Pak Army’s practical contribution towards Human Welfare of Pakistan

Nazimuddin
Pakistan is the 5th most populous country in the world and its most densely populated province is Punjab with 16% unmet need for contraception. Punjab, with a growth rate of 2.13% and a population of 110 million, is expected to grow double in the next 30 years.More than one million induced abortions and an additional million unwanted children are an outcome of the gap between the need for family planning and the supply and uptake of necessary services in Punjab. Since this gap has persisted for a decade or more, traditional approaches are unlikely to escalate change. PPIF, as its name suggests, offers an opportunity to innovate and find out-of-the-box, effective approaches for family planning communication and service delivery. The direct goal of all interventions shall be to increase access to services, especially in the underserved urban and rural areas, through innovative approaches in communication and service delivery. PPIF has set 4 Strategic Objectives which includes increasing accessibility of FP services, strengthen male engagement, reducing cost related barriers, promoting youth centered FP information & services and Social Behavior Change Communication with a view to achieving the Punjab Growth Strategy’s objective of reducing fertility to couples’ desired levels. PPIF in its first program cycle, piloted the door-step service delivery model also known as Community-Based Family Planning (CBFP) model aimed at reaching underserved communities at the convenience of their homes by improving access to family planning advisory and health services. PPIF piloted this model through locally trained women as Community Resource Persons (CRPs), called Noor meaning ‘light’ in this program cycle. A network of trained public and private health service providers was developed to improve access to FP services. Group awareness session and information dissemination through audio-visual and print material were conducted for demand generation. The program cycle aimed to implement the global high impact practice of door-step family planning service delivery in rural LHW uncovered UCs of District Muzaffargarh and peri-urban UCs of District Rawalpindi while testing the integration of socio-economic empowerment of women (called Noors) as community-based workers. Noors, were setup at their houses in Muzaffargarh. These shops not only acted as entry points for communities to access household items, women health and hygiene products but also served as family planning information points for community women. Similarly, in Rawalpindi, business-in-box bags were given to the workers with similar products that women could sell at door-step during household visits while providing family planning advisory and short term contraceptive services. Drawing on the success of the CRP model, PPIF scaled up this model in additional 10 districts which includes Rawalpindi, Sheikhupura, Lahore, Nankana, Faisalabad, Gujranwala, Kasur, Chiniot, T.T. Singh, Sargodha, Lahore & Rawalpindi. The duration of the call is 27 months. Through this intervention, it is expected to reach 823,000 MWRAs with FP information. Despite husbands predominantly being the decision makers of the household and their understanding of family planning significantly affecting women’s use of contraception, most family planning programs in Pakistan are still largely directed at women with limited opportunities for men to acquire information, counselling, and services. The fertility preference of men is increasing and currently stands at 3.8 births per woman as compared to that of women which is 2.8. Hence, engaging men in family planning programming is critical to address the socio-cultural barriers, which can severely limit their capacity to support their wives’ adoption of family planning methods. PPIF has piloted 03 interventions in districts Lahore, RY Khan, Muzaffargarh, Multan, Bahawalpur, Gujranwala, Faisalabad and Rawalpindi to improve informed choice of FP methods and services, joint decision making and accessibility of quality family planning information and services. A multi-pronged approach of globally proven and promising innovative FP practices was implemented to generate evidence for an accelerated FP uptake by engaging both men and women. In this regard, men and women were reached by increasing information channels through community workers and tele-health and provided with FP services through a network that includes previously untapped Male GPs, Hakims, Homoeopaths and Pharmacies with referral linkages to female health service providers. The success of these interventions has made the path towards the scale up in 28 districts of Punjab. Likewise, it is also pertinent to highlight social issues through SBCC interventions innovatively and engagingly that not only allows to clarify the myths and misconceptions regarding family planning but also initiates discussion among the masses. Coordination between service delivery and SBCC also helps programs achieve desired behavioral and health outcomes by ensuring smooth operations and a balance between supply and demand for services. In this regard, PPIF has launched a program call specifically aim to improve family planning knowledge, positive attitudes and practices through systematic and evidence-based Social and Behavior Change Communication Interventions. This intervention is categorized into three broad communication strategies, one is interpersonal communication and another is digital health in districts Rajanpur, Sheikhupura, Okara, Sargodha, Jhang and Sialkot. Lastly, Mass media component under which a drama serial is being developed on FP. Globally, unwanted fertility is more common among poor, rural, and uneducated women than among their well-off, urban, and educated counterparts, although this disparity is much smaller in countries with strong family planning programs. The existence of affordable government family planning facilities, it is difficult to ensure that quality services are affordable, and people can choose, obtain, and use contraceptives whenever they want them. In 2018, PPIF entered into a tripartite agreement with BISP to reach the poorest of the poor with FP services and Population Council as the research partner. This pilot was tested in District Rahim Yar Khan through which free FP services and commodities along with the transportation cost were provided to eligible Married women of Reproductive Age among BISP beneficiaries through electronic FP vouchers. The model is being scaled up in 4 districts of Punjab. Lastly, PPIF is committed to working with young people by expanding access to quality information through increased channels, integration with education programs, knowledge generation on changing youth needs and most importantly creating structures to ensure meaningful and sustainable youth engagement on family planning at all levels. PPIF has designed a program which primarily focuses on providing youth friendly services including managing provider bias and confidentiality, training of health service providers and youth friendly clinical modifications. The intervention is being implemented in Districts Attock, Khushab and Lodhran. Also, students are being sensitized on SRHR in academic institutes of Punjab. PPIF also established 5 adolescent and youth friendly centers under the project funded by UNFPA. Punjab FP Program (2023-27) has been launched with the support ofthe World Bank. It is being implemented by Primary and SecondaryHealth Department, Population Welfare Department and PunjabPopulation Innovation Fund in all districts of Punjab. PPIF will beimplementing two components in the program i.e. E-Voucher forBISP Beneficiaries and spreading awareness through Mass Media.