Sungi's Health Program endeavors to improve the health status of the poor communities, especially women and children. The program focuses on advocating for basic health rights, improving public health practices in communities particularly women and child health, capacity building of volunteers, communities, service providers and staff and form linkages with the local healthcare system.

• Improved Healthcare Policies and Services Provision Advocated
• Health Advocacy at National Level
• More Attentive to Primary Healthcare, Improved Hygiene & Sanitation, Disaster Preparedness/Mitigation & Improved Access to Healthcare services
• HIV Awareness as Part of Sungi's Regular Health Programme
• Health Projects

Promoting Health Advocacy

Establish and strengthen district health forum

During the year in Haripur a meeting of the District Health Board was held at zonal office in the last week of March, 2007. In the meeting Distt: Nazim, DCO, EDO health, MS DHQ, Population Welfare Officer, President Provincial Homeopathic Association, Green Star Social Marketing, SIHD, RDP, SC, SDV, Chamber of Commerce Haripur, PRCS, SMT, Education Deptt:, LG members, Distt: Councilor Minority, Distt: Hateeb, ACCs and the members of CSOs participated. During the meeting, community partners showed their concerns on the Basic Health Units and staff of their areas. After listening to the concerns, the following decisions were taken:

• Health staff for BHU Klinjar will be provided by the EDO health Haripur with in 10 days of the meeting.
• The Distt: Nazim and DCO will visit BHU Jab to monitor the construction work and ensure the use of good quality material.
• Any construction which is funded by the Govt: will be recognized after verifying the bills by UC Nazim and BHU staff.
• The Dewan and Saadi cement factories is establishing medical centre at Hattar Industrial state with in 10 days.
• The Distt: Govt: realized the ownership of the forum and next meeting of the Distt: Health Board will be held in July 2007 at Distt: Nazim office.
• The MS DHQ and AC Health of the zone will jointly organize 17 seminars on basic health and STIs for boys and girls of the schools and colleges.

The work plans of the participated organization are shared during meeting, and helped the participants in mutual coordination and better utilization of resources.

BHUs made functional in Battagram district
During the year the Battagram zone visited the functional BHUs in working area and subsequently after raising the awareness among people about health, they were linked with BHUs to avail the services being provided there. In total five VCs (60% MVCs) were linked with BHUs in UC Battamori and Shamlai in district Battagram.

BHUs made functional in Haripur district

• BHU Klinjar was not operational since the unit was established due to lack of staff recruitment which was to be provided by the health department in Haripur. Following the district meeting issue Health staff for BHU Klinjar will be provided by the EDO health Haripur with in 10 days of the meeting.

• The community of Jab complained of the women staff in BHU Jab charging more money for treatment. This issue was bought forward in the district health board meeting, in which the district Nazim immediately formed a committee to look into the matter. The committee visited the BHU and talk to both the female staff and the patient who gave the money. A report on this was made and presented to the district Nazim. The result of the investigation is still in process.

• The Nazim of Jab union council informed the district Nazim about the bad quality material being used in the wall construction of the BHU during the district health board meeting. The Distt: Nazim and DCO visited the BHU themselves to monitor the construction work. When the same was observed by them as well, the district Nazim called the responsible persons in works and service department of district Haripur for an explanation. When he was found at fault, he was terminated from his position.

Health Advocacy at local level The cement factories in industrial state Hattar are continuously producing environmental pollution and through this about 70 thousands population of three UCs at Hattar, Dingi and Bareela are affecting directly. As a result of this the Respiratory Tract Infection diseases are increasing day by day. Beside this, it is also badly affecting the water resources, which decreased the yield of crops. To cope this situation, the zone facilitated advocacy tools along with the help of partner organizations at Hattar. The negotiation are held with owners regarding treatment plants, information dissemination to all concerned MNAs, MPAs, UCs Nazims and EDO health, press conference and round table conference. Appropriate timeframe had given to factories owners to fulfill the genuine demands of the communities. To accelerate the above motion a meeting of Distt: health board was held at the zonal office on March 28, 2007, the facts and figures shared with Distt: Nazim in the meeting. The Distt: Nazim informed the participants, that the Dewan and Saadi cement factories is hiring one doctor, technician and free equipment and medication. The community will identify the location for the medical centre.

Water at risks campaign

The freshwater resources of Pakistan are under immense stress. The stress is from multiple sources such as urban growth, increased industrial activity and dependence of the agriculture sector on chemicals and fertilizers. Deterioration in water quality and contamination of lake and river ecosystems and groundwater aquifers has resulted in increased water borne diseases and other human health impacts.
Following the local level water quality and pollution campaign in Haripur district, Sungi Health program is involved in a national level campaign on water quality and quantity. The campaign is in collaboration with a number of civil society organizations who are collectively working on the issues. A report on “Pakistan’s Waters at Risk” was compiled and launched through a press conference. Copies of the report were sent to many organizations including the Prime Minister. According to the report, deterioration in water quality and contamination of lake and river ecosystems and groundwater aquifers has resulted in increased water borne diseases and human health impacts. Following this, an appeal was developed and printed in February, 2007.

The Prime Minister, on 13th March, 2007, invited the water campaign partners to help improve the deteriorating quality of drinking water. Participants of the meeting included Ali Habib, Director General WWF-Pakistan, Hammad Naqi, Director WWF-Pakistan, Dr Yasmeen Rashid, Chair Pani Pakistan, Ms Najia Rafiq, Manager Health Sungi Development Foundation, Nadeem Fazil, Country Director Action Aid and Roland D’Souza, Chair Shehri CBE.
The civil society demanded that Water Environmental Standards be developed and enforced, concerned agencies and industries be compelled to treat industrial and municipal wastewater and a National Water Quality Monitoring Commission be immediately established. The Prime Minister has agreed that a working group with representatives of both government and non governmental organizations be formed for implementing a regulatory framework to protect and improve the country’s water resources.
The water at risks campaign organizations (civil society members) are thankful to Prime Minister Shaukat Aziz for his positive response to their campaign regarding water contamination in the country. The civil society is hopeful that with the concern that the Prime Minister has shown steps will soon be taken to improve the situation.

Women & Men in Partner Communities are More Attentive to Primary Healthcare, Improved Hygiene & Sanitation, Disaster Preparedness/Mitigation & Improved Access to Healthcare Services Especially for Women

• Health awareness among stakeholders
Awareness raising among the partner communities about preventive health care is an on going event within the program. The health education sessions are held with men, women and school going children of the partner communities. During these sessions the partners are given detail information and awareness about health and hygiene, communicable diseases, basic health issues, preventive health measures adopted, reproductive health care, rabies, RTI, sexually transmitted diseases STDs, and anti natal/post natal care. Health education is an on going process and now information on HIV-AIDS has also been included in the campaign.

Follow up study revealed that the students of the school in which the sessions have been delivered are more clean and sensitive about health and hygiene. The environment of the schools has been also kept clean and healthy.

Considering that the earthquake victims are still affected and need psycho-social support, the program has trained its health staff in psycho-social counseling who are now providing psycho-social support to the local communities.

During the month of February a workshop on HIV/AIDs was attended by Manager Health and the Executive Director of Sungi. It was unanimously decided that HIV/AIDS is a very critical issue in Pakistan. Sungi would like to incorporate HIV programmatic interventions in its existing program area and build on an advocacy campaign on HIV/AIDs. In order to achieve this, it was resolved that unless the staff is itself educated on sexual health and HIV, it would not be possible to take the issue up at the community level.
This intervention is not possible unless the Sungi staff is itself educated on sexual health and HIV. With regard to this, the staff was oriented on the issue through a HIV theatre performance during the annual retreat for staff in March, 2007 while a banner on the preventive measures for HIV was also displaced during the annual retreat. Similarly, HIV workshops will also be held for staff later on in the year.

Battagram Zone organized training on preventive health for health committees at village committee levels during which they were also made aware about HIV and its spread. The participants spread this knowledge in the villages especially in barber shops about precautionary measures during shaving. Following the training, the participants also demanded for sterilization instruments so that they can decontaminate the tools used in clinics and salons. In order to facilitate this need, Sungi is collaborating with other NGOs and health department.

HEALTH PROJECTS IN DISASTER AREAS
1. WOMEN FRIENDLY SPACES PROJECT
Sungi Development Foundation has initiated a Women Friendly Spaces (WFS) project with financial support from Shirkat Gah. The WFS is planned to provide a space to come together around organized activities to drop in and relax, find information on health, RH and other gender specific matters and for capacity building in areas identified by the women.

Objectives
To provide women friendly spaces (WFSs), in Muzzafarabad earthquake affected areas for structured and unstructured activities including recreational activities, collective reading, using library activities.
To provide advice and referrals on issues related to women’s and adolescent girls’ general health, nutrition and reproductive health needs.
To enhance women’s capacity to participate in reconstruction and rehabilitation programmes in their areas through:

Awareness programmes
Trainings (psycho-social support, social mobilization etc)
Skill development (to enhance incomes)
Linking with service providers, existing networks/institutions, markets.

The WFSs were decided to be in three union councils of district Muzzaffarabad, namely Hattian Dupatta, Charakpura and Gojra. The sites for the centres were selected in consultation with the local communities. Each centre is operated by two local assistant coordinators in order to give an opportunity to the educated girls of the areas as well as ensure that the staff understands and can adapt to the cultural context of the centre easily. In addition, in terms of sustainability, if the staff is local, it would be easier for the community to continue with the centre and the staff.

The staff then conducted a needs assessment to understand the needs of the women of the area. The assessments showed the needs of women in the areas and what resources were available for them there. In addition, the assessment also showed the resources which can be utilized at the local level for the use of women and centres. Following this, the centres have been established in which activities such as adult literacy classes, enterprise development trainings (Crafts), Natural resource management trainings and health trainings are conducted.

2. COMMUNITY INTEGRATED SUPPORT PROJECT-HEALTH

Current status of program implementation
This nine month project is an extension of the Community Integrated Support Project. The project aims to improve the behavior and health practices of communities enabling them to live a safe and healthy life, develop capacity of already selected and new community health workers on primary health care through comprehensive training program, promote safe delivery practices in TBAs, strengthen government health service delivery, capacity building of government representatives on health rights, raise awareness on preventive and reproductive health, establish joint health forum and strengthen network for an efficient and effective referral system and develop capacity of referred hospitals on quality health service.

HEALTH PROJECT IN NON DISASTER AREAS

3. COMMUNITY HEALTH IMPROVEMENT PROJECT (CHIP)
Sungi Development Foundation is now in its second year of collaboration with Pakistan Poverty Alleviation Fund (PPAF) with respect to two community health centers in union council Kathwal (district Abbottabad) and Jabri (district Haripur). Basic health facilities including male and female OPD, MCH services, labor room, pharmacy, laboratory and well equipped out reach teams providing preventive health services at the household level are part of the project. The outreach team consists of men and women community health workers and TBAs. The outreach team consists of local community health workers hired from the same union council in which the centre is so that the project can contribute towards providing employment within the union council. This is helping to reduce the unemployment in the area.

Number of beneficiaries from the centres in the current quarter (Jan – Mar 07) was such that OPD patients were 1460 (65% women and 35% men) as compared with the 1327 patients of the last quarter. The outreach team was successful in carrying out 159 community and school health education sessions in which 4511 people (50% women) benefited.

During reporting period, the health services at CHC Jabri are continued, different health related facilities are provided to the local men, women and children for example OPD, MCH (Mother Care Health services), FP, Laboratory and 24 hour emergency service. The CHC field staffs are also collecting basic data of the village, conducting community health sessions, attending VHC meetings and school based sessions. As result the health status of the UC are gradually improved. The maternal mortality rate decreased.