Greenstar Social Marketing Pakistan (Guarantee) Limited was established in Pakistan in 1991 as an affiliate of PSI and a nonprofit, nongovernmental organization. The organization’s mission is to improve the quality of life among low-income people throughout Pakistan by increasing access to and use of health products, services, and information.
Greenstar works through the private sector and with the Government of Pakistan, to inform and empower people and improve access to quality, affordable health products and services. The focal point of all Greenstar’s efforts is “Sitara” – the Pakistani woman with a need for healthcare. We work towards helping “Sitara” meet her health needs, and those of her family.
In Pakistan 25 percent of married women have an unmet need for family planning. Maternal mortality remains high, at an estimated 276 deaths per 100,000 live births. Infant mortality remains at 78 deaths per 1000 live births.
In order to help meet this gap in provision of health services, Greenstar offers a range of over 20 socially marketed products and services for family planning, reproductive health, mother and child health, tuberculosis, nutritional supplements for children and safe water. Greenstar’s products are distributed through a nation-wide network of over 7000 franchised clinics, 75,000 retail outlets and community based distribution. The private sector social franchise health outlets are strengthened by Greenstar’s training and health services team, which enhances skills of service providers and quality of services.
Recently, Greenstar has partnered with the public sector and donor agencies to implement voucher schemes, which provide subsidized access to institutionalized health care for mothers. The long-term goal of integrating maternal health and family planning initiatives is to increase access points for the provision of information and uptake of services.
At Greenstar we believe that as we meet the health needs of “Sitara”, we meet the needs of a nation.
Greenstar estimates that in 2015, its products and services helped avert 706,453 DALYs, including, by health area:
- 290,911 HIV DALYs
- 383,974 FP DALYs
- 31,568 TB DALYs
Greensatr’s family planning programs also provided 1,963,697 couple-years of protection.
Maternal and Child Health
In order to provide improved access to family health services and information, Greenstar has developed a social franchising model. Social Franchising applies commercial franchising strategies to the nonprofit health sector to efficiently expand access to higher quality health care that is affordable to under-served communities. This business model strengthens the capacity of the health system and service delivery.
Greenstar’s franchise female service providers offer an integrated package of services that includes a range of family planning, reproductive health, maternal and child health interventions. The service providers include medical doctors, as well as lower tiered health service providers such as lady health visitors to serve low-income populations. Greenstar trains the service providers and monitors quality of care. Inpatient counseling is supported by various community based demand-generation techniques and mass media campaigns. Maternal and child health services are also provided through Mobile Service Units (MSUs) and rural clinics. Following devolution, Greenstar is engaging with Provincial Governments for public-private collaborations.
Greenstar provides competency based training for health service providers in:
- Long-term family planning methods
- Antenatal and postnatal care
- Emergency Obstetric Care (EmOC)
- Neonatal care and child care
- Female sterilization procedure (voluntary surgical contraception)
- Post-abortion care
Trainings include both classroom and clinic-based sections, and are followed by quality assurance visits by Greenstar’s health services teams.
In order to increase the range of long-term family planning options available to women, Greenstar’s training team supports the introduction of new techniques such as post-placental IUCD and sub-dermal implants.
Greenstar is implementing voucher schemes to provide subsidized health care to women from low-income groups. Currently more than 80,000 vouchers are being distributed to women from the most resource-poor areas in Punjab and Sind, through a careful criteria of selection. Recipients of the vouchers have access to the following subsidized services through Greenstar franchised clinics and public sector providers:
- Antenatal care
- Postnatal care
- Facility delivery
- Family planning counseling
- Infant care (including immunization)
The quality of delivery is being monitored through a third party evaluator. The purpose of these voucher schemes is to provide equity, access and quality in the provision of maternal and child health services. In the long-term, the objective is to encourage health-seeking behavior by women in the communities being served by the voucher scheme.
Under-five mortality in Pakistan is 94 deaths per 1,000 live births. The major causes of death among children under five are birth asphyxia, sepsis, pneumonia, diarrhea and prematurity .
In order to address these causes, Greenstar has been actively involved in the distribution of Aquatab (a water purifying product) and BabyActive (a nutritional supplement for infants) among vulnerable sections of the populations, particularly those affected by natural calamities such as floods. Greenstar distributed more than 4000 Aquatab and 3000BabyActive in Shikarpur, Sindh, in a collaborative project with Unilever Pakistan Limited. Greenstar also provides training to traditional birth attendants in the poorest parts of Khyber Pakhtunkhwa and distributed 26,300 clean delivery kits to these traditional birth attendants.
Tuberculosis (TB) is a major public health problem in Pakistan: Pakistan ranks sixth among the TB high-burden countries in the world. Estimated TB prevalence is 350/100,000 and mortality due to TB is 33/100,000. Yet, TB is both preventable and curable.
Building on its experience in training and monitoring network providers, Greenstar has been working with the National TB Control Programme in five major metropolitan cities to train private providers in TB case detection, registration and treatment. The program is funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria.
Greenstar has trained more than 1,300 private sector providers in TB DOTS and successfully treated more than 40,000 patients. Greenstar contributes 30% of case detection targets in five metropolitan cities. Greenstar’s success in TB control activities has been due to its “active case detection” model: reaching out to the TB suspect and ensuring that the patient completes their full course of treatment. Since program initiation in 2005, Greenstar’s area of responsibility has expanded to include the training of providers and support staff in drug management. Greenstar’s efforts have contributed to continuity in the TB program and national supply chain management. Further, Greenstar as an affiliate of PSI, is making a contribution toward achieving the sixth Millennium Development goal of halting and reversing the incidence of TB by 2015.
- Procter and Gamble
- Johns Hopkins Center for Communication Programs
- Population Council
- Save the Children
- Pakistan Anti-TB Association
- Association for Social Development
- Mercy Corps
- Rural Support Programme Network
- Simplified Asset Indices to Measure Wealth and Equity in Health Programs: a Reliability and Validity Analysis Using Survey Data from 16 Countries
Many program implementers have difficulty collecting and analyzing data on program beneficiaries' wealth because a large number of survey questions are required to construct the standard wealth index. We created country-specific measures of household wealth with as few as 6 questions that are highly reliable and valid in both urban and rural contexts.
- Enabling the Healthy Spacing and Limiting of Pregnancies: Programmatic Approaches to Expand Postpartum IUD Access
Under the Support for International Family Planning Organizations (SIFPO) project funded by USAID, PSI published a technical brief on 'Enabling the Healthy Spacing and Limiting of Pregnancies: Programmatic Approaches to Expand Postpartum IUD Access'. The brief introduces the need for expanded postpartum family planning options, reviews the advantages and disadvantages of the PPIUD, describes the components of successful initiatives to add PPIUD to the range of options for postpartum women, and illustrates three different models for PPIUD service delivery through case studies from the Democratic Republic of the Congo, Guinea, Zambia and Pakistan.
- Birth Spacing Ad from Pakistan
Birth spacing ad for Pakistan
- Designing an Exclusive Breastfeeding Program in Pakistan
Exclusive breastfeeding (EBF) during the first six months of life carries greater benefits than mixed feeding with respect to morbidity and mortality from infectious diseases other than HIV. This brief looks at psychological benefits of breastfeeding and the barriers involved in designing an exclusive breastfeeding program.
- Breastfeeding in Pakistan Television Commercial
Greenstar, PSI's local affiliate in Pakistan, developed this video in conjunction with USAID and the Department of Health of the Government of Sindh, to encourage mothers to breastfeed their newborns within the first hour of birth. This message began airing in 2013 as part of a five-year maternal and child health program.
- 2012 Mid Year Region and Country Dashboards, Asia and Eastern Europe
Mid-year Asia and Eastern Europe region and country impact dashboards for 2012
- Assessing a Thematic Condom Advertising Campaign on Condom Use in Urban Pakistan
This study aims to evaluate the effect of a thematic advertising campaign for Touch condoms in Pakistan in 2009.
- Changes in the Proportion of Facility-Based Deliveries and Related Maternal Health Services Among the Poor in Rural Jhang, Pakistan: Results From a Demand-Side Financing Intervention
A maternal health voucher scheme provided voucher-paid services in Jhang, a predominantly rural district of Pakistan, during 2010. A pre-test/post-test quasi-experimental design was used to assess the changes in the proportion of facility-based deliveries and related maternal health services among the poor.
- Pakistan (2011): Understanding Dr. Imrana: The Sabzsitara Provider
This research is part of a triad qualitative research series to investigate the utilization of family planning products. Research is being conducted on the three main players involved in the process of decision making regarding family planning (in the local context): The husband, the wife and the health service provider. The purpose of the current study was to assess factors contributing to varying levels of performance among health service providers.
- Samina’s Story
More than three-quarters of births in Pakistan take place at home. Read Samina's story, and how a pilot voucher program is aiming to reduce maternal and infant mortality in the country.