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PARTNERSHIPS FOR ENHANCED ENGAGEMENT IN RESEARCH (PEER)
Cycle 7 (2018 Deadline)


Enhancing reproductive health services use by married adolescent girls - role of women volunteers

PI: Tasleem Akhtar (tasleem.akhtar@gmail.com), NUR Center for Research and Policy
U.S. Partners: Adnan A. Hyder, George Washington University, and John Sandberg, George Washington University
Project dates: January 2019 - December 2020

Project Overview

7-226_Akhtar team
 Photos courtesy of Dr. Akhtar
Low use of contraception and modern contraceptives among married adolescent girls and young women who constitute more than 20% of married women of childbearing age population is dragging down the increase in Pakistan’s Contraceptive Prevalence Rate (CPR). Community mobilization to facilitate the access of Lady Health Workers (LHWs) to this age group for the provision of FPRH services needs to be tested to address the issue.

The study’s major objective is to test the effectiveness of community women volunteers in facilitating access of Lady Health Workers (LHWs) in the Lahore district of Punjab province, Pakistan, to the marginalized group of married adolescent girls ≤ 15-19 years and young women aged 20-24 years, for purposes of providing Family Planning and Reproductive Health (FPRH) counseling, supply of oral contraceptives, and for purposes of improving their family planning and reproductive health practices.

Study Hypothesis:
  • Community women volunteers will be able to provide facilitation to Lady Health Workers to access married adolescent girls and young women
  • Male involvement in inception phase will increase the chances of success of the volunteer-LHW model
  • Role of women volunteers and women councilors to support  Lady Health Workers, will facilitate the access of  Lady Health Workers to married adolescent girls and young women. This will increase modern CPR and improve reproductive health of married adolescent girls and young women.
The study results will be immediately applicable to the initiatives currently ongoing in the province for boosting FPRH, as the Government of Punjab is currently implementing the Punjab Health Sector Strategy (PHSS) 2012-2020. The results of the study are anticipated to inform health policy and strategies currently being implemented in the Punjab province. Other provinces should be able to use the results relevant to their health services delivery and population needs. The study is in line with the USAID development objective for Pakistan of “Increasing the reach of public health systems, to save the lives of women and children, strengthen families and communities, and help develop a healthy workforce.”

Summary of Recent Activities

During October-December 2019 reporting period, the main focus of the project was on smoothly carrying out the intervention activities and catering to problems on ground. The activities included;
1. Collection of Monthly Reports from LHWs: The second monthly reports were collected from the Lady Health Workers (LHWs) on October 30, third monthly reports on November 30 and fourth monthly reports on December 30th. The Field Monitoring and Supervisory and Monitoring Team Member (FSMST) collected  179 reports from LHWs,  scanned them and stored the in the Google Drive. The hard copies are stored in a locked cabinet. The dates for the collection of monthly reports from the LHWs are determined to coincide with the monthly ‘Sehat Meetings’ of the LHWs.  
2. Collation and processing of data of Monthly Reports: The data of each month’s reports was collated to summarize the findings of month, list the problems faced and the LHWs initiatives to mitigate those. The summarized reports are uploaded to the relevant Google Drive Folder   A common problem that has prevailed through out the months of intervention has been that volunteers seek renumeration for their services  in contradiction to the purpose of the project. Moreover, time constraints were underlined as a problem with volunteers saying that they can not take time out for this purpose. However, with the passage of time the intervention activities have become smooth with constant effort of the FSMT by telling them that the project does not seek extra time from them, but are integrating the message in their routine meetings with women and everyday tasks. Issues such as shortage of contraception and medication from the government does create hindrances in their way to deliver the message of family planning, however, such issues are dealt with in real time and the objective of the concept of volunteers is being achieved. 
3. Spot Checks: the Research Team and the Principal Investigator (PI) agreed that the research team members will go and visit various locations within the target area at randomly selected dates to ensure that field tasks and timelines are running smoothly. Moreover, it is done in order to have interactive sessions with the volunteers where they may be allowed to comfortably address their issues and be provided with substantial mitigation strategies. At this point, the LHWs and Volunteers have well understood the concept and purpose of the study therefore, issues such as renumeration and not having enough time are minimizing. However, if such issues do arise, these spot checks help us resolve those by reiterating the message and purpose of the study.
4. Preparation of Manuscript for Publication: A paper for publication on some of the Focus Group Discussions (FGDs) generated data is being drafted. The paper will report community perceptions and opinions about family planning and the services being provided to them by LHWs and husbands interaction
with LHWs. For this, the FGDs audios were re-transcribed to extract more detailed data. Themes from the data are being derived.

Future Plans
• Study Intervention testing phase will continue until August 31, 2020. Each FSMT member has been allocated a specified number of LHWs to supervise and monitor and collect their monthly interaction reports with their CWVs.
• Three to six monthly reports are expected to be collected over the coming 3 – 6 months.
• Data Analysis: Analysis Plan of Baseline Data will be completed during the visit of Prof. John Sandberg. Data Analysis will be completed by mid-April 2020.
• Baseline Data Report: This will be completed by May 2020.
• Publication of FGD generated data. Paper is expected to be completed and submitted for publication by April 2020
 
 
 
7-226_Akhtar team LHS and LHW7-226_Akhtar town map
  This map represents the approx. locations of field work in Nishtar Town UCs.
 

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