Population & Development

ROLE OF
FAMILY WELFARE
ASSISTANT

FAMILY WELFARE CENTRES (FWCs)

The Family Welfare Centre is one of the main service

delivery networks of the Program established in

hired premises in urban and rural areas. Each centre

caters to a population of 5000 to 7000 through the

static facility and a population of 15000 25000 by
arranging satellite camps among dispersed
population and high density areas respectively.

Major Activities
The major activities to be carried out at the FWC are as
follows:
Provide high quality family planning services
including counseling, supplies and regular follow-up
services at affordable costs and in a manner that is
acceptable to the community.
Providing MCH and well-baby care including
prenatal and postnatal care, immunization, nutrition
advice and growth monitoring in a friendly
atmosphere.

Continued . . . .
Organizing group meetings of stakeholders such as

elected representatives, satisfied clients, teachers,

hakims, private practitioners, religious scholars,
shopkeepers, representatives of local NGOs and
other active members of community.
Establishing referral linkages with secondary and
tertiary hospitals for referral of clients.

Continued . . . .
Organizing IEC campaign for promoting small family

norms among active and influential community

members and traditional birth attendants and to
foster a family well-being concept in the holistic
approach of FWC.
Holding regular meetings with elected women
councilors to elicit their support.
Distributing IEC material on better health practices
and family planning within the community.

Continued . . . .
To extend outreach services through Mobile Service

Units attached with the FWCs located at the Tehsil

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

Responsibilities of Incharge FWC

A - Service Delivery
Act as Incharge of Family Welfare Centre and
supervise the work of the staff.
To monitor FWCs and to provide technical support.
Perform FP counselling, contraceptive services,
including IUD insertion and refer Norplant,
sterilization cases after initial screening to RHS A
Centres.
To conduct initial screening and refer clients for
sterilization and Norplant to RHS A and extension
camps.

Continued . . . .
Attend to cases of general ailment and refer clients to

higher level facility, if deemed necessary.

Establish linkage with the tertiary hospitals for
referrals.
Provide mother & child care services, child nutrition
and arrange immunization services in collaboration
with government health services, wherever possible.

Continued . . . .
Supervise and support the FWA (female) to ensure

collaboration of satisfied clients and/or husbands for

promotion of RH and FP and undertake regular home
visits for motivation and follow up.
To supervise the work of FWA (F) and ensure update
eligible couple register and to prepare a list of couples
having one child, pregnant women, antenatal and
postnatal clients for counselling and spacing.
Arrange FP agents orientation, including elected
representatives, in collaboration with tehsil office.
Maintain and update client record cards/registers and
prepare monthly reports of various activities.

B - Counselling

Provide counselling to clients on various FP/RH issues such

as:
Adolescent problems
Infertility
Nutritional disorders
Cervical and breast cancer
STD/AIDS
Breast feeding
Give orientation to clients on breast examination.

Maintain record for counselling of each client.

 Responsible for keeping update IEC material/literature

for enhancing her own knowledge and/or of the clients.

Assign villages to motivators for motivation and
counselling of MWRA (married women of reproductive
age) if sufficient clients are not coming to FWCs.
Follow up of FP cases especially Injectables through FWA
(female).
Maintain quality of care and client satisfaction, arranging
periodic satisfied clients meetings.
Establish referral linkages with tehsil and district
hospitals for referral of clients.

Responsibilities of FWA (Male)

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

Worker in holding Satellite camps twice in a week in the

identified villages. He will arrange venue, move in the
community and ensure necessary logistic arrangements and

distribute appropriate IEC material.

The FWA (Male) will arrange male motivation through

interpersonal communication, audio-visual shows, distribution
of IEC material in the community.

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

and RHS-B Centres and will assist EPI teams for arrangements of
immunization services on selected days at FWCs.

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

contraceptives to RMPs, Hakims &Homeopaths in his area and
collection of performance reports and sale proceeds of contraceptives
from them.

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

couples of in the vicinity of FW Centre.

Responsibilities of FWA (Female)

The FWA (Female) would go in the field for

registration of eligible couples in the vicinity of FWC

during the days when FWW remains in the centre.
FWA (Female) will motivate and counsel clients for
adoption of small family norms and refer cases of
IUCD to FWC and contraceptive surgery cases to the
nearest RHS Centres.
During field visits she will also register births and
deaths in her area

 FWA (Female) will be responsible for follow up care

of clients and for maintenance of complete record of

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

MAGNITUDE OF THE PROBLEM

Population of Sindh has increased 7 times since

independence.
It has doubled from 1980s to 1990s.
It was 43 million in 2012 with annual growth rate of
2.3% (1.9% of Pakistan)
It has youth population of 68%

 TFR of Sindh is 3.9 , 0.9 of this is unwanted whereas

the women in Sindh want only 3 children but they

have almost one unwanted child on the average.
TFR in rural Sindh is 4.8, in Urban Sindh is 2.9
Women in rural Sindh have almost two children
more than their urban counterparts.

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

rich class is 2.5

Poorest families have approximately 3 children more
than the richest families.
With high fertility Sindhs population by 2050 will
become 83 million
With low fertility Sindhs population by 2050 will
become 62 million
i.e a strong F.P programme could make the difference
of 21 million

 TFR = 4.8 (for women with no education)

TFR = 4 ( for women with primary schooling)

TFR = 3 (for women with secondary education)
TFR = 2 (for women with tertiary education)

 47% of women want no more children

25% of women want to space their next pregnancy

25% of women want another child soon
72% of women (i.e 7 out of 10 women) and 62% of

men (i.e 6 out of 10 men) in Sindh prefer smaller and

better-spaced families
6,60,000 pregnancies that women do not want can
be avoided

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

is 25%
CPR has risen from 27% in 2006/7 to 30% in 201213. Just o.5% points rise annually over the last six
years.
Urban CPR (any method) is 42.7%, Rural CPR (any
method) is 17.4%
Urban CPR (modern method) is 32.6%, Rural CPR
(modern method) is 17.1%
CPR is 45% in Karachi, 13% in Ghotki (modern
method), 35% in Karachi (modern method)

 Total unmet need is 21%

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

=10)
Unmet need for limiting (Rural=9, Urban=12,
Total=11)
1/5th of women need contraception to space and limit
their childbearing.

 Unmet need for contraception to limit family size is

higher in rural area than in urban areas. This reflects

higher room for raising the CPR in rural Sindh. If the
demand for F.P were satisfied, the CPR would rise to
51% in Sindh.
34,106 infant and 18,365 child (aged 1-4) deaths can
be averted by eliminating unmet need.
Unwanted pregnancies can also lead to post-abortion
complications. Number of PAC cases in Sindh are
1,74,908 (Public=73,512, Private=1,01,396)

 Maternal Mortality Ration in Sindh is 214 women

(per 100,000 live births)

24% of deaths in reproductive age group in Sindh die
due to pregnancy related issues.
2800 women die each year in Sindh alone due to
pregnancy related causes.
930 maternal deaths can be saved every year by an
accelerated F.P program.
Just increasing CPR to 51% will reduce the Maternal
deaths by 33%.

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

93.
Children with mothers who have had no schooling
acound for more than double the IMR of those
mothers who have studied up to or beyond
secondary school.

GROUP WORK
Group 1: Motivating the uneducated

Group 2: Motivating the educated

Group 3: Motivating the religious group
Group 4: Motivating the Political class

Group 5: Motivating the media