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Nai Zindagi (Pakistan); reinventing harm reduction

Nai Zindagi – a non-profit organisation based in Pakistan - currently functions as Mainline’s most important partner in innovation under the Bridging the Gaps 2 programme. Nai Zindagi and Mainline look back at an effective and professional 10-year collaboration.

The partnership is important to Mainline as Nai Zindagi is a true learning organisation that reinvents harm reduction based on a combination of evidence and an open mind. 

Mainline visited Pakistan from 23 November to 30 November 2016. The team consisted of Machteld Busz (International programme manager) and Nick Veldwijk, (Country manager Nepal and responsible for innovations). Mainline’s purpose was to visit Nai Zindagi, get updated on their current work and discuss new opportunities for future collaboration.

On Thursday, Mainline visited the Nai Zindagi office, met with different staff and received an update on their work. The M&E staff provided information on the Management Information System (MIS), which Nai Zindagi developed over the course of several years.

This impressive real-time data management system monitors service delivery to clients in 28 districts in Pakistan. After four years of systematic data collection, the database provides detailed insight into the HIV-cascade: from client-registration to admission of HIV+ clients to Nai Zindagi’s ARV Adherence Unit.


Research ideas
Mainline and Nai Zindagi staff shared research ideas based on the data recorded in the MIS. In addition, the system is an important and validated resource for steering Nai Zindagi’s programmes for People Who Use Drugs (PWUD). Mainline believes that Nai Zindagi’s MIS system has high relevance for other organisations working with the same client group in other parts of the world.

Outreach activities

After receiving information on procurement policies and stock management systems, Mainline visited the CoPC+ site and related outreach activities in Rawalpindi on Friday. They joined the outreach workers in Rawalpindi after some interesting discussions in the office and witnessed the huge need for effective harm reduction programmes in Pakistan. The outreach team works in a hostile environment. They are frequently faced with local law enforcement that cracks down on PWUD and community members who oppose their work.

In the afternoon, Mainline joined two sessions of support groups for graduated AAU clients (AGA) and their female family members (AFA). It was an impressive and, at times, emotional experience to hear the stories and challenges the group members face. However, the mutual support from both the men as well as their wives/mother/other female family members was heart-warming.

On Saturday, Mainline spent the day observing the ARV Adherence Unit (AAU). This initiative allows HIV+ drug users to detox and be initiated on ARVs. The project was initially financed by Mainline as a pilot under Bridging the Gaps and was later taken over by Global Fund and duplicated in capacity. Mainline visited the morning sessions where clients discussed the night, posed questions about HIV and their difficulties in adhering to treatment. They also assessed each other’s behaviour and provided support to each other. Mainline then joined a discussion with the AAU psychologists on the behavioural change of AAU-clients over time. At the end of the day, Mainline discussed the administrative processes and Nai Zindagi’s activities to ensure a continuum of care to AAU clients post their release after a two-month stay in the AAU.

Future collaborations
During the visit several options for future collaboration and innovation between Nai Zindagi and Mainline surfaced. As previously mentioned, the existing real-time data derived through MIS can be used for other research purposes and can be a useful tool for other organisations requiring real-time data for effective programme management. In addition to effective data management, ideas around social and technological innovation, social entrepreneurship and economic opportunities for PWUD were shared. Both parties agreed that the visit has led Mainline and Nai Zindagi to acquire new experiences and new collaborative ideas. Together we share the ambition to improve the health and rights of People Who Use Drugs in Pakistan, the Netherlands and beyond. 

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