The role of partners in promoting self-care for misoprostol and sub-cutaneous DMPA in Pakistan

Abstract Background Pakistan is among countries facing protracted challenges in addressing maternal mortality with concomitant weak healthcare system complexed with inequities. Sexual and reproductive health & rights (SRHR) self-care interventions offer the best solution for improving access to quality healthcare services with efficiency and economy. This manuscript documents country experience in introducing and scaling up two selected SRHR self-care interventions. Prospective qualitative study was used and a semi structured questionnaire was shared with identified SRHR private sector partners selected through convenience and purposive sampling. The two interventions include use of misoprostol for postpartum hemorrhage and use of sub-cutaneous depomedroxyprogesterone acetate (DMPA) as injectable contraceptive method. Data collection was done through emails and telephonic follow-ups. Results Response was received from 9 out of total 13 partners consulted for the study. The two selected self-care interventions are mainly supported by private sector partners (national and international non-governmental organizations) having national or sub-national existence. Their mandates include all relevant areas like policy advocacy, field implementation, trainings, supervision and monitoring. More partners reported experience related to use of misoprostol; it was introduced more than a decade ago, is registered and being procured by both public and private sectors. Sub-cutaneous DMPA being a new intervention, is recently introduced while commodity availability remains a challenge. It is being delivered through health workers/providers and not promoted as self-administered contraceptive. Community engagement and awareness raising is reported as an essential element of successful field implementation, however, no beneficiary data was collected for the study. Training approaches differ a lot, standalone or integrated with SRHR topics and duration varying between 1day to 5 days, covering a range of cadres. Conclusion Pubic sector ownership and patronage is essential for introducing and scaling up self-care interventions as a measure to support the healthcare system in delivering quality sexual and reproductive health services. Supervision, monitoring and reporting are areas requiring further support and having leadership and governance role of the public sector. Standardization of trainings, community awareness, supervision, monitoring and reporting is required alongwith integration of self-care in routine capacity building activities (pre and in-service) on sexual and reproductive health in the country.