Implementation of Social and behavior Change Communication based Activities in District Quetta, Chaghi, Killa Abdullah, and Pishin
Background and Rational:
In Balochistan province, the highest presence of Afghan refugees and their flow into the urban areas after camp closures and the withdrawal of food assistance by the UN agencies in refugee villages has put pressure on the Balochistan mainstream education, health, water and sanitation services, particularly in District Quetta, Killa Abdullah, Pishin, Killa Saifullah, Chaghai and Loralai. Afghans concentrated in and around villages and camps have contributed to the degradation of the environment accelerating the deterioration of the physical infrastructure, forests, and livestock grazing areas. The consequences of this prolonged and Afghan presence in the province the health, education, water, and sanitation services have become overburdened. Afghans living in the province have stressed the service sector’s financial resources and infrastructure in the affected and hosting areas. Even where camps were fully closed Afghans preferred to remain in Pakistan. Afghan schoolchildren account for at least 20-25 percent of the students in schools in these areas.
The refugee-hosting communities in Balochistan are affected by poverty, a degraded natural resource base, a low degree of available infrastructure, a lack of employment opportunities, low levels of income generation, and unequal access to resources are the root causes of their poverty. These problems have been exacerbated by the prolonged presence of Afghan refugees who burden the host communities. Most are not likely to leave as long as the situation in Afghanistan is not favorable to their return.
The province of Balochistan presents a dismal situation where malnutrition remains a major health issue for decades. The key findings of the latest National Nutrition Survey (NNS)-2018, officially publicized in June 2019 reveal an alarming high level of malnutrition among children and women in the province. The survey finds that since 1997, the prevalence of wasting (low weight for height) among young children is on the rise, from 8.6% to 15.1% in 2011 and 17.7% in 2018 in Pakistan and for Balochistan it is now 18.9% against the NNS-2011 16% ratio. This is considered the highest rate of wasting in Pakistan’s history which is quite alarming and calls for taking immediate actions to address this most serious public health issue.
The situation of the health service delivery system is much worse in Baluchistan compared to other provinces. In Balochistan, mostly TBAS provide MNCH services at the community level. In Balochistan, the health department staffing issues stand out prominently, such as the shortage of female health providers, absenteeism, and political interference in staff recruitment and posting. Another key challenge is the deficiencies in health infrastructure such as the lack of repair and maintenance of buildings, and the absence or uninhabitable residential quarters affecting the working environment. The limited availability of utility services further compromises the provision of services, e.g. shortage of electricity, gas, and water supply. The beneficiaries face problems in access to and utilization of services which include antenatal care, assistance during delivery, postnatal care, newborn care, referral for EmONC, immunization, health education and counselling, and family planning services due to short supply of medicines, lack of or worn out equipment, indifferent staff behavior, short working hours of health facilities, insufficient or remote location of many primary healthcare (PHC) facilities, and lack of an organized transport system for referral services. The dominance of elders and/or male members of the family further restricts the mothers in timely seeking the services.
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