Pakistan: Winter Relief and Health Services for Rehabilitation of Returning IDPs

Registration of Repatriating Families

Priority Given to Those in Most Need

In coordination with the PDMA (Provincial Disaster Management Authority) and District Union Councilors, 167 vulnerable families were registered in four union councils (UCs) of two tehsils. The process of selection followed an intensive, three-step protocol based on four criteria:

1) Preference given to female-headed households,
2) repatriation from IDP host site within the previous 2–3 months,
3) family includes young children and elderly members, and
4) single source income of ₨15,000/- (US$150/-) or less.

Every family was visited personally by RMF Pakistan’s head office, and a copy of the national identity card of the head of household, ages of young children, pregnant/lactating mothers, and number of menstruating women in the household were recorded. Each registered family was designated a case number, and a means of communication, via mobile phone, was established with the family, either directly with the head of household or via a proxy so that each family can be contacted with the timetable of our distribution days.

Procurement, Quality Assurance, and Storage of Supplies

Supporting Local Vendors

Following RMF’s four-step protocols of procurement, RMF staff finalized different vendors for the relief goods and established MOUs with them at the start of the project. All vendors are from the local markets in the city of Mingora, the capital of District Swat. The four-step procedure is outlined below:

• Step 1: Tender for quotations is published in the local daily paper, or where this is not possible, then via
  the local market channels specific to the field site.
• Step 2: A minimum of three quotations are entertained for each type of relief good item. Preference is
  given to a vendor who can supply more than one type of good.
• Step 3: Once quotations are received, each potential vendor is then visited ad hoc for a quality assurance
  exercise. If the goods are not to our standard of quality, then additional quotations are requested from
  the market and the exercise is repeated.
• Step 4: The final selection is made based on the quality of the goods and the most reasonable rate.

Procured goods are first stored in the RMF hub clinic compound, where the RMF monitoring and evaluation officer(s) carry out quality checks. Packages are randomly selected, and after tallying with family case numbers, each packet is opened and items examined and counted. Only after a successful quality assurance exercise is the vendor paid the balance of his bill.

Distribution

The First Day of Every Month

Distributions, carried out by the RMF field staff, are scheduled in the first week of every month and take four days to complete. Each day is allocated to one union council (UC). Prior to distribution, goods are transported by rented transport vehicles to storage facilities in each UC. Each storage facility has its own security guard. Beneficiary families are informed well in advance to ensure their presence, and we do not distribute packages to substitute representatives. Verification via national identity cards and tallying with our records is carried out for each family prior to receipt of goods. By our 3rd distribution, we have begun recognizing their faces.

Measurable Outcomes

Thousands Impacted

During the current period, 455 households with a population of 3,063 were provided with project planned services. Of these were eight female-headed households. In Swat, a single woman can head a household independently only if she is elderly (above 60 years); younger single women (divorced/widowed) with young children are not allowed to live alone; they either return to natal families or continue to live with their in-laws. Within the family, their status of dependency on hosts’ graciousness make them vulnerable to mental abuse. The population of 3,063 beneficiaries was comprised of 1,562 males and 1,501 females. Children under 15 years of age were 971 male and 831 female children.

Objective 1: To provide relief shelter, i.e. winterized tents, plastic floor mats, carpets, and minor repair of damaged houses

As per our needs assessment report in the first progress report, winterized tents and repair of damaged houses was not needed. However, floor surfaces required water impervious plastic floor mats and carpets. Hence, 167 waterproof, plastic floor mats and 167 carpets were provided to the families.

Objective 2: To provide relief food, i.e. uncooked food rations and cooking provisions

A total of 455 food packages were distributed in these three months to the registered families. Each package consists of:

• Flour 40 kg
• Tea 1 kg
• Lentils 10 kg
• Rice 20 kg
• Powdered milk 2 kg
• Spices/Salt 1 packet
• Cooking oil 5 kg
• Sugar 5 kg
• Matchboxes 1 packet

In total, 18,200 kg of flour, 9,100 kg of rice, 2,275 liters of cooking oil, 455 kg of tea, 455 kg of powdered milk, 2,275 kg of sugar, 5,005 kg of lentils, 455 packets of spices, and 455 packets of matches were distributed during the current period. Packages were distributed according to the needs and size of each family; when a family consisted of fewer than 4 members, one package lasted them for two months.

Coal, a local commodity, was provided to the families as a cooking and heating fuel; a total of 6,855 kg of coal was provided during this period. At the beginning, 30 kg of coal was budgeted for a family, but later during the needs assessment, it was found that 15 kg of coal was enough for one family at an average, considering that people also had some alternate arrangements.

Objective 3: To provide warm clothing, blankets, and hot water bottles

The major component of warm clothing was given to the registered households in the first distribution at the launch of the project, as this was an immediate need at the start of winter. During this quarter, 334 polyester quilts were issued to 167 families, at two quilts per family. In addition, 832 warm shawls were provided to the adult men and women, and the teenaged boys and girls. The shawls were purchased from a local vendor, as Swati people like wearing their own traditional shawls.

Objective 4: To provide family hygiene kits and MHM (menstrual hygiene management) kits

Replenishment items for both the family hygiene kits and menstrual hygiene management (MHM) kits were provided to the registered households during this period. The replenishment items for the MHM kits included sanitary napkins and green tea, while the family hygiene kit items included shampoo, body lotion, toothpaste, hand soap and laundry soap. A total of 455 family hygiene kits and 782 MHM kits were replenished.

Objective 5: To provide primary health care via outreach satellite clinics

Providing quality primary healthcare to repatriating IDPs and other vulnerable community members is essential, as the project focus areas are high altitude villages in the mountains, where unpaved access roads block up during heavy snow days, isolating communities for long periods. Starting a primary healthcare center in such an area proved to be a challenge. The literacy rate is extremely low, so there were no medically trained personnel in the area or surroundings. The decision made was to bring medical staff from 30 km away and provide a transport allowance. With this limitation, we set up one central health unit in Chatekal, UC Beha.

Procurement of medical equipment and medicines was made from the nearest city of Mingora by the RMF field staff, following the same protocols used for our Swat health project. Staffed by a Lady Health Visitor (LHV) and a Medical Technician, this clinic operates 3 OPD days a week on-site and conducts 12 monthly outreach OPD visits to the other three UCs of the project sites, thus providing the requisite services. Beneficiaries include registered families and other vulnerable populations from the union councils of Madyan, Bashigran, Bahrain, and Beha.

During this 3-month reporting period (from January to March 2018), the Real Medicine Clinic provided healthcare services to 2,259 community members, comprising 1,094 adults (265 men; 829 women) and 1,165 children (556 boys; 609 girls). Daily OPD averaged at 25–35 patients per day. The average OPD fell during February, when there were landslides and heavy snowfall.

Primary health care consisted of 1,985 consultations, of which the majority were 568 gastric-related complaints of diarrhea, vomiting, abdominal pains, and gastritis, followed by 424 respiratory tract infections. Other complaints included urinary tract infections (228), anemia (215), scabies (125), enteric fever (135), hypertension (54), malaise and body weakness (122), and non-TRA injuries (16). Miscellaneous complaints were grouped under “other” (90).

Maternal and reproductive health services were required for 850 consultations, including 147 antenatal, 94 postnatal, and 20 family planning visits. Other common reproductive ailments were also treated, such as leucorrhea (94), dysmenorrhea (76), amenorrhea (76), pelvic inflammatory diseases (112), p/v bleeding and discharge (87), and irregular periods (62). There were also primary and secondary infertility cases (28) and MCH-related miscellaneous complaints grouped under “other” (75).