HANDS-HEALTH

PROGRAM
Annual Report
2011-2012

HANDS A Brief Profile

HANDS started its life cycle from a public sector hospital in Karachi as Health and Nutrition Project
in 1979 lead by then head of department of the Pediatrics Prof. A. G. Billoo (Sitara-e-Imtiaz). He was
seriously concern about the poor patients coming from Karachi rural in miserable conditions.
Health and Nutrition project started working in 1979 under the guidance of Professor and 1st Primary
Health Care center established in a village 40 kilometers away from city center. The interns of
professor following his vision to develop "Healthy Educated Prosperous Pakistan". The vision started
taking shape by 1993 and gradually project transform in to the organization called Health and
Nutrition development Society commonly called as HANDS.
After 33 years HANDS has evolved now as one of the largest Non Profit Organization of the country
and show case an excellent integrated development model comprised of key program on HANDS is a
nonprofit organization working in Pakistan, with key programs health, education and poverty
alleviation. Cross cutting program Social Mobilization, Disaster Management, Gender &
Development, Human Resource & Institutional Development, Information & Communication
Advocacy, Monitoring Evaluation & Research, and Social Marketing. HANDS has reach in to more
than 13 million population of 16182 villages in 24 districts of Pakistan. Considering HANDS started
Management Structure: HANDS is governed by a 14 members elected "Governing Board" lead by
Chairman. The Senior Executive Committee comprised of 04 senior executives follow organization
critically to keep on the right direction. Steering committee runs daily affairs of the organization under
the leadership of Chief Executive with the support of core team of 11 General Managers - Specialists
of respective sectors. 2064 full time staff and more 100,000 community based volunteers are the
strength of HANDS.
Management Certification: HANDS is certified by Pakistan Center for Philanthropy (PCP) and tax
exempted by Income tax department of government of Pakistan. HANDS has also successfully
completed the Institutional management and certification Program of USAID for management
standards. HANDS is also registered with European Union. We are in process to get ISO Certification.
HANDS has developed 17 policy manuals namely Finance, HRM, Social Marketing, Health, Monitoring
Evaluation & Research, Poverty Alleviation Program, Gender and Development, Information Technology,
Information Communication Resource and advocacy, Infrastructure Education, Human & Institutional D, Social
Mobilization, Disaster Management, Child protection, and Resource Mobilization.

HANDS experience in project/administrative and financial management: HANDS has undertaken

152 projects during last 5 years in the key areas of health, education and poverty alleviation with cross
cutting theme of social mobilization, gender and development, resource mobilization, monitoring
evaluation, information & communication, disaster management and human resource development.
HANDS is working with 8522 medium and small size organizations. Finance Department is equipped
with qualified personnel working in a web based Finanacial Management Information System (on line
linked all districts) through Sidat Hyder Financials. HANDS is currently managing a budget of Rs.
1800 million approx. for 2011-2012. HANDS is also equipped with Hr payroll, Operation supply chain
and all program web based software management Information System. HANDS manage 24 office
excluding head office Karachi and enjoy services of >1350 full time staff members, along with more
than 100,000 volunteers.
HANDS major funding partners: HANDS has partnering with almost with all the donors working in
Pakistan. These are Population Council/USAID, PAIMAN/USAID, The David & Lucile Packard
Foundation, Save the Children US & UK, The Aga Khan Foundation, UNICEF, Embassy of the
Kingdom of Netherlands, The Aga Khan University, Khushhali Bank/ Asian Development Bank,
Pakistan Poverty Alleviation Fund/World Bank, The Asia Foundation, World Population

Foundation/European Union, Ministry of Women Development Pakistan, National Commission for

Human Development, John Hopkins University-USA, UNFPA, Care International, GOAL
International, Medico International, DFID/UKAID, UNDP, WHO, UNHCR, Unicef and all District
Governments, different departments & ministries of Government of Pakistan.
HANDS Public Private, Private Partnership: HANDS has been working with federal, provincial
and district government education department. Most of HANDS projects are in Public Private
Partnership. HANDS has trained / benefited large number of men and women of these departments.
HANDS had several agreement and MOUs signed with many Provincial Department like Health,
Education, women Development and planning and Development. We have agreements with all district
governments wherever HANDS works.

HANDS- Health Strategy 2020:

Health Program
HANDS health program is evolved to the extent that its service are recognized and sought by
international agencies.
HANDS Health Program's include the integration of health interventions with the other social
development initiatives Health services are provided to the community under the supervision of
Health Program with local community organization.
HANDS HEALTH PROGRAMS
5.1 Maternal and child health
5.1.1 Primary Health care:
MARVI (primary maternal and child health/RH Birth spacing)
5.1.2 Traditional Birth Attendants (TBAs)
5.1.3 Community Midwifery training program (CMW)
5.1.4 HANDS NARI Model
5.1.5 Secondary Health Care
Secondary Health care units
5.2 Nutrition
5.2.1 CMAM (Community Based Management of Acute Malnutrition)
5.3 Emergency Relief

5.3.1 Health Programs/Projects in Disaster

Mobile Medical Camp
Acute Respiratory Infection Center (ARI center)
Diarrhoea Treatment Center (DTC)
5.4 SRHR
5.4.1 LSBE/MUMKIN
5.5 Disability
5.5.1 Disability rehabilitation
(Physical and mental disability)

Health Projects/Programs during 2011-12

1. MARVI Project
2. PPAF Health
3. PPAF Disability
4. PPAF Education
5. Acute Respiratory Infection Centers (ARI Centers)
6. Diarrhoea Treatment Centers (DTC)
7. GAVI Project
8. Community Midwifery School
9. CDGK HANDS Hospital Jamkanda
10. Aman Community Health Initiative (ACHI) Project
11. Shamil Project
12. Reproductive Health Initiative for Adolescent (RHIA) Project
13. Community Management of Acute Malnutrition (UNICEF)
14. Community Management of Acute Malnutrition (WFP)
15. Hamara Kal, Life Skill Based Education (LSBE) Project
16. Mobile Medical Camps
17. Mobile Service Units

HANDS Best Practices Models: HANDS offers to hundreds of public, private institution
and organizations the following specialized services in Health service sector; Community Health
Workers (MARVI), Rehabilitation of Disables, Output Based Aid (OBA) voucher
scheme(NARI), Adopt A Hospital, Community based Management of Acute Malnutrition
(CMAM) and Establishment of Birthing Station.

Training best practices;

Community Midwifery Training school, Training of Traditional Births Attendants (TBAs),
Psycho Social Wellbeing Training, IUCD Training, Community Health Workers (MARVI)
Training, Sexual Reproductive Health(SRH) Trainings, Client Centered Approach Training for
Health Care Providers

1. Community Health Workers Model for the areas where there is no LHWs
Introduction
HANDS evolved a CHW model for non LHW areas are through monthly home visits and static
health house established within her residence. She is supported by a health committee and
women' group that are voluntary boards formulated by her for assisting to provide health services
as required.
Objective
To improve Reproductive Health and Family Planning status in marginalized communities of the
country.
Methodology
The following process is followed in the selection and training of Community Based Health
Workers (MARVI) selection process.

Identification of MARVI by Community Based organization

Signing of Memorandum of Understanding with Community Based organization and
MARVI.
Training of MARVI (group of 20-25)
Identification of MARVI Health Houses
Supplies to MARVI -Equipments and essential medicines and social marketing products
Initiation of Health services including the health awareness sessions
Monitoring by Monitoring Evaluation and Research and health team
Reporting to stake holders

Services Provided by MARVI

Mobilization of pregnant women for Antenatal Services
Mobilization of pregnant women for Post Natal Services
Demand creation and sale of Social Marketing Products, Family Planning methods, safe delivery
kit iodise salt, oral rehydration salt, basic medicine
Treatment of common ailments
a. Acute Respiratory Infection (ARI)
b. Diarrhea
c. Malaria
d. Common Skin Diseases
Growth Monitoring of Under three Children
Refer normal Delivery to trained Traditional
Birth Attended (TBA)

Referrals for complicated cases to near Health Facility

Facilitation for Expanded program on Immunization (EPI )
Health Awareness Session through community visits
Finding of endline Evaluation
83 % of MARVI Workers know the recommended number of 04 antenatal checkups.
100% MARVI workers know recommended number of 02 postnatal checkups.
51% MARVI workers had knowledge of at least 4 danger signs of antenatal, natal and
postnatal period.
87% of the MARVI workers were able to identify the three delays. 83% could identify
the first delay, 93% identified second delay and 83.3% identified the third delay.
100% MARVI workers had knowledge about Family Planning and all of these had
knowledge about Pills and Condoms while 93% knew about Injectables, 80% knew about
TL & Vasectomy, 70% knew about IUCD and 30% MARVI workers have knowledge
about other methods too.
100% MARVI workers were supplied RH-FP products of about 2.3 million and 70%
were able to generate some profit. Average income of MARVI's from the sale of RH-FP
products was Rupees 1700 per-month.
MARVI workers had referred nearly 54255 women, 8594 children with complications to
secondary care facilities and save their lives.
MARVI project also supported 25 public sector health facilities through supplies,
equipments, technical training and developed into women friendly health facilities.

2. Rehabilitation of Disables
Objectives
To improve the livelihood of persons with disabilities (PWDs) and make them self reliant
Methodology
Identification of persons with disability through baseline
survey.
Assessment of type and severity of disability through medical
need assessment camp.
Awareness rising session for the communities.
Social and educational inclusion of children with disability.
Attendant ship training for family members of the severely
disable bedridden persons with disability.
Provision of supportive devices, live wheel chair, prosthesis
Enterprise development training and business incubation for physical PWDs.
Teachers training on educational inclusion for the Children with Disabilities (CWDs) in
main stream school.
Capacity building of staff for disabled persons organization (DPOs)

119 Family members of the bedridden Person with Disabilities PWD's were trained for attendant
ship training in three union councils.
Teachers training on inclusive education
provided to 150 teachers of Bin Qasim town
Person with Disabilities of three union
councils were trained for Enterprise
development
training
and
business
incubation. 83 Person with Disabilities were
give support to establish their enterprise
77 Awareness raising sessions given to the
community, Person with 64354 Disabilities
and their family members on genetically
transmitted disease, family marriages, health
and hygiene, reproductive health, care during
pregnancy, vaccination, family planning and
breast feeding etc.

3. Voucher redeeming model for referrals

HANDS Health Program introduced an innovative model of Output Based Aid (OBA) Voucher
Scheme for pregnant women in rural/remote areas IDP Camps and flood affected areas.
Objective
To mobilize communities to use identified emergency obstetrical neonatal care services
in Public / Private health facilities
To provide health care facilities to pregnant women/neonate through Output Based Aid
(OBA) voucher scheme
To strengthen referrals mechanism from Relief
Methodology
Partnership agreement signing between the service provider (Public/Private health
facilities) and HANDS. The project support only out of pocket expenses in case of
public sector has the facilities.
HANDS responsible to administer specific aspects of the model such as
To
provide
counseling on
Safe
Motherhood motivation of the IDPs to
utilize selected health services.
Identify voucher recipients based on
developed eligibility criteria.
Public and Private Health Care facilities
responsible to ensure quality EmONC
services
HANDS redeem the cost against voucher
for the pre determined service to the provider after verification from Public and Private
service
Services Provided
Appraisal and final selection of referral health facilities for Emergency Obstetric Care
(Public and Private)
Registration of all Pregnant women in camps
Antenatal Screening
Introduction of Output Based Aid Voucher Scheme to every pregnant women and
family
Mass media promotion of Output Based Aid Voucher Scheme
Redeem Output Based Aid Voucher Scheme at first care health facility level to facility
Management of pregnant women with danger signs at selected referral health facility
Verification and reimbursement

Achievement till date

Total
9 public and private secondary health care facilities were identified through a screening
process.
3244 NARI Referral Forms (Output Based Aid Voucher) and thousands of Posters and
brochures were distributed.
Providing 894 counseling's on Safe motherhood.
Performing 1333 antenatal checkups and 488 post natal checkups.
Dissemination seminar was organized in Northern Hub (Sukkur) and Southern Hub
(Hyderabad) for awareness rising of project, participated by more than 500 stakeholders.
A comprehensive communication strategy was designed with the focus to introduce
Output Based Aid Voucher Scheme and its mechanism and to promote public/private
health facilities among communities for their maximum utilization.
FM Radio message was relayed to introduce NARI referral voucher (12 times per day) on
FM 92 Nooriabad for District Thatta, FM 98 for Jacobabad and FM 104 for kashmore
district.
Cumulative Target for Health Facilities

Conduction of high risk deliveries

1000

Conduction of complicated deliveries

168

Including caesarian sections

740

Treatment of neonatal cases

500

Total Amount of Reimbursement

1,47,800

4. Secondary care services

Objective
To provide quality health care services (primary and Secondary) to marginalized communities.
To provide comprehensive emergency obstetric and neonatal services.
Methodology
The following Services are provided at the hospital:
Round the clock Out Patient Department and
Emergency services.
Labor Room.
Operation Theatre
Emergency Obstetric Care
Indoor Patient Services
Family Planning services.
Laboratory
Ultrasound facilities
X-ray facility
Blood bank facility
Ambulance Service
Achievement

Besides these, the following services were provided during last 10 years at HANDS CDGK
hospital Jam Kanda.

5. Psycho Social Wellbeing Training

Introduction
Children are particularly vulnerable during emergencies. It is essential to address their emotional
and social needs through psychosocial support activities conducted within a safe, protective
environment.
Objective
To understand the concept of Psycho Social
Wellbeing
To learn about theories of Psycho Social Wellbeing.
To differentiate the components of Psycho Social
Wellbeing
To learn how to promote Psycho Social Wellbeing
To understand concept of Child Rights in
Educational Setting
How to involve communities in the design and implementation of Education In Emergencies
Methodology

Group Work
Individual work
Pair work
Presentations
Role play
Lecture
Demonstration

Duration of the training

07 Days
Training Contents

What is mental health

Post traumatic stress disorder
Schizophrenia
Basic helping skills
Psychosocial competencies
Community consultation
Social animation

6. Medical Camp
Medical Camps are the only way in emergencies to provide basic health facility. HANDS
Provides primary health services in disaster and emergencies through its staff and with
Partnership of different stake holders. We conduct rapid need assessment in prospect health
needs of IDPs and than plans medical mobile camps.
Objective
The Main Objective of medical camps in emergency is to provide basic health services.
Services
Antenatal, Post natal, Diarrhoea, Acute respiratory infection, Skin infection, Eye infection &
Measles
Other Services
Mobile medical teams also conduct health awareness sessions on pertinent topics like, Hand
washing; breast feeding, Diarrhoea, Health and Hygiene, Pneumonia, Antenatal care, Postnatal
Care, Malaria, Safe drinking water, vaccination etc.
Methodology
All teams develop weekly and monthly work plan, and inform the resource person in the
community and share the schedule of their visit and conduct mobile medical camps as per
schedule, after conduction of mobile medical camps and health awareness sessions teams share
the report with concern on daily basis.
Pre Camp Preparations:
Team Member (Health Care Providers - HCPs) comprises of Male/Female Doctor,
LHV/ Dispenser, Vaccinator, Social Mobilizer (Vehicle & Driver) as per need
Adequate medicine for daily camps as per list of medicines (Annex)
Daily and weekly plan of the medical camps available.
Daily requisition of Medicines. (Stock register of medicines, requisition slips,
Medicines will be stored at optimal condition i.e. at room temperature, avoid direct
sunlight. Check the Batch # and expiry date.)
Equipments and necessary items available, (Apron , BP Apparatus, stethoscope,
thermometer, needle cutter, adult and baby weighing scale, safety box, disposable
gloves, stitching material )
All the MIS (OPD Register, prescription slips and reporting format) record kept
carefully.
HCP will submit the report on daily basis to DEM/DPM or in charge.

At Medical Camp:
HCP will take the history of the patients and record it in OPD slip and register.
HCPs will prescribe rational medicines,
Unnecessary medicines/injections to be avoided.
Health session and counseling of the patients will be done with the support of IEC
Material as per defined protocol.
AN and PN checkups will be conducted and for natal services
Complicated cases will be referred to secondary and tertiary health care facilities.
Privacy and confidentially will be ensured as much as possible.
Banners should be placed at appropriate place for visibility.
Safety box /needle cutters to be used for used syringes and properly disposed.

Outreach Services:

HCPs will Provide the outreach services through door to door or tent to tent services
and try to reach where no one accessed.
HCPs will provide rest of services as static camps.

Post Camp:
Reports of the camp submitted on daily basis on given MIS.
DEM/DPM, in charge after compilation, will share the reports on daily basis with
SGM Health and with HANDS M E&R Focal Person
SGM Health will share the reports with stake holders on periodic basis.

Guide Line For Conduction Of Health Education Session

Health education sessions are conducted to create awareness among the communities
regarding healthy behaviors. these sessions are conducted in routine health programs and with
the IDPs as well. Health sessions are conducted on pertinent health topics/issues like health and
hygiene, exclusive breast feeding, weaning, growth monitoring, hand washing, ARI, Diarrhea,
Vaccination, Malaria, safe mother hood etc.
Pre Session:

Selection of participants (10 -15 Participants per session)

Finalization of date & time
Identification of Venue for Session (Well ventilated, well lighted)
Selection of Health education Material/Topic

(Malaria, Classification of Dehydration & Management , Preparation of ORS,TT Vaccine Schedule, EPI
Schedule, Hepatitis, Safe Motherhood 3 Delays, Hygiene and Hand washing)
Pre inform to participants
Make list for attendance of Participants.

During Session:

Team should reach at the venue on time

Sitting Arrangement of Participants should be proper as per situation.
Attendance of Participants/Photo graphics
Recitation of Holy Quran
Welcome to the participants
Share objectives of Session
Conduct session in local Language
Conduct session with the help of IEC material
Voice of Health Educator should be clear & loud
Eye contact with all Participants
Should avoid from noise
Respect to participant (encourage participants on positive Behaviors and encourage to ask questions
for better understanding of the subject)
Conclude session with Key/take home messages

Post Session

Reporting of session with Photo graphics

7. Community Midwives (CMW) School

Introduction
The Community Midwifery is 18 months duration
program after that successful student is prepared to
be a safe practitioner of the midwifery profession
in Pakistan. This course is for female. All
community midwifery education is to take place in
PNC (Pakistan Nursing Council) approved school
of midwifery and the community training will be
conducted in their catchment area of the school.
Pakistan Nursing Council Registration
Pakistan Nursing Council Act. In accordance with the PNC Act 1973(Item 15) registration of
community midwives with PNC is compulsory.
Requirement of community midwifery school
Community midwifery school required following things which are fulfill the PNC rules and
regulations, these are as follows;

Infrastructure of Institute As Prescribed By PNC Rules and Regulation

Faculty staff of Community Midwifery school of 25 Students with 50 Beds

Teaching Staff

Community Midwifery
Following PART A: PTS
Anatomy Physiology
First Aid
Microbiology
Pharmacology
Fundamental Of Nursing
Following PART B. MIDWIFERY
Anatomy Physiology (Female & Male
Reproductive System)
Pregnancy
Normal Labour
Puerperium
Newborn
Abnormalities Of Pregnancy
Community Midwifery & Health Education
Clinical Training

1. In hospital under supervision

(Log book for assessment of practical skill supervised by instructor/ Doctor of procedures.)
(Case book for assessment of practical skill supervised by instructor)
Labor Room
Observation of normal deliveries
Assisted normal delivery
Independent normal deliveries
Deliveries in midwifery care book / journal
Field Training
1. The selected community
(Family Register for assessment of field work supervised by Community Supervisor)

8. Community Based Management of Acute Malnutrition (CMAM)

Introduction
Worldwide nearly 20 Million children under five
are estimated to be suffering from severe acute
malnutrition at any given time. The recently
published Lancet Series on Maternal and Child
Undernutrition recognise SAM as one of the top
three nutrition-related causes of death in children
under-five. However, as SAM is rarely recorded
as a cause of death and data on mortality of
untreated severely malnourished children is
scarce, estimating the proportion of deaths
associated with SAM worldwide is problematic.
Objective
To address the malnutrition in vulnerable groups (<5 children and in pregnant and lactating
women PLWs).
Management of SAM
Community-based management of SAM (CMSAM) is a relatively new, evidence-based
approach which decentralizes the management of SAM and in this way provides the potential to
reach and treat the majority of these children. Combined with inpatient care for the sickest
children and effective management of children with moderate acute malnutrition where possible,
the approach allows the adoption of a comprehensive strategy to treat acute malnutrition. The
approach also fits into a wider programming context that should include interventions and
initiatives for the prevention of malnutrition (fig.1)
Community Level Approach

To engage communities and tapping into

existing community health and nutrition
systems as well as community-level networks
(such as community leaders, religious
authorities and women's groups).
To ensure that children are identified with the
help
of
communication
before
the
development of the severe medical
complications.

To identify children with SAM at community level.

Developed soft foods specifically with the right mix of nutrients to treat a child over six
months of age with SAM.
Rehabilitation children to treat of their diseases.
To motivate community-level health and nutrition staff and volunteers involved in the
programme to ensure sustainability.

Implementation
To address the malnutrition in vulnerable groups (<5 children and in pregnant and lactating
women PLWs) the assessment is done by nutrition team at Fix or mobile OTP (Out patient
therapeutic Program) through MUAC (Mid upper Arm Circumference )
The Moderate Acute Mal nutrient (MAM, MUAC 11.5 12.4 cm ) will be identified. They will
be admitted at SFP (Supplementary Feeding Program) They will be given plumpy
supplementary till two months. High energy biscuits will be given to Siblings to prevent
malnutrition and sharing of the plumpy supplementary.
Severe Acute Mal nutrient (SAM MAUC < 11.5 cm without medical complications ) will be
admitted at OTP according to the criteria and plumpy nuts will be given to them and they will be
reassessed after two weeks. And they will be transferred after two months when their MAUC is
more then 11.5 cm to the SFP, Height weight and vitals are checked by team for all identified
SAM children and PLWs.
The SAM children with medical complication (edema, vomiting, persistent diarrhea loss of
appetite will be referred to Stabilizing Center. WHO Standardized treatment is given to these
children.
The pregnant and lactating women ( PLW) less than 21 cm MUAC will be admitted at SFP and
will be provided the 2.25 kg vegetable oil and soya blended flour one in a month till 2 months.
They will be reassessed after two months and if MAUC is more than 21 cm then they will be
discharged. And if MAUC is less than 21 cm after two months treatment they will be
reassessed/observed for two weeks at SFP. If no improvement then they will be referred to
secondary/ tertiary care facility.
All the data is shared with stake holders in Nutrition Information System (NIS).
Strategies

Human Resources: Having a sufficient and productive workforce.

Service Delivery: Improving planning, organisation, management and quality of services.

Stewardship/Governance/Leadership: Defining sector strategies, clarifying roles,

managing competing demands.
Health Financing: Ensuring fair and sustainable financing with financial protection.
Information and Knowledge: Ensuring the generation and use of information, including
for monitoring and evaluation.
Technology and Infrastructure: Ensuring adequate supplies, equipment and infrastructure.

Annexure:
Project Reports.