A Hybrid Telemedicine-Community Model for Post-Abortion and Contraception Services in Pakistan

In Pakistan, 2.2 million abortions take place each year and almost 698,000 women were treated at health facilities for complications due to unsafe abortions in 2012 (Population Council 2012). According to the 2006–2007 Pakistan Demographic and Health Survey, unsafe abortion accounts for almost 6% of maternal deaths in Pakistan, and the average for South Central Asia is 13%.  Access to basic healthcare, including sexual and reproductive healthcare, is crucial in improving health outcomes for people, especially for women and girls. Ipas Pakistan, in collaboration with Ministry of National Health Services Regulation and Coordination (M/o NHSRC) and Provincial Health Departments (DoH) is working to ensure high-quality post-abortion care and contraceptive services that are available, accessible, and acceptable to women and girls.

The COVID-19 pandemic led overburdened healthcare systems to deprioritize essential sexual and reproductive healthcare, including abortion and contraception care, while accelerating shifts in healthcare delivery to digital technologies.

In June 2020, Ipas Pakistan partnered with Sehat Kahani (SK), a local healthcare NGO and telehealth service network, and an existing network of Lady Health Workers (LHWs) to launch a novel hybrid telemedicine-community pilot. The model linked women via LHWs with mobile devices to online providers for telemedicine consultation for SRH, including abortion services, contraception, and other gynecological consultations. Ipas has conducted high quality virtual/inperson Medical Abortion (MA)/self-care trainings (3 x days) of Sehat Kahani’s pool of healthcare service providers all over Pakistan and the public-sector healthcare providers.

To educate and connect community women/girls, with Sehat Kahani (SK), web-based telehealth service application, LHWs play their intermediary role and assist women seeking SRH services without visit to any health facility. Lady Health Workers (LHWs) serve as a bridge between the local community and the service providers for safe RH/FP counselling and referral linkages with the Ipas trained providers. LHWs connect community women through android phone with SK health care providers. Ipas in collaboration with department of health has provided orientation to LHWs (working in Ipas intervention community) on the usage of Sehat Kahani web-based application for connecting women and girls with the providers and manage data collection and reporting. Since June 2020, Ipas Pakistan trained 411 LHWs and their supervisors (LHSs) from 9 districts (Islamabad, Chakwal, Jhelum, Khanewal, Lodhran, Multan, Pakpattan, Hyderabad and Jamshoro) 48 telehealth doctors.