In Pakistan, PSI’s independent network member is the national nonprofit organization, Greenstar Social Marketing Pakistan (Guarantee) Limited. Established in 1991 with the support of PSI, Greenstar supports the private sector through national provision of a broad range of high-quality family planning products. As an ‘independent network member’, Greenstar is a fully independent entity integrated into the larger PSI network.
This gives it access to cutting-edge marketing and communications techniques, commodity procurement, program management, financial stewardship, contract management, reproductive health technical expertise, and organizational development systems. Through in-country staff, remote and short-term technical assistance, and an active role on the Greenstar Board, PSI provides management and technical support to Greenstar leadership to improve the quality of services their outlets offer. The focus is placed on innovative private sector approaches and evidence‐based decision‐making. This support has spanned multiple health areas, primarily in reproductive health and family planning but also in malaria, tuberculosis, child health and HIV.
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. In order to help meet this gap, Greenstar offers a range of 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 national network of over 7,000 franchised clinics, 70,000 retail outlets and community-based distribution. Greenstar also provides training and quality assurance to the private sector social franchise health outlets within their network. Greenstar is responsible for provision of approximately 53% of all contraceptives, distributed by the private sector in Pakistan.
Market Development Approach (MDA)
PSI’s MDA in Pakistan is to conduct comprehensive research on the family planning market. This involves looking at the full spectrum of products and supply chain actors, as well as need and demand for these products. This approach builds evidence to understand how public, private and nonprofit actors can work together, to increase and improve the market for the benefit of market players and health consumers, who will have better access to the products and services they want and need.
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
Greenstar’s family planning programs also provided 1,963,697 couple-years of protection.
Family Planning
PSI leads multiple projects focused on increasing access to family planning products and services. PSI provides technical support to Greenstar for the ‘Increasing Access to and Use of Long Term Methods of Family Planning and Post Abortion Care Services’ project funded through a private foundation. This project seeks to increase access to long-term reversible contraceptives, such as IUDs and implants, by increasing the availability of these products and the number of providers that perform insertion services. It also runs campaigns to improve perceptions of and demand for long-term methods. The project also works with service providers to increase the provision and quality of post-abortion care services.
PSI also receives funding support from the United Kingdom’s Department for International Development (DfID) to implement the Delivering Reproductive Health Results (DRHR) project through non-state partners. The goal of this funding is to use a social marketing approach to expand the availability of and access to high-quality, contraceptive and reproductive health products and services. Increased provision and use of family planning services and products is achieved through support to private clinics, shops and pharmacies. Community-based distribution is targeted to under-served urban and rural areas of Punjab, northern Sindh, Khyber Pakhtunkhwa, Baluchistan and the Federally Administered Tribal Areas. Other implementing partners on this program are Greenstar, the Rural Support Programmes Network (RSPN) and the Health and Nutrition Development Society (HANDS).
Partners
GREENSTAR
Greenstar has a multi-channel, commercial distribution network, and it also maintains a social franchise of female service providers offering an integrated package of services. These include a range of family planning, reproductive health, and maternal and child health interventions. The service providers include medical doctors as well as female 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 and rural clinics. The DRHR program supports social marketing efforts while private funding supports social franchising.
HANDS
The Health and Nutrition Development Society (HANDS) was founded in 1994 as a small local organization and has grown to 31 branch offices with 1,900 staff across the country. As an implementing partner of the DRHR project, HANDS provides access to reproductive health services in three districts of Sind.
HANDS’ key expertise is in community development and disaster management. It has developed more than 100 best practice models for health, education, livelihoods, community infrastructure, and disaster risk reduction. HANDS pilots and assesses these models for both impact and cost efficiency.
RSPN
The Rural Support Programmes Network (RSPN is the largest civil society network of Pakistan, representing 11 Rural Support Programmes (RSPs)). Under DfID’s DRHR project, RSPN supports community mobilization and reproductive health services in ten districts of Sind and three districts of Punjab.
The RSPN’s mission is to reduce poverty and improve livelihoods of the poor in Pakistan, through a community-driven development approach. RSPN’s strategic strength is the outreach that the RSPs provide throughout the country. RSPs are currently working in 125 of 144 districts of Pakistan and have mobilized almost 7 million rural households into nearly 400,000 community organizations at the neighborhood level, and 1,313 local support organizations at the union council level. The RSPs’ approach has also been adapted in India, Afghanistan, Tajikistan and Myanmar.
Tuberculosis
Tuberculosis (TB) is a major public health problem in Pakistan, ranking it fifth among the TB high-burden countries in the world. Approximately 42,000 new TB cases emerge every year and half of these are sputum-smear positive. Pakistan is also estimated to have the fourth highest prevalence of multidrug-resistant TB (MDR-TB) globally.
Greenstar is working in collaboration with national and provincial (TB) control programs to address the TB epidemic. Together, they are training private health care providers, strengthening private laboratories and creating community awareness and mobilization. Ensuring diagnosis, follow-up and treatment within the communities are also prioritized. Greenstar has trained more than 15,000 private sector providers in TB directly-observed therapy (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.
Donors
- UK Department for International Development (DFID)
- The Federal Republic of Germany through KfW Entwicklungsbank (the German development bank)
- Private Foundations
Partners
- Rural Support Programme Network
- Health and Nutrition Development Society
- Private foundation support
- Association Between the Quality of Contraceptive Counseling and Method Continuation: Findings From a Prospective Cohort Study in Social Franchise Clinics in Pakistan and Uganda
This article presents evidence from social franchise clinics in Uganda and Pakistan showing that discontinuation rates for modern contraceptive use were lower among those women who received more information about their method (scored on the Method Information Index). This demonstrates the importance of quality of care in helping Sara to make informed decisions about her reproductive decision-making, and ultimately to be able to continue to use a method for which she has a need. - 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.