Healthy Markets CoP Session - Pakistan - June 9, 2023

The Healthy Markets Community of Practice (HMCoP) is a group dedicated to generating awareness of market development and private sector engagement work happening in different countries and for participants to leave with a greater understanding and appreciation of the country’s health market. The June meeting took on a hybrid format and speakers represented the Bill and Melinda Gates Foundation, ZAFA Pharmaceuticals, SINA Healthcare, Education and Welfare Trust, Population Services International, Greenstar Social Marketing, DAWAAI, Interflow Communications, and Marie Stops Society.

Previously scheduled for May, our meeting on June 9 marked the first time that the Healthy Markets Community of Practice (HMCoP) took on a hybrid format. Co-hosted by Population Services International's (PSI) Impact Hub and HMCoP secretariat Frontier Health Markets (FHM) Engage, the new format brought together online stakeholders from a host of global locations with local stakeholders who convened in person in Karachi. The June meeting was a meaningful opportunity for the HMCoP to further localization by encouraging local market actors gather in person and lead the discussion. Many thanks to Impact Hub for working with FHM Engage to bring this meeting together. 

To start the session, PSI Pakistan Country Director and Chair of Impact Hub Ayesha Leghari introduced the work of Impact Hub, a private sector working group whose objective is to bring in the private sector and examine their engagement in family planning (FP) from a market facilitation and market growth perspective. By galvanizing collective efforts by member organizations and getting the private sector to play a greater role in FP, Impact Hub hopes to amplify what is working and change what is not to improve market operations.

Following this introduction, USAID Senior Technical Advisor Andrea Bare and FHM Engage Chief of Party for Tanzania and co-facilitator of the HMCoP Farhan Yusuf gave a brief overview of the objectives of the community of practice. The HMCoP aims to improve health markets by co-creating solutions with a variety of market actors with a particular focus on private sector market actors. While the HMCoP is highly market focused, discussions incorporate key USAID principles, specifically private sector engagement, localization, and gender equity. 

The next part of the meeting was comprised of presentations from multiple speakers who gave remarks on a wide range of topics affecting Pakistan's FP market.   

Dr. Yasmeen Qazi, Senior Country Advisor on Family Planning and Maternal Newborn Child Health (MNCH) for the Bill and Melinda Gates Foundation- Dr. Qazi set the context for current FP market challenges in the Sindh province and presented existing gaps and opportunities in the market. She emphasized that increasing access to FP products and improving their quality cannot be achieved without including the private sector. 

Dr. Shaz Effendi, General Manager of Medical Affairs with ZAFA Pharmaceuticals- ZAFA Pharmaceuticals is one of the oldest private companies in the commercial sector and supports FP by manufacturing contraceptive brands and offers donations (samples) and services to NGOs and other organizations. Dr. Effendi shared that ZAFA currently holds about 90 percent of the share of the oral contraceptive market and, as such, demonstrates the key part that the private sector plays in the FP market. 

Ambareen Thompson, CEO of SINA Healthcare, Education and Welfare Trust- SINA focuses on primary healthcare and operates 37 clinical sites in urban and peri urban slums. These clinics see approximately 1.5 million people annually and about 20,000 women of reproductive age every month. Thompson’s presentation noted that of this 20,000, only about 200 are adopting modern contraception. She highlighted the importance of fulfilling the unmet needs of patients. 

Adnan Siraj Deputy Chief of Party and Head of Programs for PSI Pakistan- Through their project VIYA, PSI reimagines healthcare by utilizing digital technologies to increase access of products and services using a comprehensive strategy to address consumer needs. PSI recognizes the need for varied approaches to make progress. One such new approach is the creation of a crime thriller called Bevkhauf, meaning fearless in Urdu. This crime thriller is intended for digital platforms and includes an FP aspect that will target youth through subtle messaging. In addition, PSI plans to launch hackathons, where ideas are generated through youth engagement and finalists are given seed money to pursue their ideas. PSI has also launched game jams (events to prototype game designs) to incorporated FP and SRH themes and plans to produce both physical and digital games.

Dr. Syed Aziz Rab, CEO of Greenstar Social Marketing (GSM)- GSM makes health products available in the market at cost-effective prices and whatever revenue is generated is put back into the social franchising system. This ‘ecosystem’ provides consumer access to quality FP products at more than 35,000 pharmacies and over 140,000 chemists and retail outlets. Dr. Rab explained that in Pakistan over 70 percent of the population seeks care from the private sector and pays out of pocket, emphasizing once more the need to further develop the private sector. He also highlighted the importance of addressing barriers to FP access at the national government level. His presentation served as a reminder that the work to increase access to FP products and services needs to make commercial sense or it will not continue.

Furquan Kidwai, Founder of DAWAAI- DAWAAI is a private pharma delivery business whose vision is to use technology to achieve scale and create an infrastructure where health products and services are more accessible, affordable, and understandable. Currently DAWAAI is able to provide care anywhere in the country through telehealth and is able to discreetly deliver products to their customers. Currently, however, only 5 percent of their business is from FP products and services, and these are not actively pushed by the company. More can be done to partner with private companies like DAWAAI to increase access to FP products and services.

Aiman Rizwan, Chief Creative Officer of Interflow Communications- Interflow Communications partners with commercial development and government sectors and operates an ad agency, three FM radio stations, three television channels, and an events agency. Currently they are working with PSI on branding for VIYA, a sexual and reproductive health (SRH) chatbot, which targets youth through innovative digital approaches. Their videos are unique as they combine English and Urdu and are specifically geared toward urban and peri urban populations.

Dr. Ahsanullah Khan Chief Health and Research Executive from Health and Nutrition Development Society (HANDS)- In his presentation, Dr. Khan emphasized that there is a need to integrate the government and private sector if organizations are going to translate national health commitments to actions and results. HANDS supports FP through strengthening service delivery/access, fostering partnerships and institutional development, and strengthening community involvement and social accountability. The HANDS model is one that seeks to localize, integrate, sustain, and transform. 

Dr. Khurram Azmat, Director of Technical Service and Donor Programmes for Marie Stopes Society (MSS)- The private health sector is deeply embedded within Pakistan's health system, but it is largely unregulated. Currently, Pakistan's national health insurance program does not include outpatient services related to SRH, maternal and child health (MCH), FP, or neonatal care. MSS imagines that this gap can be filled by the private sector as 80 percent of primary healthcare facilities are in the private sector. In 2021, MSS introduced a one-year pilot program that  integrated these missing services into the existing insurance system in the Punjab province. The initial pilot has now been scaled up to take place in two additional provinces and the organization plans to share out the results of this pilot program in July. 

After the presentations, we were pleased to have a robust discussion, which brought up the following questions:

1) Can we get more programming from donors focused on Karachi?

2) Why are we not having aggressive FP messaging/advertising either nationally or locally?

3) Has any effort been made to link private sector data to the government to show how much demand there is and how that supply can be filled?

4) How do we engage youth effectively? Programming wants to include youth but we don't really talk to them.  

5) How do we move away from collecting data based solely on married women of reproductive age to more generally, women of reproductive age? 

With this food for thought, we extend a great thanks to all who participated in this engaging hybrid event. We hope participation within the HMCoP continues to grow, that our meetings remain engaging, and that organizations share the progress of their work so that we may continue to facilitate this collective learning.

Overall, we are excited that there was such a positive response to this session, and we look forward to continued participation in future sessions from everyone that attended. This hybrid format gets to the heart of localization and provided an excellent opportunity to listen and learn about the market conditions from those on the ground.

Resources

For more information on VIYA please use this link

The Nigeria IHP project, which was presented in the January meeting, has posted a blog on their private sector engagement (PSE) work. They will be posting one to two more times capturing all the project PSE work in the coming months so be sure to look out for those posts. 

On June 15, MOMENTUM Private Healthcare Delivery project hosted a webinar with partners ThinkWell and the Integrated Midwives Association of the Philippines to share how the project has unlocked private sector capacity to expand access to FP in the Philippines. Use this link to access the recording and slides from the webinar

We are interested in hearing from those of you that have been engaged in the HMCoP. Please use this survey as an opportunity to let us know your thoughts and if there are any changes you would like to see. 

Future Meetings

The next HMCoP country of focus will be Madagascar. Due to the occurrence of the Eid holiday, this meeting has been moved from end of June to July. We will share a date soon.  If you would like to take part in or contribute to this session, please email Elizabeth Peña at (epena@FHM-Engage.org) or Farhan Yusuf (fyusuf@FHM-Engage.org).

Questions?

Please email Jessica Jones (jjones@chemonics.com) or Elizabeth Peña (epena@FHM-Engage.org).