Pakistan: Demand Generation
Social Mobilization
Social mo
bilization is a continuous process that engages and motivates various inter-sectoral partners at national and local levels to raise awareness of and demand for a particular development objective. In the case of TCI in Pakistan, the objective is raising awareness about family planning as a means to address maternal and infant mortality.
The inter-sectoral partners may include and are not limited to government policymakers and decision-makers, community opinion leaders, gateway openers (i.e., influential leaders), bureaucrats and technocrats, professional groups, religious associations, non-governmental organizations, private sector entities, communities, and individuals.
What are the benefits of social mobilization?
Social mobilization addresses myths and misconceptions about family planning in local languages that women, their partners, and community influencers can understand.
- Social mobilization creates a safe space for people to discuss their family planning and reproductive health needs. Men and women are more comfortable discussing their needs in private, preferring confidentiality. Social mobilizers provide a respectful, intimate environment in which they can share their concerns about birth spacing.
- With the information that women obtain through social mobilization, they are able to make informed choices about their families and the number of children that they want to have.
- Social mobilizers can create a referral loop for a woman who needs contraception to obtain it from a trained service provider for quality service delivery.
- Social mobilization also provides women in the community with an opportunity to work with the government and private sector as advocates to increase community outreach and sensitize more people in the hard-to-reach areas while also generating an income as a social mobilizer.
How to implement
Step 1: Identify influential figures in the community to enable access for social mobilization activities
Regarding maternal and child health, key opinion leaders (KOLs) in communities have the power to mitigate misconceptions, logistics and financial constraints during antenatal and postnatal care. They can provide orders to pacify complex situations in the community due to cultural restraints and enable public and private organizations to sensitize people in the community on the importance of health, birth spacing, and family planning.
Follow these steps to identify respectable influencers in the community:
- Identify and mark significant figures in the community as gate openers to avoid any unforeseen event during the implementation of the social mobilization program
- Develop rapport and orient them about the aims of social mobilization
- Set program goals and timelines with them for effective engagement
- Familiarize oneself with the geography and identify local administrators for further execution
- Organize stakeholder meetings to familiarize local administrators and the influencers with one another and find common interests. They share important knowledge and perspectives to address any issues that may arise in carrying out social mobilization efforts.
Step 2: Identify community health workers to be recruited as female community mobilizers to conduct door-to-door meetings and awareness-raising sessions
To identify and recruit CHWs:
- Identify their highest level of education attained
- Identify training they have previously received
- Identify potential team members to build coalitions along with their supervisors
- Jot down tasks they can carry out
- Identify their follow-up protocols and maintain records
- Identify the mode of their jobs, whether they are paid or volunteers
- If volunteers identify their motivation to do the work
- Identify their commute resources and interests in traveling within cities
Step 3: Train community health workers on conducting sessions in the community to generate demand for family planning
Then, partner with organizations or experienced reproductive health professionals who can strengthen the capacity of CHWs to address these barriers through counseling community members on persistent myths and misperceptions around family planning and birth spacing and providing methods as permitted and referrals to quality service sites. Capacity strengthening should happen in the following areas and ways:
- Orient and train community healthcare workers on short-term and long-term family planning contraceptives
- Develop soft skills (such as improved communication and rapport-building) to sensitize women in the community using information, education and communication (IEC) materials
- Provide brochures, flipcharts, and other information material
- Provide tablets/electronic devices for fieldwork for real-time reporting and troubleshooting
- Provide data management tools (such as client registration books, referral books, etc.)
- Conduct role plays to assert various situations in the field and ways to address the queries
Step 4: Identify clinic outlets
- Identify public and private sector maternity health clinics in the community to create a referral loop with the community healthcare workers for invasive contraceptives, such as IUDs and injectables. These clinics work as service delivery points for antenatal and postnatal care for women in need.
- Strengthen the capacity of these service providers to provide counseling for newly-married couples and create awareness about effective family planning.
- Develop linkages between the CHW and lady health visitors (LHVs) with maternity health clinics.
- Create a referral mechanism – whether that is a token, referral slip, or something else – to identify those who have received family planning information in the community and seek contraceptive services at a facility that has trained family planning service providers.
- Develop a data management system to register married women of reproductive age (MWRAs) to track the provision of family planning services:
- Tag an LHV with a community healthcare worker to complete the provision of family planning services, especially for long-acting methods
- Ensure that the data is managed effectively and accurately
Step 5: Provide supportive supervision
Government stakeholders and private sector must always provide supportive supervision to ensure high-quality service delivery and infection control protocols in place. Involve all stakeholders throughout the implementation process. It is crucial to remain transparent, impartial, and equitable towards all resources.
Ensure that CHWs effectively conduct door-to-door sessions, neighborhood meetings, and orientation sessions. Supervisors must follow-up with the field teams weekly and then monthly to resolve issues arising in the field. Such activities will also boost confidence among the CHWs.
Various CHWs are targeting different communities. The female CHWs focus on MWRAs and unmarried women; whereas for male engagement, recruit male mobilizers to address sexual and reproductive health needs needs of men in the community. There are Family Welfare Assistants/Social Mobilizers (one male and female each) working under the Population Welfare Department, tagged with the maternity clinics for demand generation and awareness. There are almost 100,000 LHVs in Pakistan, where an average of 1,000-2,000 LHVs facilitate a catchment area of 80,000 to 100,000 population. However, they provide more than just family planning cousenling and services. So, that is why it is important to identify other females in the community who are willing to provide social mobilization activities.
Indicators for success
- Number of MWRAs reached/counseled
- Number of MWRAs registered
- Number of tokens generated/referrals provided
- Number of tokens redeemed/referrals completed
- Number of short-term contraceptives (condoms, pills and injectables) purchased
- Number of IUCDs inserted (long-term contraceptive)
Resources needed
If government and private organizations train female healthcare workers on social mobilization, the following items must be budgeted:
- Printing costs for IEC material, brochures, client record books, client registration, and referral books
- Venue for trainings
- Logistics (transport, per diems, lunch)
- Accommodation (depends on the number of training days)
What Is the Evidence?
- Healthcare workers can enhance the knowledge of both women and men about birth spacing, risks of incessant pregnancies and iron-anemia deficiencies because of unplanned and closely-spaced pregnancies.
- A study in Pakistan found that a provider using interpersonal communication (IPC) interventions generated nine more family planning clients on average per month, and two more youth clients. The study further found that the IPC providers had a positive significant impact on client volume for all outcomes.
- Contraceptive prevalence rate (CPR) increased from 42.3% at baseline to 53.0% during a community-integrated intervention in Karachi. The article highlights that door-to-door meetings played a pivotal role in addressing myths and misperceptions, allowing a 9.2% boost in the uptake of modern contraceptives. In addition, indoor sessions enabled women to communicate about their pregnancy-related issues in confidentiality.
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Tips
- Develop messages and IEC materials in local languages so that women of all cultures and backgrounds can easily understand them.
- Frame family planning messages within the broader maternal, newborn, child health goals and strategy.
- Make regular visits to meet women in the community as their needs for availing family planning and reproductive health may change over time.
- Mass media campaigns on TV and radio can help to reinforce messages being delivered via social mobilization and create an enabling environment for family planning. As a result, identify local cable providers to display advertisements or documentaries and radio channels and frequencies to play songs or messages on the radio.
- Community theater can also create an emotional connection with the subject and enabling broader understanding about unmet nee family planning. Use community theater and actors to enact real-life stories on the subject and engage social mobilizer to mobilize the community to attend the performances and link potential clients to services.
- As social mobilizers, consider stocking self-care products (menstrual hygiene care, condoms, misoprostol) to generate revenue.
- Work closely with public and private maternity clinics to ensure that there is adequate supplies to meet the demand that is sparked from social mobilization.
Challenges
- Resistance from communities (MWRAs, KOLs) because of social and cultural restraints
- Shortage of commodities at the facility and community health worker level, if she is permitted to dispense
- Unavailability of service providers at the time of need to meet the demand generated
- COVID-19 restrictions due to continuous mutations
