title: Social franchising and vouchers to promote long-term methods of family planning in rural Pakistan: a qualitative stocktaking with stakeholders.
abstract: BACKGROUND
  The overall use of modern contraception in Pakistan is quite low, especially in rural areas. Several studies have demonstrated the effectiveness of social franchising (SF) approaches in increasing access to modern contraception and improving the quality of healthcare in resource-poor areas in Asia and Africa. Drawing on best practices in SF, the Marie Stopes Society (MSS) implemented an SF model in certain rural areas of Pakistan to increase access to affordable and quality family planning (FP) services. The model was branded as Suraj (sun) and complemented with an innovative voucher scheme for intrauterine contraceptive devices (IUCDs). This paper describes the perspectives of Suraj clients, field workers mobilization (FWMs), and providers on various components of the Suraj model.
  
  
  METHODS
  A qualitative exploratory study was conducted in six randomly selected intervention districts in the Sindh and Punjab provinces. Data were collected using focus group discussions (FGDs) with clients and in-depth interviews (IDIs) with providers and FWMs. Data were manually analyzed using constant comparison and the thematic analysis approach.
  
  
  RESULTS
  Clients showed positive attitudes towards modern contraceptive methods and identified Suraj FWMs and signboards as sources of information. Almost all clients reported IUCDs as effective methods as they have manageable side effects and require fewer visits to clinics. They spoke highly of voucher schemes as these enabled them to avail free IUCD services. Clients also appreciated many components of Suraj clinics, including cleanliness, privacy, confidentiality, the sterilization of instruments, and courteous Suraj providers and FWMs. Most Suraj providers said that IUCD insertion and infection-prevention training enhanced their ability to provide IUCD services and increased their standing in local communities. They reported that the role of FWMs was crucial in mobilizing the community and increasing their FP clientele. The FWMs said that attitudes towards FP were changing because of economic pressure at the household level, increases in literacy, and community mobilization efforts.
  
  
  CONCLUSIONS
  The Suraj intervention influenced attitudes towards FP and modern contraception, positively. Women using IUCDs showed greater satisfaction with the method. The findings emphasize that SF approaches like Suraj, when complemented with vouchers and community mobilization efforts, can improve the utilization of long-term contraceptive methods among rural and underserved women. The study also identified the need for integrating FP, antenatal care, and safe delivery services.
authors.affiliation: Marie Stopes Society Pakistan, Pakistan. khurram.azmat@mariestopespk.org
authors.forename: Syed Khurram
authors.initials: SK
authors.lastname: Azmat
authors.affiliation: Marie Stopes Society Pakistan, Pakistan.
authors.forename: Ghulam
authors.initials: G
authors.lastname: Mustafa
authors.affiliation: Marie Stopes Society Pakistan, Pakistan.
authors.forename: Waqas
authors.initials: W
authors.lastname: Hameed
authors.affiliation: Marie Stopes Society Pakistan, Pakistan.
authors.forename: Jamshaid
authors.initials: J
authors.lastname: Asghar
authors.affiliation: Marie Stopes Society Pakistan, Pakistan.
authors.forename: Aftab
authors.initials: A
authors.lastname: Ahmed
authors.affiliation: Health Services Academy, Islamabad.
authors.forename: Babar T
authors.initials: BT
authors.lastname: Shaikh
mesh_terms: D003906:Developing Countries; D005193:Family Planning Services / Q000458:organization & administration*; D005260:Female; D006285:Health Planning; D006801:Humans; D010154:Pakistan; D015397:Program Evaluation / Q000379:methods*; D011787:Quality of Health Care; D012424:Rural Population; D012736:Sex Education / Q000379:methods*