In order to cater to the SRH needs of young people, Rahnuma-FPAP provides Youth Friendly Services (YFS) to young people through its static clinics. The objective of the YFS component is to increase the provision of quality, youth-friendly adolescent sexual and reproductive health services through well trained service providers (Doctors and Counselors). At Rahnuma-FPAP’s Youth Friendly Centres young people have access to voluntary counseling and testing (VCT) centers, HIV/AIDS/STI, management and care, post abortion care related services and laboratory services. To attract a large number of youth for these services, timings were changed from morning to evening. This has resulted in considerable increase in the number of youth availing services in YFCs. Furthermore Rahnuma-FPAP also provides SRHR Services to youth through mobile health camps in outreach areas, including communities, education institutions, etc.
We have enrolled more than one hundred and twenty private practitioners as a referral partners and MOUs were signed with them to provide SRH services to young people. Prior to formally allowing them to execute their services, capacity building trainings on Youth Friendly Services were conducted for their benefit. In this regard, a Quality of Care (QoC) Manual titled “How to Ensure Quality Youth Friendly and Reproductive Health Services” was piloted at Service Delivery Points. This private practitioner engagement model has resulted enhanced capacity building of thirty new service providers. The model has also brought about an increase in the number of beneficiaries received; (both male and female school students) now receive Micro-nutrients and medicines that are distributed among 5-10th grade students. More than 1373 families of school students (male and female) were registered for the provision of SRHR information and services.
Furthermore, forty referral meetings were conducted with different organizations to enhance service delivery referral mechanism and increase access to specialized SRH and other health care services for young people and their families’, especially male family members.
Integrated package of essential services (IPES) includes contraceptives, HIV and AIDS, STI/RTI, Gynecology, Obstetrics, Urology/Andrology and counseling services. All these services are available at Youth Friendly Clinics and are accessed by young people especially young married girls at Rahnuma-FPAP’s service delivery points. Performance data clearly reveals an increase in the uptake of services and outreach activities.
The implementation of IPES is supported by the Quality of Care assurance system to ensure that SRH services are of high quality, are integrated and rights-based. IPPF has made considerable progress in implementing the IPES across South Asia Region. All Member Associations (MAs) provided IPES services which included sexuality counseling, contraceptive services including emergency contraception, safe abortion care, and reproductive tract infections/sexually transmitted infections (RTIs/STIs), HIV, gynecology, prenatal and postnatal care and sexual and specialized care for gender-based violence.
To increase the outreach of services especially in far-flung rural areas where the mobility of women and youth is restricted, mobile camps were set up to provide access to SRHR services and information to marginalized groups such as young mothers and out of school youth. We have set up more than four hundred mobile camps and they remained very effective in registering more clients and provided them with SRHR services. Young people discussed their SRHR issues with qualified staff and received services. These mobile health camps were arranged with the coordination of Rahnuma-FPAP’s young peer educators. It benefited Poor Marginalized Socially Excluded Under Served (PMSEUS) group of people, female prisoners residents of Dar-ul-Aman (young girls & women protection center), Sex workers and Transgenders who felt ashamed, and hesitant to visit clinics received quality services through mobile camps. Resultantly, their medical and reproductive health needs were effectively addressed.
Counselling is one of the most important components of Sexual Reproductive Health Services and IPES package. Approximately 50% of women and young clients access counseling services through Rahnuma-FPAP’s health infrastructure. Service Providers provide counselling services on an individual basis. Counsellors provide free information, counselling and referral services regarding sexual reproductive health while ensuring complete privacy and confidentiality. In 2015, a wide range of SRHR services were provided to registered families and their family members; 100,723 services catered to the health needs of registered families, 25,573 counselling services were rendered, 52,510 general health services, 19,522 SRH and 938 family planning services were provided.
To monitor strict compliance with quality of care standards in Rahnuma-FPAP’s service delivery network, Quality Assurance Doctors are placed at all five regions. These doctors visit each SDP quarterly and conduct client exit interviews, informal interviews and FGDs. These QADs also conduct QoC trainings at each Program Management Office (PMO). To keep service providers updated with state of the art information regarding SRH and FP, QoC training workshops are also organized for Quality Assurance Doctors, Gynecologists and LHVs from all five regions at Rahnuma-FPAP’s Head Office.
Most poor people in developing countries get healthcare from private rather than public service providers. For SRH, the strongest evidence for market interventions showed that franchising can expand private sector access to family planning services for the poor; social marketing of FP messages and products can improve access for everyone and raise awareness and knowledge; private sector community-based workers can be trained to administer injectable contraceptives with a high quality of care. Social marketing is as or more cost-effective than other channels for getting contraceptives to those who want them, for increasing demand, and especially in reaching out to adolescents. Social franchising aims at ensuring access (increase the number of providers and services offered); and cost effective and provision of services in line with quality standards equitable. It thus seems imperative to harness the potential of private sector health providers who are willing to upgrade their knowledge and skills in order to add family planning to the services they offer and in this way, contribute to increased contraceptive use by making high-quality family planning services and commodities available and accessable throughout urban and peri-urban Pakistan.
It calls for partnerships between the franchisers and selected providers (franchisees) with the agreement that these providers would integrate a defined package of services, and deliver them according to the high-quality standards established by the former. In return, the franchisee receives specialized support, training, and rights to the franchise brand for as long as the franchisee maintains minimum quality standards. The franchisee also benefits from brand equity, indicating quality and reliability, created by the franchiser.
Delivering good quality care to all clients, wherever they are, is a fundamental principle of IPPF’s work. Good quality of care enhances clients’ satisfaction and their use of services. It increases job satisfaction and motivation among service providers, and it leads to greater sustainability of service provision.
IPPF promotes good quality of care by ensuring that clients have the right to information, access to services, choice, safety, privacy and confidentiality, dignity and comfort, and continuity of services and opinion.
To fulfill clients’ rights, the needs of service providers must be met as well. These needs include training, information, infrastructure and supplies, guidance, respect and encouragement, feedback and opportunities for self-expression.
IPPF’s ongoing efforts to improve quality assurance among its Member Associations aim to ensure:
High quality integrated services that, depending on the context, may include: counseling, provision of contraceptives and family planning, safe abortion care, care for sexually transmitted infections and reproductive tract infections, HIV, gynecology, gender-based violence services, adolescent sexual and reproductive health services, and maternal and child health care services.
- Increased coverage for poor, marginal, vulnerable and under-served groups by strengthening their broader service delivery system.
- A client-centric approach that is sensitive, confidential and respects sexual rights and diverse needs.
- Health services are implemented according to best practices and in adherence to quality assurance measures.
- Lessons learnt are shared with the broader community and integrated in advocacy work to inform broader policy objectives.
- Rahnuma-FPAP has worked to increase access to SRH services through static service delivery points (SDPs), mobile and outreach clinics, associated clinics and community-based distributors (CBDs).
- Concerted efforts have been made to reach remote and under-served areas by deputing a mobile team of doctors, nurses and paramedics. Mobile service delivery has been provided through sexual reproductive health service awareness sessions, special family planning sessions and services through mobile vehicles on specific days.
- Strengthened service delivery, building capacity of service providers on newer services, advanced techniques, integrated counseling, and investment in frontline workers to provide higher level of services. These strategies are combined with initiatives for education, awareness, leveraging the government system, building community ownership, developing key partnerships, upgrading infrastructure and commodities management.
There are 30 franchisees in 3 districts of Punjab which includes Lady Health Visitors and doctors, who are referred to as private service providers. The objective of the Franchisee Model is to increase access to the SRH services, through Social Franchising, with Private Practitioners (PPs), residing in peri-urban and rural areas of Pakistan. The strategy adopted was to build capacity of the selected number of PPs (30), so that they can provide additional SRH services, which they were not providing earlier (apart from the Family Planning Services). Capacity building was complemented by community mobilization, development of infrastructure, expansion of service packages and quality assurance, which was maintained and monitored by Rahnuma-FPAP.
b) Uninterrupted supply of Commodities:
Private Practitioners were supplied with commodities through Family planning representatives. The latter were responsible for the Continuous Medical Education of the providers.
c) Target population:
The target population for franchises is rural and poor, mostly married women. The market rate for Intra-Uterine Contraceptive Device (IUCDs) in the areas where these franchisees operate is Rs. 400-500, which is at least five times the cost of short term methods such as pills, injectables and condoms. Therefore, those who wish to use IUCDs and because of subsidized rates they are able to have access to long term family planning methods.
Rahnuma-FPAP spearheaded humanitarian services for marginalized and vulnerable sections of society affected by natural disasters and emergencies. Poor reproductive health compounds hardships faced by the underserved, poor and marginalized. Rahnuma-FPAP’s minimum Initial Service Package (MISP) and Standard Operating Procedures (SOPs) were formulated to aid disaster management efforts and minimize suffering.
MISP is a minimum standard set in the 2004 Sphere Guidelines, the 2009 IASC Global Health Cluster Guidance, as well as a CERF minimum life-saving criterion. In line with MISP Guidelines, we have carried out extensive MISP advocacy and lobbying efforts, launched the Research and Advocacy Fund (RAF) funded initiative during 2011/2012 and got MISP incorporated in Standard Operation Procedures (SOPs) of National and Provincial Disaster Management Plans (DMPs) of National and Provincial Disaster Management Authorities, including AJK, FATA and Gilgit Baltistan. The MISP (Minimum Initial Service Package.) is a set of priority activities designed to prevent maternal and neonatal mortality and morbidity, reduce HIV transmission, prevent and manage the consequences of sexual violence, and plan for comprehensive SRH services. The MISP includes equipment and supply kits, which complement a set of priority activities that must be implemented at the onset of an emergency in a coordinated manner by trained staff. The MISP can be implemented without a new needs assessment because documented evidence already justifies its use.
To further strengthen the advocacy success achieved, Rahnuma-FPAP launched SPRINT (I and II) Initiatives to institutionalize effective coordination amongst all stakeholders including NDMA, PDMAs and DDMAs through advocacy at large and trainings of the concerned personnel to improve health outcomes of crisis affected populations by reducing preventable sexual and reproductive health mortality and morbidity. The main objectives of this initiative are to build a supportive environment for SRH in crisis settings, to increase capacity for implementation of the MISP in humanitarian settings and to deliver a well-managed program underpinned by robust internal systems, monitoring & evaluation systems and lessons learned. We are actively working with National Health Emergency Preparedness and Response Network (NHEPRN), through its Reproductive Health Working Group, to strengthen the public sector’s capacity on MISP related SOPs.