Pakistan International Peace & Human Rights Organization
Nindo Shaher District Badin Sindh Pakistan

INTRODUCTION

People in Pakistan suffer from a high burden of both infections and chronic diseases. Health and social indicators of Pakistan are among the poorest. About one third Pakistanis live in abject poverty. Only 24% women and 54% men are literate.

Poor nutrition and repeated infections have led to a situation where 30-40% of children in Pakistan suffer from stunting. At the same time, chronic diseases such as hypertension have become prevalent; about 11 million people suffer from hypertension. While all population groups are affected, children and women in their reproductive years have suffered most. Maternal mortality ratio ranges between 350-700 for every 100,000 livebirths, and perinatal mortality rate 54-92 per 1,000 births4. In addition to focusing energies on social and economic development, this situation requires an optimally functional and fair health system. The majority of people who live in poverty and cannot afford private health care depends on the public sector. However, currently the public sector spending in health is at an extremely insufficient level of 0.9% of Gross Domestic Product in 20001.

Whatever health services are in place, are planned and run without needed community input. Primary Health Care (PHC) is reduced to some extension services with little emphasis on the PHC spirit to provide care according to need and to promote community participation. Less than optimum attention to these aspects causes health systems to suffer from inefficiency, inequity and poor utilisation. Similarly, in such a case burden of paying for health care is not fairly distributed and causes financial and nonfinancial barriers to access5. Participatory Rural Appraisal (PRA) has been documented as a powerful means of involving community in identification and analysis of problems, planning and implementation of programs. Robert Chambers defines PRA as a semi-structured process of learning from, with and by rural people. It is a community empowering method that generates information on health and social issues for utilisation by the communities and service providers for planning, development, implementation and evaluation of the programs6. PRA involves visual methods and is considered as one of the best frameworks to understand, analyse and develop programs with communities7. In the last two decades, many PRA methods have been developed to inform various aspects of health and social development. The list of reliable and valid methods includes: social maps to identify social and health assets and vulnerable individuals and groups; transact walks for topological or social features; service maps describing design and services available at a facility; and body maps describing illness.

Other methods include matrix scoring, pair wise ranking, seasonal calendars, problems walls, solutions trees and impact diagrams8. Use of combination of many of these methods for program planning, implementation and evaluation cycle has also been successfully tested9. Robert Chambers analysed the 20-year history of the development of PRA and concluded that with appropriate attitude of respect for rural people and interest in what they know and say, professionals could find innovative methods as highly useful for analysing the health context and for developing programs6. This study was conducted, in 3 rural areas of district Khairpur of Sindh Province of Pakistan in the year 2000 on behalf of a non government organisation as it is planning to provide reproductive health services in that district. The research objectives were to identify the health needs and health care accessibility, as well as initiate participation of communities in the planning process. The needs assessment utilised three research paradigms - quantitative, qualitative and participatory - jointly to understand the needs with maximum clarity and from the perspective of communities. This paper points to the utility of PRA for comunity investment in assessment and planning and for generating cotexual information that is after difficult to gather using other methods.

PAKISTAN INTERNATIONAL PEACE & HUMAN RIGHTS ORGANIZATION
P.O NINDO SHAHER DISTRICT BADIN SINDH PAKISTAN
POSTAL CODE NO:72250
PHONE NO:092-227-720227
Email: [email protected]