MCHRP Evaluation Report f1 15-09-2012

Muzaffargarh Health Recovery Project
End-Term Evaluation Report
September 15, 2012
Submitted to:-
Mr. Leyn Gantare, Country Director
Adventist Development & Relief Agency
Prepared by
Zafar Ahmad, District Team Leader
MCHRP – End Term Project Evaluation Exercise

Table of Contents
Executive Summary......................................................................................................................................6
Introduction to Evaluation Exercise..............................................................................................................8
Mechanism and Description of Evaluation Criteria......................................................................................9
Review on Interventions at BHU–Thatta Ghurmani...................................................................................11
Review on Infrastructural Renovated Interventions: ..............................................................................11
Review on Competency of Field Staff:...................................................................................................12
Community level of Satisfaction: ...........................................................................................................13
Review on Interventions at BHU–Mehmood Kot.......................................................................................15
Review on Interventions at RHC – Shah Jamal..........................................................................................19
Review on Interventions at BHU – Daya Chokha ......................................................................................23
Review on Interventions at BHU – Pathal..................................................................................................27
Review on Interventions at BHU – Kanju Wala.........................................................................................31
Review on Interventions at BHU – Chak 518.............................................................................................35

Review on Interventions at BHU – Sheikh Umer.......................................................................................39
Analysis on Renovated Health Services at BHUs.......................................................................................43
Analysis on Competency level of BHU Officials and Field Staff ..............................................................46
Analysis on Satisfaction level of Community on BHU Services................................................................49
Conclusion and Recommendations.............................................................................................................52
Community Demands .................................................................................................................................54
Infrastructural glimpses ..............................................................................................................................56
List of Annexure(s).....................................................................................................................................58
A: Evaluation Tool Kit: ...................................................................................................................58
01. Questionnaire for Interview of BHU Official .........................................................................58
02. Format for Physical Verification of Renovated work at BHU................................................58
03. Areas of Enquiry Framework for FGDs with LHWs..............................................................58
04. Format of Face Sheet for Conduct of FGDs with LHWs........................................................58
05. Questionnaire for Interview with HH Head............................................................................58
B: Physical Verification of Restoration of Infrastructural Services: ...................................................58
06. BHU Thatta Gurmani – Summary Sheet on Physical Infrastructural Evaluation...................58
07. BHU Mehmood Kot – Summary Sheet on Physical Infrastructural Evaluation....................58
08. RHC Shah Jamal – Summary Sheet on Physical Infrastructural Evaluation ..........................58
09. BHU Daya Chokha – Summary Sheet on Physical Infrastructural Evaluation ......................58
10. BHU Pathal – Summary Sheet on Physical Infrastructural Evaluation ..................................58
11. BHU Kanju Wala – Summary Sheet on Physical Infrastructural Evaluation.........................58
12. BHU Chak 518 – Summary Sheet on Physical Infrastructural Evaluation.............................58
13. BHU Shaikh Umer – Summary Sheet on Physical Infrastructural Evaluation.......................58
14. Copy of Interview with Medical Technician BHU Thatta Gurmani.......................................58
15. Copy of Interview with MO: BHU Mehmood Kot.................................................................58
16. Copy of Interview with Sr. MO: BHU Shah Jamal ................................................................58
17. Copy of Interview with MO: BHU Daya Chokha ..................................................................58
18. Copy of Interview with MO: BHU Pathal ..............................................................................58

19. Copy of Interview with Care Taker: BHU Kanju Wala..........................................................58
20. Copy of Interview with MO: BHU Chak 518.........................................................................58
21. Copy of Interview with Dispenser/Incharge: BHU Shaikh Umer...........................................58
C: Competency of Field Staff:.............................................................................................................58
22. BHU wise List of LHWs, LHVs, LHs Participated in FGD...................................................58
23. Attendance Sheet for FGD Conducted at UC Thatta Gurmani...............................................58
24. Attendance Sheet for FGD Conducted at UC Mehmood Kot.................................................58
25. Attendance Sheet for FGD Conducted at UC Shah Jamal......................................................58
26. Attendance Sheet for FGD Conducted at UC Daya Chowkha................................................58
27. Attendance Sheet for FGD Conducted at UC Pathal ..............................................................58
28. Attendance Sheet for FGD Conducted at UC Mirpur Baghal.................................................58
29. Attendance Sheet for FGD Conducted at UC Shaikh Umer ...................................................58
C: Interview with Community:............................................................................................................58
30. Consolidated List of Community members Interviewed ........................................................58
31. 810 Forms – interviewed with community in 08 union councils............................................58
32. Soft Copy of Excel Sheet – Data of 810 Forms on Conduct of Interviews ............................58

Abbreviations & Definitions
BHU Basic Health Umit
FGD Focus Group Discussion
LHS Lady Health Supervisor
LHV Lady Health Visitor
LHW Lady Health Work
MCHRP Muzaffargarh Community Health Recovery Project
IEC Informational, Educational and Communicational
SoW Scope of Work
RHC Rural Health Centre
ADRA Adventist Development and Relief Agency
Implementation Agency: The organization implemented the designed interventions by
ADRA - Pakistan

M C H R P – E v a l u a t i o n R e p o r t | Executive Summary Page 6 of 58
Executive Summary
In pursuance of ToRs for doing Muzaffargarh Health Recovery Project (MHRCP) end-term
evaluation, exercise commenced as per plan devised in the inception report. In eight union
councils 07 out of 16 (43.75%) BHUs and 01 out of 03 (33.33%) RHC of ADRA – Pakistan
supported work is taken into account as sample size for evaluation purpose.
As per document review ADRA interventions are seen addressing both hard and soft component
in recovery of health services at each of the BHU in focused union councils. Therefore,
assessment is done in order to get a developed picture on implementation (quality and quantity of
work done by the implementing agency) regarding infrastructural improvement in recovery of
health services, impact of community the ultimate beneficiary of such restored services; and
capacity building of BHUs focused staff maintaining the flow of services once the project
interventions are over.
Accordingly three layers are picked: BHU officials interviewed at length mainly regarding
infrastructural improvement of health services backed by the physical verification of work done
by the implementing agency; 61 field staff members are engaged in 07 FGDs to reveal
improvement in their knowledge, skills and demonstrated behavior; and at third layer – the
community is focused wherein more than 800 households are interviewed covering all three
dimensions on project interventions and work done by the implementing agency.
On part of physical infrastructural improvement, Paint work done is somehow appreciable and
physically seen as good. Civil/Construction/repair/plumbing work is considered well but quality
is shattered. The implementing agency has done nothing on the part of provision of electric items
and IEC material. BHU officials claim that staff is competent enough to deliver services trained
at their own resources or the organization supported other than ADRA – Pakistan implementing
agency. The version of field staff is also ratified by the head of the BHU official that
implementing agency has not arranged even a single training session.
Focusing the interventions on soft component regarding capacity of field staff reveals that
project designed interventions to capacitate the BHU staff has been unaddressed by the
implementing agency as evident not even a single training sessions is conducted. Regarding soft
component, it is pertinent to mention that 93.65% of Field Staff regard somehow improvement
passing benefit to community is due interventions other that ADRA – Pakistan. From every
corner it is evident that implementing agency has shown least concern with designing, printing
and distribution of IEC material that not even a single leaf is produced during the length of the
project interventions.
In the last but not the least, the vital stakeholder --- the community, the basis of all such initiated
interventions are taken into account not only to consult for second opinion on the investment

M C H R P – E v a l u a t i o n R e p o r t | Executive Summary Page 7 of 58
made in improvement of health units infrastructure and level of capacity improvement of BHU
staff including field as well; but to have sound understanding on level of community satisfaction
in getting benefit through such services revealing the true impact, area of improvement and
performance of implementing agency.
The community concludes that view point as seemed complaining about improper checkup at
BHU, unavailability of medicines and visit of field staff to households only during vaccination
days and improper nursing care.
There has been consistent views that s that medicines specified for the BHU are sold at medical
stores and they are charged cost of medicine at the time of treatment at health unit. Somehow
substandard medicines are available in small quantity and provided the same for all sort of
disease. None of the clinical test is available there. No IEC material is shared/provided for
transfer of knowledge and skills to deal with different diseases and prevention purpose.
LHWs conduct, job delivery is somehow appreciated by the community; whereas
LHWs/LHV/LHS job satisfaction is in question marked.
The community desperately demands for provision of medicines in sufficient and necessary
quantity, ensure clinical test facility particularly in delivery cases, 24 hours service, ambulance
facility and staff/doctor ensure presence in case of emergency.
It concludes that obviously, financial and human resources are not used effectively and fix lashes
on part Monitoring and Evaluation during implementation phase. Implementing and donor
agency must review the strategies to tight the screws adopting disciplined approach on M&E
framework to be applied during implementation phase of such projects in future.
As lesson learnt, it is recommended that the donor agency needs to take concrete steps to
strengthen ongoing physical monitoring activities during implementation phase of the project;
whereas implementing agency may come up with real time sound evidences against use of
resources to meet end objectives in letter and spirit. The disbursement of financial resources may
be linked with the “mile stone achievements” during implementation phase of the project with
sound and concrete ongoing monitoring catalyst.

M C H R P – E v a l u a t i o n R e p o r t | Introduction to Evaluation Exercise Page 8 of 58
Introduction to Evaluation Exercise
In pursuance of TORs of this assigned exercise and as communicated in the inception report;
following objectives are set to meet with the realistic interpretation of the matter:-
1) To come up with the authenticated, un-biased and real time analysis on the work done
under ADRA Scope of Work with reference to activities performed by the implementing
agency for renovation of health services under MCHRP.
2) To assess the impact, weightage to sustainability and leading to the way forward in lines
with scope of work
Keeping in view such objectives, exercise is decomposed in three layers to come up with the
answer to the question asked for on physical services provided, satisfaction of community getting
benefit from these services and competency of BHU and Field Staff delivering such services. On
Renovated of health services (applying to physical infrastructure of BHU), view point and
feedback on implementation are taken from community and the BHU High Ups supported with
bird’s eye view of Field Staff and supplemented with evaluator personal observations. Whereas
competency level of BHU Field staff is judged through community feedback primarily and
supported with the secondary observation of the evaluator. The competency is focused on three
ingredients: Knowledge, Skill and Demonstrated behavior of the officials of BHU and Field
Staff. As third layer, the grass root level personnel, face of BHU having close first interaction
with the community at their door step is also taken into account to speak about not only ADRA –
Pakistan interventions made through the implementing Agency but also come up with their
genuine feedback regarding investment on their capacity building.
The worked done through this exercise is structured in such a way that sampled and focused
BHU/RHC wise review addressing above three layers is discussed and then component wise is
summed up in analysis part of both qualitative and quantitative. As agreed in the proposal of this
exercise 50% of the targeted ADRA – Pakistan done interventions in BHU/RHC and concerned
community in the respective Union Council has been considered in this evaluation exercise
resulting to that 07 BHUs and 01 RHC contacted, FGDs conducted with 61 LHWs/LHVs/LHS
and more than 800 Households in 08 Union Councils are interviewed.

M C H R P – E v a l u a t i o n R e p o r t | Mechanism and Description of Evaluation Criteria Page 9 of 58
Mechanism and Description of Evaluation Criteria
The MCHR Project end-term evaluation is addressed on three fold pertaining to type of main
stakeholders: the ultimate personnel posted at Basic Health Unit (for which infrastructural
interventions made to make their job convenient), the BHU Field Staff particularly LHWs (their
capacity is strengthen) and the end-users (for whom whole of project is done) – the Community.
Hence feedback on impact, sustainability and weightage to delivered work is required to coincide
at one point both in terms of qualitative and qualitative assessment of this evaluation exercise.
Therefore, in order to interpret the feedback on above three ingredients; the evaluation
mechanism is designed in such a way that tools used to grab data from the triangle is set and
assigned equally consistent evaluation criteria with each of the parameters used in the tool kit.
Referring to the respective annexes pertaining to questions asked for; and quantitative responses
are recorded as slicing the degree of their opinion and feedback into following way:-
Very Satisfied Somewhat dissatisfied
Somewhat satisfied Very Dissatisfied
Neutral Not sure
The interpretation to above quantitative form of feedback is agreed on the used terms as:-
Very Satisfied: provides the level of satisfaction to the extent that respective attribute is
fulfilled to the extent 80% and leading to upward meeting all
obligations associated with that particular parameter.
Somewhat Satisfied: The level of satisfaction upto 60% and needs improvement to meet
necessary and sufficient conditions for the attribute.
Neutral: The level of satisfaction upto 40%; not quite upto the mark; somehow
shows neither satisfied nor dissatisfied. Obviously, requirements are not
met in letter and spirit but on-redo it can be improved to attain fair level
of achievement.
Somewhat Dissatisfied: The level of satisfaction upto 20%; Sure that desired specification of
the assigned task are not met any way. Minimum standards are not met.
Activity is required to perform again.
Very Dissatisfied: The level of satisfaction is just upto 10%; The agency disappointed
with the performance. Sever observations are reported in every aspect
of the activity performed. The feedback on such performance is
somehow like “it would have been better not to perform if the result is
just 10%”.

M C H R P – E v a l u a t i o n R e p o r t | Mechanism and Description of Evaluation Criteria Page 10 of 58
Not Sure: In this concern, on performance the level of satisfaction is Zero%
“DRASTIC”. It translates that the implementing agency did not even
bother to initiate the prescribed activity. Surprisingly, the stakeholders
are ignorant of such type of facility is extended on paper but not
physically exists on ground. The implementing agency made
commitment to deliver the assignment but seemed to be failed to do so;
might it have been reported as activity completed to the funding
agency. This is a big question mark not only on performance of the
agency but also leaves sever complications for the agency to take on
board for further assignments.

M C H R P – E v a l u a t i o n R e p o r t | Review on Interventions at BHU–Thatta Ghurmani Page 11 of 58
Review on Interventions at BHU–Thatta Ghurmani
ADRA – Pakistan interventions under MCHRP are evaluated on three dimensions: infrastructure
improvement at BHU, capacity building field staff in particular, and community satisfaction on
level of getting benefits through such investment.
Review on Infrastructural Renovated Interventions:
With respect to scope of work regarding infrastructural renovated health services, provided by
ADRA – Pakistan; review is conducted with physical observation visiting Basic Health Unit and
interview with the BHU available High Ups over there.
At BHU – Thatta Gurmani; Medical Technician, having length of service more that 20 years
spending most of the time posted at BHU is interviewed. It is hereby mentioned that Medical
Officer is not posted at BHU. Therefore, the senior most available official is engaged in
interview. In lines with ADRA – Pakistan interventions to renovated health services; following
key points are revealed on infrastructural improvement at BHU:-
 As per scope of work; civil work/construction/repair work
done to the extent of repairs nicely and presently very much
effective. Hence, the interviewee is “very satisfied” with the
work done in this regard.
 No Electric item is provide/installed as per list under SoW.
No plumbing/boaring work is done; no electric motor is
provided, no steel or wooden repair for windows/cupboard is
done. Absolutely, noting is done. The interviewee astonished to know that about the said job
was supposed to be done. Hence, the interviewee showed totally ignorance as “not sure” and
“very dissatisfied”.
 Paint work is done according to scope of work; presently seen effective so for; the
interviewee is also “very satisfied” with the work done in this regard.
 On the point of training to Field Staff, interviewee is of the view that no training is provided
to LHWs/LHV/LHS; told that field staff needs training to increase their competency level.
However, the staff doing well to the extent of their capacity, courteous and friendly to
community, and maintaining cleanliness at BHU is “somewhat satisfied”. Evidence can be
examined under heading of “Glimpses from the field”.
 Generally speaking, people don’t receive care from services of BHU situated at inappropriate
place with respect to the people living at far flung area under jurisdiction of BHU. Presently,
1/4th
of BHU population have access to BHU.
 No IEC material is provided/ placed at any place in BHU. ADRA – Pakistan monogram is
not seen at any place chart/poster or any other material pasted/available at BHU.

Review on Competency of Field Staff:
At BHU – Thutta Gurmani, with the strength of 19 LHWs, 08 participants are engaged to have
discussion about the competency (knowledge, skills and demonstrated behavior at work place)
level they achieved during the length of service so for.
During the discussion it is revealed that no
training for LHWs/LHS/LHV whatsoever is
conducted by implementing agency under
MCHRP interventions. This version of
statement also ratifies the view point take
from BHU – Office Incahrge on the focused
question. However trainings on the topic of
health and hygiene, cleanliness, TB issues,
Malaria, Mother and Child Health Care are
initiated and conducted from time to time
arranged by different organizations and the
parent department. No IEC material is
provided through ADRA interventions.
However field staff received supporting
material from other organizations, relevant
to job position.
Such training content has been very much
relevant to the job position of LHWs in
particular. The participants shared that
training has improved the skills and
knowledge used for effectively delivery of
assignments. It results people pay attention
and listen to follow good health practices
and show willingness to mend the ways of
living.
The skills are learnt through practical
demonstration during training sessions and
made participants fully conversant with the
procedure like hand washing, nail cutting,
etc. This practical application has also
brought positive change among children and
families. With extended good gesture,
motivation and acceptable conduct; now
people approach to field staff as taking a
step ahead to get services in the field.
Such training has developed the show good
temperament to people dealt with courtesy
and friendly environment. Now people have
trust to us and share their problems
particularly pregnant women. Prior to this
most of the women did not share
information about their health issues. Now
firsthand information is shred with field staff
seeking help to have care to the delivery
process. On enquiry, participant claim of
visiting 10 – 15 house in a month.
In order
to
achieve
such
level of
compet
ency
field
staff has to struggle to control temperament
even people show displeasure and rude
behavior.
The discussion reflected good body
language of and motivating gesture
translating key words on the floor as after
training the field staff has: “confidence”,
“Job Description is fully conversant”,
“Learnt the skills to motivate people”,
“People do agree to our advocacy extending
health services to them”, “People do respect.

During the discussion, participants seemed complaining about supervisors having no support,
coordination and lack of team building gesture. It reflects dire need of extended coordination and
cooperation among field staff in the best interest of the community. Hence demonstrated
behavior needs to be improved in essence to justify delivery of assignment in a coherent way.
Community level of Satisfaction:
The people residing around the Basic Health Unit at Thatta
Gurmani are visited and in total 95 persons are
interviewed. Female and male interviewed proportion is
43.15% and 56.84% respectively. The composition on
marital status is shown in the table.
Taking the statistics as shown in the following table clearly translates that most of the people are
“somewhat satisfied” on judgment of staff competency, courteous level, nursing care and field
staff service at their door step. Dissatisfaction level 44% on staff competency, 42% on courtesy
level to community, 34.73% on nursing care at their visit to BHU and 14.73% on LHWs visit in
the community is calculated.
Level of Satisfaction
Competency
of BHU Staff
Courtesy/
Friendliness
Nursing
Care
LHWs Service
at Door Step
Neutral 8 7 1
Not Sure 12 4 1 1
Somewhat Dissatisfied 3 21 19 1
Somewhat Satisfied 50 51 54 48
Very Dissatisfied 3 4 8 11
Very Satisfied 27 7 6 33
Grand Total 95 95 95 95
Following parameters are focused on services directly related to BHU and pertaining to soft
component of ADRA – Pakistan interventions.
Cleanliness
at BHU
Available Health
Facilities at BHU
You and Your family
getting benefit
Neutral 4 2
Not Sure 1
Somewhat Dissatisfied 2 18 13
Somewhat Satisfied 80 60 77
Very Dissatisfied 2 2 5
Very Satisfied 7 12
Grand Total 95 95 95
The table translates somehow trends likewise of previous statistics. Majority of the people
r91.57% regard that cleanliness is maintained at BHU. Towards available health facility to the
Gender
Marital Status
Married Window(er)
Male 54 -
Female 39 02

extent of BHU provision of services is counts as 63.15% people are “somewhat satisfied” on
getting benefit as well.
Transfer of Knowledge
using IEC Material
BHU Located at
Approachable Distance
BHU Services
Cost to You
Neutral 1 1
Not Sure 2 1 1
Somewhat Satisfied 25 2
Very Satisfied 38
The table drawn above speaks that 33.68% claim that any literature, IEC material is never
provided by the field staff through ADRA sort of interventions or any other source. The figures
show satisfaction on transfer of knowledge, skill using such material is due to other than ADRA
supported interventions. Majority of the people are very dissatisfied with location of BHU as
situated at far flung in the union council to approach resulting to that 96.84% are dissatisfied
with the cost to bear against the level of service they get at BHU.
Majority of the people come up with the
version that LHWs visit to the house once
in a month. Rest of the percentage ratifies
that community point of view that “field
staff visits only in vaccination days”.
The general perception of the community is
that no proper and concentrated
consultation and treatment is received at
BHU level. Field staff only takes care in
vaccination days. Depending on the
circumstances, conduct of field staff and BHU posted members change
accordingly. Cost of medicine is charged. It is also observed that
medical officer is posted on temporary basis; this results in ignorance
and dame care attitude towards service delivery. It has been desperate
need of community about permanent on consistent basis posting of
medical consultant at BHU. This 94.74% the people say “Yes” to
“somehow getting services” mixed with the interventions other than
ADRA – Pakistan. There comes the suggestion that BHU staff must observe full working hours
and rest assured their availability in emergency cases. Clinical test facility like USG, X-ray,
blood test and pregnancy test facility must be arranged. Issue rest with the consultant call at
private clinics. Ambulance service should be started to provide benefit to the community as a
whole.
9.47%
8.42%
3.16%
4.21%
72.63%
2.11%
0.00% 50.00% 100.00%
Fortnightly
Irregular Visit
Never Visited
On Weekly Basis
Once a Month
Visit on Request
Frequency of LHWs Visit to HH
5.26
%
94.7
4%
Poll on General Care
No Yes

M C H R P – E v a l u a t i o n R e p o r t | Review on Interventions at BHU–Mehmood Kot Page 15 of 58
Review on Interventions at BHU–Mehmood Kot
Basic Health Unit Mehmood Kot is located in the union council also named as Mehmood Kot,
Thesil Kot Addu, District Muzaffargarh. It has been focused under ADRA – Pakistan health
services renovation. For the purpose of evaluation of implemented work thereat; same set of
evaluation tools are used and come up with the view point of BHU infrastructural physical
verification, view point of BHU officials and community level of satisfaction being ultimate user
for all such facilities. Following is the brief on out come all three segments as under:-
On having physical verification and interviewed with the Medical Officer, Mehmood Kot; it is
revealed that:-
 Civil Construction work/repair is done upto the entire satisfaction. Whitewash, path
repairing, plaster, distemper is done well. Bounder wall as per specifications and main gate is
constructed. Tuff tiles are fixed on the passage. The Medical Officer also showed his consent
as “very satisfied” with the work done in this regard.
 None of the electric items as per Sow and specifications
mentioned thereat is provided. However a bracket fan
14” is provided. The Medical Officer states that inspite of
repeated request the demand is not honoured. Hence to
this component status is “very dissatisfied”
 None of the repair work is done; Noting is seen as
repaired work on Cupboard (doors, Slides); MO has also
denied for any sort of repair work is done under the scope of work – “very dissatisfied”.
 As for as paint work is concerned; physically seen and the Medical Officer also ratifies that
job is done to the entire satisfaction as per quantity of items mentioned in the SoW. Hence
the Medical Officer commented as “very satisfied” to this extent.
 No IEC material is provided under ADRA – Pakistan interventions. Nothing is seen
available, pasted on walls in BHU premises.
 No training on any health related topic is conducted through ADRA interventions for
LHWs/LHVs/LHS or any other staff member.
 The competency level of field staff and BHU officials is claimed as “very satisfied” in
delivery of services at BHU. The Medical Officer states that frequent number of trainings are
arranged from time to time to enhance knowledge and skills of the staff.
 Nursing care, quantum of health services, cleanliness at BHU and comfort level of staff
particularly field being courteous and friendly behaved with the people is claimed as “very
satisfied” by the Medical Officer. However, attention is drawn to work on sanitation and
community needs to be educated through coherent awareness.

The competency level of grass root field staff i.e. LHWs is reviewed using the tool of FGD. The
discussion is conducted with 09 workers engaged at a place in the house offered by one of the
participants. The focus has been interventions made by ADRA – Pakistan.
Most of the LHWs denied conduct of proper
training session by implementation agency
funded by ADRA – Pakistan. However they
informed that concerned LHs engaged them
in some sort of training sessions from time
to time. However, one day training session
(only 03 Hrs session from 01:00 p.m. to
03:00 p.m.) conducted by the
implementation agency. The charts were
used to conduct the session covering topics
on health hygiene, cleanliness, use of boiled
water, etc.
It was learnt that due care should be given to
hand wash after livelihoods handling,
cleanliness of houses, proper disposal of
waste, nail cleaning, maintaining hygiene
while cooking. Posters, pamphlets, brochure
were used in training; but noting was
provided to field staff for further use. No
IEC material is provided to distribute in the
community.
LHWs state that competency is increased
and worked resulting to that people do care.
12 – 15 Households are visited on daily
basis. Every household is visited
approximately 02 times per month. LHWs
claim that good temperament is
demonstrated on community argument on
need for provision of medicines and the
demands related to BHU preview.
They do sincere efforts in delivery of
assignment and remain polite, courteous to
people. LHWs gesture show that level of
advocacy is enhanced after training
minimize
vulnerable
behavior of
community
regarding
services
under polio
vaccination,
injecting drugs, etc.
Followings are some of the recorded
gestures, body language of participants best
explain the motivation level, enthusiasm and
commitment to work:-
“Ehsas e Zimadari paida howi hiey”; Ms.
Ateeb Saba (Developed sense of
responsibility); “Ghussa khtam howa gia
hiey”; Ms.Naseem Akhtar (Controlled
temperament);“We are servant”; “Yeh pata
chala hiey keh ab in se kaisey baat karni
hiye”; Ms. Razia Bibi (Learnt how to talk
with people); “Have confidence to talk with
politely”; Ms. Hafsa Nawaz (Got
Confidence to talk); “Logo ko qial karney
ka tareeqa aa gia hiye”; (Learnt how to
convince people)
As per quantitative opinion of the participants; 07 grade their increase in competency level as
“good” while 02 rests with “average” after conduct of training session. On question of

community receiving benefit through interventions; “satisfied” has been the response from
participants. However, BHU infrastructural improvement through ADRA interventions is graded
as “good” from majority of the participants. For further improvement, the staff demands for
provision of Blood Test facility, USG Machine, Oxygen to new born baby and X-ray equipment
at BHU for effective delivery services.
The community residing around the BHU Mehmood Kot is visited and interviews with 105
persons are recorded in order to know the level of
their satisfaction on performance of BHU officials,
service they receive and intervention done by
ADRA – Pakistan after the flood – 2012. Female
to Male ratio of interview comes to 49.52% and
50.47% respectively. However, bifurcation on the marital status of interviewee engaged thereat
is shown in the table.
Competency
of BHU Staff
Courtesy/
Friendliness
Nursing
Care
LHWs Service
at Door Step
Grand Total 105 105 105 105
In analysis of competency level of BHU staff, courtesy level, nursing care and HHWs services
visiting community house; all these parameters show very low portion of people are satisfied
with concerned performance. Dissatisfaction level carries to almost 40%. Around 60% people
are somewhat satisfied on all such ingredients as shown in the above table.
Cleanliness
at BHU
Available Health
Facilities at BHU
You and Your family
getting benefit
Very Dissatisfied 4 16
Very Satisfied 18 16 3
The above table translates that majority of the people are somewhat satisfied to the contended
level with cleanliness maintenance level at BHU, health facility and their access to get benefit
from such services. On available health facility around 25% of the people are dissatisfied.
Gender
Marital Status
Married Window(er) Single
Male 52 - 01
Female 45 07 -

using IEC Material
BHU Located at
BHU Services
Cost to You
Somewhat Satisfied 26
Very Satisfied 11
Taking above statistics into account, it is translates that people around 100% are dissatisfied with
the cost they pay against services at BHU; 60% are annoyed with the distance at BHU located
and with one voice people are dissatisfied with the transfer of knowledge to them through use of
IEC material.
The graphical presentation shows that more than
76% field staff visit to households once in a
month. The figures on frequency of visit
fortnightly, irregular and weekly basis ratifies the
community version “visit of field staff in
vaccination days” only.
The Households complain about improper
checkup at BHU, unavailability of medicines and
visit of field staff to households only during
vaccination days and improper nursing care as
well.
Community reveals that medicines specified for the BHU are
sold at medical stores and they are charged cost of medicine at
the time of treatment at health unit. Somehow substandard
medicines are available in small quantity and provided the
same for all sort of disease. None of the clinical test is
available there. No IEC material is shared/provided for
transfer of knowledge and skills to deal with different diseases
and prevention purpose. 20% are total disappointed of having
service from BHU. Whereas 80% come up with mixed opinion sometimes getting treatment and
most of the time ignorant in having services at their needy time; even through ADRA – Pakistan
interventions or support done by other organizations.
The LHV/LHS job satisfaction is question marked. The community requires medicines in
sufficient and necessary quantity be made available at the unit, ensure clinical test facility
particularly in delivery cases, 24 hours service, ambulance facility and availability of staff/doctor
particularly in case of emergency
12.38%
4.76%
0.95%
4.76%
76.19%
0.95%
0.00% 50.00% 100.00%
Fortnightly
Irregular Visit
Never Visited
On Weekly Basis
Once a Month
Visit on Request
20.00
%
80.00
%
No Yes

M C H R P – E v a l u a t i o n R e p o r t | Review on Interventions at RHC – Shah Jamal Page 19 of 58
Review on Interventions at RHC – Shah Jamal
At Union Council Shah Jamal, Tehsil Kot Addu, District Muzaafargarh, a Rural Health Centre (a
step ahead from BHU) is located and has been focus of ADRA – Pakistan for restoration of
health facilities in the area after effects of flood – 2010.
The interventions implemented through support of ADRA – Pakistan are physically observed;
viewpoint of immediate beneficiaries, and the delivering personnel are concentrated and
summarized under respective set of segments as under:-
For the purpose of physical verification of the work done at RHC – Shah Jamal is visited, work
done as per given SoW is observed; and the Senior Medical Officer is interviewed accompanied
with the official of eye-witness of all infrastructural implemented proceedings the executing
agency did at that time. Key finding of this evaluation exercise in narrated as under:-
 Civil Construction/Repair/ job is done well by the
implementing agency. Emergency room is constructed,
tuff tiles fixed on the path, plaster and white wash is done
in a coherent way. The High Ups at RHC is “very
satisfied” with this kind of work.
 There is populated list of electric items to be provided
under planned SoW. On having enquired from the Sr.
Medical Officer; it is revealed that not even a single item
is provided to RHC to fulfill the need of electric items. The interviewee was astonished as
“not sure”; where such items are provided, showed displeasure as “very dissatisfied”. Same
is the case with pluming work under SoW. Nothing is done.
 Paint work is done on main gate, windows and doors. Presently seen effective as notified
“somewhat satisfied” by the Sr. Medical Officer.
 Windows glasses are fixed but no door repair is done. Partly this component is addressed.
 No IEC material under the monogram of ADRA – Pakistan is provided or seen pasted on the
wall of RHC premises.
 As revealed by the interviewee; no training sessions is conducted for LHWs/LHVs/LHS on
board with RHC – Shah Jamal.
 Cleanliness status of RHC needs to be improved; the same is observed and responded as
“Neutral” by the respondent.
 The competency level of field as well staff posted at RHC, nursing care, courtesy and
friendliness of field staff is claimed as “somewhat satisfied” by the respondent. However,

RHC is extending health services within the ambit and resources of Centre --- generally
needy people receive care and service from the Centre.
As the LHVs are the major entity face of BHU to the community; the competency level of such
personnel is taken into account during ADRA – Pakistan interventions. In order to get their view
point and observations about degree of implementation the activities specifically focused to their
area of concern; FGD is conducted following the prescribed enquiry framework. Discussion and
observations are summarized as under:-
Nine lady health works are engaged in focus
group discussion in lines with the enquiry
frame work to have their point of view on
how competency level is changed after
ADRA interventions. It is revealed that
majority of the LHWs are provided training
even for a shorter period of time only one
day for 03 Hrs session sharing knowledge
on maintaining cleanliness, water
purification methods, hand wash method,
child care methods and how to protect from
diseases like: cough, fever, chest infection,
etc. The content is explained through charts.
Some brochures, charts are given to them for
further use in the community but not enough
to distribute per household.
The content is explained with practical
applications. The workers feel confident
knowledgeable to sufficient level and
motivated to
communicati
on and guide
people on
health related
issues.
However the
workers complained on short duration of
training session and insufficient quantity of
IEC material.
They claimed in change in their
demonstrated behavior in delivery of
assignments before and after conduct of
training as evident through the gestures as
one of the participants named Ms. Kishwar
Sultana said that, “Ab yeh Meri Life ka
Hissa bun gia hiye (Now it has become part
of my life)” in lines with serving the
community.
Statistically saying that almost all of the participants grade their competency level is increased as
“good” as 100% after capacity building exercise and services are delivered effectively. The
participants also grade ADRA- Pakistan all type of interventions as “very good” resulting to
which “somehow” community is getting benefit from services of BHU.

In the union council Shah Jamal there exists a Rural Health Centre. The vicinity adjacent to the
RHC is knocked and their view point on level of
satisfaction in take on restoration of health services
after flood – 2010. In total 109 households are
consulted and interviewed covering 30% male and
70% female population in the sampled size. The
breakup is shown as per table statistics.
.
Competency
of RHC Staff
Courtesy/
Friendliness
Nursing
Care
LHWs Service
at Door Step
Neutral 2 2
Not Sure 1 1
Grand Total 109 109 109 109
The above calculated facts translate that on competency level of RHC staff 57.79% people are
“somewhat satisfied” with the performance and on likewise pattern regard courtesy and caring
attitude of the staff. It is pertinent to mention that somewhat 22% show their serious concern on
field staff visit to household visit and “very dissatisfied with the performance.
Cleanliness
at BHU
Available Health
Facilities at RHU
You and Your family
getting benefit
Neutral
Not Sure 2 2
The cleanliness level at RHC is regarded around 76% somewhat satisfied and majority of the
people opinion is on the same line on access and available health facility to them in ambit of at
RHC once they approach there. No significant level of concern is shown in access to medical
facility. However, people are opinioned that delivery matters are not dealt vigilantly with the
sense of responsibility on part of doctor and staff.
using IEC Material
RHC Located at
BHU Services
Cost to You
Somewhat Dissatisfied 4 8
Gender
Marital Status
Male 30 - 02
Female 69 08 -

The above statistics reveal that people are “very dissatisfied” with the use of tool in provision of
any sort of IEC material to make them conversant of health issues, prevention and cure. The cost
of token fee is appropriate to the extent of service people receive.
Most of the people say that LHWs visit to
household only in vaccination days. The
significance of irregular visit is also alarming as
depicted 21.10%. Generally, people regard that
support staff visit once in a month.
Most of the people rest with the grievances that
once ADRA – Pakistan supported and provided a
water filtration plant installed at RHC. People in
general in the area and RHC interacting community
was obliged getting benefit. But, after some time,
the plant de-installed and equipment was taken from the area by ADRA – Pakistan authorities.
Such move reflected a bad impact in the area.
The household seemed complaining about unavailability
of medicines and visit of field staff to households only
during vaccination days, improper nursing care.
Community reveals that medicines specified for the RHC
are of sub standard. Somehow substandard medicines are
available in small quantity and provided the same for all
sort of disease. No IEC material is shared/provided for
transfer of knowledge and skills to deal with different
diseases and prevention purpose. The people who can afford treatment at place other than RHC
move there straight away. The people with poor financial worth only seek treatment at the centre.
Although the cost of token fee is bearable; amazingly
they are contended with the level of treatment as
compared to token fee. To the extent of fee charged at
RHC; people justify it with the level of service they
receive.
The community requires medicines in sufficient and
necessary quantity be made available at the unit, ensure
clinical test facility particularly in delivery cases, 24
hours service, ambulance facility and staff/doctor ensure presence in case of emergency.
2.75%
21.10%
2.75%
73.39%
0.00% 50.00% 100.00%
Fortnightly
Irregular Visit
Never Visited
Once a
Month
6.42%
93.58
%
Poll onGeneral Care
No Yes

M C H R P – E v a l u a t i o n R e p o r t | Review on Interventions at BHU – Daya Chokha Page 23 of 58
Review on Interventions at BHU – Daya Chokha
The BHU – Daya Chokha is located in UC – Sanawan. ADRA – Pakistan focused the BHU and
interventions are made to renovated health services thereat. For the purpose of evaluation, the
unit is taken in sampling and visited to assess the work done as physical verification
supplemented with view point of the head of BHU.
The summary on the physical verification and interviewee conducted with the Medical Officer,
BHU – Daya Chokha is summarized as under:-
 On the part of civil/construction/repair work, waiting area and washrooms are constructed;
whitewash, grouting and plastered on repair work is done nicely as per SoW. Sewerage work
and distemper was required but not done. Hence such
completed work is rated as “somewhat satisfied” by
the Head of BHU. Water supply is made possible
through ADRA intervention with installation of
electric motor, Water tank repaired. This work is done
quite satisfactory and services are restored,
community/staff getting benefit accordingly.
 Noting was done on the SoW pertaining to provision
of electric items. Such job is left; hence observation is
recorded as “very dissatisfied”.
 No IEC material is provided to post at BHU premises as well as for the use of field staff. No
banner, poster, leaflet, brochure, etc is seen pasted on walls of the BHU under monogram of
ADRA – Pakistan. The level of satisfaction to this extent is received as “very dissatisfied”.
 None of the wooden/steel work as asked for according to provided SoW is done. As told by
the Medical Officer; nothing was demand/required in this concern. Hence, it is astonished to
know that same was included and not done --- response is obvious: very unsatisfied”
 The paint work as per SoW is done and presently seems to be effective. The office incharge
showed observation as “somewhat satisfied”
 Skills and competency of staff and field personnel, cleanliness at BHU and friendly and
courtesy level of LHWs/LHV/LHS are accounted as “somewhat satisfied”
 Due to shortage of staff; nursing care is not done upto the mark. Hence the Incharge regard it
as “somewhat dissatisfied”.
 Anyhow, people in the area generally receive care and services from the available extent of
resources at BHU.

Among the strength of 30 LHWs; 07 of them spare some time to get involved in focus group
discussion to have their view point on the level of competency acquired through ADRA –
Pakistan interventions for restoration of health services. Key points on the discussion are
summarized as under:-
ADRA – Pakistan did not conduct any sort
of training relevant on LHWs/LHVs/LHs
job description. However, some other
supporting agencies arranged and conducted
training sessions relevant to their scope of
work. Trainings on the topics: T.B.
prevention, Dengue virus prevention,
Malaria virus, maintaining cleanliness,
mother child care, natal care, health and
hygiene are covered with demonstration and
content is explained through pictorial and
charts.
Demonstrated skills regarding hand wash,
nail cutting, cleanliness, etc are increased
with practical application to deliver
effectively. After consecutive trainings with
enhanced advocacy and interventions; now
people do agree for vaccination regarding
child protection and mother, polio, etc. The
conduct of the people is changed now in the
sense they treat us as useful worker and
facilitator helping to resolve health related
issues. They easily share their CNIC
information.
Before flood people did not show their
willingness but after that with our
application through acquired skills because
of trainings agree to follow the desired
procedure, good practices of life skills and
get their health related issues resolved. It is
observed that after flood people have also
changed their attitude to positive aspect on
maintain cleanliness and hygiene conditions.
People do care for maintaining cleanliness at
their own and observe cleanliness at their
homes.
The participants claim that people observe
sense of responsibility and show willingness
for vaccination of their children. Prior to
this, job of polio vaccination was entrusted
to male personnel resulting to that people
were reluctant to show their willingness for
the job. We as female persons have turned
the things into positive aspect.
On
enquiry,
it is
revealed
that no
IEC
material
is
provided.
However
charts regarding family planning, malaria,
TB, etc were provided by the sources other
than ADRA – Pakistan monogram. Such
IEC material is distributed in the community
accordingly. The use of charts has been very
effective to make the community conversant
about health issues. The trainings has
exercised a health influence on the job
assignments and behaviour in particular; as
participants shared aspiration and speak
through body language as:-
“It has changed our life; controlled
temperament”; “Sense of Child protection is
increased”; “Maintaining Minimum family
planning”; “Children are dealt with
kindness”; “Children have made us
understand to maintain good hygiene
conditions”; “Ensure cleanliness at home”;

In the Union Council Sanawan, the BHU in the village Daya Chowkha has received
infrastructural renovation of health services. In order to have honest opinion of all such
implemented work in hard and soft components of focused BHU; the people in the village
associated hoping to receive immediate response in case of need for health services are
interviewed to come up with the views as how they perceive about all such interventions carried
out by the implementing agency.
In the village 101 households are visited door-to-door
and interviewed as per questionnaire (Annexure-05)
covering strength of male and female population as
shown in the table with the percentage of 26.73 and
73.26 respectively.
The household interview is sliced into judging competency of dealing of BHU staff, available
and level of getting benefit from BHU services, convenient access to the unit, frequency of
LHWs visiting to the households and peoples’ general perception of having care at BHU.
Competency
of BHU Staff
Courtesy/
Friendliness
Nursing
Care
LHV Service
at Door Step
Neutral 4 2
Grand Total 101 101 101 101
The above table summarize the view point as majority the people as satisfied to “some extent” as
revealed from the statistics that 73.27% with competency level of BHU Staff, 57.43% regard
field staff as courteous and friendly; 80.20% think they receive nursing care to certain level at
BHU. Around 50% survey people recognize LHWs service at their door step. However, 16.37%
people are very dissatisfied with the visit of field staff to household as their objective is not
fulfilled.
Cleanliness
at BHU
Available Health
Facilities at BHU
You and Your family
getting benefit
Neutral 1 1
Not Sure 1
The strength of 77.23% ratifies the claim of BHU officials of maintain cleanliness there as
“somewhat satisfied”. However, 20.79% are very much satisfied with the level of cleanliness at
Gender
Marital Status
Married Window(er)
Male 27 -
Female 71 3

BHU. The majority of the people 91.09% acknowledge “somewhat satisfied” getting benefit of
services for self and their family in case of visiting to BHU; whereas 59.51% show the same
concern on available health facilities over there.
using IEC Material
BHU Located at
BHU Services
Cost to You
Neutral 1
Somewhat Dissatisfied 6 1
Very Dissatisfied 62
On question to provision of IEC material to household more than 62% responded as “very
dissatisfied” distorting the objective of transfer of knowledge, skills, and learning adaptation of
best practices towards health, hygiene and other services in the community. The same set of
people is “somewhat satisfied” with the cost of token fee charges at BHU or against the services
they get benefit. The more than 50% people are “very satisfied” with the location of BHU
premises as approachable from surrounded area.
The graphical presentation come up with the view
point of household that 70.30% say LHWs never
visit to their house except on the occasion of
vaccination campaign. This results in
contradiction to the version of field staff of
regular visit to HH once/twice in a month. This
shows seriously level of “dissatisfaction” on the
competency level of field staff.
On the descriptive part of interview; household seemed complaining about improper checkup at
BHU, unavailability of medicines and visit of field staff to households only during vaccination
days, improper nursing care.
Community reveals that medicines specified for the BHU are sold at medical stores and they are
charged cost of medicine at the time of treatment at health unit. Somehow substandard medicines
are available in small quantity and provided the same for all sort of disease. None of the clinical
test is available there. No IEC material is shared/provided for transfer of knowledge and skills to
deal with different diseases and prevention purpose.
LHWs conduct, job delivery is much appreciated by the community; whereas LHV/LHS job
satisfaction is question marked. The community requires medicines in sufficient and necessary
quantity be made available at the unit, ensure clinical test facility particularly in delivery cases,
24 hours service, ambulance facility and staff/doctor ensure presence in case of emergency.
2.97%
22.77%
70.30%
3.96%
Fortnightly
Irregular Visit
Never Visited
On Weekly Basis

M C H R P – E v a l u a t i o n R e p o r t | Review on Interventions at BHU – Pathal Page 27 of 58
Review on Interventions at BHU – Pathal
Pathal is one of the BHU where ADRA – Pakistan interventions are done. For the purpose of
review on infrastructural development, the process is adopted as same done in other selected
union councils.
The Medical Officer, BHU – Pathal, presently posted accompanied with his supporting staff
member evident of such infrastructural work done at BHU is interviewed. The level of
satisfaction and the information shared is summarized as under:-
 Regarding Civil/Construction/Repair work is
concerned; White Wash, Plaster, Distemper is done
nicely and seen as effective so for. In the passage,
tuff tiles are fixed. Wall and sewerage
repair/construction is not done. For patients, waiting
area and wash rooms are well constructed. Electric
motor and boaring is done for maintaining water
supply at BHU. However, earth filling measuring
13,008 CFT is not done. Heap of filling stuff is left
on the way while tranches s are left empty resulting to that stagnant water is there source of
mosquito breeding in BHU premises. Over all, Medical Officers grade the level of work as
“somewhat satisfied”.
 In regard to provision items; it is stated that Energy Savers and tube light as per prescribed
quantity are not provided. However ceiling fans and Bracket Fans are provided as per quantity
mentioned in SoW, and the equipment is function properly. “Somewhat satisfied” grading is
shown to this component.
 No cupboard, door and windows are repaired. Window glasses are not fixed. However,
window grills are fixed. The Medical Officer shows “very dissatisfaction” to implementation
of such work.
 Paint work on doors and main gate are completed and shown as effective so for. However,
paint on prescribed quantity of windows and cupboard is half completed. To the extent of
work done on doors and main gate is appreciated and the Medical Officer is “very satisfied”.
 No IEC material is provided and seen at any of the place at BHU. No proper training sessions
are conducted for field staff. The officer shows displeasure and “very dissatisfied” in this
concern.
 However, on maintaining cleanliness at BHU, courteous and friendliness of field staff, their
competency level to deliver assignment, health services available to community is graded as
“somewhat satisfied”.

 As per view of Medical Officer, generally people receive caring behavior of Nursing Staff and
get common service at BHU; the component is graded as “very satisfied”.
At UC Pathal, the total strength of LHWs is 18 with 01 LHV under a Lady Health Supervisor.
Nine LHWs are engaged in discussion to assess increase in competency level after ADRA –
Interventions. The discussion is summarized as under:-
On enquiry, unanimously told by the
participants that none of the training
whatsoever is arranged/conducted with the
support of ADRA – Pakistan for any of the
field staff member. However, some training
sessions pertaining to the job description,
mother and child health care, cleanliness, to
safeguard people for Dengue virus, health
and hygiene, precautions from Malaria
disease are arranged by the department as its
own or some supporting agency other than
ADRA – Pakistan.
In the training session, hand wash method is
learnt through content and demonstrated
application. Poster, charts and supporting
material is used to conduct training sessions.
The training received from such
organizations has played a vital role. First,
people did not cooperate; and now sense of
willingness is improved. Now, in the field,
after training, participants are capable to
replicate, demonstrate the skills and methods
on maintaining health and hygiene. The
pregnant women are provided consultation,
awareness and get them agree for routine
medical check on regular basis to avoid
further complications.
The capacity building has provided benefit
in the way to get under neutrinos children to
have access to treatment way. Disciplined
approach is adopted in vaccination to ensure
none of the child is left without vaccination.
The participants are capable to pass on
information in more concrete way so that
community gets benefit. The participants
claim that regular visits to HH on consistent
basis are performed. Behaviour of the
community is changed in such way they
field staff interventions as respectable as
they feel the information to be passed to
them is beneficial to them. The field staff
regards it as their great success.
First people were afraid of getting their
children vaccinated as thought such
intervention as effect of family planning.
Now with
extensive
advocacy,
motivation
to
households;
the
scenario is
changed. Only daily basis seven HH are
required to visit; this obligation is being
complied with accordingly. The HH having
pregnant women or bearing new born baby
is visited frequently. The participants claim
that generally, people are satisfied with the
working. Anyhow most of the people
complain of few field visits; as owned by the
workers. No IEC material is provided to us
supported by ADRA – Pakistan.

The field staff with great enthusiasm and satisfied body language shared that the gestured as:
“Sense of Responsibility is developed” after extensive trainings. “Confidence is increased to talk
with male persons”. We can communicate with the High Ups about needy and aggrieved family
member seek help on health issues. “Interest in working is increased”; “Made capable in delivery
of assignments effectively and efficiently”
In Basti Pathal, surrounded by BHU premises, households are interviewed to get their level of
satisfaction upon recovery of health services in response to support extended to basic health unit
in the vicinity.
For the purpose 93 households are surveyed door to
door where in 60% female population and 30%
male persons are covered with bifurcation on
marital status as shown in the table.
In regard to competency level of BHU staff, community grade as 73.11%, courtesy level as
54.83%, nursing care as 63.44% and LHWs service at their door step 45.16% as “somewhat
satisfied”. However, 25% take “very dissatisfied” field staff service delivery as statistics are
shown in following table.
Competency
of BHU Staff
Courtesy/
Friendliness
Nursing
Care
LHWs Service
at Door Step
Neutral 2 1
Not Sure 6 1
The community strength 13.97% for staff competency, 27.95% for dealing behavior of staff; and
22.58% on LHWs service at door step takes as “very satisfied”.
Cleanliness
at BHU
Available Health
Facilities at BHU
You and Your family
getting benefit
Neutral 3
Gender
Marital Status
Male 30 - 01
Female 60 02 -

On maintenance of cleanliness at BHU; community is somewhat satisfied but severe concerns
shown on the incomplete work of the implementing agency left on earth filling. Trenches are
seen as opportunistic way of mosquito breeding at BHU premises. The same is pointed out at
very corner in whole of evaluation exercise
using IEC Material
BHU Located at
BHU Services
Cost to You
Neutral 1
Very Satisfied 30 37
It has been unanimous voice from the community showing dissatisfaction on sharing/provision
of any type of IEC material in transfer of knowledge, skills and awareness about cure/prevention
of diseases of any kind. Hence quantum of community demonstrating displeasure is evident in
above table. Almost 90% people are satisfied with the token fee charged against service delivery
at BHU.
Majority of the people regard that field staff visit to
their house once in a month elaborating health tips,
maintaining cleanliness, hygiene conditions and
vaccination purposes. This sort of opinion also
ratifies 63.64% level of satisfaction of getting
service at door step, as revealed above
As bottom line, in spite of concerns and problems faced;
community people are of the view and 83.87% generally
think they get “somehow” response and minor level
treatment as and when they approach for services to BHU
after restoration of health services thereat. Significant
percentage of 16.13% opinioned as never received
care/treatment at BHU even for minor problem they faced.
This majority of people come up with the concerns of no proper checkup, seen nepotism by BHU
staff in extending services to their blood relatives, BHU allocated medicine is sold in the market,
LHVs visit to HH only during vaccination days, and the major concern has been about
unavailability of doctor in case of emergency. The practitioners call the patients at private clinic.
The community suggests provision cost free medicines, ambulance service in emergency,
availability of doctor and staff, delivery service for round the clock and clinical test facility
particularly for delivery care must be arranged at BHUs in dream to meet realistic interpretation
for ideal services.
3.23%
20.43%
76.34%
Fortnightly
Irregular Visit
Once a Month
Frequency of LHWs Visit to
HH
16.13
%
83.87
%
No
Yes

M C H R P – E v a l u a t i o n R e p o r t | Review on Interventions at BHU – Kanju Wala Page 31 of 58
Review on Interventions at BHU – Kanju Wala
Basic Health Unit – Kanju Wala is located at Union Council Hunjrai, adjacent to Hockey-Spur
nearby River Tounsa Beraj. This BHU has been under consideration of ADRA – Pakistan
interventions for renovated health services in the union council. For the purpose of evaluation,
the same has been taken into account; brief on outcome of the exercise is summarized as under:-
In order to review the work done on infrastructural renovated services at the BHU; same twofold
process is adopted at with the case of other sample unit --- Physical verification second by
interviewed conducted by the BHU official getting valuable view point about quality and
quantity of the job done. The strength of the field staff bifurcated as twenty LHWs with one LHS
having support of one LHV.
 In regard to civil/construction/repair work; the wall 4’
as per SoW is not initiated and constructed. However
the other civil work plaster and distemper is done;
sewerage repaired, wash rooms constructed, tuff tiles
fixed on the passage and waiting area is very much
constructed; such work is done to the level of
satisfaction as physically seen and ratified by the
interviewee passing opinion as “somewhat
satisfied”.
 As per SoW nothing is provided on account of electric items and “very dissatisfied” is
shown over there.
 No wooden repair work is done however; 03 cupboards are made fixing frame and doors on
already cemented made structure. No wood/steel work is done. Interviewee showed “very
dissatisfied” in this concern.
 Paint work as per scope of work is done well and appreciated --- comment received as “very
satisfied”
 No IEC material is provided and seen nothing available any sort of banner, poster, leaflet, etc
bearing ADRA monogram in BHU premises. The interviewee further added that none of the
IEC material is provided to field staff as well ---- “very dissatisfied” in this regard.
 The field staff level of friendliness, courteous to people, available health services to
community approaching to BHU and cleanliness in the premises is account as “somewhat
satisfied”
 It is claimed that people who approach to BHU for services, generally they receive care.
Nursing case is graded as “very satisfied” whereas competency level of BHU staff is taken as
“somewhat satisfied” to deliver the assigned job.

In the Union Council Hinjrai; the Basic Health Unit – Kanju Wala carries strength of 19 LHWs,
02 LHVs under the supervision of a Lady Health Supervisor. On having visit to BHU; revealed
that none of the field staff particularly LHWs belong to the area other than Hinjrai. The BHU
located at far flung area; for the reason staff member having not easy access show least interest
to make sure attendance on regular basis.
In spite of sufficient and necessary coordination; Evaluation Field Team has been unable to grab
attention of BHU field staff in order to get their spare time and engage in focus group discussion.
Hence the version of LHWs about competency their level has not been taken into account.
In total 99 households are visited to get their level of
satisfaction in response to health services restored at Basic
Health Unit Kanju Wala. The breakup on number of
households were interviewed is shown in the table.
Therein around 41% of female and 58% male population
is addressed to get their observations, suggestions and
findings on the level of services they receive from the
basic health unit.
The statistics in following table shows that competency of
BHU staff, behavior and dealing with community, the
extent of nursing care to patients visiting thereat and field
staff delivering services at door step is ranged 50% to 60%
“somewhat satisfied” graded by the community. Level of
“somewhat dissatisfied” is ranged upto 20% in case of nursing care and courtesy level of BHU
Staff.
Competency
of BHU Staff
Courtesy/
Friendliness
Nursing
Care
LHWs Service
at Door Step
Neutral 9 8 1
Not Sure 12 4 1 1
Gender
Marital Status
Married Window(er)
Male 58 -
Female 39 2

Cleanliness
at BHU
Available Health
Facilities at BHU
You and Your family
getting benefit
Neutral 4 2
Not Sure 1
Very Satisfied 8 14
The community opinion on getting benefit from BHU services is recorded as 81% to “somewhat
satisfied” with 13% showing “somewhat dissatisfaction”, around 14% are “very dissatisfied” on
available heath facility to their demand. Somehow on minor sort of treatment they get response
from BHU.
using IEC Material
BHU Located at
BHU Services
Cost to You
Neutral 1 1
Not Sure 2
In interpretation of above table statistics; majority of the people is satisfied with the
accessible/approachable distance to BHU and the token charged against services. But specifically
transfer of knowledge and skills through any sort of IEC material on health related issues has not
been upto the mark.
The graphical presentation shows that majority of
people reveal field staff visit once in a month.
There is significant percentage on sum up of
irregular, on request and never visiting trend of
field staff paying attention to household at door
step. This is mainly because of none of the field
staff posted at BHU Kanju Wala is not resident of
the concerned Union Council. As Union Council
and BHU is located in far flung area, very near to
flood affecting danger zone; therefore access to
such area is also difficult.
10.10%
8.08%
3.03%
4.04%
71.72%
3.03%
0.00% 50.00% 100.00%
Fortnightly
Irregular Visit
Never Visited
On Weekly Basis
Once a Month
Visit on Request

Generally, community has somewhat same observation as no
proper check up and attention by the doctor at BHU,
improper/non-availability of medicine, improper treatment
to specific disease, provision of one sort of medicine (if
available) for all diseases and cost of medicine is charged.
Unanimously told that no IEC material is provided, shared
and transferred knowledge, skills and demonstrated behavior
in dealing with the prevention on health related issues.
Most of the people seemed complaining about irregularity and unavailability of doctor at the
time of emergency. Field staff pays attention only in vaccination campaigns. “Somehow” having
none of the other option to approach and access to better medical facilities; majority of the
people is contended to say that “somewhat” but not desired facility is obtained.
The community suggests and demand as well regular visit of field staff to HH, consistent
availability of doctor particularly in emergency, clinical test facility particularly related to child
and pregnancy/delivery matters. Proper room, safe drinking water (water purification plant
should be made available) and ambulance service must be started to address the emergency need
in a coherent way.
6.06%
93.94
%
No
Yes

M C H R P – E v a l u a t i o n R e p o r t | Review on Interventions at BHU – Chak 518 Page 35 of 58
Review on Interventions at BHU – Chak 518
This BHU is located at Diyara Din Pana Road, affected by flood – 2010, resulting to that taken
into account by ADRA – Pakistan to support in restoration of health services. The BHU – Chak
518 under UC – Mirpur Baghal is selected in to the sample for evaluation exercise under ADRA
interventions carried out in this regard.
The Medical Officer Dr. Israrul Haq is interviewed to get view point on quality and quantum of
infrastructural work done at BHU; and exercise is further strengthened with physical verification
as well. The BHU has support of 25 LHWs, 01 LHS, 01 LHV and 02 Midwife in operation with
other technical staff on board. The summary of discussion on infrastructural and capacity
building related interventions is given below:-
 The civil/construction/repair work done is “somewhat satisfied”. Work on installation of tuff
times, construction of washrooms, waiting area, path is completed well and done
satisfactorily. However the wall, electric motor, boaring and demand of construction of slabs
in the store room is not done.
 Electric items are provided to the extent of BHU demand: 02 ceiling fans, 02 bracket fans
and 01 Pedestal fan and the equipment is functioning well. The energy save has not been
demand and same is not provided even listed in the SoW.
Hence note as “very satisfied” to this component is
received from the interviewee.
 Paint work as per scope of work is done as good and
presently seems to be effective – hence graded as “very
satisfied”.
 No IEC material is provided. The BHU walls are
populated with number of charts, pamphlets, brochures
etc provided by the other supporting agencies; but noting is seemed available under ADRA
monogram. The official are “very dissatisfied” to this extent.
 No Training is provided to LHWs/LHs/LHV or any other staff. It is revealed that
implementing agency committed to conduct sessions but not done any way --- hence the
grading to this component is obvious.
 The Medical Officer claims good nursing as “very satisfactory” care, provision of health
services in purview of BHU and generally people receive services from BHU; the courteous
level of all staff is “very satisfactory”; dealt with the interacting person very politely.
 The competency level of staff is justified with the ambit of BHU services.
 Concluding to observation; it is recorded that MO needs quality improvement and sewerage
be installed as per specification and prescribed length devised in SoW. This work is done as

incomplete. Water tank already available there is not properly functioning and same is not
addressed to make functioning properly.
The field strength at BHU – Chak 518 is composed as 25 LHWs, 01 LHV, 02 Midwifes, all
under the supervision of one LHS. In the focus group discussion, 11 LHWs accompanied with
LHS have spared the time and actively participated with valuable input to inquiry framework.
The deliberate discussion with the group is summarized as under:-
It is revealed that none of the training
session is arranged / conducted through
ADRA – Pakistan interventions. Some other
supporting organizations and the department
initiated trainings for field staff are arranged
on topics: polio vaccination, precautions
from dengue fever, Malaria disease,
cleaning methods of polluted water, steps on
hand washing properly, mother and child
health care, pre/post natal care, etc.
The participants claim in enhancement in
knowledge, application of skills and positive
change in behaviour after such training
sessions. It is assessed that participants are
knowledgeable and well informed on the
content required to apply for the said job.
The LHWs shared with confidence
procedure of different skills learnt through
training sessions. On inquiry stated that no
IEC material is provided through ADRA –
Pakistan interventions. Field staff sense of
responsibility is showed with the statement
as “before training irregular visits are done
to the community; but after training regular
visit are conducted on daily basis”.
Training has turned positive result in getting
willingness of people to care about health
and hygiene issues, maintaining cleanliness
at home and compliance of proper
vaccination for the family.
The intensity of enhancement in
competency, commitment to work and sense
of responsibility is assessed through the
sentences and body language of participants
as: “In early days of job we were annoyed
with the
behaviour
of people;
but now
have
developed
temperam
ent and
patience to listen others”. “Feel great
satisfaction helping people in resolution of
their health related issues”. “Now regularly
visit to field as per plan.”

In the union council Mirpur Baghal, the basic health unit is situated at Chak – 518 nearby the
main road. Thereat 101 people in the vicinity
adjacent to BHU are interviewed. Male to Female
ratio of households is 45.54% and 54.45%
respectively. However, marital status wise
bifurcation of people engaged in interviews is
shown in the table.
Under following table, trends somewhat like same as received from the people in another
sampled union councils. Here in this union council around 50% of the people are “somewhat
satisfied” as contended with the received services while speaking on the components:
competency of BHU staff, their courtesy level with the public, nursing care at BHU and field
staff extended gesture at community’s door step.
Competency
of BHU Staff
Courtesy/
Friendliness
Nursing
Care
LHWs Service
at Door Step
Neutral 2 5 5 2
Not Sure 4 3 2 1
Grand Total 101 101 101 101
The statistics show that around 35% people are dissatisfied in one what or the other on receipt of
services with reference to above noted components. However, around 10% of the sample size is
seen satisfied with BHU related services.
Cleanliness
at BHU
Available Health
Facilities at BHU
You and Your family
getting benefit
Focusing to maintenance of cleanliness level, it is appreciable that more that 90% of the
population is satisfied. Level of availability of health services to people rests with 50%; and
around 40% is able to get benefit from such services. Dissatisfaction level is significant getting
figure around 50% as deprived of enjoying benefit of services in ambit of BHU.
Gender
Marital Status
Male 39 01 06
Female 52 02 01

using IEC Material
BHU Located at
BHU Services
Cost to You
Somewhat Satisfied 17
The above table statistics clearly shows that 83.16% regarding transfer of knowledge with use of
IEC material, almost 100% due to BHU premises located at inappropriate place in the union
council and cost charged to them against provision of services are “dissatisfied” straight away.
Nothing is left to translate on such opinion. Hence ADRA – Pakistan interventions and the
organizations other ADRA support; all are in question marked revealed through community
point of view.
The graphical presentation shows that field staff
normally visits once in a month to households.
However, there is significant portion of irregular
visits to households prevails. Such trend supports
to the version of community members that “field
staff only visits in vaccination days.
People generally seem complaining about the
doctor’s unavailability at BHU. No proper
medicine is provided. Field staff charge cost of
medicine. BHU staff is competent but not
competent enough to deal with amicably. Filed staff mostly visit during vaccination days. No
proper treatment is available at basic health unit. It is apparently seen people are fed up with the
BHU staff as in emergency getting no proper treatment and
dealing with the case. Majority of the people have
observations on doctor’s incompetency in dealing with the
patients. Most of the people are referred to some other
places even in emergency. It has been one voice on non-
availability of any sort of material or transfer of knowledge,
skills, awareness on health related problems, issues, etc. It
is evident from the poll significant number of people are
annoyed with the services of BHU is delivering. This
resultant that either from ADRA – Pakistan interventions or the supported extended by other
NGOs in the area benefits are not extended to the community. People suggest that proper trained
staff should be posted. BHU be equipment with necessary clinical test facility particularly
dealing with mother and child health care. Ambulance services should be provided. Medicine
should be provided free of cost.
1.98%
10.89%
0.00%
3.96%
82.18%
0.99%
0.00% 50.00% 100.00%
Fortnightly
Irregular Visit
Never Visited
On Weekly Basis
Once a Month
Visit on Request
43.56
%
56.44
%
Pollon General Care
No Yes

M C H R P – E v a l u a t i o n R e p o r t | Review on Interventions at BHU – Sheikh Umer Page 39 of 58
Review on Interventions at BHU – Sheikh Umer
In the Union Council Shaikh Umer there are two BHUs are located. The ADRA focused BHU in
the UC is also named as BHU – Shaikh Umer. The unit is operating with 19 LHWs, 02 LHVs, 01
LHS supported with 02 midwifes as interacting staff with the community. Presently the Medical
Officer is on leave, the senior most official is acting as Incharge – BHU designated as Dispenser.
Interview is conducted with the Unit Incharge and observations, viewpoint of the interview
regarding renovated health services under ADRA – Pakistan interventions are summarized as
under:-
 Regarding civil/construction work as per SoW, plaster is done, tuff tiles in the passage fixed,
white wash, distemper is done; waiting room and wash
rooms are constructed. Sewerage, electric motor, boaring
is not provided/completed as scope of work is designed. It
is dire need for electric motor for water supply purpose.
The need recognized and included scope of work; even
commitment was made for restoration of such facility but
the implementing agency did not pay attention to complete
the task. Hence the civil/construction work is graded as
“somewhat satisfactory”.
 Electric items are not provided as per SoW. However as per our demand 10 ceiling fans are
provided whereas initially it was quantified as 03; specification are not taken into account.
The other items like energy saver, tube lights, call bell, wiring; noting is done/provided. With
this view, the job under this category of restoration of services is graded as “somewhat
satisfactory”.
 Wood/Steel work not done as per scope as it was not required as well; but SoW suggests to
do the job. No IEC material is provided, pasted in the premises not even a single poster,
banner, etc. The work is regarded as “very unsatisfied” by the interviewee.
 The competency of field as well staff working at BHU is regarded as “somewhat satisfied”.
Most of the staff is available and 24 Hrs delivery services are ensured.
 Although no designated sweeper is posted at BHU; yet generating through own resources; a
person is hired focusing to maintain cleanliness at the unit. Cleanliness status at BHU is
“very satisfied”.
 Generally, people receive care from BHU services as claimed by the interviewee. The posted
staff and field staff in particular are courteous and friendly. None of the complaint is received
from the community about conduct of the staff. “Somewhat satisfied” is the grading given
by the interviewee.

The total strength of field staff is 24 with bifurcation as 19 LHWs, 02 LHVs, 02 Midwifes under
01 LHS. In focus group discussion 11 LHWs and LHS spared some time and shared their point
of view about competency level in delivery of assignments.
The summary of brief points raised revealed during discussion is given below:-
On enquiry of training sessions
arranged/supported through ADRA –
Pakistan interventions, the answer from
participants has been the same as responded
by the field staff posted in other sampled
BHUs. However, training sessions on
different set of topics are arranged by the
department or any other helping
organizations in order to enhance the
competency level of working staff at BHU.
It is pertinent to mention that LHS
exclusively acknowledged participation in a
training sessions arranged by ADRRA –
Pakistan, alongwith same cadre staff posted
at other BHUs.
The other supporting organizations arranged
trainings sessions on health and hygiene,
cleanliness, methods to purify drinking
water, prevention of TB, Malaria, etc for
whole of the field staff posted at BHU. Such
training sessions has been helpful is raising
awareness, increase in knowledge and
sensitization about health issues to transfer
the skills to flourish best practices in the
community.
Such training sessions are supported with
the provision of booklets, charts, pamphlets,
brochures, leaflets, pictorials, etc to
strengthen the knowledge and fully
conversant of methods and skills for
effective
demonstrati
on in the
community.
Such
instrument
has worked
as catalyst
in facilitation of job assignments. It is
revealed that very small quantity of such
type of IEC material is provided by ADRA –
Pakistan support. Nothing is also seen
pasted under ADRA monogram on the walls
of BHUs.
The participants shared the enhancement in
their knowledge, skills and demonstrated
behavior through the sentences and body
language as:-
 “We go to the community and explain
hand wash method by doing practical –
Asmat Bibi”
 “Controlled temperament, increased
patience level; now very soft spoken
with the community – Samina Bibi”
 “After training, behavior is changed now
and community feel satisfaction with our
working – Fozia Bashir”
 “Attending training sessions has
increased our confidence level to work
in the community – Samina Nawaz”

With such discussion; observation is drawn that 50% - 60% knowledge of the participants is
increased, skills are enhanced and demonstrated behavior is improved dominated by
sensitization.
In total 107 households are visited at union council
Shaikh Umer in order to get view point of their level
of satisfaction regarding restoration health services
focused to BHU situated in the union council. Male
and Female ratio of interacting HH is calculated as
45.79% and 54.20% respectively. Marital status wise picture is portrayed in the table referred
above.
Competency
of BHU Staff
Courtesy/
Friendliness
Nursing
Care
LHWs Service
at Door Step
Neutral 1 6 5
Not Sure 7
Grand Total 107 107 107 107
Explanation to above table translates that competency of BHU Staff, courtesy/friendliness
behaviour to community, nursing care and LHWs providing service at step; majority of the
people interviewed at “somewhat satisfied” to this extent.
Cleanliness
at BHU
Available Health
Facilities at BHU
You and Your family
getting benefit
Neutral 4 1
Not Sure 1
In regard to maintaining cleanliness, available health facilities and access is generally graded by
the community sowing 73.83%, 59.81% and 71.02% respectively. However 28.97% people show
level of dissatisfaction on having access to health facilities at BHU. Also, people 26.16% are
unsatisfied with the maintenance of cleanliness at the place they intend to receive health care
facilities.
Gender
Marital Status
Male 48 - 01
Female 51 07 -

using IEC Material
BHU Located at
BHU Services
Cost to You
Neutral 1 1
Somewhat Dissatisfied 8
Very Dissatisfied 61
The above table clearly states the community level of dissatisfaction on provision of IEC
material and transfer of knowledge, skills and demonstrated behaviour. It also ratifies the
question marked performance of implementing agency on this sort of component.
The graphical presentation shows that majority of
people reveal field staff visit once in a month.
There is significant percentage on sum up of
irregular, on request and fortnightly visiting trend
of field staff paying attention to household at door
step.
However, community responded on the descriptive
pat of the interview as complaining that no fan and
drinking water is available for patients. Medicine is
not provided properly. Proper check is not done. For every sort of diseases; only one type of
medicine is provided. The community regards token fee as appropriate charged at BHU. Mostly
medicines are asked to purchase from the market and if available there; cost of medicine is
charged. The clinical test facility is not available.
The people suggest that emergency services must be rest
assured made available in every circumstances particularly in
deliver matters. Doctor should be regular and punctual and be
on duty in full working hours. Quality medicines should be
made available at free of cost. There is no water filtration
plant; must be made available. The community also demands
a specialist doctor for children. They are also in need of
ambulance service to deal with the emergency situation.
11.21%
4.67%
0.93%
5.61%
77.57%
0.00% 50.00% 100.00%
Fortnightly
Irregular Visit
Never Visited
On Weekly Basis
Once a Month
21.50
%
78.50
%
No Yes

MCHRP Evaluation Report f1 15-09-2012

MCHRP Evaluation Report f1 15-09-2012

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MCHRP Evaluation Report f1 15-09-2012