Background
Family Planning 2020 (FP2020) is a global partnership that supports the rights of women to enable 120 Million more women in 69 poorest countries to use contraceptives by 2020.
In London Summit on Family Planning, 2012 where more than 20 governments made commitments to address the policy, financing, delivery, and socio-cultural barriers to women accessing contraceptive information, services, and supplies, Pakistan specifically committed to achieve universal access to reproductive health and raise contraceptive prevalence rate (CPR) to 55% by the year 2020. Given the ground realities in provinces, the CPR was rationalized and reduced from 55% to 50% by 2020. The Provincial Health and Population Welfare Departments of the four provinces-together with some federal representatives, formally announced their target goals for 2020: Punjab 55%, Sindh 45%, KP 42%, Balochistan 32%. The commitments made by the government of Pakistan cover the realm of policy, finance, and service delivery.
Punjab's Progress on Commitments of 2012
Progress Made
- Punjab’s CPR has risen from 41% in 2012 to 47% in 2017 and will reach 52% by 2020
- Integrated efforts by joining hands of the public and private sector will help achieve CPR target of 55% by 2020
- Population emergency was declared in 2013
- Punjab Population Policy 2017 has been approved by the Provincial Cabinet. The Policy fosters a right-based approach to family planning. It ensures service availability at the community level, contraceptive commodity security, ensuring resource availability, inter-departmental coordination for consolidation of services, and ensuring support of development partners and private entities
- Formulation of a cross-sectoral scheme to implement the policy is under process with the technical support of the World Bank
- Punjab Health Sector Strategy 2012-20 has been developed for improving maternal and child health, nutrition, and control of communicable and non-communicable diseases. It aims to strengthen district health systems and integrate essential health services
- Population Welfare Programme Punjab received PKR.19.337 Billion from 2010 to 2017 through PSDP
- Provincial public-sector spending on FP increased from PKR.107.200 Million in 2012-13 to PKR.1,472.281 Million in 2016-17 (1273% increase)
- PKR.1,500 Million for the development schemes in the ADP 2017-18 and PKR. 4,197.293 Million in the current budget have been allocated
- Punjab Population Innovation Fund (PPIF) with PKR. 200 Million in 2016-17 and PKR. 250 Million in 2017-18 has been established to support innovative FP/RH projects of public and private sector
- Population Welfare Department (PWD) has procured contraceptives worth PKR. 830 Million from 2014-17 whereas Health Department has purchased commodities worth PKR.1,192 Million
- Draft Costed Implementation Plan (CIP) for PKR. 20.141 Billion (PKR. 12.102 Billion for Health Departments and PKR. 8.039 Billion for PWD) has been prepared
- Contraceptives services have been included in Essential Health Service Package (EHSP).
- Contraceptives are provided free of cost
- Services of Lady Health Workers have been regularized since 01-07-2012
- Established 600 new Family Welfare Centres, 11 new Family Health Clinics, refurbished 92 Family Health Clinics and reactivated 86 Mobile Service Units
- An un-interrupted supply of contraceptives ensured
- A web-based contraceptive Logistics Management Information System (CLMIS) is fully operational. Android-based monitoring and third-party monitoring through Monitoring & Evaluation Assistants (MEAs) is also in place
- 03 out of 05 Training institutes strengthened
- Quality of training improved and courses accredited by Pakistan Nursing Council
- Task sharing with paramedics for Implanon insertion started in Lahore, Faisalabad, and DG Khan
- Franchising of clinical services started in 05 low CPR districts in collaboration with NGOs and the private sector and a new brand of ‘Khushhal Gharana Clinic's established
- Established 17 new Adolescent Health Centres and 09 Adolescent Reproductive Health Education Cells in collaboration with Education Departments
- Collaboration between Health and Population Welfare Departments is increasing
- A joint referral system involving Lady Health Workers (LHWs) and outreach workers of the Population Welfare Department installed
- Standardized manual for FP counseling skills developed and refresher training provided to all outreach workers
- District Technical Committees meet every month
- Regular public awareness campaigns are held since 2014-15. The theme of Healthy Timing and Spacing of Pregnancy (HTSP) is actively promoted
- Research-based booklets/fatawa developed and disseminated on Islam and FP
- TV talk shows developed and aired to dispel religious misconceptions about FP
- Awareness messages are tailored for different segments and there is a strong focus on men and low CPR districts
- Departmental Website, Facebook page, Helpline and Call Centre are actively used for awareness creation
Commitment
Objective
- Achieve universal access to Reproductive Health and raise CPR by 55% (revised to 50%)
Policy and Political
- Provincial Population Policy and Health Sector Strategy will be developed
Financial
- Annual public spending for FP services will be increased to ensure universal access by 2020
- Provinces will raise additional resources to access quality services by training staff in client-centered services and ensuring the availability of contraceptive commodities
Programme and Service Delivery
- Contraceptive services will be included in the Essential Health Services Package
- FP will be made a priority for Lady Health Workers (LHWs)
- Supply chain management, training, and communication campaigns will be strengthened. There will be an increased focus on men for FP
Pakistan's Commitment Made at the London Summit for Family Planning 2017
Following the 18th Constitutional Amendment and Devolution of responsibility for FP financing, policy-making, and program implementation, this commitment package represents the revitalized focus and ownership of the federation and the provinces and regions of Pakistan, to the pledges made in the 2012 Summit, and to additional commitments made jointly by the provinces for adding direction and transparency to achieving FP2020 goals. The Government of Pakistan acknowledges that all citizens are entitled to high quality FP information and services. Therefore all provincial Chief Ministers pledge to personally monitor and oversee their respective provincial FP2020 goals through regular stock takes. This will ensure that services are optimally provided by all public and private health sector facilities to meet the reproductive health needs of both men and women and also reach out to the marginalized so that no one is left behind.
Statement from the Minister Population Welfare Department
Way Forward
The Family Planning 2020 future initiatives are:
- Punjab FP 2020 Working Group constituted with Minister Population Welfare in the chair to coordinate with Federal and Provincial Governments, NGOs and development partners
- The roles of Population Welfare and Health Departments will be redefined
- PWD will take lead in the implementation of the Population Policy. It will coordinate, provide training, ensure the quality of services and ensure contraceptives commodity security
- Health Departments will ensure delivery of FP services at all service delivery outlets. Gynecologists, doctors associations, private practitioners, paramedics, and Lady Health Workers will take FP as a priority. FP counseling skills and provision of services will be emphasized in medical education
- Continuous awareness campaigns regarding long-acting methods for birth spacing
- Expansion of task sharing project for training of paramedics in Implanon insertion
- Training of Community Mid-Wives for long-acting methods
- Improvement of contraceptives commodity basket by introducing Implanon NXT and Sayana Press
- Strengthening of logistics system to ensure delivery of desired method mix
- Emphasis on RH/FP in medical education
- Establishment of RH training centers in remaining 19 districts
- Regular refresher trainings of all cadres
- Life skills education, pre-marriage counseling, delaying first birth, and spacing in subsequent births will be continuously addressed
- Introduction of training modules regarding youth-friendly services
- Scaling up of adolescent-related projects in the province
- Setting up youth-friendly spaces at selected FHCs and at other appropriate sites