American Refugee Committee - Pakistan Program

ARC’s Afghan Refugee Programme (Balochistan)

ARC has been providing health care services to the Afghan refugees since establishing operations in Pakistan in 2002. ARC Pakistan is one of the lead agencies in Balochistan, Province, Pakistan providing health care programs to approximately 110,000 Afghan Refugees in Mohammad Khail, Saranan and Surkhab districts, through Primary Health Care and comprehensive Reproductive Health Care including Emergency Obstetrics, HIV/AIDS Awareness, Adolescent RH and Gender Based Violence. The health care programs are designed in a culturally appropriate manner and aim to increase access to comprehensive, integrated health care. The RH program aims to decrease infant and maternal mortality/morbidity.

Objectives of Quetta Program

To provide preventive and curative health care services: The project ensures the provision of an integrated primary and reproductive health care service delivery program to approximately 85,000 Afghan refugees in the Surkhab, and Saranan old refugee villages, and reproductive health and emergency obstetrics care services to approximately 13,750 refugees in the Mohammad Khail camp, who have settled in Balochistan, Pakistan over the last 20 years. All of the beneficiaries live in refugee camp settings. ARC Pakistan works with both recently arrived refugees post 9/11 and refugees who have settled in Pakistan during crises of Soviet Invasion and occupation, Taliban Regime, 4 year long drought and famine.
To continue to provide life saving emergency obstetrics within the ARC comprehensive RH Units: Prior to ARC’s program, pregnant women often faced unsafe and unclean deliveries at home as no emergency obstetric care facilities for handling high risk and complicated deliveries were available or accessible for these camps. Most of the women had to rely on traditional methods of managing deliveries and the resultant complications, which often ended in the death of the newborn and/or the mother. ARC’s program introduced emergency obstetrical services and emphasized capacity building of traditional birth attendants. ARC has trained 260 Community Health Workers (CHWs) and 205 Traditional Birth Attendants (TBAs) to date, who now provide a skilled service to these women, in addition to being able to identify and refer high-risk and complicated pregnancies to the Labour Room including referral services, ultrasound facilities, adolescent RH, youth clubs, community health education sessions, HIV/AIDS Awareness, Mother Child Care, Gender Based Violence prevention and treatment program, including an awareness and counseling Out Reach Worker’s program
To reduce the HIV/AIDS transmission through awareness programs
To provide the community with well trained TBAs and CHWs: 100% of YCL staff received training on GBV, STIs. HIV, RH, Mother Child Care, Malaria, Diarrhea and other common diseases
Increase and maintain EPI coverage: ARC continues to provide the Expanded Program of Immunizations comprising DPT, measles, polio, BCG, TT vaccinations and Hepatitis B vaccines for children under 1 year of age. During January to December 2007, 1435 under 1 children received birth BCG and are protected against Tuberculosis. 1459 children under 1 were vaccinated against measles. 4202doses of DPT were given to children under 1 year. 1439 children under 1 were fully immunized against TB, measles, diphtheria, pertussis, and tetanus. BCG, measles, and fully immunized coverage continue to be above expected benchmarks due to monitoring by the EPI supervisor, and close coordination between LHVs and vaccinators.
Through Youth Clubs, spread PHC and RH messages to adolescent Afghan girls: ARC established Youth Clubs for adolescent girls and boys to provide psychosocial support by gathering, social and vocational trainings. Two Youth Clubs were established in New Saranan and Surkhab Model for 70 adolescent girls. Beneficiaries reported that they developed different skills and improved their knowledge of health issues. For boys ARC has established 4 Youth Clubs where they receive health education and football training.
To provide counseling and treatment services for victims of gender based violence in a culturally appropriate and clandestine manner: In the “refugee context” sexual and gender based violence is a common issue. Commonly, women are victims of violence infringed by their husbands, in-laws or by the members of the same community. This violence includes both psychological and physical harm. ARC established a GBV program to recognize the victims and developed a system that involved active screening, crisis debriefing case management and counselling.
To provide a comprehensive RH program to reduce infant and maternal mortality/morbidity: The Clinic provides facilities to register pregnant patients for antenatal examinations. Pregnant women are vaccinated against Tetanus, Toxoid, screened for Syphilis through RPR tests, Blood examined for grouping, Rh incapability’s screening. ARC also screens hemoglobin % age, urine for albumen and sugar to detect diabetes and antenatal screening of high risk pregnancy. One of the common causes of neonatal mortality is the development of Neonatal Tetanus. Immunization is carried out in the Antenatal Clinic through Tetanus Toxoid vaccination. Efforts are made to ensure that all antenatal cases receive at least two doses of TT vaccination. Pregnant women reporting for delivery are assisted in safe and clean deliveries. Postnatal visits are carried out to follow up and also to check any complications arising due to infections or some other complications.
To increase the awareness of the local community: The Community Mobilization Program uses participatory processes to involve local institutions, local leaders, community groups, and members of the community to organize collective action toward a common purpose. Community mobilization is characterized by respect for the community and its needs. For that, ARC conducted surveys regarding health and general surveys. The main focus of those surveys was to promote awareness and action to satisfy a mandate. To provide data for results from a well-designed com-implementation of a plan to realize the future, community planners may also realize that there is more than one way to accomplish the vision.
Polio Eradication Program: ARC regularly participates in polio eradication efforts arranged by the GOP. During National Immunization Days (NID) campaigns ARC is provided door to door polio vaccination in the refugee villages and in year 2007 gave a total of 204,094 doses of polio vaccine.
TB DOTS program: Facility of Sputum test for TB Patients is available in ARC’s facilities. In line with WHO & DOTS program, TB treatment is provided by doctors for a period of 8 months. Patients are follow-up by outreach workers. A total of 21 patients were provided with TB DOTS treatment during 2007.
Malaria Control Program: Patients suspected to have malaria are referred from either the OPD or by ORWs working in the community. During the year 2007, 1496 patients were tested for malaria and 216 identified as positive for malaria using the ARC Laboratories. There were 201 Vivax and 15 Falciparum cases reported.
Growth Monitoring: ARC emphasizes the importance of growth monitoring to all families with children less than 1 year of age and specifically focuses on providing services to high-risk children aged 1-3 through daily OPD clinics. The Growth Monitoring program is essential to ensure healthy physical and mental development of all children under 1 and high risk children between 1 and 3. Last year, 1194 infants were routinely screened as part of the Growth Monitoring program. Total 1.0% (n=20) were found to be below the expected weight for the given age and were enrolled in the high risk program and will be monitored every month for weight gain until 3 years of age.
Learning Center: The classes for the first session of the ARC LC commenced on 4th September 2007 and 60 registered students completed the course on December 2007. 60 students were selected for the first intake of classes. The teachers and students followed curriculum developed for the Computer lessons and English language. From August through December 2007 (5 months) a total of 69 sessions have been held (approximately 17 sessions per month) with 322 participants (average of 80 participants per month). This is beyond the annual target of 24 sessions (6 camps x 4 times) with 100 – 120 participants. A selection criterion was set up for the enrolment of students for English and Computer classes. 120 students of ages varying between 12-18 years appeared in the entry test and 60 students qualified for the session securing 40% marks. However, one candidate from each beneficiary family was enrolled at a time.