The Real Taste of EVA Recognition?

Farooq Khan, Community Empowerment Manager, KP

“Right to Information because Life has a Purpose”, and, “let me Congratulate EVA BHN to be the first Non-Governmental forum where RTI Commissioner is addressing the communities regarding this useful law/act”, said by Professor Kaleem Ullah RTI Commissioner (KP) during a Check-In meeting at District Nowshehra on December 21, 2015.

EVA BHN is fortunate to be able to take advantage of Provincial RTI Commissioner Presence at District level. The Commissioner was very happy with the EVA BHN approach of engaging communities in an Empowerment journey where RTI is further synchronizing with it. He appreciated that EVA BHN has included the RTI orientation session in the community groups/mobilizers RTI Commissioner Presenting the act at Check-In Meeting Nowshehra

The Commissioner delivered a detail presentation in front of CG coordinators (male/female) from 21 Union Councils of District Nowshehra where each were representing a Community Group of their respective Union Councils. Among these CG Coordinators, a few were also on behalf of Local Government as well. The presentation covered the History of the RTI, the law/act in Pakistan and specifically in Khyber Pakhtunkhwa, the rollout of the act, the advantages of the service, and the response/feedback time allocated along with the complaint mechanism and related challenges in the execution. He further mentioned that Khyber Pakhtunkhwa is the first province in Pakistan who had passed this bill in 2013 and is active since (early) 2014.

The Commissioner mentioned/advised the participants to talk about this act/service at their respective union council and make the communities aware to be further empowered. In this regards, he distributed the RTI leaflets and broachers. He said, “If you don’t know your Rights & Entitlements, you can’t ask/fight for it”, and “having information and awareness is the actual Empowerment”. He shared some success stories from Khyber Pakhtunkhwa as well and was very happy that people of the province were utilizing this service.

The Community Group Coordinators were very happy with such a useful law/act, which is a service easily available at District Level. The CG Coordinator M Suhail Khattak (who is General Councilor as well) thanked the EVA while saying that, “this service is amazing and we all are thankful to you (EVA) for bringing the RTI commissioner at this forum which has further raised our motivation to work for our respective communities to be further Empowered”.

EVA Citizens – The Critical Mass for Improving Accountability for Health Rights

Ihatsham Akram, Senior Policy & Advocacy Advisor

EVA completed its 2^nd year of implementation in December 2015. Of the many good things that one comes across while reading the project annual report, what stands towering is the 7,410 citizens across the nine districts that EVA has capacity built to raise their voices for their health rights.

There is a long way to go but the foundation has been laid for an accountability drive that rests in the minds and hearts of these citizens who are learning to call for their rights through different empowerment interventions of EVA. These EVA-Citizens provide the critical mass that can be the source of the empowerment to wider society within their reach at whatever level they exist. EVA-Citizens include ordinary men and women, LG representatives, journalists, religious leaders, duty bearers, health workers, screen-writers, teachers and many more. In their own circles these EVA-Citizens can help spread and consolidate the change that they are hosting under the EVA flag.

In the coming years it will be of extreme significance that the energies of the Critical Mass of EVA Citizens are multiplied and channelled strategically for the optimal use of generating the responsiveness of the system and not wasting the opportunity.
Facilitating them in growing into a bigger mass through bringing them together, helping them exerting their energies at the right nodes of the health and governance system of the country and making them aware of the power they can together possess would be key elements of the growth of EVA Citizens.

EVA-BHN – A ray of light for UC Manduri, Nowshera

Samira Shams, Project Officer, Voice and Accountability, KPK

Despite the fact that district Nowshehra has remained a hub of different interventions post-2010 flood, ranging from relief, rehabilitation to post traumatic psychotherapy, capacity building, a few to count. The majority of the people are well aware of community based interventions, yet, there are still some areas for which this concept still remains alien. Village Manduri is one of such areas where people were not familiar with the concept of participatory approach of development via group formation. That is why the people were reluctant to become part of group, take initiatives themselves and work for their betterment. People of the village were not even in favour of EVA-BHNs’ initial gathering but due to their social and cultural values, they facilitated EVA-BHN and arranged a large gathering where EVA-BHN team shared their aim and purpose with the people. The team also explained the cause of EVA-BHN and how community participation can contribute in the fulfilment of these goals. This resulted in a positive projection and the people pledged to join hands with EVA-BHN. They also agreed to form a Community Group.

The gathering, however, consisted of only men and for the same reason of social and cultural barriers, women were not allowed to take part in any such activities. A female colleague of EVA-BHN was not allowed to even sit in the gathering or talk to other women of the community. After the meeting took place and the group was sensitised, male members agreed to support a separate gathering for women since the EVA-BHN project is directly related to the MNCH, therefore, they agreed that women would be able to form a separate group and thereby play their role in the EVA-BHN activities.

In the next meeting of group formation, female members of the community gathered in the house of one of the community members. A female team member of EVA-BHN talked to the women, and explained the important role that women can play to ensure better maternal health and nutrition. She said that EVA-BHN is providing platform so that people can get their entitled health rights. All women participants agreed to become members of the Community Group and also assured that they would play their active role in all EVA-BHN activities.

In the entire UC Manduri, there is only one health facility- Basic Health Unit. There is no facility for delivery or other reproductive health related issues. The entire population have either to rely on traditional Dai (Midwives), LHVs or have to cover a distance of 10-15 km to avail MNCH related facilities in the Nowshera cities. EVA-BHN is therefore a ray of light for the people of this village since this is the platform where they are able to demand their health rights from the government.

“VOICE Raised, DEMAND Generated & Govt RESPONDED, Community felt EMPOWERED”

Farooq Khan, Community Empowerment Manager, KP

During DAF Nowshehra, District Health Officer-DHO appreciated the Community Group Coordinators along with the community members of Union Council Mandoori for raising Voice, putting pressure to make Govt and Politician Accountable for Successful deployment of a long pending Expanded Program Immunization-EPI Technician in their Basic Health Unit-BHU.

Union Council Mandoori is the farthest part of District Nowshehra and lies at 54 Km from Nowshehra City towards Attock Punjab. The catchment population of the BHU Mandoori is 24000 (individual) according to 1999 census unevenly distributed among 10 villages. The population increase significantly during last 16 years. Being farthest health facility, the BHU deprived of many facilities including one EPI technician and the position remained vacant for last 10 months.

During the DAF meeting held at DHO office Nowshehra on November 04, 2015, the DHO Dr. Arshad Khan appreciated the EVA BHN Mandoori Community Group for their consistent and loud voice for re- filling the EPI Technician position successfully, which was/is a vital need of the Mandoori Community. Dr. Arshad further talked about and mentioned that, “the CG Coordinator Mandoori (HM Shahid) and his core group members consistently followed the deployment of the EPI Technician at all relevant forums and for the reason I transferred 03 technicians to fill the vacancy but the political interference couldn’t allowed us to do so and transfer orders reversed three times. The Community Group members put huge pressure on the Govt as well as on the politicians and finally succeeded by re-filling the EPI Technician post. Dr. Arshad mentioned this was impossible without EVA BHN voice as no one was ready to work in that remote area as EPI technician. The Community Group trained by EVA-BHN knew the way how to raise Voice and how to satisfy the dire need of the area”.

The CG coordinator (HM Shahid) mentioned that, “we are very happy and feel Empowered by getting the EPI technician after four attempts, but we found our Voice worthy and affective. We all are thankful to EVA BHN and Dr. Arshad (DHO) for his all-time available support and guidance. We are also at final stage of securing fund for our BHU through collective Voice of our Community Group”.

KAP Profile—A Means to Guide Evidence-based Programming and Tracking Progress

Dr Asmatullah, Snr M&E Manager, Punjab

Palladium undertook a cross-sectional survey in 12 districts of Punjab with 800 respondents, employing the multi-stage cluster method. The study aimed to establish knowledge-attitude-practices (KAP) profile for priority maternal and child life cycle interventions and documenting the heard or un-heard voices of citizens regarding their health and nutrition rights/entitlements and to hold duty bearers to account.

With regard to maternal and child life cycle interventions, the study provides an insight to the related conditions (barriers and/or enablers). The survey finding depicts a mixed trend, pointing towards high coverage for certain indicators, alongside the need to further improve the quality of care, access to & availability of the priority RMNCH & nutrition services.

Concerning improved health governance, the vast majority of the respondents shared their opinion in favour of the future and desirable state in comparison to the current non-existing state as: a) citizens should have the right to healthcare, b) citizens should have the knowledge of the provided healthcare by government, c) citizens should hold elected officials/duty bearers to account for meeting health/nutrition needs of the population, and d) citizens should have role in decision-making for health.

The study found that 1/3 of mothers were not satisfied with the care that they received from public and private healthcare providers in the maternal life cycle. Despite their dissatisfaction, almost none of them filed a complaint to the relevant authorities, as overwhelming 95% were unable to identify any complaint mechanism for filing their complaint, should they have any to file. Interestingly, almost all of the respondents agreed that the government should establish an accessible complaint handling mechanism.

The survey findings and recommendations provides an opportunity to shape/re-shape the PHNP programme design/service delivery model to achieve impact at scale. The recommendations are grouped for both strands of PHNP, while taking into account their peculiar roles, such as: a) enabling the rights holders to hold governments and duty bearers to account, b) improving community health, care practices, and addressing social challenges and wider integration of health/nutrition interventions

Media reports on DAF Peshawar…

On 26 November 2015, the KP EVA team facilitated the meeting of DAF Peshawar. Members from communities across the district came together to voice their demands and grievances to the district health department and to DSM PPHI. Also attending the meeting were members of the district ulema council who defended the right of the citizens to demand better services from the government.
Wisal Yousafzai from EVA’s trained journalist cohort of 2015 reported on the event for The Frontier Post.

The DSM PPHI committed to the community and to the members of the district ulema council that he would visit a BHU in the district with them in the coming week to inspect the facilities.

The Public and the Public Servants – the DAFs are bringing them closer!

Ihatsham Akram, Senior Policy & Advocacy Advisor

“We are servants of the public and answerable to them” were the words of the Officer who heads the Department of Health in Swabi. He was addressing the District Advocacy Forum (DAF) facilitated by EVA in Swabi District. It was no less than a dream coming true that for the first time in Pakistan that health officials are coming to citizen forums for braving the questions and issues being raised by citizens. Given the participation and discussion of DAF in Swabi and in other districts it appears that such structures are direly needed and fill a vacuum that had long existed with respect to engagement of citizens and duty bearers.

Except the courts of the land and lately to some extent media that also mostly keep itself distanced from the health issues for it being a soft beat, the citizens do not have many opportunities to talk about their health issues and demands. The EVA DAFs are not only opportunities but are a motivation as well for citizens and interestingly for both users and duty bearers. The issues log of the DAFs reflect that many of the issues are being raised by the duty bearers at these forums as well with an anticipation that citizens will put their weight behind and help duty bearers overcome the barriers especially the systemic hiccups of red tapeism.

Whereas, DAFs are becoming the epicenter of the change with respect to raising of voices and demands, it will be critical that DAFs could also contribute to the culture of responsiveness that extends beyond listening of demands to concrete actions of duty bearers. The development of the District Health Development Plans in response to DAF demands in Nowshera district, opening up of a hospital in Layyah that had been dysfunctional for a long time after it being set up, recovery of a misplaced generator in District Headquarter Hospital Layyah are some of the examples that augur the potential of DAFs to create a culture of responsiveness that is underpinned by accountability by citizens.

Welcome to the project team blog for EVA

Welcome!

This is a blog for the EVA project team. Empowerment, Voice & Accountability for Better Health & Nutrition is a four year project implementing in Pakistan, primarily focussed on the ‘demand side’ of Reproductive, Maternal, Newborn & Child Health and Nutrition services and will complement the ‘supply side’ activities under the broader Provincial Health & Nutrition Programme framework through:

• Enhancing Communities’ understanding of their health rights, entitlements and engagement in monitoring the planning and delivery of services
• Organising communities at all levels to catalyse the precipitation of desired policy changes at the local, provincial and national level

This blog is a place for EVA staff to share their experiences on the project.

Annette Fisher, Technical Project Manager