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Adapting to COVID-19 – Blending critical needs with sexual and reproductive health and rights in Pakistan

This is an interview with Tabinda Sarosh, Pathfinder’s country director in Pakistan, and Xaher Gul, a senior technical advisor in Pakistan.

At Pathfinder, we often talk about ‘strengthening health systems’ as a critical facet of our work. But in recent weeks—and surely in the upcoming months—this technical jargon will have critical, real-world impacts. As COVID-19 spreads, Pathfinder’s programs on the ground are working to rapidly adapt to a new landscape, and to scale up immediate responses and ensure continuity for our sexual and reproductive health services despite the pandemic and COVID-19 risk.

Our Naya Qadam project, based in Pakistan, is a stellar example of this work. Funded by the Bill & Melinda Gates Foundation in Pakistan’s Punjab and Sindh provinces, Naya Qadam reaches thousands of young women ages 15 to 24 at a critical time—after a pregnancy—and gives them the power to decide if or when they want to become pregnant again.

Just a few weeks into a global pandemic, our in-country leadership have developed a four-pronged plan to incorporate COVID-19 response into both short-term actions and longer-term needs and adaptations.

The response includes four main approaches, each of which is rapidly evolving: commodity security, communications, access to services, and policy support. Each approach is integrated with gender-transformative lens. They build upon two years of health systems strengthening and infrastructure development undertaken by the Naya Qadam project, and 30 years of Pathfinder’s work in Pakistan—giving us a strong starting point.

First, we must ensure commodity security.

Commodity security is a challenge in many of the places where Pathfinder works, and COVID-19 will exacerbate this challenge. But a nimble response ensures as much continuity as possible. In practice, this means taking a number of steps. First, Pathfinder needs to assess what supplies the health system has (for family planning and personal protective gear). Then, we take a look at the current stocks of goods available. Finally, we determine where the supplies are located, and how to shuffle them to necessary locations in advance of the COVID-19 infection spreading. While we must anticipate disruptions, strong infrastructure exists within Pakistan. The Pathfinder International Pakistan team works with the public sector to help distribute goods and create budgets to inform procurement for goods moving forward.

Second, we must undertake a Naya Qadam COVID-19 response communication campaign.

Reaching all members of a community with messages on COVID-19 safety is a critical step, but any communications campaign must be targeted to ensure that all members of the community receive messages, including the most vulnerable and hard to reach. But we don’t need to reinvent the wheel to disperse these messages—we simply need to tweak our existing approach. On the ground, this takes place in a few ways. First, we use vehicles to play recordings in communities served by Naya Qadam, broadcasting messages as they drive through towns. Second, we work with local Imams. Each day, these Imams are accustomed to bringing everyone in with the call to prayer. As mosques are shut down, we can work with Imams to disperse critical messages on COVID-19, a call that is literally heard throughout entire communities. Each of the messages must be tailored to the influencers who are distributing them. For example, Imams will be dispersing a different iteration than an influencer who is speaking on TV. Behavioral frameworks help inform the specific messages.

Third, we must ensure continued access to services.

Despite living through one of the greatest global health care challenges in our time, we must continue to provide essential sexual and reproductive health services, while maintaining the safety of frontline workers and the women they reach.

So how do we do this?

We start by using the infrastructure we already have. In Pakistan, we have clinical supervisors who work with midwives and Lady Health Workers. To adapt to COVID-19, we are creating virtual WhatsApp clusters so we can continue to be in contact. These virtual WhatsApp clusters allow for digital support and supervision among service providers, provider trainings on responding to the pandemic and its implications for provision of sexual and reproductive health services, and virtual meetings with master trainers. While it’s not a perfect remedy for in-person work, it allows us to maintain service and information flow to those women who need it most.

We also need to be cognizant of equity issues, as many women who depend on Lady Health Workers don’t have access to mobile phones. To this end, we will build in communications via traditional birth attendants and Naya Qadam youth champions while sustaining recommended, evidence-based physical distancing practices during interactions.

Last, we must ensure policy relevance and support.

Effective responses require that strong policies are in place. Any sustainable and long-term solution will have to incorporate strong national policies in order to have positive impacts on communities. Much has been accomplished by the Government of Pakistan in terms of implementing the mandates from FP2020. All four provinces in Pakistan have drafted costed implementation plans for family planning and built task forces made up of public and private stakeholders.

As Pathfinder and Naya Qadam evolve past the initial emergency response phase of this epidemic, protecting progress made toward FP2020 and ensuring good policies emerge will be at the forefront of our work.

What’s next?

None of this work, or the adaptation of it, is created in a vacuum. As COVID-19 spreads, it’s a matter of adapting that which we already know and already do and utilizing the tools at our disposal to create a rapid, inclusive response, one that keeps our staff, and our beneficiaries safe.

Infectious disease epidemics, like the Ebola epidemic and COVID-19, exacerbate gendered vulnerabilities in a myriad of ways from the suspension of critical sexual and reproductive health services, all the way to the long-term negative costs to women and girls post-crisis, including to girls’ school enrollment and women’s empowerment broadly.

As the next few weeks and months evolve, remaining adaptable, and bringing solutions from the ground up, will allow Naya Qadam, as well as Pathfinder programs worldwide, to confront these new challenges swiftly and thoughtfully, putting women and girls and their families at the center of what we do.

For more videos from our recent interview with Dr. Sarosh and Dr. Gul, visit our YouTube playlist on Naya Qadam’s evolving response.