The TCI team in Karachi West.
Sindh is one of Pakistan’s four provinces, located in the southeastern region of the country. Its capital, Karachi, is not only the largest metropolitan city in Pakistan but also the nation’s foremost economic, commercial, and industrial hub. According to the 2023 census, Sindh has a population of approximately 22.8 million, with an average annual growth rate of 2.57%.
Since 2022, The Challenge Initiative (TCI), in close coordination with provincial leadership, has been supporting both the Population Welfare Department (PWD) and the Department of Health (DOH) to improve access to high-quality family planning and reproductive health services. PWD and DOH are the primary government entities mandated to deliver family planning and health services across the province.
TCI has been implementing a set of priority high-impact practices and other interventions (HIPs and HIIs) across eight densely populated districts of Sindh. These include Family Health Days, Whole Site Orientation, deployment and support for community health workers, on-the-job training, and capacity building of healthcare staff in different components. In parallel, TCI has also focused on nurturing Health Champions and Master Coaches within the local system to sustain capacity and ownership at the community level.
During implementation in Sindh, it was observed that one of the most critical and high-demand interventions, outreach services such as satellite camps and mobile service units, had not been conducted for several years. The absence of these camps contributed to a low uptake of family planning methods and stagnation in the number of additional users, particularly in urban slum communities where most families face financial barriers, limited mobility, and restricted access to health facilities.
A key reason for the inactivity of outreach camps was logistical and transportation constraints. Through consistent advocacy, coordination, and evidence-based engagement, TCI successfully mobilized provincial leadership to revive outreach services across both departments. TCI provided technical assistance to ensure these camps were effectively operationalized, including proper transport arrangements, efficient commodity supply management, and deployment of trained service providers such as doctors, Lady Health Workers, and Community Health Volunteers. Strong emphasis was also placed on maintaining quality-of-care standards, particularly infection prevention, privacy, confidentiality, and comprehensive counseling, which are key to improving community access to health services.
Satellite camp providing services to communities in Sindh.
One particularly impactful improvement was the systematic scheduling of follow-up visits for clients adopting long-acting reversible contraceptives (LARCs), especially IUCD insertions. Many women had previously hesitated to adopt LARCs because of concerns about complications, myths and misconceptions, and lack of follow-up care. Ensuring predictable and accessible follow-up through outreach significantly increased client confidence and satisfaction.
TCI further ensured that information, education, and communication (IEC) materials were available during outreach sessions, while community workers played a vital role in restoring trust by mobilizing women and assuring continued access to services, including general medicines alongside family planning options.
An important systems-level achievement during this process was the strengthened collaboration between PWD and DOH. As coordination improved, PWD began supplying family planning commodities directly to DOH facilities, enabling outreach camps to become a routine and sustained service delivery mechanism under DOH systems. This marked a significant step toward institutionalization and sustainability.
Dr. Naima, Focal Person for Family Planning and Deputy District Health Officer for Malir, further explains the situation in her own words:
Outreach activities were previously delayed due to operational challenges. It is encouraging that the DOH has now established regular outreach sessions, held once or twice a month. Appreciation is extended to the TCI and PWD teams for their continued advocacy and support in ensuring a steady supply of essential commodities.
As a result of the HIIs, and particularly the revitalized outreach services, LARC uptake increased from 10% in 2023 to 20% in 2024, and further to 21% by the end of Quarter 3, 2025, demonstrating both community demand and the effectiveness of strengthened service delivery systems.
