Report
Program Review & Union Council Micro Planning
sharing workshop May 15, 2014 in Thatta
Reported by
Jamal Khatoon
BCC Coordinator Thatta
Report -Program Review & Union Council Micro Planning sharing workshop on May 15, 2014 in Makli, Thatta
Background
Merlin is implementing WINS (Women and Infant/Children Improved Nutrition in Sindh)
programme it is an EU funded program to address the malnutrition in 49 targeted UCs of
Thatta. The goal is to improve the malnutrition status of children (under five) and women of
reproductive age. The programme will be able to achieve its objectives by addressing chronic
and acute malnutrition amongst the target groups through integration of CMAM program with
health services.
The key activities of this programme are based around four expected results. (1)Case
Management, (2) Prevention, (3) Resilience and (4) Evidence and Impact.
The first result, which focuses on improving population access to nutritional care through the
district health system will involve the following activities: community mobilisation and
screening, a supplementary feeding program, outpatient therapeutic program, stabilisation
centre (SC) services, referral of SAM cases to the SC, promotion of infant and young child
feeding practices, multi micronutrient supplementation, and de-worming campaigns. This will
be implemented across 49 static health facilities in Thatta district. The second result, which
focuses on improving maternal and child health/nutritional status through increased knowledge
and practices by mothers/caregivers, will be based on a behaviour change and communication
strategy. This will include commissioning a number of surveys to establish baselines and to
formulate the communication strategy to be implemented. The strategy will be implemented
by using a network of Lady Health Workers, Community Resources Persons (CRPs), Community
Health Committees, breastfeeding support groups, all to communicate good nutritional care
practices, with supporting IEC materials. The third result focuses on improving food access to
children 6-18 months old, through gender-sensitive social transfers (Conditional cash transfers),
which in turn contributes to improving complementary feeding practices, and offers protection
from stunting, in the long run.
The fourth final result focuses on scaling up the evidence-base of sector-wide approaches to
address malnutrition, and communicating the impact of the approach to wider stakeholders,
through films, trainings, workshops, publications and seminars and this workshop directly
addressing to the result four for Establishment of an efficient and effective nutritional
surveillance and response system at district level in collaboration with relevant stakeholders.
And revitalisation of the community-based structure of Lady Health Workers (LHWs) to
efficiently provide nutrition promotion at the community level and strengthen their linkages
with Community Mobilizers, Community Resource Persons and health facilities in their
catchment area.
For the purpose of coordination and integration among all stake holders for an extensive
coverage of Malnutrition Merlin Thatta has prepared District level Micro plan and UC level
Micro Plan of 49 UCs Merlin’s service providing area. Out of those UCs only 3 UCs Sonda,
Report -Program Review & Union Council Micro Planning sharing workshop on May 15, 2014 in Makli, Thatta
Sujawal and Mureed Khoso were presented and discussed in the workshop for the
understanding of the microplan. All the Merlin staff and stakeholders from the above 3 UCs
participated in the event which includes Community Mobilizers, CHC, BSGs, LHWs, FWWs, LHVs,
Vaccinators, OTP Assistants and NAs.
Abbreviations
CRP
LHWs
DoH
DHO
TOT
CM
CMW
FWW
NA
LHV
BSG
CHC
IYCF
CMAM
EU
WINS
OTP
FSNC
BCC
GAM
SAM
MAM
SC
SFP
MUAC
CCT
FMS
Community Resource Persons
Leady Health Workers
Department of Health
District Health Officer
Training of Trainers
Community Mobilizer
Community Mid wife
Family Welfare Workers
Nutrition Assistant
Leady Health Visitor
Breastfeeding Support Group
Community Health Committee
Infant Young Child Feeding
Community Based Management of Acute Malnutrition
European Union
Women and Children/Infant Improved Nutrition in Sindh
Out Patient Therapeutic Programme
Food Security Nutrition Coordinator
Behavioral Change Communication
Global Acute Malnutrition
Severe Acute Malnutrition
Moderate Acute Malnutrition
Stabilization Center
Supplementary Feeding Programme
Mid Upper Arm Circumference
Conditional Cash Transfer
Field Monitoring Supervisor
Facilitators of the workshop
S.No
1
2
3
4
Name
Mansoor Baloch
Dr. Zahida Perveen Memon
Dr. Hanif Memon
Aftab Ahmed Tuniyo
Designation
Program Manager Sindh
Sr. Health & Nutrition Coordinator
Food Security & Nutrition Coordinator
Sr. CCT Officer
Report -Program Review & Union Council Micro Planning sharing workshop on May 15, 2014 in Makli, Thatta
Welcome note and Objective sharing
The chief guests were DSM PPHI, DoH Thatta, DO Social Welfare, EU WINS representative, PNC and PM
Merlin Thatta to make it a joint event, to represent their organizations.
Event started after recitation of Holy Quran by Jasarat Ilyas. The event was facilitated by Aftab Ahmed
Sr.CCT Officer Merlin Thatta.
Welcome note and opening remarks were presented by Mansoor PM, Merlin Sindh. He expressed
thanks to all participants from community, chief guests, media personals, NGOs, WFP, PPHI and Govt of
Sindh for coordinated support in health and nutrition related services. PM Merlin Sindh Mansoor Baloch
briefly described the objectives of the event.
Objectives of the workshop:
1. Establishment of an efficient and effective nutritional surveillance and response system at
district and Community level in collaboration with relevant stakeholders.
2. And revitalization of the community-based structure of Lady Health Workers (LHWs) to
efficiently provide nutrition promotion at the community level
3. and strengthen the linkages of existing structures of Govt, PPHI and NGOs with Community
Mobilizers, Community Resource Persons and health facilities in their catchment area.
Dr. Durreshehwar more added that as Merlin has organized this Micro plan sharing workshop with
coordination of DOH, PNC and PPHI, in the same way Provincial Nutrition Cell has also formed
integrated nutrition strategy in all sectors of Govt department i.e. Health, Education, agriculture,
livelihood, women development, irrigation and PHE in district Thatta and in other 4 districts of Sindh.
The objective of this strategy is to provide coordinated service delivery at district level and local level.
EU WINS Program an overview
Dr. Zahida Sr. Health and Nutrition coordinator of Merlin Thatta presented and overview of the EU WINS
Programe Thatta.
Program Back Ground
The 2011 National Nutrition Survey (NNS), compiled by the Ministry of Health, indicates that in Sindh
Province, 17.5% of children under five years old are suffering from acute malnutrition, of which 6.6 %
are severely malnourished. These rates of acute malnutrition exceed the WHO’s emergency threshold
level of 15% GAM.
• National Nutrition Survey 2011 indicates that Sindh is the most food deprived province of
Pakistan with only 28% of households food secure 21.1% food insecure without hunger, 33.8%
food insecure with moderate hunger and 16.8% food insecure with severe hunger (72% Food
insecure).
• Prevalence of “Hidden Hunger” or micronutrient deficiency as a major challenge presently
constrains the development of a healthy population.
Report -Program Review & Union Council Micro Planning sharing workshop on May 15, 2014 in Makli, Thatta
•
•
Vit. A deficiency in the province affects 37.1% of women and 53.3% of children, both figures are
the highest in the Pakistan.
Moderate and severe anaemia affects 59.7% of pregnant women and 72.5% of children in the
province.
SMART SURVEY FINDING DISTRICT THATTA
Wasted Children
Indicator
MUAC
Stunted Children
Z-Score
Indicator
Result
GAM
17.2%
18%
Stunting ( H/A< -2 z)
38%
SAM
6.9%
5.8%
Under weight (W/A <-2)
29.9%
MAM
10.3%
12.2%
Mortality Rates
Description
Results
Crude Mortality rate
Number/year/1000 population
7.6 per 1000
Under five mortality rate male
Male death/year/1000 live births
69 per 1000
Under five mortality rate Female
Female death/year/1000 live births
130 per 1000
Causes of Death: Diarrhea, Measles, Fever while majority respondent (75%) could not provide the
reasons of death
Objective of the program
The overall objective: improved nutrition status of children and pregnant & lactating women in
Pakistan.
The specific objective of the program is strengthened capacity to address the high rates of malnutrition
in district Thatta of Sindh Province, Pakistan. Target groups are SAM Children, PLWs, Nutritionally at-risk
HHs and Capacity Building of DoH, PNC, DHO, PPHI Medical Doctors, nurses, LHVs, LHWs, TBAs and CRPs
Conditional Cash Transfer
 Health Facility Level
 Enrollment of targeted household via screening at Health Facility & community levels;
 Screened children 6-18 months will be enrolled for CCT program under the project of EU
WINS.
 Health facility Staff ensure all screened children 6-18 list.
Report -Program Review & Union Council Micro Planning sharing workshop on May 15, 2014 in Makli, Thatta
 Screened children 6-18 months will be enrolled in the program after verification through
birth certificate and EPI card.
 Community Level
 Assessment door to door and screening of children 6-18 months at each household
level.
 Registered beneficiary receive cash for 6 six months before existing the program.
 Cash disbursement through Microfinance Institute or Banking
CCT Assessment Methodology
 VPC (Village Project Committee)
 Screening
 Registration 6-18 months
 Verification door to door
 Follow up (in case of absentees)
CCT is working in 19 UCs and has completed assessment in 12 UCs and have registered 15694 Children
of 6 to 18 Months.
Up Coming Plan for CCT







After the completion of registration Base Line
Awareness Session
Distribution
Post Distribution Monitoring
Impact through rescreening and follow ups
Lesson Learning (Case Studies & Successful Stories )
Complaint Response Mechanism (M&E and Teams )
Few of the participants asked few questions on the WINS overview for their clarification which were
answered by Dr. Zahida Perveen Sr. Health & Nutrition Coordinator.
Micro Plan Sharing
Dr. Hanif Memon Food Security and Nutrition Coordinator Merlin Thatta presented General Micro Plan
of the programe and Micro Plan of UC Mureed Khoso, Sujawal and Soonda.
Group work/ sectoral input
Participants from all 3 UCs were divided in 3 groups and micro plan of their respective UCs were given to
them for their proper understanding about activities that at what extent and activities they can support
for the maximum coverage in these UCs. The all stakeholders understood the UC’s micro plan and
agreed to conduct Health and Nutrition sessions and refer the malnourished children and women to the
Health Facility during their programme activities.
Way forward
After presentation of Micro plan and group work many of the questions raised by participants which
were answered by Merlin, PPHI, DoH and PNC and suggestions were also welcomed.
Report -Program Review & Union Council Micro Planning sharing workshop on May 15, 2014 in Makli, Thatta
1. Dr. Durreshehwar appreciated the efforts of Merlin and donor EU supporting the government of
Sindh in nutritional interventions in Thatta. Answering the question from some of the
participant Dr. Durreshehwar responded that we are always here for your support, you come to
work voluntarily and ask for any support within the health department and outside the
department. Clarifying the confusion of one of participant she said measles doesn’t occur due
malnutrition but happens through a virus.
2. Abdul Gaffar Surahiyo DSM PPHI appreciated the efforts of Merlin regarding integration and
coordination in UC level micro plan furthermore he added that Govt is the leader of all the
interventions NGOs are only for the support and ultimately Govt will be leading the all
interventions done by NGOs. He more added that contaminated water and Ghutka is a very big
issue Thatta the first priority of Thatta community is Ghutka not nutrition though use of Ghutka
is very harmful for health. Nutrition is important part of primary Health Care.
3. EPI Focal person Thatta it is good initiative of the Merlin to incorporate the vaccinators in
activities at UC level it will support in maximum referrals for vaccination.
4. Mansoor PM, Merlin Sindh shared that coordination meeting for micro plan sharing will also be
organizes at UC level with all the stakeholders of the concerned UC.
5. Aftab Ahmed Tuniyo Sr. CCT Officer, Merlin Thatta shared that Merlin will prepare profile format
to get data of all stakeholders in Thatta.
6. Dr.Zahoor Ahmed Memon DHO Thatta shared about Measles and Rubella that Rubella is less
severe than the measles and death ration of the Rubella in Thatta is less than measles. There are
different myths in community regarding measles and one of the strong myth of the community
about measles is that nobody should see the measles survivor otherwise measles will get angry on whole
family and will remain for more time with survivor or will also affect other family members. we all
together have to work to change those myths of community which is a big hurdle in measles
vaccination. DHO Thatta shared more that we are working with coordination at district level but
we appreciate Merlin to initiate this coordination at staff of TB dots and malaria workers also
can be included in this community level integration.
7. Imran Ashraf from EU added that LHWs are the back bone of any plan because they are already
working with community they have already built community linkage and this micro plan play a
very important role in implementation and sustainability of the EU WINS program. He more
shared about planning for new 4 years program in 8 districts of Sindh which will start from Jan 1,
2015. The upcoming program will be focused on Nutrition component and learning, good
practices and area of improvements will be incorporated in the planning of program.
Vote of Thanks
Dr. Dureshahwar presented vote of thanks all the participants, Merlin to organize such a health
workshop to strengthen the integration and coordination of all the stakeholders at UC level and District
level.
The event was closed with this sharing that all UCs micro plan will be finalized in UC level coordination
meetings of stakeholders in which all the UC level stakeholders; (NGOs, LHWs, LHVs, Midwives,
Vaccinators, FWWs, TB Focal person, Malarial Focal persons and Merlin) will be invited to participate in
the UC level Micro plan sharing workshop.
In the end lunch was served to participants
Report -Program Review & Union Council Micro Planning sharing workshop on May 15, 2014 in Makli, Thatta
Participants of the workshop
Total number of participants in Microplan sharing workshop were 150 .
Participants from UC Sujawal, Mureed Khoso and UC Soonda
1.
2.
3.
4.
5.
Vaccinator
LHWs
CMWs
FWWs
LHVs
6.
7.
8.
9.
10.
WAHDAT Network
CHCs
OTP Assistants
CMs
NAs
9.
10.
11.
12.
13.
14.
15.
16.
IR
NRSP
WFP
RTJ International
Takhlique foundation
INDUS Earth
Coordinator (WHDT)
Marrie Stopes Society
Participants from NGOs
1.
2.
3.
4.
5.
6.
7.
8.
Aga Khan Nutrition
Plan International
SAFCOW
SPO
Right To Play
Aga Khan Building
CWS
HANDS
Participants from Government
Org/Designation
PNC
DHO
DDO/DNFP
LHW District Co
EPI Focal Person
SWD
MNCH
PPHI DM
PPHI Exe M&E Officer
PWD
MS Thatta
MS Sujawal
President Press Club Thatta
President Press Club Makli
Name
Dr.Durre Shahwar
Dr.Zahoor Ahmed Memon
Dr.Khalid Qureshi
Dr.Mohan
Dr.Suleman
KB Bahrani
Dr. Hassan Gandhro
Abdul Gaffar Surahiyo
M.Hassan
Riaz Shar
Dr. Aziz Tahrani
Dr. Ameer Ahmed Shah
M.Ali and team
syed Gul Shah and team
Report -Program Review & Union Council Micro Planning sharing workshop on May 15, 2014 in Makli, Thatta
Merlin staff
1.
2.
3.
4.
5.
BCC Coordinator
FSN Coordinator
FMSs
Nutritionists 1
CMS from UCs Sondha, Sujawal and Mureed
Khoso
6.
7.
8.
9.
10.
11.
NAs from 3 UCs
OTPAs from 3 UCs
Sr. Health & Nutrition Coordinator 1 & 2
CCT team
Sr. M&E Officer
Program Manager Sin
Program Review & Union Council Micro Planning
Agenda
S.No
Activity
Time
1.
Registration
10 am
2.
Tilawat
10:15
3.
Welcome
10:20 am
4.
EU WINS Program an overview
10:30 am
5.
Feedback/ inputs
11:00 am
6.
Micro Plan Sharing
11:40 am
7.
Group work/ sectoral input
12:20 pm
8.
Way forward
01:00 pm
9.
Adjourn& Vote of Thanks
01:30 pm
10. Lunch
01:45 pm
Report -Program Review & Union Council Micro Planning sharing workshop on May 15, 2014 in Makli, Thatta
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Report -Program Review & Union Council Micro Planning sharing workshop on May 15, 2014 in Makli, Thatta
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Report -Program Review & Union Council Micro Planning sharing workshop on May 15, 2014 in Makli, Thatta
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Report -Program Review & Union Council Micro Planning sharing workshop on May 15, 2014 in Makli, Thatta