Leadership matters in building support for family planning programming


Kamlesh Giri, Senior Technical Advisor for Clinical training. He is sharing his insights on the transition to Phase II of the SAFPAC program in Pakistan where he was visiting for program support and FP counseling training. 

After returning from my Pakistan trip with almost my entire two weeks spent in the old city of Multan, in the Punjab Province I feel excited to share my thoughts about my trip. Supposedly, Multan city dates back to the Indus Valley civilization and has been witness to history down the ages for the last five thousand years. Currently it is a bustling city with a population of 3.8 million. CARE also works in the adjoining district of Muzaffagarh separated from Multan by the river Chenab and together there are twenty-six health facilities that we support in these two districts. The Supporting Access to Family Planning and Postabortion care initiative (SAFPAC) works to bring family planning and reproductive health services to the population of these two districts. On the west side of Muzaffagarh district flows another major river of Pakistan, the Indus River (the same one that bears the name of the Indus valley civilization). With the recent floods that devastated many parts of Pakistan starting in 2010, and almost every year since then but with lesser intensity, this geographic region has suffered from wide spread flooding affecting millions of people living in the outlying areas of these two rivers. SAFPAC preserves to bring much needed reproductive health services to the underprivileged population of this region.


I arrived in Islamabad at the unkind hour of 3 am after flying through several time zones for more than 18 hours, which has always bothered me. This is my third visit to Pakistan with this project, but there seems to be no international flights coming from the USA that have a friendlier arrival time.  So I have made my peace with it. Later that day I was fortunate to join the senior management team, CARE Pakistan, for a business lunch along with the country director, the deputy director for programs, health coordinator, security officer, and recently joined program manager for the WARHI project, and the SRHE senior tech advisor from CARE USA. The WARHI project is the local name for the SAFPAC initiative in Pakistan. The country director was kind enough to host lunch for the team and offered a relaxed environment to discuss relevant program issues. We had a chance to touch upon the vexing issue of slow start of Phase II for the WARHI project that officially started in January 2013.  Some compelling reasons surfaced during this conversation that I have captured in my trip report and debrief notes.


The Executive District Officer-Health (EDO-Health) is the chief health officer for a district. As the WARHI project works in two districts, there are two EDOs we work with on an almost every day basis. EDOs are powerful figures in the district and it is always reassuring to have them on your side. In the first phase of WARHI/SAFPAC project, for some inexplicable reason, we felt restricted in our communication with the EDO’s office. Our efforts to build bridges with the EDO’s office were at best a creaky, dilapidated suspension bridge bordering on crevices of misunderstanding and suspicion, or so it seemed. In phase I of WARHI, it seemed we had to struggle hard to get MOH staff participate in our FP/RH trainings, and any support we received seemed to be a passive reluctant okay. Our efforts to build MOH capacity in training in FP/RH remained dismally discouraging. The then WARHI staff (phase I) expressed their helplessness in moving this agenda forward and for a full one and half year (and beyond) we looked at the government health facilities from across the river Chenab (both literally and figuratively) with water all swollen up to the banks. It was difficult to feel excited about program activities with this working landscape.  


The second day of arrival we flew to Multan and met with the rest of our CARE WARHI staff along with the AWAZ foundation staff who were our implementing partner for the WARHI project Phase II. To achieve better work efficiency, the AWAZ Foundation was co-located in the Multan WARHI project. This filed team was young, full of energy and ready to change the FP/RH landscape of this region.


The WARHI project team along with the health coordinator for CARE Pakistan and I went to meet with the EDO Multan. The EDO’s office is housed in a large building, several floors, with a lot of office space, small rooms with file storage cabinets, tables, chairs, photo copiers and printers all snugly fitted into this room. The EHO’s office was more spacious. As is usually the case, the EDO was caught up in field visits of his own as part of the National Polio campaign. The polio campaign had intensified with a recent identification of a polio case (suspected) in Multan. This had caused plenty of commotion within the MOH machinery and extra resources were being invested to counter this threat. This month alone had seen 3 weeks of intensified vaccine distribution, both door-to-door and facility level distribution. Needless to say the EDO’s office was feeling the extra weight of this program on its shoulders. Incidentally, Pakistan is one of the only three countries in the world where polio is still endemic. Polio campaigns are major public health events in most developing countries, with the powerful endorsement of World Health Organization (WHO) behind it. Our meeting with the EDO was very cordial and discussed our program activities. The EDO reiterated his interest in the program and outlined some of the support he needed from CARE/WARHI project to upgrade its District Training Center (DTC) in Multan. There was genuine interest by the two parties in each other’s programs, and CARE/WARHI was not shy to state our mandate for supporting FP/RH services and anything beyond that would be difficult for us to support. In the same breath CARE was bringing a lot to the table with the facilities and training center upgrades, trainings and capacity building of providers, data management, and providing a supply of FP commodities for the duration of the project. This was well appreciated by the EDO.


The EDO’s office from both the districts had made special arrangements to ensure that at least one participant from each of the 26 health facilities attended the FP counseling training planned for the following week. This was done despite the MOH directive to intensify the polio campaign requiring full participation by the health providers in the districts. The EDO’s office had arranged for substitutes for providers coming to the FP training for four full days so that they would not be missed at the polio campaign. The MOH program manager for MCH and FP programs personally assured the participants during the training that they need not have to worry about explaining their whereabouts to the polio campaign during these training days, as this was expressed as a concern by many of the participants. He even made time to attend the FP training whenever he could, which was about 50% of the time! That, I thought, was amazing! And on the final day of the FP training, both the EDOs from the two districts made time to participate in the closing ceremony and certificate distribution to the participants .This was a huge moral boost to the participants and it was a great privilege for the WARHI project to receive this endorsement from the government. The certificates were jointly signed by the MOH, CARE and AWAZ. For me as a program backstop and technical advisor, it was exhilarating to see this transformation in our working relationship with the MOH. So I asked myself, what had changed from phase-I to phase-II to make the water on the Chenab River recede to make crossing the river possible?  Why did the rickety bridge over the Chenab River look transformed to a strong one with the steel beam suspensions overhead? My personal conclusion was that leadership matters a lot in catalyzing the change that we hope to see in our family planning programming! Kudos to CARE Pakistan team for bringing about this much sought after change.

Written by Kamlesh Giri in October 2013.

For questions or further information, please contact Kamlesh Giri, Senior Technical Advisor for Clinical training,

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