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Annual Report of Midwifery Project 2012

Annual Report of
Midwifery Project

Figure 1 Batch of 2012 to 2014

Naheed Hassan
Fellow of IDSP Sindh-Pakistan
No woman should die giving life.

Figure 2 : By Rozina Kanwal , Midwife from Quetta

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List of Acronyms

CMW Community Midwife

HANDS Health, Nutrition and Development Society

RTI Regional Training Institute of Quetta

IDSP Institute for Development Studies & Practices

TDSP Trust for Development Studies & Practices

L.H.V Lady Health Visitor

CGF Charitable Gift Fund

AKU Agha Khan Hospital

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Dr. Quratulain Bakhteari

Author of the report:
Ms. Naheed Hassan & Rubina Usman

Editor of the report:
Ms. Asma Zafar
Mr. Saeed Shah

Composing & designing:
Asma Zafar
Naheed Hassan
Rubina Usman
Muhammad Yaseen

Financial Reporting:
Mr. Muneer Shaikh

Supported by:
Ms. Naheed Hassan
Muhammad Yaseen

Institute for Development Studies & Practices (IDSP - Pakistan)
7-A, Al-Mashriq Street, Arbab Karam Khan Road | Quetta, Pakistan
Ph: 0092-81-2470243 - 2471776
Fax: 0092-81-2447285

Trust for Development Studies & Practices (TDSP - Pakistan)
House No.56-R Mahmood Ghznavi Road,
56-R, Block-2, P.E.C.H.S | Karachi, Pakistan
Ph: 0092-21-34549009

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Table of Contents

Glossary of Acronyms……………………………………………………………………..

1. Message from the Founding Director IDSP-Pakistan
2. Executive Summery
3. Introduction of IDSP/TDSP
4. Introduction of Partner Institute HANDS
5. Background
• Pakistan Maternal Health Indicators
• Referral System
• Scope of Practice Midwifery

6. Affiliation with the existing courses of the HANDS ,CMW School
7. Midwifery Training Program Continuing Medical Education(CME)
(2 Months Refresher Course)
8. The Project
9. Project Planning
10. Project Objectives
11. Project Implementation
12. Selection of Training Institute
13. Overall Course contents
14. Faculty of Course
15. Project Location of CME Course
16. Midwives’ Selection Criteria
17. Partnership with HANDS
18. Criteria for Training
19. Learning Facilities
20. Identification and Selection of Suitable Candidates
• Selection Committee
• Selection Criteria for Midwives
• Orientation Phase
• Selection Process
• Project location in Sindh & Balochistan Provinces
• List of Selected IDSP CMW

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Table of Contents

Admission Criteria:

21. Overall Course Quarters

• Details of each Quarter
• Result of PTS Examination
• Medical Checkups of IDSP CMW
• Result Hepatitis B & TT Vaccination of All CMW Students

22. Challenges of Changing World


Appendix A: Pictures of Midwives
Appendix B: News Clips
Appendix C: Agreement of Midwives for training
Appendix D: Flyer of the Course
Appendix E: Test & Interview Sheet

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The process of designing and conducting this project, collecting information and
analysing the training institutions and initiating a new concept of developing midwives
was very challenging .The consultation meetings & field visits during the inception of this
innovative project provided sound basis to determine the focus of this initiative.

We are greatly indebted to the blessings of Almighty God we are able to compile this
report of the Project. It is a matter of immense pleasure and pride that we accomplished
this task within scheduled time and with required quality.

We value the efforts of Ms. Joan Kagle, whose generous support, understanding and her
exceptional intellect for human being suffering on our challenges is exceptional .It was
not possible to make reality of midwifery training in the remote areas of Baluchistan and
Sind; without Ms. Kagle’s kind cooperation. Her gift will help us create midwives’ network
in communities across the provinces of Baluchistan and Sind, thus help to save mothers
and deliver their babies with love, respect and professional support.

We are very thankful to MS. McArdle, Alison from Fidelity, Charity Gift fund, for helping
us in preparing in our contract and guiding us regarding management and operation of the

We are deeply obliged to Dr. Qurat-ul-ain Bakhteari, Founding Director of IDSP-Pakistan
and the Trustees as we as the Team Leader of Midwifery training project for trusting the
capabilities & providing leadership and encouragement to project’s team at all levels.

We are thankful to the Training Institution HANDS, particularly Mr.Khalid Pervaz -Senior
General Manager-Health Promotion Program HANDS ,Mr. Tanveer Shaikh- Chief
Executive HANDS and Ms .Musarrat Rani- Principal Community Midwifery School of
HANDS Jamkanda,Karachi,Mr. Mir. Mumtaz Khaskheli Chief HID Executive of HANDS and
Mr.Ahmad Jan- Provincial Manager of HANDS Quetta, Balochistan for their support.

We deeply acknowledge the genuine support of Dr. Samina Hussain from Regional
Training Institute Quetta, Asia Mangel-L.H.V from Khuzdar ,L.H.V Shreen from Mustung
&Najma- L.H.V from Sibi for identifying committed young women for midwifery training
from Balochistan.

We highly acknowledge the teaching and training staff from Agha Khan Hospital for their
training and assistance, Dr. Kaneez Fatima, Dr.Naresh Kumar Gowalani, Dr.Rifat, Ms.
Kauser Saeed Khan, Pharmacist- Afshan Naz,Ms.Farzana & Mr.Syed Ali Bilgrami .

We highly appreciate the support of Mr.Safder Hussain- Associate Director of IDSP
Quetta, Saeed Shah-Project Director Academic Development Program and Ms. Kamal Jan-
Associate Director Women Leadership Program and its Team.We also acknowledge the
support of Mr.Hubdar Ali Project Manager of ZAANT district campuses.We appreciate the
effort of Mr. Khalil Ronjha- Coordinator IDSP campus in Hub in selection of potential

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midwives from Hub .We are also thankful to Taraki Foundation and Individuals who
supported us during selection process of potential midwives in Sindh and Balochistan .

The excellent professional efforts of Ms Robina Usman Coordinator of Midwifery project
are highly appreciated. Ms. Usman’s technical guidance and supervision was excellent in
post training assessment and we got good results. It is due to Ms. Rubina’s efforts and
leadership that we are able to present the achievement of first phase in this report. It is
highly important to recognize the excellent leadership role played by Ms.Sajida Khir
Mohmmad- coordinator of Midwifery Project ,Balochistan.It was Ms. Saijda’s effort and
co-ordination that we were able to enrol more than 15 women from Balochistan.To
satisfy the families of the girls was a great challenge that Ms. Sajida faced and solved
very professionally .

We are thankful to the Mr.Muhammad Yasin -Admin and Finance Manager TDSP, TDSP
team, Ms.Sadaf Younas - Accounts Assistant, Mr.Mehmood Ahmad-Admin Assistant and
Mr.Hameedullah- Admin and HR Manager IDSP who provided administrative and
financial management support & facilitation throughout the project activities. We highly
acknowledge Mr. Muneer Shaikh- Chief Financial Officer of TDSP Karachi & Mr. Sayed
Asher Ali- Program Manager of TDSP Karachi .We are thankful to Ms. Asma Zafar -
Manager Institutional Support of TDSP/IDSP-Pakistan for providing great support to
achieve the project goals.

We want to acknowledge the contributions of Fidelity Charity Grant Funds and
Ms.Alison’s efficient support in guiding us to follow the agreement.

The last but not the least, we appreciate the efforts made by the families of the selected
young women for Midwifery Training .Their efforts demonstrated the commitment and
will of the poor ,struggling rural families, who accompanied their young daughters ,
sisters ,wives & relatives to ensure the safety and meaningfulness of leaving them for two
years in Karachi’s training hostel .

Ms. Naheed Hassan

Lead Faculty Member
Midwifery Project

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Executive Summary

The present report covers Oct. 2011 to Sept. 2012 project period.

The project was conceived in view of the acute need for the rural women for their
maternal health care for safe deliveries. The encouragement and support from Ms .Joane
Kagle made the concept real. The excellent funding support from Fidelity Charity Gift
Funds, the institutional infrastructure and the excellent women graduates in the rural
Balochistan created by IDSP’s Women Leadership Program, with overall support of the
Trust for Development Studies and Practices Pakistan, made it all happen.

The report gives an overview of the status of maternal mortality rate of Pakistan in
general, focusing Sindh and Balochistan particularly. Pakistan has one of the highest rates
of maternal, pre-natal and child mortality recorded internationally. Research indicates
that 40 per cent of all deaths in Pakistan are preventable.
Some the major areas covered in the present report is the mobilization of more than fifty
families and communities in 20 or 25 districts of Balochistan and Sindh. About 100 men
and women to Karachi to ensure that all that we had claimed in our motivation and
community education processes is true and real, and their women will be safe and there
is not influence of men in the whole environment. The project management team did an
excellent job of hosting the families in the IDSP hostel in Karachi, gave them full
orientation, with food and bedding, arranging their travel to the training institute. A
detailed orientation was given again on the training institute and the living space as for
the under training women. Then they participated in the inauguration ceremony of
midwifes training course. The whole event went on for a week, before all sent beak
happy and satisfied.
The other major breakthrough that helped was the purchase of a building for midwifes
hostel and IDSP’s office in a very modest and safe middle class locality in Karachi. The
establishment of the hostel was one of the fundamental part of midwifes project. The
IDSP’s midwifes do not go home on weekends, they all come to IDSP hostel and relax, go
to sea side, to entertainment parks, zoo and market places, films, theaters, they take
gender and women empowerment classes for leadership training. Their families come to
meet them, and they can call their families.
Another achievement is IDSP and HARD partnership for midwifes training. HARD is a very
practical and relevant training institution. It not only teaches and training midwifes but
also has a very well designed health program for the women student of midwifes
Besides the launching of a two years midwifes training program, refreshers, for the
previously trained midwifes was also held. It was also a very great opportunity for
midwifes to learn about medicine, herbal treatment, communication skills, gender
relation and dynamic, plus their own health care as women.
One very fundamental outcome is the pre midwifes training cost for two years courses
and for start three month refreshers (see the financial report). The report also explains
the technical aspects of the course in details.

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Introduction of IDSP/TDSP

A lot has been done - Much remains to be done still:

Institute for Development Studies and Practices IDSP-Pakistan, is an emerging national
research and practice based national institution based in Balochistan & is working under
the umbrella of Trust for Development Studies & Practices (TDSP). It is committed since
its inception in 1998 ,to its mission of creating, nurturing and engaging adolescents,
youths and young women and men in to professional cadres of community development
with a connection to national and international opportunities. Its major focus is on
excluded adolescents, youths and young population from the national mainstream of
formal education, life as a citizen and from decent, dignified and meaningful livelihood.
(Especially for women)

IDSP today, is managed and operated by its young graduates and fellows who were its
learners in its courses or who joined to create it as part of their practice based learning
since 1998.Since its inception IDSP has launched 12 development courses, 5
mainstreaming gender in development courses, three course cycles of reflective learning
for adolescents & one community development course. These are some of the major
courses that have engaged more than 5000 youth and young numbers of youth across
the country.

Today IDSP'S young managers, program directors, faculty members as fellows of IDSP are
engaged in nurturing and developing directly full time 37 fellows who are working with
more than 70 + communities across Baluchistan and Sindh. While more than 2000
graduates are engaged in social, economic and political activities and programs. Many of
them are on leading position in public and private sectors, from community to
international levels.

The idea of IDSP stemmed out of a critical need- to create a learning space for the
development and intellectual bolstering of the different groups of the motivated
individuals from various fields of research and development. IDSP has been conducting
theory and practice based courses on the themes of development studies, Gender
mainstreaming and community development. The hub of IDSP activities is Quetta. IDSP
mainly engages the excluded adolescents, young people from various parts of Pakistan in
a stimulating learning process in which they share, learn and create together practices
for people-cantered development and sustainable community partnerships.

Introduction of Partner Institute: HANDS

Organization Name: Health And Nutrition Development Society
Acronym: HANDS
Website Address:

HANDS registered tax exempted and PCP certified, European Union Accredited, not for
profit organization, working since 1979 with key programs of Health, Education, Poverty

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Alleviation, and cross cutting programs of Social Mobilization, Gender, Human and
Institutional Development, Disaster Management, Information and Communication,
Monitoring, Evaluation, Research and Social Marketing. HANDS are benefiting more than
13 million people of 16,703 villages in 24 Districts of Pakistan.

The participatory approach of HANDS makes it popular among communities and
transparent its decisions and activities that perpetuate its partnership with the
community and government. HANDS was formally registered in 1993 and has undertaken
many projects during last 16 years (1993 – 2011). These projects reflect HANDS expertise
in many sectors, such as health, education, poverty infrastructure training (capacity
building), gender & development, social mobilization, public awareness and early
childhood development.
Background: Overview
Increasing women’s access to quality health service to have the best possible health care
during pregnancy and childbirth is a basic right of every woman. There is much that
needs to be done. Every year approximately 350,000 women die while pregnant or giving
birth, up to 2 million new borne die within the first 24 hours of life, and there are 2.6
million still births. The overwhelming majority of these deaths occur in low-income
countries and most of them could have been prevented. This happens because of no
access to functioning health facilities or to qualified health professionals.
Pakistan has the highest mortality ratio in South East Asia. As per available statistics 80%
of females deliveries at home by unskilled workers called by basic name (Dai). Only
trained persons can save motherhood in the communities and avert maternal mortality.

Pakistan Maternal Health Indicators
 Pregnant women receiving prenatal care: 61%
 Births attended by skilled personnel: 39%
 Births in Health Facilities: 35%
 Women receiving postpartum care: 22%

Figure 3- National Nutrition Survey Report 2011- Aga Khan
IDSP conducts two types of courses regarding midwives trainings which include three
months practice based course for those women who are already trained in the field of

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midwifery but only require practice. After the oral assessment of selected midwives they
are provided 3 months in-house training with practices. IDSP bears cost of all trainees
including boarding, lodging, transportation, and resource material. IDSP has already
conducted 2 months training with support of Quttar Hospital and one (1) refresher
course with support of Aga Khan Hospital. IDSP has affiliated trainings with HANDS CMW
School which is registered by Nursing Counsel Pakistan. The IDSP program model is
comprised of 3- month training courses. During practical session these midwives trainees
have dealt more than 1150 delivery cases in Quttar Hospital Karachi.
Secondly IDSP includes fresh girls/ women for the two year theory and practice based
courses which are being implemented with the collaboration of HANDS training
organization in Karachi. This course is held in IDSP Sindh Campus and 25 learners are
enrolled from Sindh and Balochistan.
A referral based system had been introduced to enable them to link up with secondary
health outlets public sector. In addition, a network of midwives has been devised as per
their geographical areas. This network serves as a platform to share experiences and
provides help where needed. The network is linked with the Doctors, Pharmacists,
Teachers and Midwives, providing health facilities to community whenever required.
Referral System

Figure 4- Referral system
Scope of Practice-Midwifery
o The midwife works in partnership with women, on her own professional
responsibility, to give women the necessary support, care and advice during
pregnancy, labour and the postpartum period up to six weeks, to facilitate births and
to provide care for the new-born.
o The midwife understands, promotes and facilitates the counselling processes of
pregnancy and childbirth, identifies complications that may arise in mother and baby,
accesses appropriate medical assistance, and implements emergency measures as

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necessary. When women require referral, midwives provide midwifery care in
collaboration with other health professionals.
o The midwife may practise in any setting, including the home, the community,
hospitals, or in any other maternity service. In all settings, the midwife remains
responsible and accountable for the care she provides.

The Project: “MAA”

IDSP is focusing all interventions to build capacity of youth and women in Baluchistan.
The province has least health facilities especially for Mother and Child care because of
less accessible areas and lack of human resources. Based on previous experiences and
utilizing existing human and technical resources, IDSP has designed a project for rural
women and children for mother & child health care. The project, called “MAA”, is
designed in a way to establish capacity of local women in Midwifery and extend their
access to far flung areas so as to provide Mother and Child care and reduce mortality
among pregnant women and new-borns.

Project Planning
The planning phase consisted of consultative meetings,
selection of training venue, course guidelines, selection
criteria of Trainer & Trainees and suggestions for training
points as an important part of planning. The consultative
meetings gave ideas to develop partnership with training
Institutes and developed support mechanism for midwives.

Midwifery Hostel

To facilitate the midwives during their stay at Karachi, IDSP
has purchased a building that serves as a hostel for Midwifes.
Due to it the family members and relatives of midwives can
easily meet them when the midwives feel homesickness due
Figure 5- Skype Meeting
to being away from their families for long .The administration with Director of IDSP
of the hostel also provides them entertainment opportunities
by taking them to picnics, dinners, etc.

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Figure 6. IDSP's Midwifery Hostel, Karachi Figure 7. Inauguration Ceremony of Midwifery
Hostel by the midwifes themselves

Figure 8. Cake Cutting Ceremony by midwifes to Figure 9. Well come to Midwives’ Families in IDSPs
celebrate their own hostel newly purchased Midwifery Hostel

Inauguration (18 months course) and 5th Graduation Ceremony of CME course
From March 30th to April 3rd ,2012 the ceremony Inauguration (18 months course) and
5th Graduation Ceremony of CME course was celebrated at IDSP’s Midwifery Hostel.150
people had participated from Sind and Balochistan including Midwives, their family
members,relatives,friends IDSP Learners,Fellows,IDSP Quetta Team and HANDS
Team.IDSP provided all sort of assistance in organizing boarding,lodging,logistics,etc to
the participants.

Project Objectives
o Develop a new professional cadre of Midwives in Sindh & Balochistan.
o Develop physical bases for capacity building of women in Balochistan in Midwifery.
o Develop a network of midwives in Balochistan
o Bring Behaviour Change to procure Services of Midwives
o Provide refreshers and further institutional and community support.

Project Implementation
The project was designed with the consultation of faculty and training institutions. A
detailed discussion was held to conduct training and find out trainers for refresher
course study with the coordination of faculty of Aga Khan Hospital Karachi.

Selection of Training Institute

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Following institutions were visited and selected during the planning phase of the project:

1. Koi Goth Hospital Karachi: Dr. Shershah’s training institute
There was a problem of safety and security and also there was no practical space in
hospital. Moreover, the tutor of the training institute did not satisfy the Midwifes with
their behaviour, while attitude of Dr. Sher Shah & his team was extremely humiliating
and discouraging.

2. Aga Khan Hospital Karachi (Kharadar)
Aga Khan Medical University School of Midwife and Nursing has comprehensive training
program. But the assessment of their graduate revealed that they have less practical
training. Training of midwifery was started and AKU midwives completed 1st quarter of

3. HANDS Community Midwifes (CMw) Training School Karachi
HANDS CMW training program at CMW School: this training Institute is located at Malir,
Karachi. The hospital has residential facility and well trained and professional staff to
build capacity of selected trainees in midwifery.

Affiliation with the existing courses of the HANDS - CMW School

IDSP affiliated its 3 months’ refresher course and the 18 months course with HANDS-
CMW school. Midwifery Basic Training duration is 18 months with the technical training
support of HANDS.IDSP’s program model comprises of 3 months training and refresher
courses. Before the course content was prepared in consultation with the trainers and
midwives ,it was agreed that after the oral assessment of selected midwifes they would
be provided 3 months for refresher course and 18 months in house training with
practices. IDSP bears cost of all trainees including boarding, lodging, transportation,
shoes, and resource material.

Midwifery Training Program Continuing Medical Education CME (3 Months Refresher

A comprehensive training program was designed for 35 selected midwives of Balochistan
for 3 months course. Following themes have been selected for refresher course:
Overall Course contents
1. Women Leadership

• Concept of Gender
• Violence against women
• Women & civilization
• Media roll and issues
• Health & Nutrition
• Self Awareness

2. Reproductive Health of Women

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• Antenatal care & Medicine (PIH,APH, Abortion, ,Partograph ,Pre-term labor)
• Postnatal care & Medicine
• Infertility
• Stis
• Lab Reports
• Menstrual Cycle pelvis

3. Women and Motherhood
Child Care & Medicine , IUGR,Perpullum,Breast Feeding

A: First Month

 Concept of Gender
 Violence against women
 Women & civilization
 Menstrual Cycle pelvis
 Unani and Herbal Medicine
 Health & Nutrition

B: Second Month

 Media roll and issues
 Self Awareness
 Antenatal care & Medicine (PIH,APH, Abortion, IUGH,Partograph ,Pre-termlbor)
 Postnatal care & Medicine

C: Third Month

 Child Care & Medicine
 General Medicine
 First Aid
 Lab Reports
 Recitation of Holy Quran

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Mr. Ali Ms. Raheela Dr. Sara Dr. Kaneez

Dr. Nareesh Pharmacist Afshan Naz Dr. Rifat & Kausar S.K

M.B.B.S from Chandaka Medical College (University of Sindh, Jamshoro)

• Dr. Kaneez Fatima
Resident Medical Officer AKU

Pharm D from Federal Urdu University.

• Muhammad Ali Bilgrami

• Ms.Raeela
Master in Herbal Medicine

Project Location of CME Course

In its Refresher course IDSP identified midwives from Balochistan province for practical
training. During the planning phase IDSP selected 28 midwives from 8 districts of
Balochistan and provided practical training at Sindh Government Quttar Hospital,

Midwifes’ Selection Criteria (CME COURSE)
o Midwives from the villages of Balochistan
o Midwives who have completed their theoretical training
o Willing to serve their communities in maternal and child health care
o Having creditability in their communities
o Ages between 20-3

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Midwifery Training Program (Basic 18 Months Training )

A comprehensive training program was designed with
collaboration of HANDS CMW School.This is basic
training of midwifery which has a duration of 18
months and is divided in 6 quarters. IDSP selected 25
midwives from Sindh & Balochistan for 18 months
course. Following are the details of overall process
from advertisement to 2nd quarter of training because
this training will be completed in September 2013.

Partnership with HANDS
1. Improving access to the safe maternal & new born
Health Care services in rural areas of Sindh &
Balochistan through developing skilled local
community midwives. Figure 10- Partnership
2. Enhancing women empowerment & leadership with HANDS
through the CMW training program

Criteria for Training

o Recognize training Institute
o Availability of trainers
o Infrastructure
o Equipped facilities
o Labor room condition
o Operation theater
o Classroom facility
o Residential facility available
o Facility of community work
Figure 11. Midwives in
o Facility of antenatal & post natal care
Class Room

Learning facilities

o Midwife training Center
o Practical Room
o Library
o Para medical staff ready to facilitate

Identification and selection of suitable candidates

Selection Committee 

Regional Training Institute (RTI) Quetta Team 
Leady Health workers (LHW) in Balochistan Team

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Institute for Development Studies & practices (IDSP-PAK) Balochistan Team 
Health & Nutration Development Socity (HANDS-PAK) Sindh Team

Selection Criteria for Midwifes

 Willing to serve their communities in maternal and child health care
 Female preferably young and not restricted from home.
 Permanent resident of the area from which she is applying
 Qualification: 10th grade preferably science background
 Age: 18 – 25 Years

Orientation Phase

1. Adds in 2-3 most popular local newspapers in local and national languages ( KAWISH
2. Developed pamphlets & distributed them through personal contacts, Lady Health
Workers and IDSP learners / graduates.
3. NGOs (Taraqi Foundation ,RDO ,Aurat Foundation,)
4. Line Department (RTI, Women university, Balochistan University, girls collage ,
Islamia collage ,vocational centers , Health centers )
5. CBOs , Community and personal contacts

Selection Process

• Target of midwives was 30 from Balochistan & Sindh.
• Balochistan (Sibi ,Quetta , Mustung ,Khuzdar Lasbela , Panjgur ,Turbat, Kalat
,Kharan ,Noshki,Bolan ,Nasirabad, Pishin,Gawadar ) 14 districts
• Sindh ( Larkana ,Khirpur ,Mirpur Khas , Dadu , Karachi ,Hyderabad ,Hala
,NawabShah , Shahdad Kot ,Jamshoro)

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Project location in Sindh & Balochistan Provinces

1. Karachi
2. Dadu
3. Larkana
4. Khairpur
5. Hyderabad

1. Zhob
2. Naseraad
3. Sibi
4. Quetta
5. Kharan
6. Mustung
7. Khuzdar
8. Lasbala
9. Pangur
10. Kech
11. Gwadar

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List of Selected IDSP Community Midwives

S/NO Pictures IDSP CMW

Arifa D/OAbdul Samad Balochistan


Asia D/O Abdul Rauf Sindh


Atia D/O Amanulla Balochistan


Azra D/O Nazir Ahmed Mir Khan Sindh


Bakhtawar D/O Ahmed Khan Sindh

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Farzana D/O Nawaz Ali Balochistan


Fauzia D/O Mola Buksh Balochistan


Gulnaz D/O Raaza Muhammad Khan Sindh


Muniza D/O Muhammad Hussain Balochistan


Nayta D/O Amir Hamza

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Nargis Malik D/O Pir Jan

Reema D/O Abdul Qadir


Saima HashimD/O Muhammad Hashim


Safia D/O Abdul Jabbar Sindh


Salma Hassan D/O Hassan Balochistan


Salam Sultana D/O Muhammad Panah

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Samreen Akber D/O Muhammad Akber Sindh


Shahida Parveen D/O Moula Bukhsh Balochistan

Shaheen D/O Ghulam Sarwar Sindh

20 Sultana D/O Abdul Qadir Sindh


Sajida Parveen D/O Muhammad Essa Balochistan


Sunober D/O Muhammad Juman Sindh

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Surya D/O Safdar Sindh


Rubina D/O Muhammad Ibrahim Sindh


Zahra D/O Noor Buksh Sindh

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Admission Criteria:

Documents required for selection are following
• Matriculation (10th grade) Certificate.
• Matriculation Mark Sheet.
• Domicile Certificate.
• Character Certificate.
• Citizen National Identity Cards (C.N.I.C)
• Two Photograph.

Training is divided in 6 quarters and each quarter is based on 13 weeks .After every 13
weeks exams are due .The details of quarters are as follows:

Overall Course Quarters

1st quarter P.T.S Examinations------------ after 13 Weeks
2nd quarter-------------------------------------after 13 Weeks
3rd quarter -------------------------------------after 13 Weeks
4th quarter -------------------------------------after 13 Weeks
5th quarter-------------------------------------after 13 Weeks
6th quarter-------------------------------------after 13 Weeks

Weekly Class test = 4 total, per month

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Details of each Quarter
Quarter: 01
Week 1 Week 2 Week 3 Week 4 Week 5
Orientation Orientation General anatomy General anatomy Microbiology
and physiology and physiology
Week 6 Week 7 Week 8 Week 9 Week 10
Microbiology Pharmacology Pharmacology First Aid First Aid

Week 11 Week 12 Week 13
Basic nursing care Basic nursing care Basic nursing care

Quarter: 02
Week 1 Week 2 Week 3 Week 4 Week 5
Basic nursing
care Basic nursing care Basic nursing care Review exam Break
Week 6 Week 7 Week 8 Week 9 Week 10
Introduction to Reproductive Reproductive Fetal Skull Female
midwifery system: system: Female external external
female pelvis female pelvis genitalia genitalia
Week 11 Week 12 Week 13
Physiology of Preparing for Physiological
reproduction: pregnancy changes of
Fertilization Infertility pregnancy

Quarter: 03
Week 1 Week 2 Week 3 Week 4 Week 5
Antenatal care Antenatal care Antenatal care Antenatal care Management
Hands on Hands on training Hands on training Hands on training of first stage of
training in ANC in ANC in ANC in ANC Labour
Hands on
training in LR

Week 6 Week 7 Week 8 Week 9 Week 10
Management of Management of Management of Physiology and Physiology and
first stage of first stage of first stage of management of management
Labour Labour Labour second stage of of second
Hands on Hands on training Hands on training labor stage of labor
training in LR in LR in LR Hands on training Hands on
in LR training in LR

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Week 11 Week 12 Week 13
Physiology and Physiology and Physiology and
management of management of management of
second stage of second stage of second stage of
labor labor labor
Hands on Hands on training Hands on training
training in LR in LR in LR

Quarter: 04
Week 1 Week 2 Week 3 Week 4 Week 5
Physiology and Physiology and Physiology and Management of Management
management of management of management of Puerperium of Puerperium
third stage of third stage of third stage of Hands on training Hands on
labor labor labor in post partum training in post
Hands on Hands on training Hands on training ward partum ward
training in LR in LR in LR

Week 6 Week 7 Week 8 Week 9 Week 10
Family planning Family planning Abnormalities of Sexually Disorders
Hands on Hands on training early pregnancy transmissible caused by
training in FP in FP clinic Hands on training diseases in pregnancy
clinic in Gynecology pregnancy Hands on
clinic Hands on training training in
in Gynecology Gynecology
clinic clinic

Week 11 Week 12 Week 13
Disorders caused Diseases Multiple
by pregnancy associated with pregnancy
Hands on pregnancy Hands on training
training in Hands on training in ANC clinic
Gynecology in ANC clinic

Quarter: 05
Week 1 Week 2 Week 3 Week 4 Week 5
Prolonged Malpositions and Obstetric Complications of Complications of
pregnancy and malpresentations emergencies Hands third stage of labour third stage of
disorders of Hands on training on training in LR Hands on training in labor
uterine action in LR LR Hands on
Hands on training training in LR
in LR

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Week 6 Week 7 Week 8 Week 9 Week 10
Care of the Care of the newborn Care of the newborn Breast feeding
Care of the newborn Hands on training in Hands on training in Hands on
newborn Hands on training Newborn Nursery Newborn Nursery training in Breast
Hands on training in Newborn Feeding Clinic
in Newborn Nursery
Week 11 Week 12 Week 13
Breast feeding Health Education Health Education
Hands on training Practical training in Practical training in
in Breast Feeding HE classes HE classes

Quarter: 06
Week 1 Week 2 Week 3 Week 4 Week 5
Health Education Health Education Community Community Community
Practical training Practical training Midwifery Midwifery Midwifery
in HE classes in HE classes Home visits and Home visits and Home visits
community work community work and
Week 6 Week 7 Week 8 Week 9 Week 10
Community Community Community Community Community
Midwifery Midwifery Midwifery Midwifery Midwifery
Home visits and Home visits and Home visits and Home visits and Home visits
community work community work community work community work and
Week 11 Week 12 Week 13
Preparation Preparation leave Final Assessment
leave Examinations

Result of PTS Examination-CMW School HANDS Jamkanda

Roll Name of CMW Anatomy FON First Micro Phar First A/P Micro Phar FON Total
NO & (100) Aid biolo ma Aid (Viva) (Viva) m (Viva) (650)
Physiolo (50) gy (50) (Viva) (100) 25 (Viva) (100)
gy(100) (50) (25) (50)
Arifa D/O Abdul
1 Samad 74 78 44 43 37 20 65 22 43 63 489
2 Asia D/O Abdul Rauf 64.5 65 36 38 31.5 17 53 16 28 74 423
3 Atia D/O Amanulla 52 72 40 41 36 20 54 22 44 54 435
Azra D/O Nazir
4 Ahmed Mir Khan 77 90 42 43 35 18 56 17 36 63 477
Bakhtawar D/O
5 Ahmed Khan 32.5 60 26 30 16.5 13 50 15 8 16 267

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Farzana D/O Nawaz
6 Ali 52 66 37 26 32 16 60 18 26 35 368
Fauzia D/O Mola
7 Buksh 38 69 34 34 20 16 54 19 32 52 368
Gulnaz D/O Raaza
8 Muhammad 80 74 45 44 27 20 90 23 39 72 514
Muniza D/O
9 Muhammad Hussain 83 95 47 46 32 21 83 24 44 84 559
Nayta D/O Amir 505.
10 Hamza 89.5 81 48 34 36 20 78 23 40 56 5
Nargis Malik D/O Pir
11 Jan 73 90 40 46 32 10 65 22 43 66 487
Reema D/O Abdul 457.
12 Qadir 75 69 33 43 31.5 21 56 23 37 69 5
Saima HashimD/O M
13 Hashim 67 85 42 39 28 20 76 23 40 69 489
Safia D/O Abdul 513.
14 Jabbar 87.5 86 43 40 32 21 68 23 35 78 5
Salma Hassan D/O 499.
15 Hassan 71 82 43 39 29.5 20 72 20 44 79 5
Salam Sultana D/O M
16 Panah Malah 19 30 30 25 30 13 10 15 16 19 207
Samreen Akber D/O
17 M Akber 39 65 37 39 33 17 55 18 39 69 411
Shahida Parveen D/O 428.
18 Moula Bukhsh 82 A 40 46 27.5 19 71 24 42 77 5
19 Shaheen 81 82 45 44 36.5 18 70 22 39 63 5
Sultana D/O Abdul
20 Qadir 76 71 32 41 29 19 78 22 38 52 458
Sajida Parveen D/O 479.
21 M Essa 78.5 71 43 43 32 18 68 23 39 64 5
Sunober D/O
22 Muhammad Juman 52 71 40 33 34 16 50 18 35 34 383
23 Surya D/O Safdar 63 78 39 41 21 17 56 22 28 73 438
RubinaD/OMuhamm 429.
24 ad Ibrahim 65 68.5 40 29 25 20 55 20 32 75 5
Afshan KhanD/O
25 Meer Muhammad 86 89 44 48 34 21 60 23 45 86 536

Medical Checkup of IDSP’s Under Training CMW
The medical check-up was done in two phases. 19 CMWs’ were checked
in first phase in April,2012.5 CMWs’ had medical check-up in
May,2012.These Tests include:
1. CBC
2. Blood glucose
3. Urine D/R
4. Hepatitis B antigen
5. Hepatitis C
6. Chest X- Ray
7. ESR

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1. Treatment has been started according to the needs of students.
2. CMW treated according to their problems.
3. Ms. Bakhtawar is Hep C positive case but at a very initial phase and with no
problematic symptoms, her treatment is in process.

Hepatitis B & TT Vaccination of ALLCMW Students

1. Gathering of CMWs.
2. Introduction of Hepatitis
3. vaccination& TT
4. Vaccination done
IDSP has provided financial assistance and helped Figure 11. Midwives during Vaccination
midwives in fulfilling the following requirements:
• Domicile
• National Identity card
• Bank Accounts
• Use of Bank Cards
Figure 3Midwife during TT Vaccination

Challenges of Changing World
o Social & cultural barriers for residential course
o Law & order condition generally in Karachi and
Baluchistan specifically for girls.
o Bringing behavior change to allow girls out of
province & out of city, hostel living.
o One interesting lesson was that unmarried young
women who were not exposed to any kind of
medical setting related to child birth; it was too
over whelming for the women without any
exposure of maternity related work or
o Too much use of cell phone
o Home sickness
o Missing the family celebration occasions
o Knowledge of English language in medical
writings in books.
It is a very major achievement that we addressed all
the above mentioned challenges with excellent
result, except one challenge and that is law and
order situation in the city of Karachi and Balochistan.

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Way Foreword
• Conduct 3 CME Refresher courses in which we have to graduate 75 midwives
(25 midwives in each course) by September, 2013.
• Organize Certificate Distribution ceremony in September 2013.
• Get partnership with government health departments in Sind and Baluchistan
• Monitor and evaluate the needs of midwives.
• Give awareness t midwives on Women Leadership and Self (particularly on

Figure 4 Traditional welcome with AJRAK (Shall) Figure 5. Midwives' Selection Process in SINDH

Figure 15 Midwives’ Selection in BALOCHISTAN Figure 16 Lamp lighting Ceremony

Figure 17 Certificate Ceremony of CME Course Figure 18 Labour room

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Figure 19 Midwives’ during Examination Figure 20 Midwifes hostel in CMW school

Figure 21 Midwives dormitories

Advertisements in Local News Papers

Daily Kawish is a local being published in Sindhi language in Sindh province of Pakistan

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International Pledge for Midwifes

This pledge was taken by the Midwifes on the start of the course with candle lights.

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Figure 22 Back view of CME course Certificate Figure 6Front View of CME Course Certificate

Figure 7Front View of Brochure Figure 8 Back View of Brochure

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Reading Material given to Midwives for the support

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