medicines. All these factors is contributing in lack of community support for midwifes and their work. There is a very urgent need of community education on the role of a trained midwife and safe motherhood. Lack of District Hospital Support: The only district hospital in Lasbella district does not give space for the young newly trained midwifes to further practice their skills. The government doctors would usually divert the patients to their own private clinics, thus the hospital has almost no women visiting or using the government hospitals for child births. It is usually Traditional midwifes or the private hospitals operated by government doctors. Any patience the mid wife could help deliver their babies.

Recommendations of Midwifes: For improving the previous status the midwifes suggested that,

1. They need practice and at least an opportunity must given where they can practice delivering the babies on their own but having surety that if something goes wrong there is a hospital they are working with. 2. They require community support and community education on safe births. They wanted to select their own training institute, although they are from Balochistan but they preferred to come to Karachi then to go to Quetta for training. 3. They needed tuition fee support and also living and boarding support, also need for some stipend is required as they will be completely out of work during the training. Based on these outcomes selection of midwifes was made. 4. All seven midwifes showed their willingness to enroll in the refresher and practice based training in one of the hospitals in Karachi. 5. Their aim was to practice the delivery of minimum 50 births per each enrolled midwife on their own,. 6. They want to choose the training institution themselves. 7. it was suggested that the midwifes will require community support when they come back from the training.

5.

Section Five

Institutional Strategy for Future Sustainability: In any case a support program will be developed around the fellow midwifes to make her stronger in her services to the communities as well as emerge as a empowered young women recognized by her professional skills of midwifery. Once the institution based training is completed the project will develop strategies to ensure community support for education in maternal and reproductive health care (CSEMRHC), in the residential communities of midwifes. Eight teams of CSEMRHC educators and promoters will be developed and established. A detail step wise training and education course in CSEMRHC will be created for the CSEMRHC educators and promoters. Its design will be developed with the trained midwifes once they return from their training. In each team of CSEMRHC educators and promoters will be a woman and a man team. Their management will be from IDSPS campus. By the end of the project period these teams will be professional community educators and promoters of CSEMRHC, working alongside with midwifes in the communities.

6.

Section Six

Challenges and Out Comes and Next Phase

A) Challenges: However the women from both recommended districts could not be selected by their campus faculties, due to sudden violence out break against women in Khuzdar and Mustung, acid was thrown on the faces of four women in Mustung, letters were sent to the organizations in Khuzdar and Mustung, who employed women that they will be attacked, families of working women were threatened if they do not stop their women from going out and working. The families were too afraid to send their daughters any where away from home. While the young and inexperienced women in child birth did not want to go away and live in a hostel in a hospital for 18 months. 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. Both the above limiting factors did not let women to be nominated from the selected districts to join the training. B) Out Come: It has been decided that IDSP need to select trained midwifes who are not doing well due to lack of confidence and supervised practices. Also it was very obvious that women from Balochistan cannot participate in course at present due to law and order condition.

Next phase plan 1. 2. 3. 4. 5. Establishing community support for midwifes in their communities. Establishing a working system with community support. District hospital linkages. Monitoring the outcome. Refreshers and further support for mid wives

ANNEXURES
Annex No. 1

Annex No. 2

KHALIL AHMAD ROONJAH

PERSONAL

NAME: Fathers NAME: DATE OF BIRTH: LOCAL: N. I. C: ,'-.@'.A:

KHALIL AHMAD ROONJAH MUHAMMAD AMIN 25th Jan 1982 District Lasbella. 5150119098911

Urdu, Baluchi, Sindhi English and Lasi

ADDRESS:
Present: (WANG) 620309,620423 03337976753 Permanent;.: Lasbela Email: QUALFICATION: Ahmad Abad Wang Tehsil Bela Distt. khalilroonjo@hotmail.com Khalilroonjo@yahoo.com Welfare Association for New Generation Labella at Bela 90050 Phone: 0853-

BASIC EDUCATION:
1- Matriculation 1998 Faisalabad Board of Intermediate and Secondary Education Panjab 2000 - Baluchistan Board of Intermediate and Secondary Education Quetta 2003 University of Balochistan Quetta 2008 University of Balochistan Quetta

2-Faculty of Science:

3-Bachelor of Arts:

4-Master of Arts:

PROFESSIONAL EDUCATION:
1-Primery Teaching Certificate 2001-Directorate of Education Schools Balochistan Quetta. 2- Certificate of information Technology CIT :Institute for development studies & practices Quetta PTC ;EXPERIENCE

1)- PROJECT COORDINATOR

Worked with WANG (Welfare Association For New Generation) in District Lasbel during the program of HIV / AIDS awareness through UNICEF. (2001 2002) My responsibilities were; Identification of high risky Groups in Costal Area Lasbela. Conduct Training program on Basic HIV / AIDS. Reporting of Activity.

2)- MASTER TRAINER

Worked with AMAL Human Development Network Islamabad in 8 district of Balochistan (Awaran, Lasbela, loralai, Turbat, Khuzdar, Punjgoor, Gwadar, Quetta) during the program of Increased Awearnes on HIV / AIDS through capacity building of NGOs . (2000 -2002) My responsibilities were; Update meeting with concern stakeholder in District. Plan work shops with district NGO and CBOs. Facilitated the ToT Training on HIV/ ADIS on Hamari Sehat Manual Activity reporting. Published the activity report through press media.

3)- PRESS SECRETARY

Worked with Balochistan AIDS network Quetta.

(2001 -2002) My responsibilities were; Published Network news through press media. Write article on HIV / AIDS awareness..

4) RESEARCHER/DATA ANALYST.
Worked with IDSP, Pakistan in District Lasbela and Quetta during the program of Education Policy and Planning ESRA. (2003 2005) My responsibilities were; Write research proposal (Community Participation in Education). Data collection (Focus Group Discussion, Interviews). Transcription and Deduction of research Study Data for Data Analysis of research study. Conducted different forums such as workshops, seminars, Dialogues on education policy and planning with different stack holder of District. Developed a district Education Profile. Reporting of Activities. 5) RESEARCH

FELLOW

Worked with IDSP, Pakistan in District Lasbela during the Development Course. (2000 2001) My responsibilities were; Write research proposal (Poverty Evaluation of Fisher man community). Conducted Base line Survey of costal area DAM somiyani Developed different Individual Groups to collect Data. Social and Economical Analysis was done with community on research findings. Write research report. Develop Fisher man community organization on research findings.

6)- FIELD

RESEARCHER

Worked with IDSP, Pakistan & P&D Department Balochistan in District Awaran, Pungoor, Gwadar during the program of Pakistan Participatory Poverty Assessment Balochistan. (2002) My responsibilities were; Site selection. Conduct meeting with Line department. Introductory meeting with community. Focus Group Discussion on PRA tools. Reporting and analysis of activity

7)- Community Mobilization O

Worked with Mercy corps International Lasbela District on PAIMAN Project Since 2005.

i!"#

My responsibilities were; Conduct Sensitization meeting with all concern stakeholders in District. Plan work shops with district NGO and CBOs. Conduct Community Mobilization Activities thought traditional mass media. Format support groups and health committees. In all Lasbela. Facilitated the ToT Training on Mother and New Borns health issue Activity reporting. Published the activity report through press media. Organized Theaters performance and Health camps on MNH duity of Action Ai project. . SOCIAL IN OL E!EN":
/eing a Social activist my involvement in the social activities #as natural$ Since my early age! I entered into the #elfare activities individually! but after#ards! having reali"ing the necessity of the community involvement! I gathered the young generation of the area to over come the social problems e$g$ Aducation! )ealth! @nemployment! %ater B Sanitation$ 'lso to eradicate the social evils mostly Drug 'buse etc$ /y considering the above facts in the area! an organi"ation is set up under the name of %elfare 'ssociation for -e# .eneration (%'-.) in 4565$The Crgani"ation is no# playing the leading role for the #elfare of community #ith the constructive ob ectives$ In the plate farm of %'-. I conducted many events ant activities$ These areD

Organized various Programs on Education, Health, Anti Drugs, and Environment, Sports and Healthy Entertainments on National, universal and other days.

 Conducted Free Medical and Surgical camp, Skin Diseases camp, Eye camp etc by the Coordination of other NGO`s Organized Walks against Drug and pollution. Campaigning for Health and Sanitation. As an Incharge of Child Welfare Section Organized the Annual Programme by the name of BABY SHOW in Tehsil level by the coordination of UNICEF.. Parti#ipatio$ o% t&e "rai$i$gs' Works&ops' Co$%ere$#es

A: - Participated the Basic Organizational Management organized by Society for the Community Support for Primary Education Balochistan Quetta. B: - Participated the Workshop as a TOT on HIV Aids and our Health by AMAL Human Development Network Islamabad. C: Participated the Workshop as a TOT on HIV Aids and our Health by Provisional Aids control Program Quetta & UNICEF. D: Participated as a Saarc scout in 2nd Saarc and 8th national Boy scout jamboree from 22nd to 29 September 1994 held at Quetta Pakistan Quetta . E: Participated as a learner in 6thmonth development course in Institute for development studies & practices Quetta F: - Participated in three days proposal writing workshop organized by Balochistan Aids Network Quetta & UNAIDS
(D Participated the 5th Islamic orientation camp for young #riters Islamabad organi"ed by Da8#ah 'cademy International Islamic @niversity Islamabad

H: Participated 14 days training PRA organized by P&D Department and Institute for development studies & practices Quetta
I D Participated three days #orkshop on Self and .ender organi"ed Society for Ampo#ering )uman (esource (SA)A() /alochistan

): Participated si7 days )IE2 'ids care and Founseling Training of trainer #orkshop by '&', )uman Development -et#ork Islamabad$

H: Participated three days workshop on Hygiene Education organized Society for community support for primary education in Balochistan
*: Participated si7 days on labor rights by Pakistan institute of labor education B research 0arachi$ L: Participated 5 days on interactive thither training by S'P ,ahore

M. Participated 30 days Training on Community mobilization organized by Mercy Corps and PAiMAN Project.

References

Dr.Saeedullah Khan Senior Program Office (South) Mercy Corps Pakistan Quetta Phone: 03008383381 Ali Naqvi Program Manger Institute for development studies & practices (IDSP ) Pakistan Phone (0812) 449775, 445192

Saima Gull Manger NGO SANJOK Quetta 03218039731

Annex No. 3

Training structure and process

WOMEN GIRHT TO LIFE AND HEALTH is the program of Qatar Hospital. Basically this program provides the midwifery training for those community girls. This program designed the courses of 18 months duration. Dr. Quratulain Bakhtiari discussed the idea of midwifery training for women of Balochistan with Dr. Shair Shah. They designed the 3 months training after the oral assessment of selected midwifes which is based on theory and practice. Assessment is the fundamental of the midwifery course and it is the designed three times in course 1st assessment held in the starting of training and in the 2 nd phase will take mid

duration of training and final they will take exam form midwiferys in the last month of training.
MIDWIFE TRAINING PROGRAM CAPACITY BUILDING

Following are the activities in which training midwifes will participate. 1 14 days Competency Based Training CBT! this incl"des # $mergency %&stetric Care ' (ealing in emergency in pregnancy 4 )ormal *a&o"r + Management of complication li,e &leeding- hypertension and infection . )ormal *a&o"r / Management of 'rd stage of *a&o"r 0 Postpart"m 1emorrhage 2 )eonatal Res"scitation ("ring their training midwife will spend their time in *a&o"r Room- antenatal wardantenatal clinic- postnatal clinic and %peration Theater. Patient will &e ta"ght a&o"t the management of pregnant women in comm"nity ("ring last 0 wee,s of training st"dents activities are satisfactory they are actively involve in the management of patients inward and la&o"r room. The candidates are ,een and ready to learn.
Midwifes daily working schedule is mentioned below, 1 Shazia and Sonia Evening in OPD from 8:00 PM to 8:00 AM 2 Najma and Sumaia Morning from 8:00 AM to 8:00 PM 3 Hanifa, Sumera and Rubina Morning and Evening 4 Study Houres Daily 2 or 3 Hour Management of the training project There is team which is responsible for training process in Qatar Hospital. Which are mentioned below, 1 Dr. Shair Shah Head of the Qatar Hospital and responsible for the Midwifery program 2 Dr. Shaista and Dr. Sara Trained and supervise the midwifes 3 Haidar Sahab Give administrative support to Midwifes like food, water, etc.