Why Pathfinder Works in Pakistan
Pakistan is the sixth most populous country in the world with more than 43 million women of reproductive age. With maternal mortality rates estimated to be around 376 per 100,000 live births, approximately one in every 93 women in Pakistan will die from preventable causes related to pregnancy and childbirth. Pakistan also has a high unmet need for family planning at 25 percent, which is largely a result of lack of access to services and lack of trained medical professionals and staff able to provide family planning services, in addition to a high prevalence of misperceptions regarding the use of contraception.
Recognizing Pakistan’s need for reproductive health and family planning services, Pathfinder began working in Pakistan in 1950. Today, with funding from The Bill and Melinda Gates Foundation and the David and Lucile Packard Foundation, Pathfinder works to implement programs promoting modern family planning methods, improved awareness of family planning options, and increased contraceptive prevalence. Pathfinder is working in close association with the provincial governments of Punjab and Sindh, as well as various local NGOs, focusing on generating demand for services and increasing awareness of the healthy timing and spacing of pregnancy, with the goal of improving the health of mothers and their children.
Pathfinder also works to advocate and build consensus towards implementing the Karachi Declaration, the landmark pledge signed by the Ministries of Health and Population Development in Pakistan in 2009 to promote the scale-up of best practices to improve maternal, child, and neonatal health and family planning. Pathfinder’s advocacy approach in Pakistan includes identifying government provincial “champions” for reproductive health, developing and disseminating advocacy messages, and working with religious leaders and other community leaders to promote health-seeking behaviors.
Evidence for Decision-Making
A key aspect of Pathfinder’s approach to systems’ strengthening is collecting evidence that enables public, private, and community partners to make informed health-related decisions. In Pakistan, examples of the kinds of evidence we collect to range from the “number of clients redeeming vouchers for private sector services (by family planning method)” and the “number of trained community reformers (religious leaders and teachers) that promoted healthy timing and spacing of pregnancy through community events in the past quarter” to the “number of female health workers trained on family planning counseling, referral, and audience segmentation skills.” Some illustrative data from Pathfinder’s work in Pakistan indicates that from November 2009 to May 2012:
- 593 female health workers were trained in the area of family planning counseling and referral
- 49 master trainers, 43 home care providers, 22 religious leaders, and 25 male secondary school teachers have been trained in family planning. These training attendees also supported the development of district strategies to scale up best practices in family planning in 60 districts in Pakistan.
- Pathfinder reached over 89,000 people in Pakistan with contraceptive services
Building Capacity, Strengthening Systems
Pathfinder is committed to building capacity with government and local partners to integrate high-impact and cost-effective family planning and reproductive health best practices into maternal, neonatal, and child health services throughout Pakistan. Pathfinder has worked strategically to ensure the strengthening of the government’s family planning programs at the provincial and district levels, particularly since Pakistan’s decentralization of the health system in 2010. In partnership with local district government, Pathfinder planned, organized, and facilitated workshops to reinforce best practices in family planning, reproductive health, and postabortion care. These best practices were then used to develop district action plans, which will be implemented in collaboration with provincial governments and district offices to improve services for women and children in 60 districts.
In addition, Pathfinder is working closely with national partners to remedy the acute shortage of qualified healthcare specialists and adequate health facilities in rural areas of the country. The World Health Organization (WHO) estimates that 70 percent of the population never sees a doctor in their lifetime. To address this gap, Pathfinder has focused heavily on strengthening the capacity and skills of Lady Health Workers—government-trained, community-based primary health care workers, who along with providing health services, are also able to educate and provide family planning methods and maternal and child health services to women in their homes. Pathfinder also works with the Department of Health and other stakeholders to strengthen the health care system by improving monitoring of service delivery and assessment at various supervisory tiers. Training modules developed by Pathfinder have already been adopted by the Pakistan Nursing Council, a national regulatory entity that registers all nurses, midwives, and Lady Health Workers in the country, and are being used by the Punjab Lady Health Workers to standardize service delivery in the areas where they work.
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