Reaching the Unreached: Transforming Reproductive Health Access through the MARVI Model in Umerkot, Sindh

Pakistan, the fifth most populous nation, continues to have limited access to healthcare services, particularly in maternal and child health. Limited access to healthcare and family planning services is driven by multiple factors, including healthcare workforce shortages, non-rational deployment of the healthcare providers and fragmentation within healthcare systems. These factors are reflected in consistently high maternal and infant mortality rates, as well as a total fertility rate of 3.5 children per woman. The Government of Pakistan launched the Lady Health Workers Programme, which aimed to enhance access to healthcare services. However, no further recruitment took place after its initial implementation. The contraceptive prevalence rate (CPR) remained stagnant at 30.2% from 2007 to 2017, partly due to limited number of LHWs serving communities. In 2007, to address this gap, the HANDS Welfare Foundation launched the MARVI model intervention to serve the marginalized community at its doorstep and augment the CPR through the community-led model of intervention at Umerkot. It not only enhanced the CPR from 9% to 27% in the underserved areas of Umerkot but also improved access to healthcare services through contextualizing the intervention to community norms while ensuring the privacy of the users. This community-led reproductive health initiative reflects global health principles by leveraging task shifting to empower the rural women as community health agents across other districts of Sindh. This approach contributed to the success of the intervention as a context-specific solution for improving sexual and reproductive health in resource-constrained settings while enhancing women’s well-being.