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Thank you Shikha for the wonderful comment, it feels great to have other women uplifting and motivating each other! Many thanks for your suggestion and you are absolutely right in suggesting the inclusion of other stakeholders however our initiative struggles with the basic involvement of females from within the community. I believe employing and boosting the morale of such females principally would initiate their participation in improving the community after which they can be collaborated with other stakeholders and in the future we could definitely consider the addition of supportive male individuals. Once again, cheers for the worthy feedback!

Thank you Anubha Sharma for the appreciation! I absolutely agree that women can do wonders when it comes to improving the lives of their families and communities! Cheers

Is the application / software still being built or are their existing educational or telemedicine platforms that could be used? If you are already leveraging LHWs, can the sensitization services be delivered through them? Or is there a reason that a higher tech solution to connect to other professionals is needed?

Unfortunately, the clinical and technical capacity of existing network of LHWs to deliver sexual and reproductive health is limited in Pakistan. We realized that to overcome the gap of sexual and reproductive health service provision and uptake, we needed to plug in specialists to deliver high quality care. We wanted to capitalize on developing a network of existing human health resource and infrastructure at community level by providing them capacity building and technical training to effectively utilize a digital solution to deliver SRH services and advocacy.

Based on this need, we developed an in-house real time digital solution that is currently functional across 14 telemedicine centers in Pakistan. The use of our solution to provide sexual and reproductive health services can help bring needed care to women who do not have physical access to services or health centers. As women in underserved communities are often home bound and are not allowed traveling to health centers, our solution will decreasing the need for clinic visits through approaches that allow telephone follow-up or self-assessment. The unique feature of the portal is that it offers a real-time screen sharing option that enables health care professionals to educate girls and women regarding their sexual and reproductive health conditions and its consequences. In addition our innovative approach with text messaging can help support adolescents to access sexual and reproductive health services by providing information and reminders about medications and appointments.

Our digital innovation aims to build young people’s individual capacity to make safe choices; to make Sexual and Reproductive Health services better adapted to young people’s individual needs; and to strengthen the linkages between information and service provision.

This is a creative idea that addresses multiple challenges within the community, what considerations are given to the local environment, is it safe to engage in a hub and spoke model? 2) What are the rates of use of mobile technologies? Most importantly, what are the rates of women's access to technology? How are girls privacy taken into account?

As per 2016 statistics, Pakistan has a total population of 192,826,502 out of which 34,342,400 are internet users. This equates to a 17% penetration of internet uptake in Pakistani population. In addition, three fourths of the population in Pakistan has access to mobile technologies. Women in low- and middle-income countries are reported to have limited access to cell phones, with South Asian women being 37% less likely to have cell phones than men. For women in Pakistan, unfortunately several factors, such as literacy and cultural barriers, act as inhibitors that lead to the ICT gender divide.

Our hub and spoke model is a unique and first of its kind effort to digitally make reproductive health truly accessible to every low-income marginalized Pakistani. To improve acceptability and uptake at the community level, we leverage existing clinical infrastructure of community health nurses and convert them as our e-spokes by plugging in technological facilities. Adolescents feel safe to avail services via our model as the health workers deployed by us, as these frontline health workers already have been active in the community and has continued to deliver health services in the past.

Policies and procedures are in place to protect the privacy and confidentiality of young people. All user information is stored on cloud and is password protected to ensure privacy. Beneficiaries availing the virtual consultations are instructed to use headphones for their privacy. At Hubs, a separate room in dedicated for the adolescents to connect with the virtual doctor for consultation and information to ensure visual and auditory privacy. The doctor or nurse attending the adolescent is instructed to speak in a lowered voice when asking them personal or private questions. Sehat Kahani team has also developed training programme which includes policies and procedures for protecting the privacy and confidentiality of our beneficiaries. We conduct trainings and online modules for master trainers to reinforce privacy and confidentiality. The performance and practices of service providers and staff in relation to privacy and confidentiality are regularly monitored and appropriate actions taken. We also induct our beneficiaries in feedback loop whereby we request them to report whether or not their privacy and confidentiality was protected while availing the consultation.