ROLE OF

FAMILY WELFARE ASSISTANT

Population & Development

FAMILY WELFARE CENTRES (FWCs)

The Family Welfare Centre is one of the main service

delivery networks of the Program established in

hired premises in urban and rural areas. Each centre

caters to a population of 5000 to 7000 through the

static facility and a population of 15000 25000 by

arranging satellite camps among dispersed

population and high density areas respectively.

Major Activities

The major activities to be carried out at the FWC are as follows:

Provide high quality family planning services including counseling, supplies and regular follow-up services at affordable costs and in a manner that is acceptable to the community.

Providing MCH and well-baby care including prenatal and postnatal care, immunization, nutrition advice and growth monitoring in a friendly atmosphere.

Continued . . . .

Organizing group meetings of stakeholders such as elected representatives, satisfied clients, teachers, hakims, private practitioners, religious scholars, shopkeepers, representatives of local NGOs and other active members of community.

Establishing referral linkages with secondary and tertiary hospitals for referral of clients.

Continued . . . .

Organizing IEC campaign for promoting small family norms among active and influential community members and traditional birth attendants and to foster a family well-being concept in the holistic approach of FWC.

Holding regular meetings with elected women councilors to elicit their support.

Distributing IEC material on better health practices and family planning within the community.

Continued . . . .

To extend outreach services through Mobile Service Units attached with the FWCs located at the Tehsil Headquarter level.

Organizing group meetings separately for youth, men and women with an objective to discuss social issues like human rights, drug abuse, domestic violence and child abuse.

Responsibilities of Incharge FWC

A - Service Delivery

Act as Incharge of Family Welfare Centre and supervise the work of the staff.

To monitor FWCs and to provide technical support.

Perform FP counselling, contraceptive services, including IUD insertion and refer Norplant, sterilization cases after initial screening to RHS A Centres.

To conduct initial screening and refer clients for sterilization and Norplant to RHS A and extension camps.

Continued . . . .

Attend to cases of general ailment and refer clients to higher level facility, if deemed necessary.

Establish linkage with the tertiary hospitals for referrals.

Provide mother & child care services, child nutrition and arrange immunization services in collaboration with government health services, wherever possible.

Continued . . . .

Supervise and support the FWA (female) to ensure collaboration of satisfied clients and/or husbands for promotion of RH and FP and undertake regular home visits for motivation and follow up.

To supervise the work of FWA (F) and ensure update eligible couple register and to prepare a list of couples having one child, pregnant women, antenatal and postnatal clients for counselling and spacing.

Arrange FP agents orientation, including elected representatives, in collaboration with tehsil office.

Maintain and update client record cards/registers and prepare monthly reports of various activities.

B - Counselling

Provide counselling to clients on various FP/RH issues such as:

Adolescent problems

Infertility

Nutritional disorders

Cervical and breast cancer

STD/AIDS

Breast feeding

Give orientation to clients on breast examination.

Maintain record for counselling of each client.

Responsible for keeping update IEC material/literature for enhancing her own knowledge and/or of the clients.

Assign villages to motivators for motivation and counselling of MWRA (married women of reproductive age) if sufficient clients are not coming to FWCs.

Follow up of FP cases especially Injectables through FWA (female).

Maintain quality of care and client satisfaction, arranging periodic satisfied clients meetings.

Establish referral linkages with tehsil and district hospitals for referral of clients.

Responsibilities of FWA (Male)

The FWA (Male) will assist the Family Welfare Counsellor/

Worker in holding Satellite camps twice in a week in the

identified villages. He will arrange venue, move in the

community and ensure necessary logistic arrangements and

distribute appropriate IEC material.

The FWA (Male) will arrange male motivation through

interpersonal communication, audio-visual shows, distribution

of IEC material in the community.

The FWA (Male) will refer vasectomy cases to Vasectomy Centres

and RHS-B Centres and will assist EPI teams for arrangements of

immunization services on selected days at FWCs.

The FWA (Male) will be specifically responsible for distribution of

contraceptives to RMPs, Hakims &Homeopaths in his area and

collection of performance reports and sale proceeds of contraceptives

from them.

The FWA (Male) will be responsible for registration of eligible

couples of in the vicinity of FW Centre.

Responsibilities of FWA (Female)

The FWA (Female) would go in the field for registration of eligible couples in the vicinity of FWC during the days when FWW remains in the centre.

FWA (Female) will motivate and counsel clients for adoption of small family norms and refer cases of IUCD to FWC and contraceptive surgery cases to the nearest RHS Centres.

During field visits she will also register births and deaths in her area

FWA (Female) will be responsible for follow up care of clients and for maintenance of complete record of the acceptors to improve use continuation

The FWA (Female) will look after the centre and administer Injectables and undertake IUCD (after completion of the training), when the Incharge of the FWC would be away for Satellite camps. For this purpose she will be provided extensive training at RTIs.

MAGNITUDE OF THE PROBLEM

Population of Sindh has increased 7 times since independence.

It has doubled from 1980s to 1990s.

It was 43 million in 2012 with annual growth rate of 2.3% (1.9% of Pakistan)

It has youth population of 68%

TFR of Sindh is 3.9 , 0.9 of this is unwanted whereas the women in Sindh want only 3 children but they have almost one unwanted child on the average.

TFR in rural Sindh is 4.8, in Urban Sindh is 2.9

Women in rural Sindh have almost two children more than their urban counterparts.

TFR in poor class is 5.3, in middle class is 4.2 and in rich class is 2.5

Poorest families have approximately 3 children more than the richest families.

With high fertility Sindhs population by 2050 will become 83 million

With low fertility Sindhs population by 2050 will become 62 million

i.e a strong F.P programme could make the difference of 21 million

TFR = 4.8 (for women with no education)

TFR = 4 ( for women with primary schooling)

TFR = 3 (for women with secondary education)

TFR = 2 (for women with tertiary education)

47% of women want no more children

25% of women want to space their next pregnancy

25% of women want another child soon

72% of women (i.e 7 out of 10 women) and 62% of men (i.e 6 out of 10 men) in Sindh prefer smaller and better-spaced families

6,60,000 pregnancies that women do not want can be avoided

CPR (any method ) is 30%, CPR (modern method) is 25%

CPR has risen from 27% in 2006/7 to 30% in 2012-13. Just o.5% points rise annually over the last six years.

Urban CPR (any method) is 42.7%, Rural CPR (any method) is 17.4%

Urban CPR (modern method) is 32.6%, Rural CPR (modern method) is 17.1%

CPR is 45% in Karachi, 13% in Ghotki (modern method), 35% in Karachi (modern method)

Total unmet need is 21%

Unmet need for spacing (Rural-7, Urban=13, Total =10)

Unmet need for limiting (Rural=9, Urban=12, Total=11)

1/5th of women need contraception to space and limit their childbearing.

Unmet need for contraception to limit family size is higher in rural area than in urban areas. This reflects higher room for raising the CPR in rural Sindh. If the demand for F.P were satisfied, the CPR would rise to 51% in Sindh.

34,106 infant and 18,365 child (aged 1-4) deaths can be averted by eliminating unmet need.

Unwanted pregnancies can also lead to post-abortion complications. Number of PAC cases in Sindh are 1,74,908 (Public=73,512, Private=1,01,396)

Maternal Mortality Ration in Sindh is 214 women (per 100,000 live births)

24% of deaths in reproductive age group in Sindh die due to pregnancy related issues.

2800 women die each year in Sindh alone due to pregnancy related causes.

930 maternal deaths can be saved every year by an accelerated F.P program.

Just increasing CPR to 51% will reduce the Maternal deaths by 33%.

IMR is 74 (per 1000 live births), Under 5 mortality is 93.

Children with mothers who have had no schooling acound for more than double the IMR of those mothers who have studied up to or beyond secondary school.

GROUP WORK

Group 1: Motivating the uneducated

Group 2: Motivating the educated

Group 3: Motivating the religious group

Group 4: Motivating the Political class

Group 5: Motivating the media