June 16, 2025 • 23 mins
What if healthcare systems weren't just centralized services but dynamic partnerships rooted in trust, relevance, and equity?
That’s the driving vision behind Community Delivery Platforms. In this episode we talk about collaborations among governments, local communities, UNICEF, and partner organizations to make essential health and nutrition services accessible to every mother, child, and household, no matter where they live.
Join host Qali Id as we unpack the strategies, struggles, and successes of community delivery platforms, with insights from:
- Afrika Mukaneto, SBC Specialist, UNICEF Regional Office for South Asia
- Waqas Shafi, SBC Specialist, UNICEF Pakistan
- Bridget Job Johnson, Chief of SBC, UNICEF Bangladesh
Want to learn more about how SBC can be used to strengthen systems? Check out episode 5, on SBC in Support of Systems Strengthening. We’ll also have another episode coming out soon on Community System Strengthening - stay tuned.
Resources:
- Community Health and Delivery Partnership website
- Aalo Clinic offsetting the burden of health care costs in the slums of Bangladesh | UNICEF Bangladesh
- Community leaders come forward to protect at-risk families against dengue | UNICEF Bangladesh
The views and opinions expressed by the contributors are their own and do not necessarily reflect the views or positions of UNICEF or any entities they represent. The content here is for information purposes only.
The ABCs of SBC is hosted by Qali Id and produced and developed by Helena Ballester Bon in partnership with Common Thread.
Check out UNICEF’s latest publication on Social and Behaviour Change, Why don’t you just behave! For more information about UNICEF SBC, check out the programme guidance.
We care about what you think — you can share your thoughts on the podcast using this feedback form. For all other inquiries, please contact sbc@unicef.org.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Afrika (00:00):
the vision you're talking about is every community
(00:03):
member, every child, no matterwhere they live, they have
access to services, right?
So this is not somethingthat you can do alone.
You need a joint effort, jointadvocacy from different partners
to elevate community healthnutrition as a priority within
national agenda and policies.
Qali Id (00:24):
Welcome to the ABCs of SBC, where we dive into how
social and behavior change isreshaping systems and lives.
.
I'm your host, and todayWhat happens when healthcare
is out of reach, notculturally relevant, costly,
or simply not working?
(00:45):
It doesn't have to be this way.
Around the world, governments,local communities and
organizations like UNICEF arecoming together to change this
through the Community HealthDelivery Partnership or CHDP.
The CHDP is a collaborationof global, regional, and
national stakeholders committedto supporting country led
(01:07):
efforts to expand accessto equitable, high quality,
essential health services.
It does this by workingwith countries to strengthen
community-based primaryhealthcare with community
health workers at theheart of the system.
At the core of this effortis a powerful truth.
Investing in communityhealth just makes sense.
It has eased the burden onoverwhelmed health facilities,
(01:30):
expanded access to reproductivehealth services, strengthened
health literacy and built trustand resilience in communities.
In this episode, we'll explorehow this collaboration is
helping countries deliver healthservices, and how social and
behavior change is helpingmake that vision a reality.
We'll from Africa Muto,SBC specialist for UNICEF's
(01:51):
Regional Office for SouthAsia, who you heard at the
beginning of this episode.
Waqas Ali Sah, SBC specialistin unicef, Pakistan.
And Bridget Job Johnson, chiefof SBC for unicef Bangladesh.
Let's hear from Africa.
Who describes CHDP andits wide reaching Mission
Afrika (02:10):
CHDP is a platform that can.
Significantly increase,, the reach and impact of
community-based, , service,, across key sectors, not
only in health, but health,nutrition, but also other key
social sectors which havea role in contributing to.
Health, nutrition and wellbeingof children, , across the world.
Qali Id (02:33):
That collaborative cross-sector approach is at
the heart of CHDP, and asAfrica puts it, what really
drives change at the community,household, and individual levels
is social behavior change.
Afrika (02:47):
We are fostering continuous dialogue with the
communities participation,engagement of not only
families household, butalso community leaders and
community structures, right?
That's 1, area.
The other area is.
Facilitating community'sownership of children
health and wellbeing.
(03:07):
Because the community knowsbetter than anyone where
the vulnerable families andthe vulnerable children,
the mothers who need whoat the highest risk, right?
another example I can give,is, . The health system, health
providers do need evidencethat cannot be found without
us talking to the community.
(03:27):
So community voices areimportant to ensure that we
are providing evidence-basedprograms, evidence-based
health services, , andalso ensuring that we are.
Hearing from the communityso that the health services
that we're providing areaddressing the specific needs
(03:48):
of the communities where theservices are being provided.
Because it's not aone size fits all.
Qali Id (03:54):
This highlights how important community
feedback is and how thatfeedback loop strengthens the
links between communities,providers and policy makers.
It's not just aboutlistening, it's about
acting on what's heard.
In fact, this kind ofresponsive, people-centered
approach is exactlywhy community-based
primary healthcare issuch a powerful tool.
(04:14):
Now let's turn to Bridget,job, Johnson and Bangladesh,
to hear how improving healthservices for urban slum
populations in Dakar beganwith a service first approach.
Unfortunately, andperhaps predictably,
these efforts fell short.
Bridget (04:29):
The attempt by the government over the years to
provide good primary healthcareservices, especially to the
urban slum dwellers has beenchallenge, at different phases.
They had implemented the firstface of the project, which was
really based on input, whichwas really based on people
(04:51):
coming to utilize the servicesand the services were there.
So it was let'sestablish the services.
let's staff the clinicand the people will come.
And people were not coming.
Qali Id (05:03):
And with that, a second phase began focusing
on community structures, butalso collaboration with the
CSO, implementing partners,the Department of Health,
ward leaders, and unicef, totry to diagnose the problem
and build better on existingcommunity networks and
collaboration to design servicesthat worked for everyone.
Bridget (05:24):
Starting from really trying to understand
the problem together toidentify the role that each
of the parties could play.
And when I talk about theseparties, I'm talking about
the religious leaders.
I'm talking aboutcommunity volunteers.
And then we haveWe have the world leaders
(05:46):
who has responsibility, ofcourse, politically for the
world and for their people.
And so we've been able to bringthese elements together and the
youth groups in some of theseurban slums, and bringing all
of them together has reallychanged the status quo the
status quo in terms of really,the ownership of the health
(06:12):
services within the locationthat this is been implemented.
Qali Id (06:16):
The result of this collaboration was
the Allo Clinic program.
Six Allo clinics wereestablished so that the
underserved could haveconvenient quality access to
health services in places,and at times of the day
that met their unique needs.
Bridget (06:31):
So we have what we call the Allo clinics.
The allo clinics areclinics in the urban slums.
There is a very strongcollaboration between
the community and,the health services.
Also because thesehealth services are
organized in a way that.
It is a C that is looking atwhat happens at the community
(06:55):
up to the health facilitylevel, and then back to
the community in terms offeedback, in terms of dialogue
and being on the same page.
And those who are benefitingfrom this is really the urban
population is really the women,the children, and of course
the rest of the populationin the urban locations.
(07:16):
Another benefit that hascome from this is the
increased willingness ofthe population to use the
services because now theyknow what to expect and they
know that their opinion counts
Qali Id (07:29):
That sense of ownership is a game changer.
What Bridget describesisn't just better
communication, it's socialaccountability and action.
When people see their voicesreflected in how services
are designed, when openinghours fit their lives, when
they're invited in servicesimprove, people return,
and everything shifts.
(07:50):
And this is the kind oftransformation the CHDP
aims to support by promotingcollaboration across national,
regional, and global levels.
The CHDP works to optimize theefficient use of resources,
reducing duplication ofefforts, shared expertise, and
multi-sectoral partnershipsto expand the reach and
impact of services like theseAllo clinics, especially for
(08:12):
underserved urban populations.
Trust is at the centerof health systems.
It determines the use ofavailable health services, in
particular among underservedor marginalized communities
who tend to be more at riskfor SBC specialist Waka Isha
in Pakistan, some of themost at risk are mothers.
(08:33):
Here he paints a vivid pictureof the obstacles women face
when trying to access care.
Waqas (08:40):
I think there are multiple factors, , that prevent
her from accessing medical care.
One of one of them couldbe, geographical barriers.
Planning areas are quitefar located from the health
facilities with limited orno transport facilities.
So that prevents the motheror the female caregiver from
accessing the medical services.
The other could be financialconstraints that we have seen
(09:01):
even when the services are free.
So we have seen at thebasic health units,
the services are free.
Of course, theservices are available.
But due to financialconstraints they do not have
cost of means to bear thetransportations cost for
medicines and others indirectcosts that may be associated
with seeking healthcare.
So financial constraint isalso one of the key barrier.
(09:23):
The other barrier that Iwould like to mention here is.
The gender and cultural norms.
So in many households,women need permission from
their husbands or fromtheir mother-in-laws to
visit a health center, whichoften leads to either a
delayed or a denied care.
The other barrier would bearound, the low awareness
and misinformation.
Many mothers, they rely ontraditional healers or home
(09:44):
remedies, because they haveeither lack of knowledge
or they have misconceptionsabout modern treatments.
. Other thing that I would liketo mention here as well apart
from the demand side, thehealthcare workers which in this
case are mostly over burdened.
So the lady health workersor the midwives or the other
front end workers that theyhave are quite overburdened
and which often leads tolong waiting times and
(10:06):
inconsistent service delivery.
These are some of the barriersespecially for a mother or
a female caregiver that shepasses through each day in
order to access medical care.
Qali Id (10:18):
So there's a lot going on here.
We have access, long distances,financial challenges, social and
gender norms, misinformation andmistrust, overworked healthcare
workers, and long waiting times.
And these are just a few ofthe barriers that women must
overcome in rural Pakistan.
It's a complex mix, andin many ways these issues
(10:40):
are deeply interconnected.
This is where partnershipslike the CHDP can add real
value by working alongsidegovernments to ensure that
community health strategiesare not only responsive to the
existing barriers, but that thesolutions are properly costed,
prioritized, and includedin national health budgets.
Let's hear more from Wakas.
Waqas (11:01):
So in order to address the barriers we are working
on, empowering play healthworkers as trusted providers.
So we are training themon the counseling skills
on providing maternal andchild health services.
And we are also providing themwith basic essential supplies
as well to to equip them withnecessary supplies so that
they can also deliver basicservices at their health houses.
(11:23):
In areas where we have, wedon't have LHW coverage, we
have hired couple counselorsas well to reach out to these
communities and to serve as ladyhealth workers . I think that
strategy is working very well, in Balochistan, in Raja, where
we have lower LHW coverage.
In addition to that, I thinkwhat is actually working and
what we have put in place thesemother support groups involves
(11:45):
mothers from the communities.
Some of the mothers areaccessing the health services.
They are the onesthat are following all
the desired behaviorswithin their households.
But then there are also mothersthat are not accessing services
due to to misinformation,misconceptions due to lack of
support from their families.
It, it serves as a peersupport network where the
(12:06):
mothers then often engagetheir mother-in-laws, , to,
to address their concerns.
.
Qali Id (12:10):
So in areas where workers, couple counselors
were hired and trained to reachfamilies and women's champion
networks and mother supportgroups were established.
These are invaluablespaces for peer support,
sharing information,and raising awareness
about healthy practices.
But of course, women can't drivethis change alone, especially
(12:31):
in more conservative areas ofPakistan where social norms
restrict women's autonomy.
Something powerful is happening.
Wakas reflects on how maleengagement in communities
has evolved, particularlythrough the creation of
father support groups.
These groups provide a platformfor men to discuss health and
nutrition practices, connectwith peers and foster supportive
(12:54):
environments within theirfamilies and communities.
This shift didn'thappen overnight.
It began with the interest andinitiative of a single father.
So it all started, withone father in, , in one of
the district in Balochistan,, who reached out, , to our
teams, , and . Whose wifewas basically part of the,
, women champion network.
(13:15):
He suggested that he wouldlike to be part of, the same
network as well, where he canalso, , mobilize other men
within the community to be partof the men champion network.
So that's how theinitiative started.
They had a curiosity in thebeginning on why these women
champion networks are beingcreated and what's their
(13:35):
role and what are they doing?
So the curiosity basicallyled them to understand the
effectiveness and the objectiveof these networks, and that's
where the interest was created.
So one of the father thenreached out and based on his
suggestion and based on theinterest and the motivation that
we saw, we had to create, . Amen champion network in one
of the district first, , thatmen champion network, not only
(13:57):
engaged fellow other championsas well who were fathers,
who were husbands, who werebrothers, who can then bring
about the required support thatis needed for these women to
access healthcare services.
But they also reached outto, some of the, community
influences as well.
Religious leaders were involved.
, other community elders wasinvolved who had a say,
, within these communities andwho can shape up traditional
(14:20):
beliefs and practices.
So that's how by the demandand in the trust of one father,
we were able to replicatethat in the entire districts.
Now we are thinking toreplicate the same in other
locations where we areimplementing the CHDP program.
In SBC, we call this a positive deviant.
Someone who, despite facingthe same challenges and limited
(14:43):
resources, as everyone elsein their community, still
manages to adopt healthier,more positive behaviors.
In short, they figured outwhat works right there in
their own context, and they canshow others the way forward.
That one father's action createda ripple effect reshaping how
men see their role in health andcaregiving today in Pakistan.
(15:05):
Mother and father supportgroups are a growing
network of local champions.
They're not outsiders,they're neighbors, role
models and positive deviance.
Now let's hear fromBridget about how community
volunteers and communityleaders were used during
major outbreaks like dengue.
Bridget (15:28):
In 2023, there was a very big dengue
outbreak in Bangladesh.
And for the first time,almost all the districts were
reporting cases and Dhaka wastop on the list of cases and
community engagement therewas a lot of work that was
done because the communityvolunteers and the community
(15:48):
leaders really pulled together.
Typically in the urban slumsince are not very organized.
You have all the opendrains, you have the
refuse all over the place.
And I remember going out tosee some of those what they
call cleanup campaigns whereyou know, several people in
the community comes together.
They identify locations wheremosquitoes could be breathing
(16:12):
and then they go together.
Really community efforts.
Young people, women, men, they clean up these places.
And make sure that thereis no room for community
for mosquitoes to breedin those locations.
There was very intensivework at the community level,
especially to encourage.
Those who might be presentingwith the dengue fever symptoms
(16:37):
to quickly seek medical care andnot just go to the pharmacies
. And the number of people whoactually were sick and came
to the health facility to seekcare was really unprecedented.
Qali Id (16:50):
The success of the Allo Clinic program extended
beyond acute phases of outbreaksand health emergencies.
It demonstrated somethingdeeper that when communities
are engaged, not justas beneficiaries, but
as partners and leaders,systems begin to shift.
Bridget (17:12):
Yes, it's not only for disease outbreak, but the
significant increase between2022 and 2023 we're here
to see the 20, 24 figures.
There was a very.
Steep increase from 19% usageof the Allo Clinic to 37%
(17:32):
that is more than a hundredpercent doubling , in one year.
And that is a very significant.
So I think that engagementbetween community, I think
that partnership of thedifferent elements at both
the health service and thecommunity level definitely is
bringing a very good results.
Qali Id (17:52):
What Bridget illustrates here is how CHDP
is designed to support apeople-centered approach that
builds on community strengthsand promotes local leadership,
trust and accountability.
These are the building blocksof resilient health systems,
especially in times of crisis.
The ambition is significant.
And for Africa, the insightsgained from Bangladesh and
(18:15):
Pakistan suggests that CHDPcould pave the way for a
more equitable and inclusiveglobal health landscape.
Afrika (18:24):
It's a world where every mother and child have
access to and receive highquality, essential health,
nutrition, social services.
At the community fromcommunity workers who
are fairly paid, skilled,supplied, and supervised,
it means that what, where amillion of children, mothers,
(18:44):
and community member nolonger suffer or die from
preventable death due tothe lack of access to timely
equitable in quality healthcare.
Qali Id (18:53):
Better coordination, policy and investments by
all partners is essential toachieving universal healthcare
and global health security.
Saving lives, improving equityand building trust between
our social systems and people.
And it's the people whoare driving change with SBC
as a catalyst helping tofacilitate conversations and
(19:15):
meaningful participation.
For Bridget, the future is aboutbuilding on the Allo Clinic
and its key feature relevance.
Bridget (19:25):
Giving me, rice, which I might like to eat very much
is a very good beginning, butgiving me rice in the mood
that I prefer to eat it andat the right time of the day
makes a lot of difference.
So again, it's reallyabout the relevance.
If CHDP and SBC achievestheir goal in 10 years,
(19:51):
it'll be fully communityowned and community driven.
And that is because capacityfor the community to
address issues that relates tohealth, to be accountable more
and more for the health of thecommunity will be enhanced.
There is no alternative to it.
Qali Id (20:13):
I asked Waqas about the future of CHDP in Pakistan
Waqas (20:21):
if we succeed in, , the CHDP and, , the SBC
interventions, there will bedemand from the communities.
. I would see an improvedservice design where,
, women have better accessto, , healthcare services
where women have, , accessto female service providers,
, at the healthcare sites.
, we would be able to see thatthere are less cases of, mother
(20:44):
and child health,, illnesses,, within the communities.
And there's more support, , tothe health service systems,
, within the communities.
Qali Id (20:50):
When systems listen, they change, and
when communities lead, theyare more likely to thrive.
CHDP is showing that withthe right support, health
systems don't just servepeople, they partner with them.
Creating systems that aremore trusted, more equitable,
and better prepared forwhatever comes next.
(21:11):
And across South Asia, it'salready reshaping the way
healthcare works for families.
Bridget (21:18):
I've seen it in many elements of work that I do,
that when the private sector,the public sector, and the
community work together,there is always a win-win.
Qali Id (21:31):
This is what happens when you reimagine
healthcare, not just as aservice, but as a partnership.
Thank you to our guests, AfricaMuto, Bridget job Johnson,
and Waqas Ali Sha for sharingtheir stories and insights.
You can learn more about theCommunity Health Delivery
Partnership by visitingthe link in our show notes.
(21:54):
Thank you for joiningus on the ABCs of SBC.
If you like this episode, shareit with a colleague, or better
yet, with someone working on thefront lines of community health.
I'm Qali Id.
Until next time.
the vision you're talking about is every community
(00:03):
member, every child, no matterwhere they live, they have
access to services, right?
So this is not somethingthat you can do alone.
You need a joint effort, jointadvocacy from different partners
to elevate community healthnutrition as a priority within
national agenda and policies.
Qali Id (00:24):
Welcome to the ABCs of SBC, where we dive into how
social and behavior change isreshaping systems and lives.
.
I'm your host, and todayWhat happens when healthcare
is out of reach, notculturally relevant, costly,
or simply not working?
(00:45):
It doesn't have to be this way.
Around the world, governments,local communities and
organizations like UNICEF arecoming together to change this
through the Community HealthDelivery Partnership or CHDP.
The CHDP is a collaborationof global, regional, and
national stakeholders committedto supporting country led
(01:07):
efforts to expand accessto equitable, high quality,
essential health services.
It does this by workingwith countries to strengthen
community-based primaryhealthcare with community
health workers at theheart of the system.
At the core of this effortis a powerful truth.
Investing in communityhealth just makes sense.
It has eased the burden onoverwhelmed health facilities,
(01:30):
expanded access to reproductivehealth services, strengthened
health literacy and built trustand resilience in communities.
In this episode, we'll explorehow this collaboration is
helping countries deliver healthservices, and how social and
behavior change is helpingmake that vision a reality.
We'll from Africa Muto,SBC specialist for UNICEF's
(01:51):
Regional Office for SouthAsia, who you heard at the
beginning of this episode.
Waqas Ali Sah, SBC specialistin unicef, Pakistan.
And Bridget Job Johnson, chiefof SBC for unicef Bangladesh.
Let's hear from Africa.
Who describes CHDP andits wide reaching Mission
Afrika (02:10):
CHDP is a platform that can.
Significantly increase,, the reach and impact of
community-based, , service,, across key sectors, not
only in health, but health,nutrition, but also other key
social sectors which havea role in contributing to.
Health, nutrition and wellbeingof children, , across the world.
Qali Id (02:33):
That collaborative cross-sector approach is at
the heart of CHDP, and asAfrica puts it, what really
drives change at the community,household, and individual levels
is social behavior change.
Afrika (02:47):
We are fostering continuous dialogue with the
communities participation,engagement of not only
families household, butalso community leaders and
community structures, right?
That's 1, area.
The other area is.
Facilitating community'sownership of children
health and wellbeing.
(03:07):
Because the community knowsbetter than anyone where
the vulnerable families andthe vulnerable children,
the mothers who need whoat the highest risk, right?
another example I can give,is, . The health system, health
providers do need evidencethat cannot be found without
us talking to the community.
(03:27):
So community voices areimportant to ensure that we
are providing evidence-basedprograms, evidence-based
health services, , andalso ensuring that we are.
Hearing from the communityso that the health services
that we're providing areaddressing the specific needs
(03:48):
of the communities where theservices are being provided.
Because it's not aone size fits all.
Qali Id (03:54):
This highlights how important community
feedback is and how thatfeedback loop strengthens the
links between communities,providers and policy makers.
It's not just aboutlistening, it's about
acting on what's heard.
In fact, this kind ofresponsive, people-centered
approach is exactlywhy community-based
primary healthcare issuch a powerful tool.
(04:14):
Now let's turn to Bridget,job, Johnson and Bangladesh,
to hear how improving healthservices for urban slum
populations in Dakar beganwith a service first approach.
Unfortunately, andperhaps predictably,
these efforts fell short.
Bridget (04:29):
The attempt by the government over the years to
provide good primary healthcareservices, especially to the
urban slum dwellers has beenchallenge, at different phases.
They had implemented the firstface of the project, which was
really based on input, whichwas really based on people
(04:51):
coming to utilize the servicesand the services were there.
So it was let'sestablish the services.
let's staff the clinicand the people will come.
And people were not coming.
Qali Id (05:03):
And with that, a second phase began focusing
on community structures, butalso collaboration with the
CSO, implementing partners,the Department of Health,
ward leaders, and unicef, totry to diagnose the problem
and build better on existingcommunity networks and
collaboration to design servicesthat worked for everyone.
Bridget (05:24):
Starting from really trying to understand
the problem together toidentify the role that each
of the parties could play.
And when I talk about theseparties, I'm talking about
the religious leaders.
I'm talking aboutcommunity volunteers.
And then we haveWe have the world leaders
(05:46):
who has responsibility, ofcourse, politically for the
world and for their people.
And so we've been able to bringthese elements together and the
youth groups in some of theseurban slums, and bringing all
of them together has reallychanged the status quo the
status quo in terms of really,the ownership of the health
(06:12):
services within the locationthat this is been implemented.
Qali Id (06:16):
The result of this collaboration was
the Allo Clinic program.
Six Allo clinics wereestablished so that the
underserved could haveconvenient quality access to
health services in places,and at times of the day
that met their unique needs.
Bridget (06:31):
So we have what we call the Allo clinics.
The allo clinics areclinics in the urban slums.
There is a very strongcollaboration between
the community and,the health services.
Also because thesehealth services are
organized in a way that.
It is a C that is looking atwhat happens at the community
(06:55):
up to the health facilitylevel, and then back to
the community in terms offeedback, in terms of dialogue
and being on the same page.
And those who are benefitingfrom this is really the urban
population is really the women,the children, and of course
the rest of the populationin the urban locations.
(07:16):
Another benefit that hascome from this is the
increased willingness ofthe population to use the
services because now theyknow what to expect and they
know that their opinion counts
Qali Id (07:29):
That sense of ownership is a game changer.
What Bridget describesisn't just better
communication, it's socialaccountability and action.
When people see their voicesreflected in how services
are designed, when openinghours fit their lives, when
they're invited in servicesimprove, people return,
and everything shifts.
(07:50):
And this is the kind oftransformation the CHDP
aims to support by promotingcollaboration across national,
regional, and global levels.
The CHDP works to optimize theefficient use of resources,
reducing duplication ofefforts, shared expertise, and
multi-sectoral partnershipsto expand the reach and
impact of services like theseAllo clinics, especially for
(08:12):
underserved urban populations.
Trust is at the centerof health systems.
It determines the use ofavailable health services, in
particular among underservedor marginalized communities
who tend to be more at riskfor SBC specialist Waka Isha
in Pakistan, some of themost at risk are mothers.
(08:33):
Here he paints a vivid pictureof the obstacles women face
when trying to access care.
Waqas (08:40):
I think there are multiple factors, , that prevent
her from accessing medical care.
One of one of them couldbe, geographical barriers.
Planning areas are quitefar located from the health
facilities with limited orno transport facilities.
So that prevents the motheror the female caregiver from
accessing the medical services.
The other could be financialconstraints that we have seen
(09:01):
even when the services are free.
So we have seen at thebasic health units,
the services are free.
Of course, theservices are available.
But due to financialconstraints they do not have
cost of means to bear thetransportations cost for
medicines and others indirectcosts that may be associated
with seeking healthcare.
So financial constraint isalso one of the key barrier.
(09:23):
The other barrier that Iwould like to mention here is.
The gender and cultural norms.
So in many households,women need permission from
their husbands or fromtheir mother-in-laws to
visit a health center, whichoften leads to either a
delayed or a denied care.
The other barrier would bearound, the low awareness
and misinformation.
Many mothers, they rely ontraditional healers or home
(09:44):
remedies, because they haveeither lack of knowledge
or they have misconceptionsabout modern treatments.
. Other thing that I would liketo mention here as well apart
from the demand side, thehealthcare workers which in this
case are mostly over burdened.
So the lady health workersor the midwives or the other
front end workers that theyhave are quite overburdened
and which often leads tolong waiting times and
(10:06):
inconsistent service delivery.
These are some of the barriersespecially for a mother or
a female caregiver that shepasses through each day in
order to access medical care.
Qali Id (10:18):
So there's a lot going on here.
We have access, long distances,financial challenges, social and
gender norms, misinformation andmistrust, overworked healthcare
workers, and long waiting times.
And these are just a few ofthe barriers that women must
overcome in rural Pakistan.
It's a complex mix, andin many ways these issues
(10:40):
are deeply interconnected.
This is where partnershipslike the CHDP can add real
value by working alongsidegovernments to ensure that
community health strategiesare not only responsive to the
existing barriers, but that thesolutions are properly costed,
prioritized, and includedin national health budgets.
Let's hear more from Wakas.
Waqas (11:01):
So in order to address the barriers we are working
on, empowering play healthworkers as trusted providers.
So we are training themon the counseling skills
on providing maternal andchild health services.
And we are also providing themwith basic essential supplies
as well to to equip them withnecessary supplies so that
they can also deliver basicservices at their health houses.
(11:23):
In areas where we have, wedon't have LHW coverage, we
have hired couple counselorsas well to reach out to these
communities and to serve as ladyhealth workers . I think that
strategy is working very well, in Balochistan, in Raja, where
we have lower LHW coverage.
In addition to that, I thinkwhat is actually working and
what we have put in place thesemother support groups involves
(11:45):
mothers from the communities.
Some of the mothers areaccessing the health services.
They are the onesthat are following all
the desired behaviorswithin their households.
But then there are also mothersthat are not accessing services
due to to misinformation,misconceptions due to lack of
support from their families.
It, it serves as a peersupport network where the
(12:06):
mothers then often engagetheir mother-in-laws, , to,
to address their concerns.
.
Qali Id (12:10):
So in areas where workers, couple counselors
were hired and trained to reachfamilies and women's champion
networks and mother supportgroups were established.
These are invaluablespaces for peer support,
sharing information,and raising awareness
about healthy practices.
But of course, women can't drivethis change alone, especially
(12:31):
in more conservative areas ofPakistan where social norms
restrict women's autonomy.
Something powerful is happening.
Wakas reflects on how maleengagement in communities
has evolved, particularlythrough the creation of
father support groups.
These groups provide a platformfor men to discuss health and
nutrition practices, connectwith peers and foster supportive
(12:54):
environments within theirfamilies and communities.
This shift didn'thappen overnight.
It began with the interest andinitiative of a single father.
So it all started, withone father in, , in one of
the district in Balochistan,, who reached out, , to our
teams, , and . Whose wifewas basically part of the,
, women champion network.
(13:15):
He suggested that he wouldlike to be part of, the same
network as well, where he canalso, , mobilize other men
within the community to be partof the men champion network.
So that's how theinitiative started.
They had a curiosity in thebeginning on why these women
champion networks are beingcreated and what's their
(13:35):
role and what are they doing?
So the curiosity basicallyled them to understand the
effectiveness and the objectiveof these networks, and that's
where the interest was created.
So one of the father thenreached out and based on his
suggestion and based on theinterest and the motivation that
we saw, we had to create, . Amen champion network in one
of the district first, , thatmen champion network, not only
(13:57):
engaged fellow other championsas well who were fathers,
who were husbands, who werebrothers, who can then bring
about the required support thatis needed for these women to
access healthcare services.
But they also reached outto, some of the, community
influences as well.
Religious leaders were involved.
, other community elders wasinvolved who had a say,
, within these communities andwho can shape up traditional
(14:20):
beliefs and practices.
So that's how by the demandand in the trust of one father,
we were able to replicatethat in the entire districts.
Now we are thinking toreplicate the same in other
locations where we areimplementing the CHDP program.
In SBC, we call this a positive deviant.
Someone who, despite facingthe same challenges and limited
(14:43):
resources, as everyone elsein their community, still
manages to adopt healthier,more positive behaviors.
In short, they figured outwhat works right there in
their own context, and they canshow others the way forward.
That one father's action createda ripple effect reshaping how
men see their role in health andcaregiving today in Pakistan.
(15:05):
Mother and father supportgroups are a growing
network of local champions.
They're not outsiders,they're neighbors, role
models and positive deviance.
Now let's hear fromBridget about how community
volunteers and communityleaders were used during
major outbreaks like dengue.
Bridget (15:28):
In 2023, there was a very big dengue
outbreak in Bangladesh.
And for the first time,almost all the districts were
reporting cases and Dhaka wastop on the list of cases and
community engagement therewas a lot of work that was
done because the communityvolunteers and the community
(15:48):
leaders really pulled together.
Typically in the urban slumsince are not very organized.
You have all the opendrains, you have the
refuse all over the place.
And I remember going out tosee some of those what they
call cleanup campaigns whereyou know, several people in
the community comes together.
They identify locations wheremosquitoes could be breathing
(16:12):
and then they go together.
Really community efforts.
Young people, women, men, they clean up these places.
And make sure that thereis no room for community
for mosquitoes to breedin those locations.
There was very intensivework at the community level,
especially to encourage.
Those who might be presentingwith the dengue fever symptoms
(16:37):
to quickly seek medical care andnot just go to the pharmacies
. And the number of people whoactually were sick and came
to the health facility to seekcare was really unprecedented.
Qali Id (16:50):
The success of the Allo Clinic program extended
beyond acute phases of outbreaksand health emergencies.
It demonstrated somethingdeeper that when communities
are engaged, not justas beneficiaries, but
as partners and leaders,systems begin to shift.
Bridget (17:12):
Yes, it's not only for disease outbreak, but the
significant increase between2022 and 2023 we're here
to see the 20, 24 figures.
There was a very.
Steep increase from 19% usageof the Allo Clinic to 37%
(17:32):
that is more than a hundredpercent doubling , in one year.
And that is a very significant.
So I think that engagementbetween community, I think
that partnership of thedifferent elements at both
the health service and thecommunity level definitely is
bringing a very good results.
Qali Id (17:52):
What Bridget illustrates here is how CHDP
is designed to support apeople-centered approach that
builds on community strengthsand promotes local leadership,
trust and accountability.
These are the building blocksof resilient health systems,
especially in times of crisis.
The ambition is significant.
And for Africa, the insightsgained from Bangladesh and
(18:15):
Pakistan suggests that CHDPcould pave the way for a
more equitable and inclusiveglobal health landscape.
Afrika (18:24):
It's a world where every mother and child have
access to and receive highquality, essential health,
nutrition, social services.
At the community fromcommunity workers who
are fairly paid, skilled,supplied, and supervised,
it means that what, where amillion of children, mothers,
(18:44):
and community member nolonger suffer or die from
preventable death due tothe lack of access to timely
equitable in quality healthcare.
Qali Id (18:53):
Better coordination, policy and investments by
all partners is essential toachieving universal healthcare
and global health security.
Saving lives, improving equityand building trust between
our social systems and people.
And it's the people whoare driving change with SBC
as a catalyst helping tofacilitate conversations and
(19:15):
meaningful participation.
For Bridget, the future is aboutbuilding on the Allo Clinic
and its key feature relevance.
Bridget (19:25):
Giving me, rice, which I might like to eat very much
is a very good beginning, butgiving me rice in the mood
that I prefer to eat it andat the right time of the day
makes a lot of difference.
So again, it's reallyabout the relevance.
If CHDP and SBC achievestheir goal in 10 years,
(19:51):
it'll be fully communityowned and community driven.
And that is because capacityfor the community to
address issues that relates tohealth, to be accountable more
and more for the health of thecommunity will be enhanced.
There is no alternative to it.
Qali Id (20:13):
I asked Waqas about the future of CHDP in Pakistan
Waqas (20:21):
if we succeed in, , the CHDP and, , the SBC
interventions, there will bedemand from the communities.
. I would see an improvedservice design where,
, women have better accessto, , healthcare services
where women have, , accessto female service providers,
, at the healthcare sites.
, we would be able to see thatthere are less cases of, mother
(20:44):
and child health,, illnesses,, within the communities.
And there's more support, , tothe health service systems,
, within the communities.
Qali Id (20:50):
When systems listen, they change, and
when communities lead, theyare more likely to thrive.
CHDP is showing that withthe right support, health
systems don't just servepeople, they partner with them.
Creating systems that aremore trusted, more equitable,
and better prepared forwhatever comes next.
(21:11):
And across South Asia, it'salready reshaping the way
healthcare works for families.
Bridget (21:18):
I've seen it in many elements of work that I do,
that when the private sector,the public sector, and the
community work together,there is always a win-win.
Qali Id (21:31):
This is what happens when you reimagine
healthcare, not just as aservice, but as a partnership.
Thank you to our guests, AfricaMuto, Bridget job Johnson,
and Waqas Ali Sha for sharingtheir stories and insights.
You can learn more about theCommunity Health Delivery
Partnership by visitingthe link in our show notes.
(21:54):
Thank you for joiningus on the ABCs of SBC.
If you like this episode, shareit with a colleague, or better
yet, with someone working on thefront lines of community health.
I'm Qali Id.
Until next time.
Popular Podcasts
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
24/7 News: The Latest
The latest news in 4 minutes updated every hour, every day.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com