BACKGROUND
XXXXXXX is a non-profit Organization registered in Pakistan since 28th October 2002 under the voluntary Social Welfare Agencies Act 1961. XXXXXXX is registered with the United Nations with its body the ECSOC (United Nations Economic and Social Council). The XXXXXXX is affiliated with XXXXXXX aims to provide necessary assistance of promoting the enjoyment of the Human Rights pertaining to the people of Pakistan. It lays emphasis to create opportunities for the implementation of developmental projects pertaining to various sectors i.e. Education, Health, Social-welfare, Violence-Against-Women (VAW), and provision of legal aid to prisoners, poor women & other deserves persons.
The project is Reducing Stigma of TB and Children and women have access to appropriate feeding services, including through provision of essential supplies – especially therapeutic foods for the management of severe acute malnutrition (SAM) through Community Management of Acute Malnutrition (CMAM) approach from the rural and urban areas where 2 Tehsil of district Malakand will be targeted. Our XXXXXXX will focus to train many volunteers, Nurse and lay men by the specialist trainers and Doctor who are well equipped and experienced so that there will be identification and proper treatment through our mobile clinic and general services. Our XXXXXXX is a local initiative that attempts to begin a transition by improving the quality of life style in all ages groups that of disadvantaged or the vulnerable groups or individual through providing or supporting them with life skills, teaching , treatment and behavioural change (attitude, practice and knowledge) and Voluntary Testing and counselling and all other development activities for community health services. The proposed project will support for appropriate infant and young child feeding (IYCF) is accessed by vulnerable children (girls and boys), pregnant women and breastfeeding mothers; especially protecting and supporting exclusive breastfeeding by dissuading and monitoring the donation of breastmilk substitutes and providing safe breastfeeding areas for nursing mothers and promoting timely and appropriate complimentary feeding. Children and women have access to appropriate feeding services, including through provision of essential supplies – especially therapeutic foods for the management of severe acute malnutrition (SAM) through Community Management of Acute Malnutrition (CMAM) approach. The Children and women access micronutrients from fortified foods, supplements or multiple-micronutrient preparations e.g. home fortification to address micronutrient deficiencies in emergencies. Children and women access behaviour change communication interventions for protecting and promoting existing positive nutrition practices wherever possible to enable communities, cope with subsequent shocks.
SITUATIONAL ANALYSIS
As we know that pakistan is the most populated and uneducated country in asia. Annually around 430,000 people including 15,000 children contract tuberculosis (tb) in pakistan while not less than 70,000 deaths every year can be attributed to the disease in the country. Tuberculosis (tb) is a leading cause of death worldwide. Pakistan ranks sixth globally among the 22 high-tb burden countries and contributes an estimated 43 percent of the disease towards the eastern. Mediterranean region. Pakistan is also estimated to have the fourth highest prevalence of multi drug resistant tuberculosis (mdr-tb) globally. Over 95 percent of tuberculosis deaths occur in low and middle-income countries. A large number of people infected with the tuberculosis bacilli are not diagnosed either because of poverty or because of lack of awareness about the seriousness of the disease. The delay in diagnosis along with unsupervised, inappropriate and inadequate drug regimens, poor follow up and lack of social support programmes for high-risk population, are some of the reasons for not reaching the target rates and emergence of a drug resistant form of tuberculosis. Tuberculosis is an ancient disease however, poses serious challenge in the modern era in developing as well as developed countries. Every year millions of peoples are infected with tb and millions of peoples loss their lives.
According to the need base assessment a total of 8000 patients of TB are registered at THQ Hospital Dargai and the male to female ratio was 46.74% and 53.26% respectively. The high No. of patient were registered during 2013 while the lowest in 2011. On the basis of percentage high prevalence of PTB-SS+ve was recorded in 2013 while almost similar ratio was also reported in 2014. Overall prevalence of PTB-SS+ve was notified to be 40.08%. Of the total 55.71% suspected cases of PTB 40.08% were found smear positive while 15.63% were negative. High cases of smear positive was reported in female 57.63% while in case of smear negative the male individuals was high as compare to female.
In Despite of these, child malnutrition rates throughout in Pakistan remain persistently high. The history of National Nutrition surveys conducted in the last 3 decades (1985-87, 2001-02, MICS 2007) depict a worrying situation of malnutrition in Pakistan [13% acute malnutrition rate and much higher rates of chronic malnutrition]. However, the threat of acute malnutrition is no more hidden in the country, the current malnutrition crises is really is an alarming level in the proposed area, reiterating the dire need to address this serious public health problem on priority basis. Gradually increasing food insecurity, hikes in the prices of food commodities, lack of antenatal and postnatal counselling and traditionally poor infant and young children feeding practices contribute to the increased prevalence of acute malnutrition in most areas of Malakand. Furthermore, the gender biased environment, poor agricultural reforms and isolation could amplify the food insecurity affecting the vulnerable population. The lack of access to basic health care services, high morbidity rates, damaged infrastructure and price hike further compound these issues and has the potential to affect the nutrition wellbeing of the population. Diarrhoea and malaria are common in the proposed area and these diseases have a negative synergy with malnutrition. It is expected that all of these factors will adversely impact and further worsen the nutritional status of pregnant women and the youngest and most vulnerable children especially in Agra & Khaar Malakand.
XXXXXXX has result oriented track record in the domain of nutrition with UNICEF and has a very strong presence in district Malakand where it has provided nutrition services to the IDPs residing with host communities in 20 health facilities of district Malakand. There is a great need to continue these life-saving nutrition services among the displaced population and to provide these services to more areas within Malakand district where the IDPs will be accommodated. The continuum of the nutrition services will help manage the already registered acute malnourished cases, and to reach additional malnourished vulnerable children and women among the newly displaced IDPs and hosting communities as well.
in the proposed area, our project will work in district Malakand 300 to 500 villages and 02 sub division will be targets. On other hand, in village’s level, there is no good treatment center and doctor. This is why our XXXXXXX will build up them, social awareness training in the community and medical camp and treatment services. Even some government hospital in the city but lack of financial support poorest people cannot do this and they died in the early. For this reason, our project is needed for this community for the better life and good health.
PROJECT GOAL AND OBJECTIVES
The objectives of the Project are to:
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- To improve access to and quality of health services in district Malakand with a particular focus on primary health care, maternal health and Tuberculosis TB and HIV/ AIDS
- To increase social safety net access for orphans and vulnerable children and all ages groups for the health service by XXXXXXX
- Sstrengthening the capacity of the Health sector, teaching to the people in the villages and building awareness in the society.
- Facility-level support to improve access, quality and efficiency of services, and development them.
- Strengthening the community and also the treatment quality in the rural and urban.
- Component one will support interventions, which will strengthen the capacity of the health care system at different levels especially in the areas of governance, management and performance. Component two will: i) Provide support to clinics, health centres and hospitals to improve access to and quality of health services, and ii) Support nursing training institutions to expand midwifery.
- Public awareness expanding leaflet and banner and microphone will exposures of the subject issues. Not only this but many youth people will train in the community who can work as the volunteers with us.
- Children and women have access to appropriate feeding services, including through provision of essential supplies – especially therapeutic foods for the management of severe acute malnutrition (SAM) through Community Management of Acute Malnutrition (CMAM) approach.
- Support for appropriate infant and young child feeding (IYCF) is accessed by vulnerable children (girls and boys), pregnant women and breastfeeding mothers; especially protecting and supporting exclusive breastfeeding by dissuading and monitoring the donation of breast milk substitutes and providing safe breastfeeding areas for nursing mothers and promoting timely and appropriate complimentary feeding.
- Children and women have access to appropriate feeding services, including through provision of essential supplies – especially therapeutic foods for the management of severe acute malnutrition (SAM) through Community Management of Acute Malnutrition (CMAM) approach
- Children and women access micronutrients from fortified foods, supplements or multiple-micronutrient preparations e.g., home fortification to address micronutrient deficiencies in emergencies
- Children and women access behaviour change communication interventions for protecting and promoting existing positive nutrition practices wherever possible to enable communities, cope with subsequent shocks.
- Children and women access micronutrients from fortified foods, supplements or multiple-micronutrient preparations e.g., home fortification to address micronutrient deficiencies in emergency
- Children and women access behaviour change communication interventions for protecting and promoting existing positive nutrition practices wherever possible to enable communities, cope with subsequent shocks
PROJECT IMPLEMENTATION STRATEGY
Near the DHQ hospital Batkhela will be the XXXXXXX branch office so that we can give them medical services who are very dangerous situation TB. Supporting and referring for treatment of opportunistic infections e.g. malaria, TB, diarrhoea, and others diseases also. Encourage positive participation of People Living with TB. Train many people including boys, girls, men & women in the community. Leaflets and banner will distribute beside of the road and market places where many people will know through this and understand the matter well. g. Giving briefing ideas in the daily local newspapers for awareness. The workers will go to the villages regularly and teach and train people house to house who can also voluntarily help of works. In the city health centre and other local NGOs will be supported with us to work together to cure TB from the target areas. Regular monitoring of the People Living with TB and all ages groups. The proposed strategy for nutrition is designed to ensure the provision of lifesaving nutrition services for acutely malnourished children (boys and girls), pregnant and lactating women in off-camp; to prevent poor nutritional outcome through rigorous promotion of optimal infant feeding practices, proper hygiene/sanitation and improved maternal nutrition; micronutrients supplementation and nutrition education on locally available foods; setting up of a robust reporting and information system and monitoring mechanism; establishment of a strong surveillance system, and emphasis on capacity development of health care providers for all target areas to be implemented in partnership with the agency surgeon, Donor and WHO.
The agreed activities will be coordinated through the Nutrition Cluster with FDMA and other relevant clusters including Health, Food and WASH, and will be implemented with support from DHO and WHO.
This intervention will support the people of district Malakand for ensuring provision of life saving preventive and promotive nutritional services for vulnerable children (boys and girls) and pregnant & lactating women at the community and facility level that meet national and internationally recommended minimum standard of care for a population affected in the targeted area.
The project will focus on treatment of acute malnourished children and women and prevention of poor nutritional outcomes through rigorous promotion of optimal infant feeding practices, proper hygiene/sanitation and improved maternal nutrition. In addition, micronutrients supplementation and nutrition education on locally available foods and setting up of a robust reporting and monitoring mechanism will be emphasized. The program will be implemented in partnership with the Agency surgeon and provincial nutrition cell of the DGHS KP. XXXXXXX will report to donor on all activities for this project and will be responsible for implementation of activities related to the community outreach component, outpatient therapeutic program (OTP), supplementary feeding program (SFP) and referral/follow-up to stabilization centres (SCs) as well as improved infant and young child feeding, micronutrient supplementation and nutrition/health and hygiene education. The key strategic components are given below;
COMMUNITY OUTREACH
Outreach Workers (ORW) Nutrition Staff, and other community-based staff will be trained in the identification of TB patients & acutely malnourished children using Oedema assessment and mid-upper-arm circumference (MUAC) measurement, will be responsible for referring clients to nutrition centres & hospitals on daily basis or other agreed upon plan. In addition to identification of TB patient’s acutely malnourished children, ORWs will communicate promotion messages on health and nutrition, will follow-up with defaulters, and will identify pregnant and lactating women for SFP and care during pregnancy and in the immediate postnatal period. Simultaneously, ORWs will identify cases of acute malnutrition in the community through active case searches. In each area at sector level health committee & nutrition support committee will be formed, and sensitized through regular meetings. In meetings nutrition education sessions will be conducted to prevent from TB malnutrition and adopt healthy behaviour in childcare. Behaviour change communication through health, hygiene and nutrition promotion is the vital components for sustainability. This endeavour is designed to promote Infant Young Child Feeding (IYCF) practices with more emphasis on exclusive breastfeeding and proper complementary feeding. ORWs will work in close association with the community, form committees of female in the community and will conduct sessions to disseminate key messages related to improved IYCF practices & health, good maternal nutrition and health and hygiene.
OUTPATIENT THERAPEUTIC PROGRAM
The patients of TB & children with severe acute malnutrition (SAM) with appetite and without complications will be treated with ready-to-use therapeutic foods (RUTF) and symptomatic outpatient medications in the nutrition centres. The severely TB patients & malnourished child will come to the nutrition centre & hospital every week for a medical examination and treatment, and to receive RUTF. Children without appetite and/or with complications will be referred immediately to inpatient care in Stabilization Centres until they are stable to be discharged. These children then continue treatment at home in the OTP with RUTF, +/- outpatient medications. On discharge from the OTP, children will be referred to the SFP as moderately malnourished children. Through this PCA, a total of 10 Nutrition sites will function in selected health facilities of district Malakamd under XXXXXXX oversight. Referral services from the community also pertain to lady health workers involvement.
STABILIZATION CENTRE
Children without appetite and with complications will be treated as inpatients at a Stabilization Centre until they are stable for discharge. XXXXXXX will refer clients and will ensure they are treated in the stabilization centre established at various hospitals in Khyber Pakhtunkhwa. To the fullest extent possible discharged children will be referred to OTP once they are stabilized.
PROJECT ACTIVITIES
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- Mobilization and field work This shall include data collection and development of a database. The Identified shall be informed of the training that shall be carried out by technical personnel in Health Education. And also, the treatment in the villages house to house. Our nurse and doctors will be available for this service.
- Prevention activities: prevention activities will be conducted among the population: information campaigns, and a tuberculosis hot line. Contests for mass-media will be organized and held; information materials on tuberculosis prevention will be designed and published. It is planned to conduct awareness-raising activities among the most vulnerable populations (homeless persons) to motivate them to undergo testing, to provide material and moral support to this category of people using the resources of the Belarusian Red Cross, the Ministry of Internal Affairs, the sanitary-epidemiological service, and the Ministry of Labor and Social Protection.
- Training Experienced Health Educator will be the facilitator who shall deliver quality skills to the target group. This shall be conducted on face-to-face basis. This training shall be residential for 14 days (two weeks). Thereafter, short refresher courses shall be conducted depending on the report and assessment from the monitoring and evaluation desk.
- Monthly debates and moderation: A monthly debate and moderation among the target group before the general community shall be conducted from place to place in all the Parishes in NECT Sub-County thorough out the year
- 24,000 mothers/caretakers are educated on importance of early initiation of breastfeeding, exclusive breastfeeding up to six months of age, appropriate complementary feeding, good nutrition during pregnancy and lactation and improved hygiene practices through Behavior Change Communication (BCC) approach
- A total of 30 women support groups will be established three per SFP/OTP sites to support IYCF social mobilization activities
- Screening conduction in 10 facilities
- 10 fixed nutrition sites remain functional for provision of CMAM interventions in the target health facilities.
XXXXXXX staff and DoH receives trainings on CMAM/IYCF protocols for the management of malnutrition.
Trained & equipped ORWs continue community mobilization, screening & identification of acute malnourished children and PLW, and follow-up to ensure enrolment.
HCPs of CDO in their respective centers identify 1926 MAM children &2120 PLW in SFP. Register 770 SAM children in OTP and ensure treatment of 193 children in SC, as per CMAM protocols, in coordination with the community outreach and concerned centers.
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- 13427children and 11307 mothers are provided with multi-micronutrient (MM) supplements
- Mothers and care takers know about symptoms, causes, and preventive measures of malnourished children and mothers,
- Activist and village level opinion makers (religious leaders, teachers and influential) know about symptoms, causes, and preventive measures of malnourished children and mothers’ malnutrition and have the skills to transfer the communities in general
Monitoring and Evaluation The project team together with the local community and local government in NECT with monitor the project. The result should be measurable on the context of attitude, practice and knowledge of the community services. The indicator should measure clearly the impact of the project in the Community. The reports shall guide the management on any other interventions to be addressed in the following project period.
GENDER EQUITY
All planned activities consider gender equity. The mother-child and women health services are targeted towards the most vulnerable of the present crisis. Based on the Gender marker (prepared by ISAC), XXXXXXX will aim to reach/achieve at least 2A marker for its nutrition intervention packages which target women and children (the most vulnerable). The nutrition services will be provided on need basis.
SUSTAINABILITY
The sustainability will accrue mainly from the trained community personnel in the project area and proper treatment so that our XXXXXXX bring the good honor ship in the community throughout the project life and the project strategic approach of linking the all arrangement in line with the normal Government policy in addressing the problem the capacity of the people all ages groups will be built to make aware them regarding the TB diseases. Health & nutrition’s committee will be formed & will be trained on the project work frame & after the phase out they will do their task. This intervention will introduce the culture of improved nutrition behaviours to the population and will help in demand creation for health among people living in different areas. A referral mechanism will be established where TB patients & complicated malnourished cases will be referred to the nearby stabilization centres established at district headquarter and/or teaching hospitals in Khyber Pakhtunkhwa. Local capacity will be built through involvement of local communities in project implementation. Involvement of Ulema will have long term positive implications on the overall development process of the district. The approach and intention of the proposed project is to work in conjunction with the Agency health authorities and in consultation with the provincial and national nutrition working groups and other stakeholders, with an aim to strengthen the service provision and to revitalize the district health system to take ownership of the services in long run in Malakand.
The project proposal endorses the vision of integrated CMAM approach at health facility and community level, relying on the XXXXXXX staff and community outreach workers to sensitize the targeted populations and sustain the preventive aspects of CMAM, in long run with a particular focus on dissemination of key information relevant to appropriate IYCF practices. The project will focus on the service providers (XXXXXXX staff) and community to sustain the impact of the CMAM interventions by ensuring:
MONITORING AND EVALUATION
The purpose of project monitoring and evaluation is to provide all stakeholders with updated information on project implementation progress, and on the progress made towards achieving the project goals and objectives. Project monitoring will be performed in line with standard procedures and will be underpinned by recurrent evaluations of progress towards the achievement of certain project results and project objectives. The developed indicators will help determine the extent to which expected project results are achieved by means of measuring what has actually occurred and comparing it to what was planned with due regard of such aspects as quality, quantity and time. The monitoring and evaluation plan is a fundamental document that shapes the working relationship with the donor fund.
The following tools will be used for project monitoring and evaluation:
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- Semi-annual and annual program and financial project reports prepared by the Project Management Unit
- Field trips by the Monitoring and Evaluation, the doctors, DHQ hospital head, the donor Programme Officer, and other project personnel that are intended to evaluate project implementation progress;
- Participation of a monitoring and evaluation officer in regular meetings with thematic coordinators of individual project components;
- Awareness sessions during which reports prepared by the Project Management Unit are reviewed and actual results are checked against the expected ones;
At the consent of donor fund, the donor may revise the key target indicators of the project on the basis of progress reports if unspent financial resources are available or if there is a change of needs.
The XXXXXXX Country Office will perform recurrent monitoring of project implementation by way of visiting sites, and inform the concerns on project implementation progress. The sessions of the TB & Nutrition will be held more frequently if necessary. That will allow stakeholders to rapidly identify and eliminate any project-related problems and to ensure uninterrupted implementation of project activities.
