A Word With the ‘Mother of Social Franchising’

Below, we talk with Dr. Rehana Ahmed, a Senior Reproductive Health Advisor at the World Health Organization.

PSI: Tell me about your background, your areas of expertise, and your professional journey.

RA: I am a medical doctor and also the daughter, wife and mother of doctors. I trained in Pakistan and UK, with an executive MBA from Columbia University. My area of focus is maternal and reproductive health, at the primary care level.

How did I get to this point? My personal awakening came when my elder sister, just a year older than me, had an arranged marriage at the age of only 19. This really hit me hard, because that seemed to be how things would go for me as well. I became determined not to go that route. I thought one way to avoid it was to get a professional education, so I worked to get into a premier medical college in Karachi. This delayed the prospect of marriage, got me into a profession and I also ended up marrying a classmate. Thus, I broke some of the social and cultural barriers women generally face in conservative families. If you don’t focus on education, the family thinks what is this girl doing? Getting her married seems to be the general answer, particularly where young women rarely live on their own or do things independently. But that doesn’t mean that I could forget that I was an eastern woman – where one has an obligation to fulfill many roles. I did all that plus in my case I was determined not to lose the thread of my professional life. In Pakistan, when girls get into a profession first and marry after, they often end up having to leave their job, for lack of family support. I think if we can help women keep their professional track going, it is easier to scale back and then pick up when they can, because once the foundation is laid one can keep building upon it. Too many women doctors set aside their careers and it has become a cause for national concern.

I do believe I also played a noteworthy role in my husband’s successful career, all the while keeping in touch with my own and in the upbringing of our three children.

Our first son was born in UK, on the day that man landed on the moon. He graduated from Yale and completed his JD/MBA from Harvard. Our daughter, who is two years younger than him, is a doctor in the UK NHS; and our youngest has a PhD in philosophy from Exeter University UK. I believe early parenting efforts and energy have an impact on our children’s academic success. As my husband was a busy surgeon, it meant the day-to-day responsibility for their discipline was mine. Needless to say my early professional career was impacted, yet I persevered and did not let go and PSI played a substantial role in my steadfast determination.

PSI: How did your engagement with PSI shape your career ambitions?

RA: When our youngest son graduated from Brandeis University, he elected to pursue philosophy. While he awaited admission for his Masters program, he needed books that were not available in Pakistan. I remember asking Dick Frank (the previous PSI CEO) to bring a few of these from America on his next visit to Pakistan. When he arrived a few weeks later, he had placed a pile of books on my desk, saying he had hand-carried them. I was overwhelmed, it was a heavy burden he carried—literally!

Dick also gave me a book, the biography of Katharine Graham, her evolution from a housewife to the chairman of a major publishing company. He said that one day I would become a CEO. Dick’s belief in me—and support for women—had some influence in the direction of my career.

Although I started as a training manager at Greenstar Social Marketing, I did rise to become CEO, just as Dick Frank had envisioned, and now at culmination, I am the top governance officer—Chair of the Board of this very same NGO. My profession spans over medical practice into management, leadership and governance. With a lifelong mindset of learning, I relished in innovations; a successful example is Social Franchising for Greenstar Social Marketing, designing a service delivery channel in partnership with over 7000 private health clinics—without owning any one of them. It can be described as the UBER for family planning & mother and child health.

I recall being told that social franchising can only happen in Pakistan, which was not true because I was able to propagate the model to several countries in Africa and Asia. In a 2013 Stanford Innovation Center newsletter is a quote* that calls me the mother of social franchising. It took me by surprise but I suppose when you move something out of Pakistan and into several countries it is noticed, especially by donors and the development community. Now PSI is tweaking the model into social enterprises in several countries.

The next phase of my career started in 2004, when my husband transferred to East Africa, we lived in Kenya and Tanzania for 14 years. By then our children were adults and I had time to focus on the skills that I had acquired along the way.

PSI: With your kids grown, you had the opportunity to re-focus on your career. How did this shape the professional journey that ensued?

RA: In East Africa I first became the reproductive health specialist for the UN Millennium Development Goals project in Nairobi, my work was with the Jeffrey Sachs Model for the Millennium Villages. My position there was funded by the Packard Foundation. When I completed this contract, I became a freelance consultant.

MSI recruited me as an advisor for setting up their franchises, which we rolled out in 17 countries. I visited most of these countries and would explain the approach to local staff. I really had a great time developing people and helping them to understand what franchising for health services meant and what steps were needed to bring the model to life. We developed the manuals and the materials that were required. Then again in Kenya, FHI360 asked a group of us to develop their franchise for HIV/AIDS, they called it Gold Star. So there was Greenstar in Pakistan, Blue Star in several countries, and then Gold Star. While PSI had 22 social franchises funded by the large anonymous donor, they didn’t have one common brand, instead allowed each country to develop their own branding relevant to local context. There is evidence that social franchising as a health services model can increase access and improve the quality of services and if scaled up could add to national impact.

Upon return to Pakistan in 2018, I continued my consultancy work. My first assignment was through Population Council funded by UNFPA, I would rate this as a highly important piece of work, as it was to design the strategy framework for public-private partnerships for universal coverage (UHC) of reproductive health. It needs partnerships to reach UHC, especially in mixed health systems, such as in Pakistan.  

PSI: PSI certainly pops up in several places throughout your professional journey. How was it that you came to join the PSI Board and what motivates you about PSI’s mission to make it easier for all people to lead healthier lives and plan for the families they desire?

RA: My long affiliation with PSI is first because of Greenstar Social Marketing, which was co-founded by PSI. Both organizations continue to work closely together.

The story of my joining the PSI Board is very interesting. It was in 2007 that I was short-listed by the recruiters to interview for the CEO position at PSI. At that time I was in Kenya and they arranged a remote meeting, which was not such a common practice then. I in turn booked the UN conference room; it was late evening when I faced a screen with a Committee of a few PSI Board Directors in the DC office, these included Bill Harrop, Frank Loy and Gail Harmon. As I had traveled widely for my consultancy work, within Africa and Asia, and made a point of always visiting PSI offices on those trips, I was able to discuss what the PSI country offices were facing. My reproductive health work also allowed me to answer their in-depth questions. I had told the recruiters that I could not relocate to Washington but it seemed I remained a person of interest on their list. A few days later, I got a call from the Board Chair Frank Loy inviting me to join the PSI Board, this was an honor I accepted immediately, and I have been a PSI Board Director since 2007 to present, except for the one gap year because of term limits policy.

PSI’s mission aligns completely with my work. Serving low-income families globally is something I have been loyal to and stayed with from the very beginning. I have often heard poor women say, “I wish I had more for my children and not more children.” This is a very succinct way of saying how deprived children become when there are too many of them. When you work in the field, you really have no option but to realize the importance of the work that we do.

PSI: What does consumer-powered healthcare mean to you and how do you see it catalyzing change for the people PSI serves?

RA: The term consumer-powered healthcare (CPH) has not been popularized yet, so one has often to explain what it means. It is designing basic health care with the consumer at the center.

Consumers have to take responsibility for their own health and wellbeing, especially with prevention and health promotion. And now with the global community committed to both Universal Health Coverage (UHC) and to achieve SDG 3—health and wellbeing—neither can be achieved within current health systems unless we bring consumers into the forefront.

Consumer-powered healthcare means that people should be able to access health care and healthcare systems when they need it and without financial hardship. Another key component of this is self-care because it is cost-effective as an intervention and it offers a high return on investment to public health. If you are following all the self-care measures, then you are also helping improve health outcomes.

One can’t help but mention COVID-19. What are we telling people? We are telling people to wash their hands, put on a mask, keep a distance; all of this is behavior and it is consumer-powered education, a vital part of consumer-powered care. PSI and Greenstar are health leaders for prevention, so we need to push solutions that we know work to expand national UHC agendas. This includes digital and medical technology, like HIV self-testing in South Africa and Sayana Press in Pakistan. This is the way to give consumers the power.

And we can’t forget about youth. I remember participating in a PSI human-centered design training in Tanzania, led by a former Board member Pam Scott, and out of this we designed Adolescent 360, PSI’s flagship girl-centered sexual and reproductive health project. The evidence generated from the project proves that this is the way to go. It is not so much a discussion about should it happen, the discussion is about how much should go into the hands of consumers and when does care stay with the medical professionals. UHC can be achieved if we work in close collaboration with national governments and support from donors. Scaling it all up and making it substantial and sustainable are areas that we need our attention.

PSI: What are you looking forward to in the remainder of 2021?

RA: Back in Pakistan, I am Chair of Greenstar Social Marketing (GSM) Board and remain a Director on the PSI and PS Kenya Boards. I am also with the World Health Organization (WHO) Reproductive Health Scientific & Technical Advisory Group and teach the MSc Health Policy & Management Programme of The Aga Khan University, Karachi. All this will continue through next year.

In addition, I am going full circle and using some of my clinical acumen to provide medical advice through telemedicine. I am also open to taking on consultancy work.

PSI: Any final fun or interesting facts about yourself that you’d like to share?

RA: Over the years I have become a plant enthusiast (I am no gardener; that is hard work!). I have found it rewarding to know about plants and take their perspective when planting, their preference for sun or shade etc. When we were in Kenya and Tanzania, I found the vegetation lush and whatever you put in the soil grew easily. I took an interest in learning plant names and set a target for learning one plant name a day. So much so that my friends often send me pictures and ask the names of plants, instead of going to Google. I also think that if you are working with nature, you are very forward-looking because every day you can see something new and different. Plants do not allow you to become mentally old because there is so much hope. You simply will see something new each day.

When in Kenya I was learning Swahili and one day while on a forest walk, I asked the guide “wapi miti?” or “where are the trees?” What I was wanted to ask was ‘which is this tree’, and as we were standing in the middle of the forest, everyone had a good laugh.

* quote in Standford Center for Innovation in Global Health article about PSI: Taking a Service Model to Scale

Sign up to
Receive Updates

Donate to
Support Our Work