The Marvis of community healthcare

Rehmat Dai is one 3,400 female health workers, primarily serving as a midwife and leading community healthcare in their respective areas.

Trained under the Marvi programme launched by the Health and Nutrition Development Society (HANDS), she is part of a vast network of female health workers, committed to helping the sick and providing medical assistance and guidance to pregnant women.

Dai, 35, referred to as 'Marvi' in neighbourhood Lehri goth and by her acquaintances, herself is a mother of five.

Taking pride in her work, she also proudly tells everyone of having studied at a school for a year and clearing first-grade examinations.

"Plus, I have completed six healthcare training sessions," she told The Express Tribune, adding that her eldest daughter, Madiha, helped her with understanding the literature given to her as part of the training sessions.

Dai joined the Marvi programme in 2015 and today, she feels contented serving others and basks in her popularity.

"Just ask anyone in the neighbourhood and they will be able to guide you to my house. I am very popular here because I selflessly help people," she smiled.

However, her services are not limited to just providing medical assistance. From accompanying people to tertiary care hospitals to helping them in getting a national identity card, she is always ready to be the much-needed helping hand.

"People call me on my phone anytime and I am by their side to support them. This is my responsibility," she said. "Besides, I support my family as my husband is unemployed and take care of my family's health." She added that Marvi workers were being provided financial support for setting up shops inside their houses too.

Dai is just one example of the courageous and selfless women involved in community service in Pakistan despite their limited resources.

Like her, many others have been trained to provide healthcare assistance in their respective areas under the Marvi programme.

The programme was launched by HANDS chief executive officer Dr Shaikh Tanveer as a pilot project in Umerkot in 2005. Inspired by Bangladesh's healthcare system, it was aimed at providing support to needy mothers and their newborn babies.

"Today, at least 3,400 women serve as Marvis (term used for women working under the Marvi programme) in eight districts of Sindh, including Karachi rural, Thatta, Sujawal, Badin, Umerkot, Tharparkar, Sanghar and Ghotki," he said. "They are also working in two of Punjab's districts, Muzaffargarh and Sheikhupura."

Each of them serves in areas of their residence, where there is no lady health worker, according to Dr Tanveer.

When asked how Marvis were selected for training, he said the training criterion was very flexible. "We select the best from each area and in most cases, they are illiterate but perform exceptionally well," he elaborated.

According to him, Marvi workers have been operating in 60 per cent areas of Sindh and as per data shared by the HANDS, since the launch of the programme, Marvis have prevented at least 600 maternal mortalities, 800 child mortalities and over 150,000 unsafe abortions.

"They are a cadre of community health workers, serving in areas where there are no lady health workers," he said, adding that each Marvi worker was provided guidance by a lady health visitor, especially in connection with delivering technical and skill-based health services.

Marvi workers are not just a community of health workers, but agents of change to promote positive behavior, he said, adding that the health sector wouldn't witness significant improvement in the absence of strong community healthcare infrastructure.

Besides, he dubbed the launch of Marvi programme an "initiative for women."

According to HANDS chief services executive Ghulam Mustafa Zor, almost half of Marvi workers have been provided tablets and they have electronic gadgets with a minimum of 15 health-related videos.

Stating that they received no support from the government to run the programme, he said they still intended to expand it to other areas in the country.

Published in The Express Tribune, October 11^th, 2020.