36 outreach workers (called Aapis or sisters) were recruited from within the community to provide door-to-door counselling for family planning (FP), Business in a Box (BiB) products, contraceptives, and referrals. The selection was based on self-enrolment, time availability, and permissions from the household head to work outside the home. Selected Aapis received a 3-week interactive, pictorial-based, and low literacy-centered entrepreneurship training for counseling, marketing, sales, and basics of business management and planning, to enable local women as microentrepreneurs selling common need products to help community women overcome the issues of “mobility” and travel costs.
Aapis received a monthly stipend of PKR 3,000 (USD 27) and were asked to work for a minimum of 4-5 hours a day, 6 days a week, although work hours were not strictly monitored. Their income was further supplemented by a BiB revolving credit that was seeded with a grant of PKR 10,000 (USD 90) from which they could purchase common household or women-needed sale items such as sanitary pads, undergarments, cosmetics, baby diapers, kitchen supplies, and phone sim cards. Aapis had the flexibility to determine the products they carried and the pricing at which to sell them.
Aapis systematically visited and registered 35,771 households in the area, reaching 42,000 married women of reproductive age (aged 18-49 years) (MWRA). They used a one-page questionnaire to collect data on household demographics, FP needs, and empowerment indicators, provided FP counseling and contraceptives (condoms and pills), and referred women to local public or private clinics for long term contraceptive services (injections, IUCD, implants, or tubal ligation). Contraceptives were provided free of cost by the government's Population Welfare Department (PWD) and passed on to MWRA at no cost. Counseling technique was based on cognitive behavioral therapy (mCBT) that was adapted for low literate outreach workers in collaboration with the Department of Behavioral Sciences of the National University of Science and Technology (NUST), Islamabad.
Referrals were made initially to the local public sector clinic. From the third month onwards, referrals were expanded to 9 private providers (mainly female) that were trained by PWD trainers on family planning and LARCs, counseling and side effect management as part of a certified Hamari Sehat (our health) Network, and who carried a variety of method mix options. Healthcare providers (HCPs) also participated in the health camps and provided MWRA with antenatal or postnatal care along with FP services. They received supplies at subsidized costs (25% below market) that were replenished by AHKF.
If a MWRA accepted a new method or referral, Aapis would follow up on her in one week to ask about and provide support in case she encountered a side effect. Follow-up visits were based on a decision algorithm and recorded in the database.
A cluster of 6 Aapis was complemented with 1 male mobilizer. Male mobilizers (i) counseled spouses of MWRA that reported resistance to FP by their husbands (these were identified by the Aapis) and (ii) engaged local men in unstructured health-livelihood relevant discussions on economic benefits of smaller families and how they could expand income generation sources.
All data were recorded centrally, and key indicators such as number of visits by neighborhood, new users, and individual methods were depicted on an online dashboard. The project team reviewed this weekly with the research partner (Research and Development Solutions—RADS) to allow for program decisions.
Aapis received a monthly stipend of PKR 3,000 (USD 27) and were asked to work for a minimum of 4-5 hours a day, 6 days a week, although work hours were not strictly monitored. Their income was further supplemented by a BiB revolving credit that was seeded with a grant of PKR 10,000 (USD 90) from which they could purchase common household or women-needed sale items such as sanitary pads, undergarments, cosmetics, baby diapers, kitchen supplies, and phone sim cards. Aapis had the flexibility to determine the products they carried and the pricing at which to sell them.
Aapis systematically visited and registered 35,771 households in the area, reaching 42,000 married women of reproductive age (aged 18-49 years) (MWRA). They used a one-page questionnaire to collect data on household demographics, FP needs, and empowerment indicators, provided FP counseling and contraceptives (condoms and pills), and referred women to local public or private clinics for long term contraceptive services (injections, IUCD, implants, or tubal ligation). Contraceptives were provided free of cost by the government's Population Welfare Department (PWD) and passed on to MWRA at no cost. Counseling technique was based on cognitive behavioral therapy (mCBT) that was adapted for low literate outreach workers in collaboration with the Department of Behavioral Sciences of the National University of Science and Technology (NUST), Islamabad.
Referrals were made initially to the local public sector clinic. From the third month onwards, referrals were expanded to 9 private providers (mainly female) that were trained by PWD trainers on family planning and LARCs, counseling and side effect management as part of a certified Hamari Sehat (our health) Network, and who carried a variety of method mix options. Healthcare providers (HCPs) also participated in the health camps and provided MWRA with antenatal or postnatal care along with FP services. They received supplies at subsidized costs (25% below market) that were replenished by AHKF.
If a MWRA accepted a new method or referral, Aapis would follow up on her in one week to ask about and provide support in case she encountered a side effect. Follow-up visits were based on a decision algorithm and recorded in the database.
A cluster of 6 Aapis was complemented with 1 male mobilizer. Male mobilizers (i) counseled spouses of MWRA that reported resistance to FP by their husbands (these were identified by the Aapis) and (ii) engaged local men in unstructured health-livelihood relevant discussions on economic benefits of smaller families and how they could expand income generation sources.
All data were recorded centrally, and key indicators such as number of visits by neighborhood, new users, and individual methods were depicted on an online dashboard. The project team reviewed this weekly with the research partner (Research and Development Solutions—RADS) to allow for program decisions.
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