Written by APF + Sehat Kahani Pakistan Fellow (2024) Rahim Hirani

My recent fellowship with the American Pakistan Foundation (APF) gave me a unique opportunity to collaborate with Sehat Kahani, a telemedicine platform addressing the healthcare needs of underserved communities in Pakistan. My project, titled Utilization and Barriers of Sexual and Reproductive Health Services among Afghan Refugees in Pakistan, aimed to explore the healthcare challenges faced by Afghan refugees, particularly concerning sexual and reproductive health (SRH). This experience not only allowed me to conduct meaningful research but also provided deep insights into systemic healthcare challenges and the importance of innovative solutions.

THE URGENT NEED FOR SRH SERVICES AMONG AFGHAN REFUGEES

Afghan refugees in Pakistan are among the most vulnerable populations, with limited access to basic healthcare services. Refugees, especially women and girls, often face significant barriers in accessing SRH services, which include maternal health, contraception, STI treatment, and responses to gender-based violence. In a country that has hosted millions of Afghan refugees for decades, gaps in healthcare delivery—particularly SRH services—are exacerbated by cultural, economic, and systemic factors.

The majority of Afghan refugees reside in overcrowded camps in provinces like Khyber Pakhtunkhwa and Balochistan. These camps are typically under-resourced, with healthcare facilities that are overwhelmed and unable to provide the comprehensive services needed by the refugee population. Additionally, urban refugees compete for limited healthcare resources, making SRH services even harder to access for this already marginalized group.

My fellowship with APF and Sehat Kahani has been a transformative experience that…has provided me with invaluable insights into the challenges and solutions in global health and has equipped me with tools to identify and address healthcare gaps [while] advocating for healthcare solutions that make a lasting impact on underserved populations.

KEY FINDINGS FROM THE RESEARCH

My research aimed to assess both the utilization of SRH services by Afghan refugees and the barriers they face in accessing these services. I designed a cross-sectional study with a survey distributed through Sehat Kahani’s clinics. The survey gathered responses from 464 Afghan refugees, providing a robust dataset for analysis. Several important insights emerged from the study:

• Awareness of SRH Services: 76% of respondents were aware of SRH services, primarily through healthcare workers. This highlights the crucial role healthcare providers play in disseminating information to vulnerable populations.

• Utilization of SRH Services: Approximately 61% of respondents reported using SRH services in the past year, with contraceptives being the most commonly utilized (54%). This high utilization rate reflects the critical need for accessible reproductive healthcare among refugees.

• Barriers to Access: The most frequently cited barriers included inconvenient service hours (35%), long distances to healthcare facilities (28%), and lack of transportation (16%). Cultural and religious opposition, while less commonly cited, along with fear of stigma, remain concerns for some individuals.

• Impact of SRH Services: Despite these barriers, 85% of respondents expressed satisfaction with the SRH services they received, and 83% felt supported by their community in accessing these services. This highlights the positive impact of accessible healthcare services, particularly telemedicine solutions like Sehat Kahani, on vulnerable populations.
  

PERSONAL REFLECTIONS ON THE FELLOWSHIP

Working on this project allowed me to contribute to addressing pressing healthcare gaps, even though it was conducted remotely. The fellowship not only expanded my academic horizons but also provided a platform to engage with pressing public health issues. The support from Sehat Kahani and APF was instrumental in the successful execution of the project, and I am grateful to have worked with such a dedicated team of healthcare professionals.

One of the most rewarding aspects of my fellowship was the series of sessions organized by Sehat Kahani that offered a deeper understanding of Pakistan’s healthcare infrastructure. These sessions allowed us to explore topics like the funding of healthcare projects, the critical clinical questions facing healthcare providers, and the systemic challenges in Pakistan’s healthcare system. Learning from experts who are actively navigating these obstacles broadened my perspective and equipped me with a more nuanced understanding of the complexity of healthcare delivery.

These insights have also sharpened my ability to compare healthcare challenges in Pakistan with those in the U.S. The ability to analyze and reflect on similar challenges in different settings has inspired me to think creatively about potential solutions. This experience has underscored the importance of developing culturally sensitive healthcare interventions and identifying areas where innovations, like telemedicine, can improve access and equity.

LOOKING FORWARD: BRIDGING GAPS AND ENHANCING ACCESS

There is still much work to be done to improve healthcare access for Afghan refugees in Pakistan, particularly when it comes to SRH services. Our study offers important data that can be used to inform policy decisions and healthcare interventions aimed at improving refugee well-being. By extending clinic hours, improving transportation options, and reducing service costs, more refugees will be able to access the care they need.

My fellowship with APF and Sehat Kahani has been a transformative experience that reaffirmed my commitment to healthcare equity. It has provided me with invaluable insights into the challenges and solutions in global health and has equipped me with tools to identify and address healthcare gaps. I look forward to applying the lessons learned as I continue my journey as a physician-scientist, advocating for healthcare solutions that make a lasting impact on underserved populations.