Six Monthly Performance Verification and Project Monitoring for Delivering Reproductive Health Results (Department for International Development, DFID, Pakistan)

This is the ongoing verification of the DFID's large national programme "Delivering Reproductive Health Results via Non-State Providers".

Evaluability Assessment of the OP II Operational Plan Results Matrices (UNICEF)

RADS is undertaking a comprehensive evaluability assessment of One UN Programme-II Operational Plan (2013-2017) results matrices to review and propose changes for the remaining period of the OPII programme. Evaluability Assessment (EA) is a systematic process to examine the extent of a project or programme evaluation in a reliable and credible fashion and ascertain whether its objectives are adequately defined and its results verifiable. The assignment involves in-depth review of OP-II result matrices in the context of Human Rights Based Approach (HRBA) and Result Based Management (RBM). RADS is conducting the assessment in an interactive and participatory manner with frequent meetings and discussions on the result matrices with all the stakeholders i.e. all the UN agencies.

“Dhanak” Programme - Baseline, Midline, and Endline Survey (DKT Pakistan)

Jhang and Chiniot (Punjab, Pakistan). Thematic Areas: Maternal and child health care, family planning, women empowerment, community empowerment.

Parent to Child Transmission of HIV (PPTCT) - (UNICEF)

Punjab, KP, Sindh, and Balochistan. Thematic Areas: HIV awareness, prevention, and treatment; maternal and child health-care, reproductive health, women empowerment.

Health Facilities and Health Providers - Baseline Study (University of Gottingen, Germany and GIZ)

Haripur and Nowshera, KPK. Thematic Areas: Maternal and child health care, antenatal, delivery and postnatal care.
This study is a Knowledge, Attitudes and Practices (KAP) Survey regarding antenatal, during delivery, and postnatal care. RADS is facilitating this baseline study in Nowshera and Haripur areas where 25 Health Facilities, 80 community midwives (CMWs) and 70 lady health visitors (LHVs) are being surveyed. RADS’ field teams are conducting electronic data collection under the supervision of doctors, and close monitoring by RADS, GIZ and University of Gottingen.   

Baseline Assessment of Gap Inc.'s Personal Effectiveness and Career Enhancement (PACE) Program [International Centre for Research on Women (ICRW)]

Artistic Milliners - Karachi, Pakistan. Thematic Areas: Women empowerment, economic empowerment.
Empowerment of female garment workers is a fairly neglected area in development discourse. These women possess immense potential, which if rightly tapped upon, can translate into very positive outcomes for the women both personally and professionally. It can also gear up the productivity and efficiency of the garment sector, contributing positively to Asia’s rising market trends. The PACE program aims to address this and deliver outcomes positively impacting both, the women, as well as the factory where they are based. 

In this regard, RADS conducted a baseline assessment prior to the implementation of the program in Artistic Milliners (Karachi) by conducting a Knowledge, Attitudes and Practices (KAP) study. We compared two factory units - one which will undergo the PACE program as well as a control unit. Upon completion of the program, this information will be contrasted with an endline evaluation to assess changes attributed to it.  

Understanding SRHR and Family Planning in Khyber Pakhtunkhwa for GIZ

GIZ is implementing a large project to improve the situation of SRHR and FP in Khyber Pakhtunkhwa. RADS conducted the baseline survey of the districts of Noshera and Haripur to collect quantitative and qualitative information. Data were collected using tablets in order to maintain accuracy and to monitor data collection in real time.

Urban Poverty and Health Site

Urban Poverty is one of the emerging fields in development. Rural to urban migration is a key driver for civilisation. However, the process of transition is not smooth and many new migrants find themselves living in poor surroundings and able to access limited opportunitites and services. Dhok Hassu/ Zia Colony is one of approximately 17 urban squatter settlement sites in and around Rawalpindi/ Islamabad. Parts of it are in very early stages of settlement while others are well settled with 3 story houses. RADS and Akhter Hameed Khan Resource Centre are studying aspects of poverty, health, employment and sanitation to understand gaps and identify avenues for interventions in the community that are community driven and self sustaining.

Understanding Information Use and Decision Making by Adolescent Girls and Women

In Pakistan, Maternal and Neonatal Health Outcomes lag many of its regional neighbour and are particularly worse for young and adolescent mothers. This situation is compounded by socio-cultural emphasis on early marriages and having children immediately after marriage, both of which limit these adolescent girls’ opportunity for formal education and appropriate reproductive health information, thus increasing their vulnerability and lack of empowerment.
These structural and dynamic factors strongly influence hierarchical constructs in the society that expects girls to be subservient throughout their lifetimes to elders, notably husbands, and mother-in-law.  In addition, reproductive and sexual information remains a taboo for many pre-marital girls and is therefore not shared with them before marriage and they are expected to learn it immediately post marriage. All of these factors leave newly married adolescents and young women unprepared for significant life choices such as fertility, hygiene, family planning and skilled birth attendance.  Objectives Our research, supported by the Research Advocacy Fund (RAF) explored how this crucial reproductive health information is acquired and processed by young women in rural Pakistan and how this “processing” evolves as the woman grows older. The purpose was to put forth evidence based findings to government and civil society decision makers, mainstream media and the education system on the most appropriate and feasible means of getting adolescent girls the information they need and determine suitable modalities of doing so.   Study Design This was a mixed methods study comprising quantitative and qualitative methods. For the quantitative component we conducted a population based cross sectional household survey. The qualitative study was done by conducting focus group discussions and in depth interviews with eligible study participants.

Impact Evaluation MARVI project

With the literacy of just about 6%, Umerkot hardly has women who fulfill the minimum educational requirements for becoming a Lady Health Worker depriving the area of the likely interventions. HANDS, in collaboration with PACKARD sought to cater to this issue by training an alternate brigade to the Lady Health Worker chain. This alternate chain called the MARVI workers, consisted of illiterate women who were trained rigorously to play the part of Lady Health Workers.
As of today, the project has survived almost 5 years of interventions and has well-provided the targeted community with RH/FP services and has facilitated the MARVI workers to become economically empowered. We propose comprehensive evaluation that looks at multiple aspects of the project including the empowerment and social capital of  Marginalized Areas  Reproductive Health and Family Planning Viable  Initiatives (MARVI) workers, their operational details, program and operational issues faced, lessons learnt, the level and contribution of social mobilization, measure if and how are these communities better off (and in which aspects), the relative contribution of the health and social mobilization to this wellbeing and how may this experience be replicated in other impoverished communities in Pakistan or elsewhere.

Key Outcomes to Measure:

  • Awareness and knowledge (FP/RH/ MNCH) of MW and communities
  • Access to services and products; quality improvements in services
  • Personal Empowerment, Social Capital and Social Entrepreneurship of the MARVI worker
  • Effects of social mobilization on the community and on RH services and uptake
  • Quality and Accessibility to RH and FP services
  • Cost Effectiveness of the approach
  • Nexus of social change and health approach and proportional contribution of each

Study design:

The proposed research will be conducted via both quantitative and qualitative analysis. An attempt will be made to truly point out the impact the interventions have made on the lives of individual MARVI workers and an overall effect it has had on the areas they have penetrated.

Impact Evaluation MARVI project

Maternal Health and Domestic Violence: Impact of Personal and Social factors

This study looking at Gender Based Violence (GBV) was funded by Research Advocacy Fund and conducted by Rutgers WPF and RADS (2012-2013). Gender based violence adversely affects the reproductive and general health of women and is common in Pakistan and the region (Aurat Foundation 2010, UNFPA 1998, Rutgers WPF 2011). Violence and discrimination have significant and often long lasting physical and psychological effects beyond just health. GBV is often associated with higher incidence of depression, suicide or premature death, poor quality of life, miscarriages, maternal mortality, unsafe abortion, lack of health care access, disempowerment, social isolation, and low birth weight infants etc (WHO 2011). Although various forms of violence affect women throughout the cycle of their lives, a woman is particularly vulnerable to intimate partner aggression and violence.

The Influences of Political Economy and Evidence Use in the Decision Making: Do Policy Makers Care?

Policy making and decisions in health are influenced by a host of factors -political, economic and social priorities all affect how policies are made, who makes them and how they are implemented.Health systems have a vital role in providing social protections for the poor and marginalized populations. Even the meager investments within the Pakistani health sector are compromised by inefficiencies that stem from poor operational decisions. It is particularly pertinent to note that the brunt of these poor decisions is inordinately borne by the poorest and most marginalized women who have the least social or economic capital to cope with diminished public sector performance.  This study aims to highlight and ultimately recommend changes to the dynamics of the decision making process within the health sector

The Influences of Political Economy and Evidence Use in the Decision Making Do Policy Makers Care

Evidence for Policy and Action Grant Initiative

Research and Development Solutions received a grant from the USAID Small Grants Program (2011-2013) to make evidence accessible to Decision and Policy Makers in Health. Under the grant we collated and analyzed data on Family Planning and Childhood Immunization and made these analyses available to Government Officials, Donors, Politicians, Media and Communities in the form of policy briefs, working papers and/or evidence based advocacy.
Working with publicly available databases, research studies and program data to understand how family planning and immunization services are planned, implemented and monitored in Pakistan. Our aim was to engage with all stakeholders to make these analyses available to them and even work with them to answer specific questions when possible.

Our work with stakeholders also included efforts to build Institutional Capacity for sustained Evidence Use in making policy and program decisions beyond this grant initiative. During this grant we worked closely with the Punjab Policy and Strategic Planning Unit (PSPU) and the Knowledge Management Unit (Health Department Punjab). 
Evidence Generation
  • Synthesis of Existing Evidence
  • Secondary Data Analysis
  • Cost Effectiveness/ Utility
  • Assessment and Documentation of Best Practices and Successful Models
  • Program Performance Analysis
  • Working with officials to facilitate uptake of evidence
  • Identify evidence that will support resource generation and performance evaluation
  • Work with Parliamentarians to make actionable evidence about family planning and immunization available to them for potential use in their routine work
  • Understand decision making processes
  • Work with print media to provide evidence based material to develop news and articles

Maternal Health and Domestic Violence: Impact of Personal and Social factors

Research Questions   1. What are the patterns of domestic violence among pregnant women? 
2. How is domestic violence socially constructed, how is it resisted through women's agency, and what are the available options for women at the household, community and institutional levels? 
3. What can we learn from positive deviant households that are free of violence? 

Study Design 
Using a qualitative study design we conducted FGDs( 48) and IDIs (120) with women, men and community opinion makers  in 6 districts (Dera Ghazi Khan, Muzaffargarh, Kashmore, Jacobabad, Jafferabad, and Naseerabad) of Pakistan in 2012-2013. 

Salient Findings
  • GBV is a common reality in these 6 rural communities of Pakistan with widespread prevalence of verbal abuse to escalating physical violence
  • Despite societal condemnation and awareness, GBV when present remains pervasive and continues even during the pregnancy.
  • GBV is recognized by the woman (victim), family and friends and yet "deliberately overlooked" and treated as private matter. 
  •  The fear is that breaking the silence and seeking external help would enrage the abuser and is considered socially and individually the step of last resort. 
  • There are very few (if any) institutional or collective support options available for these rural women. 
  • Our work showed and validated the position outlined by Nesbitt that in pastoral or nomadic communities (as opposed to agrarian) cultural norms that promote GBV as acceptable are deeply entrenched in both the abuser and often the victim herself. Change in these norms will require multi-level approaches that teach women how to deal with violence, penalize men for engaging in violence, and have strong institutional support to offer respite to women affected by violence. 
  • Our study also showed that older women (mother in law and older wives) often aggravate and use violence as means of perpetuating their own power in the household. 
  • Economic empowerment and education are once again the most feasible long term factors and interventions that can truly reduce violence in conservative rural societies.