Written by Farhan Khalid

Pakistan was ranked as the second-worst country in terms of gender parity (145 out of 146 countries) in the Global Gender Gap/Parity Report released by the World Economic Forum in July 2022. Out of the four key indicators that form the basis of the gender parity index – including Educational Attainment, Health, and Survival, Political Empowerment, and Economic Participation and Opportunity – the country ranked 145th on economic participation and opportunity and 143rd on health and survival.  

It could be argued that the Covid-19 pandemic, apart from other ongoing factors, played a vital role in these alarmingly low numbers on the gender parity index, keeping in mind the significant loss of employment and livelihood opportunities for women, serious disruption of health services, closure of educational institutes and withdrawal of children from schools, especially female students. 

Additionally, due to the cultural dynamics and patriarchal social structures, most of the major decisions for women are made by the older and male members of the family. This is one of the key obstacles preventing women from accessing validated information and making informed decisions for themselves and their children. These dynamics have also played an important role in women not getting vaccinated during the pandemic, further impacting their health and survival.  

Accountability Lab, in collaboration with the Department of Health KP, initiated the Gov-HER-Nance project in December 2021 in three districts of Khyber Pakhtunkhwa including Mardan, Nowshera, and Peshawar. The project aimed to (a) strengthen the voice of marginalized women in matters affecting their well-being and shift policies that relate to issues affecting their health during health emergencies; (b) improve the delivery of support services by national and provincial authorities; and (c) increase awareness among marginalized populations regarding Covid-19-related health and hygiene practices and available support services.  

The project has directly engaged over 2500 women from the most vulnerable communities in the project districts through interventions including capacity-building workshops focusing on leadership, communication and advocacy skills, and countering misinformation. The project also provided communication and outreach support to the department of health in KP through digital media and radio campaigns; town hall meetings for effective community feedback; and community awareness sessions with local women and elders to counter misinformation regarding COVID-19, reaching an estimated
500 000 people.

This blog shares six of our key takeaways below, including best practices learnt and what to do to ensure gender equity and inclusion when it comes to health policies in Pakistan.

• Mainstreaming women in decision-making is the key for improved service delivery

The key stakeholders of the Gov-HER-Nance project were the female leaders and counselors from the target districts. Local female leaders, due to the nature of their work, have direct access to communities and play a vital role in mobilizing them.  They are well-informed about the local issues and cultural sensitivities within their communities and are well-respected amongst their peers. Based on the need assessments carried out at the inception of the project with inputs from female leaders, they were equipped with the relevant skills and knowledge to improve the access of marginalized women from local communities to public offices during the project. They also reported increased knowledge around countering misinformation regarding Covid-19 vaccines, strategies to ensure women’s participation in political processes, and communication and leadership development. These female leaders then played a key role in sensitizing women from their respective communities to strategic avenues in approaching government departments for redress related to health, education and other social issues. Further training around countering the myths and misinformation regarding the Covid-19 vaccines also led to a significant number of women getting vaccinated soon after the community awareness sessions were conducted.   

• Women have severely limited access to some public services

One of the key findings of the project noted serious gaps in service delivery mechanisms by some government departments. This is the result of various factors ranging from a lack of capacity to deal with women-related issues and inadequate resource allocation, to ageing infrastructure and limited participation of women at the policy-making level. For instance, during community sessions with women, it came to light that there were no specific vaccination centers for women during the pandemic in the target districts. This was one of the key reasons why women from some of the most vulnerable and conservative communities could not get vaccinated initially. On the other hand, women were faced with issues in registering for cash and other financial support programs by the government since they didn’t have a national identity card. This issue was also discussed during the town hall meetings with the relevant government departments. Alarmingly, women from these communities have little to no knowledge about the existing mechanisms to access government services including health, education, and other social services. A lack of information about available facilities for women is another key reason that women from local communities don’t access public offices for the redress of their issues on a regular basis.   

• Partnerships between governments and civil society yield impressive results

Accountability Lab Pakistan partnered with the Health Department of Khyber Pakhtunkhwa to implement this project in the target districts. The collaboration not only increased the outreach and visibility of the project’s activities but also increased the output and impact through shared resources and expertise. For instance, during training workshops, community awareness sessions, and town hall meetings, officials from the Health Department actively participated and voluntarily shared their technical expertise with attendees. Additionally, the collaboration also helped the Health Department in reaching out to some of the most vulnerable communities and increasing the visibility of the awareness-raising campaigns during the pandemic. As the project moved along, AL also developed partnerships with other government departments including the social welfare department, NADRA, Education Department, and Local Administration. All these partnerships proved pivotal in achieving the desired outputs and outcomes of the project.  The project proves that targeted and well-planned interventions work well to improve public service delivery to local women. 

• Ownership of the project by communities is vital for the project’s success

Keeping in mind the cultural dynamics of the project districts, the interventions during the project were carefully designed. Moreover, since the prime participants of the project were women from the most vulnerable communities, the interventions had to be designed to create ownership of the project activities by the local female population.  For this purpose, AL’s field team maintained continuous coordination with the women participants and also adopted a participatory approach during the planning of activities. For instance, the content of community sessions was developed based on feedback from female counselors taken on board. This was done to ensure that the needs of women from respective communities were effectively reflected and addressed during the sessions. This overall participatory strategy encouraged women from the targeted communities to take complete ownership of the project and participate actively throughout.  

• Creating direct linkages between Government Departments and communities often leads to the immediate redress of issues

Through the town hall meetings conducted in the targeted districts, the project created direct access for local women to approach public offices for immediate redress. The project also created space and acceptance within government offices for public feedback, leading to improved trust between the state and citizenry. For instance, during the town hall meetings, there was a group of women faced with the issue of registration of their CNICs. This was discussed with the representative from the NADRA  and the issue was resolved timeously. Similarly in Mardan, women were faced with the unavailability of dedicated health centers for women, leading to very low Covid-19 vaccination rates. The district health officer (DHO) took notice of their concerns and within a week of the meeting, a dedicated vaccination center for women was set up in the central hospital of the city.

• Initiatives like Gov-HER-Nance could be replicated in other districts and provinces  

The Gov-HER-Nance program served as a pilot project in three districts of Khyber Pakhtunkhwa. However, women are faced with similar problems throughout the country, especially in the most vulnerable districts in KP. Replicating Gov-HER-Nance in other districts could greatly assist local women to know about their basic rights, the available infrastructure of public services, facilitate the effective redress of challenges, and help them in building confidence and leadership skills. On the other hand, the project and network of women leaders could also support government departments in gaining access to grassroot communities of women.

*Khalid is AL Pakistan Programs Manager 

Sheena Adams