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

The health challenges facing Pakistan are considerable and generally trends in the health burden continue in a downwards direction. Currently only 0.7 per cent of the GNP is allocated for the health sector. Health related problems are further compounded by low literacy levels for men and women. Since its inception, the main work of the Pakistan Red Crescent Society was in the field of health, ranging from general hospitals, TB hospitals, and a leprosy home to over 170 mother and child health centres and basic/mobile health units located throughout the country. The Federation, through partner national societies, provided increasing support in recent years for the implementation and management of various health-related programmes, with particular focus on mother and child health, first aid and the blood programme.

The national society in the last couple of years had an additional burden of various emergencies in the country, but it has taken the opportunity that emergencies and additional funding have provided to further build its health capacity and activities. In particular, the drought programme in Baluchistan Province in 2001 enabled the branch to establish four mobile health units to provide preventive and basic curative health care to 40 drought-affected village communities. The drought is ongoing, as is the work of the teams. Around 8,000 people in these villages benefit each month from the work of these teams. This experience, plus that of basic health units in both Baluchistan and the north west frontier province (NWFP) formed the basis for additional health facilities to be provided to the Afghan refugee population and the local vulnerable population during the 2001/2002 Afghan humanitarian crisis appeal. Most of the health activities which started as emergency operations will now be included into the ongoing planned work of the society and the country appeal 2003/2004, as the needs have not yet diminished and the situation remains a chronic one.

Another major achievement during 2002 was the strengthening of the national health team and the promotion of the former head of the national training and resource centre to deputy director of health, responsible for the coordination and management of all the national society�s health activities. There is a clearer overall strategic vision for the direction and focus of the health programme, and for 2003/2004, this will focus on two projects, one providing the essential basic health services to the community, and including HIV/AIDS, reproductive health and community based first aid; and the second project focusing on the need for further strengthening of health programme management and implementation capacity, including the key role of training and will focus on two district branches within each province, making the links with branch development and using health as the entry point. These two projects, health service provision and capacity building, cannot be considered as separate entities as they are completely interdependent and endeavour to make the wider links with other core activities of the society.

One priority highlighted for 2003 is the national society�s commitment to increasing HIV/AIDS activities and linking this with the recruitment and retention of non-remunerated blood donors. In the first instance this will be the inclusion of an HIV/AIDS component in all training and health education provided. It is recognized that there is much to be done both inside the national society and within the wider community to address this issue, but it is also clear that the government is becoming more committed and that the enormity of the threat is becoming more widely understood. PRCS is an active member of the newly-established South Asia Regional Network for HIV/AIDS (SARNHA) and has a named focal person for HIV/AIDS-related matters.

In terms of lessons learned, the issue of sustainability of health programmes always arises. Indeed the provision of health services is inherently unsustainable in that qualified professional personnel and good quality medicines are required, as well as transport for mobile units. Nevertheless, given the huge health needs in the far-flung areas of the country and the harsh geographical conditions requiring strong vehicles, a balance needs to be struck between the sustainability issue and the need to provide essential health services where no other organization or government agency is providing them. The issue of cost recovery within health activities was the focus for the start of a case study towards the end of 2002. This will be further developed during 2003 and an active effort will be made to investigate and develop better local resource mobilization for health programmes. Income generation from first aid and some limited cost recovery from health units are just two examples which the national society is already undertaking, but it is believed that even in the current socio-economic context in Pakistan, there are possibilities for broadening the in-country donor and partner base for health activities.