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

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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

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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

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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

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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

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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.


Page 12 of 58

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.


Page 13 of 58

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.

Level of Satisfaction 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


Page 14 of 58

extent of BHU provision of services is counts as 63.15% people are “somewhat satisfied” on

getting benefit as well.

Level of Satisfaction 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%

94.74%

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.


Page 16 of 58


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


Page 17 of 58

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.


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.


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.


Married Window(er) Single

Male 52 - 01

Female 45 07 -


Page 18 of 58


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,


Page 20 of 58

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.


Page 21 of 58


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.

.


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.


at BHU

Available Health

Facilities at RHU

You and Your family

getting benefit

Neutral

Not Sure

2 2



Very Dissatisfied

2 5



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






Male 30 - 02

Female 69 08 -


Page 22 of 58

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.


Page 24 of 58


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”;


Page 25 of 58


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.


of BHU Staff

Courtesy/

Friendliness

Nursing

Care

LHV Service

at Door Step

Neutral

4 2



Very Dissatisfied

1 1 17


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.


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


Married Window(er)

Male 27 -

Female 71 3


Page 26 of 58

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”.


Page 28 of 58

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.


Page 29 of 58

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.


of BHU Staff

Courtesy/

Friendliness

Nursing

Care

LHWs Service

at Door Step

Neutral 2 1

Not Sure 6 1



Very Dissatisfied

3 25



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”.


at BHU

Available Health

Facilities at BHU

You and Your family

getting benefit

Neutral

3








Male 30 - 01

Female 60 02 -


Page 30 of 58

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 Dissatisfied 68 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


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.


Page 32 of 58


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.


of BHU Staff

Courtesy/

Friendliness

Nursing

Care

LHWs Service

at Door Step

Neutral

9 8 1

Not Sure 12 4 1 1







Married Window(er)

Male 58 -

Female 39 2


Page 33 of 58


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



Very Dissatisfied 23 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



Page 34 of 58

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


Page 36 of 58

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.”


Page 37 of 58


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.


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.


at BHU

Available Health

Facilities at BHU

You and Your family

getting benefit



Very Dissatisfied

12 37



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.



Male 39 01 06

Female 52 02 01


Page 38 of 58


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.


Page 40 of 58


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”


Page 41 of 58

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.


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.


at BHU

Available Health

Facilities at BHU

You and Your family

getting benefit

Neutral 4 1

Not Sure 1



Very Dissatisfied

6 16



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.



Male 48 - 01

Female 51 07 -


Page 42 of 58


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

M C H R P – E v a l u a t i o n R e p o r t | Analysis on Renovated Health Services at BHUs

Page 43 of 58

Analysis on Renovated Health Services at BHUs

Flood – 2010 damaged severely institutional infrastructure in every corner of flood porn areas.

ADRA – Pakistan interventions to restore such physical entities in health sector has been great

attempt. The most significant component under MCHRP is the restoration of health services

through renovated infrastructure at targeted BHUs/HRC/THQ.

In pursuance of SoW as provided for evaluation purpose from which 07 BHUs and 01 RHC are

selected to assess the effectiveness and efficiency on the quality and quantity taken under

implementation. In this concern; two-prong strategy is adopted: the physical assessment of

available infrastructural intervention at respective BHUs/RHC supplemented with the feedback

of the immediate head having interviewed providing fair and justified analysis, conclusion,

recommendations and suggests on level of effectiveness and efficiency of the implementing

agency.

Following the SoW, physical assessment is done by the Evaluator visiting the sampled

BHUs/RHC and evaluation summary sheet is developed (referred to Annexure: 06 to 13).

Secondly, focused on the findings of referred summary sheet(s), interviews are conducted with

the following immediate officials (evident of work done by the implementing agency at BHUs)

heading/posted threat: - (Evidence under signature; Annexure: 14 – 21)

Sr.

# BHU/RHC Name Name of Interviewee Designation CNIC #

Posted (Years)

01. Thatta Gurmani Mr. Muhammad Israr-Ul-Haq Medical Technician 32303-0752741-9 20

02. Mehmood Kot Dr. Alamdar Hussain Gillani Medical Officer 32303-0746159-7 04

03. Shah Jamal (RHC) Dr. Naseer Ahmad Rana Sr. Medical Officer 32304-8233673-1 10

04. Pattal Dr. Muhammad Shehram Medical Officer 32303-3733434-3 01 M

05. Daya Chowkha Dr. Hayatullah Khan Medical Officer 32303-7092780-5 10

06. Kanju Wala Mr. Abdul Aziz Care Taker 32303-6614101-7 20

07. Chak 518 Dr. Ikram-Ul-Haq Medical Officer 32303-0804055-9 10

08. Sheikh Umer Mr. Arshad Bashir Dispenser 32303-9859772-3 07

The analysis is carried out into three slices: verification on quality and quantity of infrastructural

work done and provision of IEC material to BHUs by the implementing agency; secondly

viewpoint of BHU officials on maintain cleanliness, level of services available at BHUs and

degree of generally people receive care from BHU services; and at the third slice enquiry is made

on increase/decrease of staff competency, courtesy, friendliness and nursing care to community;

all in lines with ADRA – Pakistan interventions in particular.


Page 44 of 58

On the work done by the implementing agency; feedback on quality backed by the quantity of

respective items on infrastructural improvement is summarized under following table:-

Feedback

Civil Work /

Construction /

Plumbing Work

Provision/

Installation of

Electric Items

Wooden / Steel

Repair / New

Work Done

Paint

Work

Done

IEC

Material

Provision

Very Satisfied 37.50% 12.50% - 62.50% -

Somewhat Satisfied 62.50% 25.00% 12.50% 37.50% -

Neutral - - 12.50% - -

Very Dissatisfied - 37.50% 62.50% - 87.50%

Not Sure - 25.00% 12.50% - 12.50%

Keeping in view the detailed analysis under heading of “Review on Infrastructural Renovated

Interventions” as above under respective UC evaluation exercise; summary of analysis is provide

in lines with above table given below:-

As per respective scope of work civil work includes construction of wall, waiting area,

washrooms, somewhat miner repair plaster, white wash of the premises, distemper, water

tape fixation, boaring, electric motor for restoration of water supply in the BHU premises. On

the quantity and quality of implementation is drawn as 62.50% somewhat satisfied;

somehow serious concern on the part of quality of work done.

Focusing to provision/installation of electric items as per SoW, 62.50% work is not done

ab-initio. In BHU Sheikh Umer, some ceiling fans are provided, manufactured by the

company other than the company mentioned in SoW. Hence satisfaction level on such items

has been only 12.50%. It shows that the implementing agency has not taken this category of

work into consideration at all.

Under wooden/steel repair/new job 75.00% work is evaluated as “not done/upto the

mark”. However, 25% of the work is done bearing somehow question mark on quality but to

somewhat acceptable.

The paint work is observed as done, presently seems in good and effective so for. Almost

100% of the officer bearers at BHU show satisfaction to this work.

Zero percent consideration is given to provision of IEC material either at BHU or to the

field staff or to distribution of the same in community. No work whatsoever is initiated in

this concern by the implementing agency.

Second slice of analysis on officials’ point of view received about maintenance of cleanliness at

BHUs, quantum of available services in purview of BHU scope of work and honest opinion


Page 45 of 58

regarding people generally receive care approaching to Basis Health Unit. It is summarized as

under:-

Feedback Cleanliness at

BHU

Available

Health Facilities at BHU

Community

Generally Cared

Very Satisfied 50.00% 25.00% 87.50%

Somewhat Satisfied 37.50% 62.50% 12.50%

Neutral 12.50% 12.50% -

It is also observed that BHUs take care of cleanliness in focused areas dealing with the patients.

As there is always room of improved; therefore some officials show concern with their level of

satisfaction is just 12.50%. Opinion on available health facility at BHUs (delivery services, natal

care, general medicine related. Health hygiene related, vaccination, awareness etc); majority of

the officials show their opinion as the quantum of services need to be improved. However on

question to general care of community at BHUs, majority of the officials claim to the extent of

resources available (human and financial), people received care from services of BHUs.

At third slice: degree on increase/decrease of

staff competency, courtesy, friendliness and

nursing care to community; all in lines with

ADRA – Pakistan interventions in particular

analyzed as shown in the graph. The BHU

heading official grade the knowledge, skills and

demonstrated behaviour of staff working under

their supervision is competent enough

performance and deal in a friendly & courteous

way with the community. However, there

emerged need to improve level of nursing care as

some heading official show their concern in this

area of deliver of assignment.

It concludes that:-

The implementing agency has done nothing on the part of provision of electric items and IEC

material.

Paint work done is somehow appreciable and physically seen as good.

Civil/Construction/repair/plumbing work is considered well but quality is shattered.

BHU officials claim that staff is competent enough to deliver services. 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.

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.

25.00% 25.00%

62.50%

75.00% 75.00%

25.00%

12.50%

Staff Competency

Friendliness and Courtesy

Nursing Care

Very Satisfied Somewhat SatisfiedSomewhat Disstatisfied

M C H R P – E v a l u a t i o n R e p o r t | Analysis on Competency level of BHU Officials and

Field Staff

Page 46 of 58

Analysis on Competency level of BHU Officials and Field Staff

As competency is composed of three ingredients: knowledge about the job description &

conversant to the content used to perform the task; secondly the skill to apply the acquired

knowledge effectively; and last but not the least, the demonstrated behaviour at work place to

blend knowledge and skills in a competent fashion. Obviously, in pursuance of dream team

members, conduct of training programs plays a vital role to mend the ways. Following is the

table showing quantum of strength and percentage shared and speak about the level proficiency

to their job position after flood interventions.

Name of BHU/RHC

Field Strength LHWs

at FGD

LHV/LH

S

at FGD

Participation

%age in

FGD LHWs

LHV

& LHS

Thatta Gurmani 19 02 07 - 33.33%

Mehmood Kot 26 02 09 - 32.14%

Shah Jamal (RHC) 20 01 08 01 42.86%

Daya Chokha 30 05 07 - 20.00%

Pathal 18 02 09 - 45.00%

Kanju Wala 20 02 - - 0.00%

Chak 518 25 02 10 01 40.74%

Shaikh Umer 19 03 11 01 54.55%

Total 177 19 61 03 32.65%

From this 32.65% overall strength; and 61 out of 177 LHWs (34.46%) in sampled 07 BHUs and

01 RHC, it is revealed that:-

Unanimously denial the conduct of any sort of designed training relevant to their job

position after flood through ADRA – Pakistan interventions. This results that 100% of the

field strength unanimously say that no training session whatsoever is conducted for any of

the field member, by ADRA – Pakistan supported implementing agency for renovation of

health services.

No IEC material like Charts in particular, brochures, pamphlets, etc are provided for use in

the field or to be pasted on walls of the BHUs. It results that on the part of implementing

agency, this component has been un-addressed as not initiated since inception.

Such valuable field force generally ratifies (ir-respect of the quality of such interventions

and quantity in letter and spirit) somehow improvement on infrastructural renovated health

services at BHUs through ADRA – Pakistan supported implementing agency.


Field Staff

Page 47 of 58

Spreading above hard facts to the full length focused BHUs under ADRA – Pakistan

interventions; it concludes that almost 100% of the field staff has been deprived of such

support through the implanting agency --- obviously project objectives to this extent are not met

with realistic interpretation of the matter.

However, keeping in view the discussion at length (as summarized under heading of “Review on

Competency of Field Staff” above for each of the sampled BHU/RHC) with the participants;

statistics are taken into account as under:-

Name of BHU/RHC Level of Increase in Capacity Building

Average Good Grand Total

CHAK 518 1 10 11

DAYA CHOWKHA

7 7

MAHMOOD KOT

9 9

PATHAL

9 9

SHAH JAMAL

8 8

SHEIKH UMER

12 12

THATTA GURMANI 3 4 7

Grand Total 4 59 63

The above statistic is evident of 93.65% of participants claim that after flood with the

interventions of supporting agencies other than the ADRA – Pakistan at BHU; capacity of

officials is enhanced taken as “Good”; while 6.34% regard it as “average”.

Responding to the question on restoration of

health services focusing improvement in

infrastructural interventions at BHUs carried

out by the implementing agency through

ADRA – Pakistan support; the participants

take it as kind and extended gesture; 26.98%

count as “good” and 73.02% resulted it as

“very good”.

Name of BHU/RHC

Level of Field Staff Satisfaction on over all renovated services through MCHRP

Satisfied Leading

to High

Highly

Satisfied Total

CHAK 518 7 1 3 11

DAYA CHOWKHA 1

6 7

MAHMOOD KOT 6

3 9

PATHAL 8

1 9

SHAH JAMAL 1

7 8

SHEIKH UMER 1

11 12

THATTA GURMANI 1 1 5 7


CHAK 518

DAYA CHOWKHA

MAHMOOD KOT

PATHAL

SHAH JAMAL

SHEIKH UMER

THATTA GURMANI

Very Good

Good


Field Staff

Page 48 of 58

The above statistics provide the results that field staff as key stakeholder of which 39.68% are

just satisfied, 3.17% are satisfied leading to some higher degree and 57.14% are highly satisfied

in delivery of services at BHU/RHC through overall restoration of renovated health services in

attempt to all activities (pertaining to both hard and soft component) under MCHRP.

In the last but not the least, the most important

stakeholder, the ultimate beneficiary – the

community for whom the project inception is

justified; it is vital to know the extent people feel

level of relief through such interventions. Before to

go to the community; let we share the honest

opinion of the immediate interacting entity i.e.

BHU field staff of which only 4.76% say that

community is getting benefit through ADRA – Pakistan interventions; majority of the strength

93.65% regarding people getting benefit as “somehow” dominated by the interventions done by

other supporting agencies. However 1.59% is of the view that community is not getting benefit

anyway.

It concludes 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 as revealed

from statistics and view point of the field staff.

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.

Such hard facts show lashes on part of the implementation and monitoring of the project

against the objectives, strategies and approaches established in the project document. The

weaknesses to this extent have not been overcome during implementation phase.

It clearly reflects that resources (financial, human, materials) have not been used efficiently

to strengthen capacity through ADRA – Pakistan interventions for the well-being of the

community.

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.


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.

Ref: [Annexure(s): 22 to 29]

4.76%

93.65%

1.59%

Benefit through ADRA

Benefit other than ADRA

No Benefit

M C H R P – E v a l u a t i o n R e p o r t | Analysis on Satisfaction level of Community on BHU

Services

Page 49 of 58

Analysis on Satisfaction level of Community on BHU Services

At third slice in getting ratification and to provide fair justification of work done by the

implementing agency with support of ADRA – Pakistan interventions; the community --- the

ultimate beneficiary of all such interventions is engaged. In lines with the satisfaction level of

community members as demonstrated in review of each of BHU as above; here as under the

compact analysis is provided:-

Total 810 people under bifurcation of 43.20% as male and 56.79% as female population is

covered. The union council and marital status wise male female population covered is seen in

above table.


of BHU Staff

Courtesy/

Friendliness

Nursing

Care

LHWs Service

at Door Step

Neutral 6 41 36 4

Not Sure 48 12 5 4





Grand Total 810 810 810 810

Narrowing the criteria as described under evaluation mechanism section above; focusing the

above table the grading area: Neutral and not sure may be merged with somewhat dissatisfaction

perceived by the community. Hence it shows that people 17.65% on competency of BHU Staff,

27.77% on courtesy of staff, 30.74% for nursing care and 20.61% regarding field staff service at

door step are “dissatisfied”. However, community satisfaction level prevails as 64.69% for staff

competency, 55.18% on courtesy level, 61.35% upon nursing care and 54.93% services during

field visit of staff accordingly is “somewhat satisfied” as revealed through above table.

Name of UC Female Male Grand

Total Married Single Window Total Married Single Window Total

HUNJRAI 39

2 41 58

58 99

PATHAL NO.4 60

2 62 30 1

31 93

SANAWAN 71

3 74 27

27 101

SHAH JAMAL 69

8 77 30 2

32 109

SHAIKH UMER 51

7 58 48 1

49 107

MIRPUR BHAGHAL 52 1 2 55 39 6 1 46 101

THATTA GURMANI 39

2 41 54

54 95

MEHMOOD KOT 45

7 52 52 1

53 105

Grand Total 426 1 33 460 338 11 1 350 810


Services

Page 50 of 58


at BHU

Available Health

Facilities at BHU

You and Your family

getting benefit






In regard to cleanliness; majority of the people are somewhat satisfied and more than 15% are

very satisfied with such maintenance at BHU level. Somehow the likewise opinion is shown

regarding quantum of available health facilities at BHU level but access to them has been in

question mark. As heath service are not equally accessible to all sections of life. Hence it is

evident that 26.66% people are very dissatisfied as deprived on getting benefit from such

services This also puts ADRA – Pakistan interventions on soft as well as hard components

implementation in question mark and project get observations.


using IEC Material

BHU Located at


BHU Services

Cost to You






It is clearly explained in evidence of IEC material non-provision by the implanting agency.

Dame care attitude of implementing agency on this sort of component is ratified at all three slices

of this evaluation exercise. Almost 50% of the community is not satisfied with the location of

BHU premises and the cost they have to bear to approach or to access to the services they have

dreamed to cope with their needs particularly in emergency situation.

The graphical presentation shows that 75.06%

people experience one visit of field staff to their door

step. Unanimously, at all eight union council people

version “field staff visits during vaccination days

only” is ratified. Focusing on irregular visit, visit on

request, never visited figures it constitutes that

15.31% people are very annoyed with the field staff.

Generally is seen that community members have

complaints as proper check is not done perceived

that mostly medical officers do not pay attention to

listen them. Cost of medicines is charged. Free of

6.79%

12.59%

1.36%

2.84%

75.06%

1.36%

0.00% 50.00% 100.00%

Fortnightly

Irregular Visit

Never Visited

On Weekly …

Once a Month

Visit on Request



Services

Page 51 of 58

cost medicine is rare and mostly provided to blood relatives or the person who exercise influence

politically. Majority of people fee severe problems in delivery matters. In emergency no doctor is

available. The staff does not care to the desirable extent.

For every sort of diseases; only one type of medicine is provided. The community regards token

fee as somehow appropriate charged at BHU but mostly seemed complaining of over-charging.

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. It has been unanimous demand

for provision of ambulance service to deal with the

emergency situation at BHU level. The graphical

presentation suggests that 27.28% people are totally

unsatisfied with the level of services at BHU level. The remains 72.72% are somehow satisfied as

some times received services and most of the time deprived of such services either due to staff

incompetency, inappropriate behavior, non-availability of resources etc. It is pertinent to

mention that such percentage is constituted in result of combined interventions either done by

ADRA – Pakistan or some other supporting organization and government initiatives done in

attempt to restoration of health services after flood – 2010.

Keeping in view all three slices of this evaluation exercise, it concludes that:-

- Implementing agency work has not been upto the mark. Soft component on proposed

interventions has been ignored ab-initio.

- Interventions pertaining to physical infrastructure improvement is somehow considered but

sub-standard work is done just to get rid of SoW.

- None of the training session is conducted for field staff to strengthen and enhance

competency level regarding knowledge, skills and demonstrated behavior of field staff.

- Community is un-satisfied in general and seemed particularly deprived of getting benefit

through ADRA – Pakistan supported interventions.

- Project design was good but implementation has been poor.

- The project objectives are not seen providing benefit in letter and spirit to the community ---

the ultimate beneficiary of all such restoration activities.

- The resources (financial and human) are not used effectively and efficiently for the well

being of the community.

27.28%

72.72%

Poll 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 | Conclusion and Recommendations

Page 52 of 58

Conclusion and Recommendations

Majority of the community people, BHU officials, Field Staff particularly LHWs extensively

told that none of the literature, pamphlets, posters, charts or any motivation material under

Informational, Educational and Communicational aspect is provided in necessary and

sufficient quantity. Almost to negligible extent the IEC material is used in training sessions

as no sound evidence is reported on conduct of trainings. At some places 2 – 5, or 5 – 10

charts are provided for further use in the field as told by the field staff only at Shah Jamal.

Noting is found placed in any of the BHU/RHC even in evidence of ADRA – Pakistan

intervention under the head of IEC material provision.

It is found, observed and seen recognized by BHU officials and Field Staff, in black and

white the ADRA – Pakistan interventions extended in the targeted area; ir-respect the fruit of

such interventions is passed in letter and spirit to the community. Anyhow, every one

thanked for such support from ADRA – Pakistan. But the community has not ratified such

level of satisfaction.

It has been concluded that field staff claim regular visit to households to the extent of twice

in a month or so. Whereas the community point of view negates such version as majority of

the people more that 75% reveal field staff pay maximum one visit in a month otherwise in

vaccination campaign. This attracts some lashes on the part of supervision of field staff.

The Community at Union Council Hunjrai regarding BHU – Kanju Wala has severe

observation on unavailability of doctor, irregular staff and poor response in case of

emergency. Infrastructural improvement, establishing waiting area, construction of wash

rooms cannot deliver until staff is committed to provide requested services. Such behavior on

the part of BHU officials need to mend. This reveals that capacity building measures either

through ADRA interventions or some other agencies has not changed the approach in

restoration of health services in the union council and people are still deprived of getting

desired treatment.

Implementing agency work has not been upto the mark. Soft component on proposed

interventions has been ignored ab-initio.

Interventions pertaining to physical infrastructure improvement is somehow considered but

sub-standard work is done just to get rid of SoW.

None of the training session is conducted for field staff to strengthen and enhance

competency level regarding knowledge, skills and demonstrated behavior of field staff.

Community is un-satisfied in general and seemed particularly deprived of getting benefit

through ADRA – Pakistan supported interventions.

M C H R P – E v a l u a t i o n R e p o r t | Conclusion and Recommendations

Page 53 of 58

Project design was good but implementation has been poor. 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 as revealed from statistics and view point of the

field staff.

The project objectives are not seen providing benefit in letter and spirit to the community ---

the ultimate beneficiary of all such restoration activities.

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.

Such hard facts show lashes on part of the implementation and monitoring of the project

against the objectives, strategies and approaches established in the project document. The

weaknesses to this extent have not been overcome during implementation phase.

It clearly reflects that resources (financial, human, materials) have not been used efficiently

to strengthen capacity through ADRA – Pakistan interventions for the well-being of the

community.

Paint work done is somehow appreciable and physically seen as good.

Civil/Construction/repair/plumbing work is considered well but quality is shattered.

BHU officials claim that staff is competent enough to deliver services. 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.

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.


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 | Community Demands

Page 54 of 58

Community Demands

In the Union Council Shah Jamal; the field staff as well as Sr. Medical Officer demanded for

the water filtration plant to reinstall. The plant once installed then removed by ADRA –

Pakistan for use at some other place. They people have requested for such utility to continue

again.

The Sr. Medical Officer – RHC, Shah Jamal has requested to handover ADRA – Pakistan

newly constructed Emergency room to RHC for use. The room under lock and key since

long. It must be taken into operation and be equipped with necessary medical equipment with

emergency treatment so that people in the area get benefit as early as possible.

It has been consistent and frequent demand from all segments of interactions that support for

medicine at BHU level must be provided in sufficient and necessary quantity. As most of the

people are poor; in one way or the other they get consultation at very nominal cost say Rs.5/=

as token fee charged for BHU services. But they have to bear cost of medicine at their own.

This creates over burden to spend for some other priorities. Hence, community needs some

cushion to already meager disposable income; and relief in this concern.

Union Council – Mahamood Kot; the field 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 BHU at Union Council Thatta Gurmani demands for provision of Electric Water Cooler

at the unit so that community, field staff, visitors and patients in particular are able to get

utility for such facility.

The Medical Officer, BHU – Pathal request for immediate attention to complete the earth

filling assignment as per SoW. It was planned to fill the trenches with soil covering 13008

CFT but more than half of the work is left to complete resulting to that stagnant water there is

a source of mosquito breeding cause the spread of disease in BHU premises.

The Medical Officer, BHU – Chak 518, demands for provision of grass cutter. Grassy plot is

maintained well; but not having grass cutter, not properly maintained on regular basis.

Visiting area at BHU – Chak 518 is constructed well but direction of such structure is located

in such a way that sun is directly affecting to the visitors sitting over there. A Sun Shed is

demanded as it seems genuine for effective utilization of the waiting area. Water Supply

should be arranged at residential area.

The unit Incharg of BHU – Shaikh Umer demands for support to purchase office tables,

computer table and chairs. Specifically, stressed for support of construction of a meeting hall

as the unit face difficulties for conduct of frequent meetings of field staff in particular. With

respect to the strength; no proper space is available for conduct of trainings, meeting and

M C H R P – E v a l u a t i o n R e p o r t | Community Demands

Page 55 of 58

other campaigning issues from time to time. Unit has to make request to notable person to

spare some space to conduct such events.

At BHU – Shaikh Umer, no water supply is available. Electric motor is out of order. Under

ADRA renovated health services SoW, it was required to be solved. But not implemented

and the problem exists till to date. The Incharge has requested to ADRA for such intervention

on urgent basis in order to meet with the realistic interpretation of the matter.

M C H R P – E v a l u a t i o n R e p o r t | Infrastructural glimpses

Page 56 of 58

Infrastructural glimpses

BHU: Thatta Gurmani

BHU: Chak 518

BHU: Daya Chowha

M C H R P – E v a l u a t i o n R e p o r t | Infrastructural glimpses

Page 57 of 58

BHU: Hunjrai

BHU: Mehmood Kot and Pathal

BHU: Shah Jamal and Shaikh Umer

M C H R P – E v a l u a t i o n R e p o r t | List of Annexure(s)

Page 58 of 58

List of Annexure(s)

A: Evaluation Tool Kit:

01. Questionnaire for Interview of BHU Official

02. Format for Physical Verification of Renovated work at BHU

03. Areas of Enquiry Framework for FGDs with LHWs

04. Format of Face Sheet for Conduct of FGDs with LHWs

05. Questionnaire for Interview with HH Head

B: Physical Verification of Restoration of Infrastructural Services:

06. BHU Thatta Gurmani – Summary Sheet on Physical Infrastructural Evaluation

07. BHU Mehmood Kot – Summary Sheet on Physical Infrastructural Evaluation

08. RHC Shah Jamal – Summary Sheet on Physical Infrastructural Evaluation

09. BHU Daya Chokha – Summary Sheet on Physical Infrastructural Evaluation

10. BHU Pathal – Summary Sheet on Physical Infrastructural Evaluation

11. BHU Kanju Wala – Summary Sheet on Physical Infrastructural Evaluation

12. BHU Chak 518 – Summary Sheet on Physical Infrastructural Evaluation

13. BHU Shaikh Umer – Summary Sheet on Physical Infrastructural Evaluation

14. Copy of Interview with Medical Technician BHU Thatta Gurmani

15. Copy of Interview with MO: BHU Mehmood Kot

16. Copy of Interview with Sr. MO: BHU Shah Jamal

17. Copy of Interview with MO: BHU Daya Chokha

18. Copy of Interview with MO: BHU Pathal

19. Copy of Interview with Care Taker: BHU Kanju Wala

20. Copy of Interview with MO: BHU Chak 518

21. Copy of Interview with Dispenser/Incharge: BHU Shaikh Umer

C: Competency of Field Staff:

22. BHU wise List of LHWs, LHVs, LHs Participated in FGD

23. Attendance Sheet for FGD Conducted at UC Thatta Gurmani

24. Attendance Sheet for FGD Conducted at UC Mehmood Kot

25. Attendance Sheet for FGD Conducted at UC Shah Jamal

26. Attendance Sheet for FGD Conducted at UC Daya Chowkha

27. Attendance Sheet for FGD Conducted at UC Pathal

28. Attendance Sheet for FGD Conducted at UC Mirpur Baghal

29. Attendance Sheet for FGD Conducted at UC Shaikh Umer

C: Interview with Community:

30. Consolidated List of Community members Interviewed

31. 810 Forms – interviewed with community in 08 union councils

32. Soft Copy of Excel Sheet – Data of 810 Forms on Conduct of Interviews

Documents

MCHRP Evaluation Report f1 15-09-2012