BACKGROUND

Pakistan is lagging behind its neighbors and other developing countries in terms of Health and Population . Life expectancy stands at 64 years, and adult literacy rates have increased to 53 %. Despite the fact that Pakistan’s per capita income $736 is higher than the average for the low income countries. IMR of 77/1000 live births is higher than the average for low income countries and South Asia. Women in reproductive age constitute 24 % of total population. The sex ratio in Pakistan is adverse to women, 108:100. Population growth rate is 1.9 % annually with total with total fertility rate of 4.07. Maternal morality rate ranges from 350 to 400/100,000 live births. One of the major reasons of high maternal mortality is poor access to prenatal care (51.1%) of rural women have no access, dearth of trained attendants at birth (80 % births at home with the assistance of untrained birth attendants).

The Pakistan Red Crescent Society (PRCS) in keeping with its humanitarian mandate as a member of the International Federation of Red Cross and Red Crescent Societies (IFRC) undertakes to provide health services to the most vulnerable people in Pakistan. This role is undertaken as an auxiliary to the government of Pakistan. PRCS is a signatory to the Federation Health Policy (1999). (Click Health & Care Policy)

Pakistan’s health infrastructure has had to cope with a large influx of Afghan refugees since the early eighties. The situation has been exacerbated after September 11,2001 and the 2500 km western border areas are being subjected to a perpetual conflict situation and as a result of the spill over effect major cities have been subjected to man induced disasters. The situation has further deteriorated after October 8, 2005 earthquake which affected NWFP and Pakistan part of Jammu and Kashmir region.

PRCS as an auxiliary organization to the government is committed to playing a key role in Disaster Preparedness and Response. In keeping with its resolve for Emergency Health Service Provision, PRCS has identified:

* FATA which is subjected to a perpetual conflict situation. Required health inputs through seven Mobile Health Units (MHUs) with fully equipped ambulance for health care to the underserved communities are planned by the end of 2008.

* Northern areas which are prone to natural disasters like earth quakes and man induced disaster situations. A number of interventions in the shape of basic health units and field hospitals have been established which are providing primary health care to the victims of earthquake. The National Society in collaboration with IFRC is planning to play a key role in reviving the health facilities of the area.

* AJ&K is also prone to natural disasters and conflict situation along with LOC with Indian occupied Kashmir. Large number of families have been displaced. Provision of a mobile health unit with ambulance has been planned for this area. PRCS is providing basic health care services through field and mobile health structure to the remote and hard to reach areas of Azad Jammu and Kashmir.

* There are large pockets of under served population in southern Punjab and upper Sindh in the Thar desert. The existing Health infrastructure is not able to cater to the scattered population in small villages. Establishment of Red Crescent Health Centers (RCHC) in upper Sindh and Southern Punjab has been planned.

The primary heath care services provided in RCHC by male and female doctors and support staff include basic curative services, MCH and immunization services. Reproductive Health services are provided as an integrated package within PHC services. Outreach service provision to the surrounding under served villages / communities on regular bases form part of service provision.

Health Education Sessions include preventive measures for common communicable diseases like Hepatitis A ,B & C and HIV/AIDS. Health talks include information on hygiene, clean environment and nutrition. Motivational sessions are carried out on regular basis in community meetings. Patients pay a nominal registration fee on first visit which is waived if the patient is unable to pay. Medicines are provided free of cost.Counseling and testing services are being provided by VCT Center in Lahore.

Provision of quality services is ensured through upgradation of skill and knowledge of the service providers. Provision of equipments, medicines and other required inputs is ensured.

Reproductive Health including Family Planning services in an integrated manner within the primary health care services provision has been initiated.

Component of Reproductive health services are:-

• Comprehensive family planning services for females and males.
• Maternal health care including safe motherhood and pre and post abortion care for complications.
• Infant Health care (new born to children of age less than 1 year).
• Management of Reproductive Health related problems of adolescents.
• Management of other reproductive health related problems of women.
• Prevention and management of RTIs / STDs and HIV/AIDS.
• Management of infertility.
• Detection of breast and cervical cancers.
• Management of reproductive health related issues of men.

Pakistan Red Crescent Society is pioneer in First Aid Training in the country and it’s mission is to “save lives, prevent physical disability and alleviate human suffering by responding to daily emergencies or conflicts where health professionals are absent or overworked” through trained First Aid providers. PRCS aim is to have a “First Aider in Every Home”

Establishment of National Training & Resource Centre (NT&RC):

First Aid Training & Resource Center was established at PRCS National Headquarters, Islamabad with assistance of St. John Ambulance in 1999. First Aid Training Centers have been established at PRCS Branch offices at Lahore, Karachi, Quetta and Peshawar. A First Aid Training Center is established in AJK. Establishment of First Aid Training Center in selected disaster prone districts has been planned for stepping up of First Aid Training activities at sub district level on a regular basis.

Activities at NT&RC:

The NT&RC at Islamabad apart from conducting First Aid Training courses continuously upgrades training material on First Aid according to laid down international standards. The center is involved in planning & implementation of training activities and projects which are in conformity with Pakistan Red Crescent Society mission. NT&RC also maintain links with the Branch Training Centers through provision of technical assistance, supervision and monitoring of training activities for ensuring uniform quality training. Provision of essential inputs for the training centers i.e. availability of staff dedicated for First Aid Training, training aids & equipment and other support are ensured.

First Aid in Present Scenario:

In view of the persistent conflict prone situation along the western border and its spill over effects in the major cities in the form of man induced disasters, First Aid training for staff are the felt need of embassies, UN agencies, multinational organizations, industrial concerns, Police Department and Government Organizations. Accordingly First Aid course on commercial lines are being organized by the Training Centre at NHQ and the Provincial Branches.

Community Based First Aid provides the basic knowledge to the local community regarding handling of emergencies in the home or in the community which will reduce disability, prolonged illness and unnecessary deaths. CBFA also emphasizes preventive health care and environmental hygiene which leads to a healthier life style. Women participation in CBFA training is encouraged for imparting a feeling of self worth and self reliance. The knowledge gained in CBFA training also facilitates the effective management of disaster on a small scale.(See PRCS First Aid Training Policy)

PRCS aims to acquires the status of key stakeholder in the prevention of the spread of HIV/AIDS.
HIV prevalence in Pakistan is currently estimated 0.10 per cent of the adult population, or 70,000 – 80,000 cases. However, the potential for a rapid, widespread epidemic is high, with risk factors common to other countries with high HIV prevalence. These risk factors include, low literacy, poverty, high fertility, low contraception uptake, and poor access to health and education.

All four provinces (Punjab, Sindh, Balochistan and North West Frontier), the Federally Administered Tribal Areas (FATA), and Azad Jammu and Kashmir (AJ&K) have recorded HIV infections. Till March 2006, 2843 HIV cases and 339 AIDS cases have been reported.

The strategies being adopted are:-

1. Informing communities regarding HIV/AIDS by inclusion of session on HIV/AIDS in all First Aid syllabi, in health awareness talks and in sessions on dissemination of the 7 Fundamental principles and Humanitarian values.

2. To reduce stigma, modify risk-taking behavior and enable people to make choices about their own and their family’s health.

3. To developed strong links with other player in the field particularly where youth education or school life skill projects are being initiated.

4. Provision of testing for HIV/AIDS, including pre and post test counseling. A Voluntary Counseling and Testing Center has been established in the Shah Alam Complex hospital in Lahore as a pilot project.

5. Recruitment of Voluntary non-remunerated Blood Donors through information, education and motivation with the National Blood Donor center taking the lead role in setting up pilot projects which are replicated in the provinces.

6. Observing World HIV/AIDS day on December 1st an image building activity and for dissemination of information amongst the masses.

7. Regional Collaboration: Through taking active part in the South Asia Regional Network for HIV/AIDS (SARNHA) for strengthening the regional response by RC/RC on HIV/AIDS particularly in view of the considerable cross border movement involving all the Asian and Middle East countries. (Click to see PRCS HIV/AIDS Strategic Plan)