Pakistan Population Policy

National Population Policy – 2010

DRAFT

Jan 18, 2010

MINISTRY OF POPULATION WELFARE ISLAMABAD

CONTENTS I. Preamble ..........................................................................................................................1 II. Recognizing Demographic Problem and Projections.....................................................1 III. a) Review of Approach - Evidence from the field ........................................................3 III. b) Review of Organizational Pursuits ...........................................................................4 IV. Rejuvenating the Imperative .........................................................................................6 V. Population and Development Goals...............................................................................7 VI. National Population Policy - 2010................................................................................8 GOALS....................................................................................................................8 OBJECTIVES .........................................................................................................8 PREREQUISITES .................................................................................................9 GUIDING PARAMATERS ...................................................................................9 STRATEGIES.........................................................................................................9 Enhancing Access to Service Delivery and Improving Quality..............................9 Advocacy, Communications and Demand Generation..........................................12 Programme Management and Efficiency .................................... ............................. ............... ............... ........13 .13 Programme Monitoring and Evaluation................................................................14 Research in Population and Development.............................................................15 Population and Development for Policy Support..................................................16 Annex -1 FAMILY PLANNING AND AND REPRODUCTIVE REPRODUCTIVE HEALTH INDICATORS. .18

National Population Policy - 2010

National Population Policy – 2010

DRAFT

I. Preamble Right Right from from 1950 1950s s high high popu populat lation ion growth growth in Pakis Pakista tan n was was recog recogniz nized ed as a major major impediment to its socioeconomic development process. All population projections and predi predicti ction ons s for for Pakis Pakistan tan becam became e true true even even in the the prese presence nce of Popu Populat lation ion Welfa Welfare re Programme which was though formally established in early 1960s, could not bring the desired desired change change in fertility. fertility. Pakista Pakistan’s n’s population population doubled doubled in around around 23 years years during during 1970s and 1990s. Pakistan’s population over the last six decades has increased from 34 million million in 1951 1951 to 171 million million in mid 2009 – five time increase. increase. The high populati population on growth rate evolved due to rapid decline in mortality rate and slow change in fertility rate, which continued over thirty year period. Pakistan witnessed witnessed a decline in growth rate only in mid 1990s with gradual fall in fertility closely associated with a rise in contraceptive use rate. The onset of much awaited fertility transition – brought total fertility rate down from around six births in 1980s to around four births in late 1990s. Based on fertility trends of 1990s, Population Policy 2002 projected to reach replacement level fertility by 2020. The progress witnessed in fertility appears not to achieve this objective. The other indicators of health such as the infant mortality rate and maternal mortality ratio are also disappointing according to the Pakistan Demographic and Health Survey 2006-07. Paki Pakist stan an ente entere red d an era era of fert fertil ilit ity y tran transi siti tion on to clai claim m ‘dem ‘demog ogra raph phic ic divi divide dend nd’’ demonst demonstrate rated d by changin changing g age structure structure (youthfu (youthfull populat population) ion),, reduced reduced depend dependency ency ratio (fewer children to be fed and increased population joining labour force) to benefit development of Pakistan through enhanced employment opportunities, productivity and reduced consumption pattern. The desired outcome is not automatic but dependent on: effec effectiv tive e famil family y plan plannin ning g progra programm mmes es (to contin continue ue fertil fertility ity transi transitio tion n proce process) ss);; accelerated accelerated policies of human development development aiming at transforming transforming a youthful population population into a productive workforce; and policies that lead to stable macroeconomic conditions are associated with the growth of productive and rewarding jobs for men and women. With the new evidence available from the PDHS 2006-07, it is clear that Pakistan is slow in achieving various targets, and as such serious review of the opportunities for the dividend for some time to come, is urgently needed.

II.. II

Reco Re cogn gniz izin ing g Dem Demog ogra raph phic ic Pr Prob oble lem m an and d Pro Proje ject ctio ions ns

Governme Government nt of Pakista Pakistan, n, as a policy policy matter, matter, always recognized recognized the need need to lower lower population growth rate to be consistent with its existing resource base to maintain its development development path. Several previous previous Prime Ministers addressed the issue of population population growth growth as natio nationa nall prior priority ity in lead leading ing publ public ic forum forums s but but their their polit politica icall state stateme ments nts remained rhetoric as these could not translate into credible and continued ‘political will’. Noneth Nonethele eless, ss, a varie variety ty of factor factors s imped impeded ed conti continu nued ed smoo smooth th decli decline ne in ferti fertilit lity: y: continuing high illiteracy among women, slower than desired speed in fertility decline noted for recent years along with rising poverty, persistent sense of insecurity and mounting inflation. The positive signal of fertility decline is overtaken overwhelmed not only by sluggish economic growth but rise in absolute population size which continues to baffle the development planners and policy makers to match scarce resources for ever rising demand for basic necessities.

1


Based Based on the fertil fertility ity tren trends ds reflected in recent demographic surveys two sets of population projections up to 2015 and on to 2030 are presented. The assumptions used here account accou nt for recent recen t trends trend s of a moderately moder ately faster fast er and slow decline decli ne in fertilit fert ility y accompanied by a standard decline in mortality that reflects improved life expectancy (at birth for males from 63.7 years in 2005 to 70.0 years in 2030, and for females from 64.1 to 73.4 years for the same period) over the years. The Scenario I assumes that unwanted fertility will be eliminated by 2015 and the total fertility rate will fall from its level of 4.1 in 2003-05 to 3.0 children in 2015 and will continue its decline to reach 2.2 by 2030. The Scenario II assumes that that fertility wil l continue to fall at its current pace, with no • special efforts to accelerate the decline. The TFR will be 3.4 in 2015, and 2.6 by 2030. The Scenario III encompa III encompasses sses impossibly fast decline in fertility, and as such requires • no description. •

These two scenarios differ in their implications for Pakistan’s Pakistan’s population population size as well as for the age composition of the population in 2020 and in 2030. According to Scenario 1, population size by 2020 will be 210 million and 243 million by 2030; corresponding corresponding figures figures for Scenario Scenario 2 are 216 and 255 million. million. These figures are considerably considerably higher than the earlier projections projections of the Planning Commission which estimate population to be 181 million in 2010, 195 million by 2020. This reinforces the very sharp difference that fertility trends can make on population size and related outcomes. under Three Different Scenarios, 2009-2030 Table 1.1: Projected Population (Millions) under Three Scenarios

2009

2015

2020

2030

(TFR 3.0 by 2015, 2.7 by 2020 and2.2 by 2030) II. Current Current Course: Course: Slow decline

171.2

192.7

210.6

243.6

TFR 3.4 by 2015, 3.1 by 2020 and 2.6 by 2030) “Planned Course”: Impossibly fast decline

171.2

195.4

216.1

255.3

(TFR 2.08 by 2020 & 1.92 by 2030)

181.2

194.7

218.0

264.6

I. Proposed Course: Moderate decline

Pakistan is a signatory to ICPD Plan of Action 1994 whereby a paradigm shift was envisioned that provided a much needed expansion in reproductive health areas beyond simple simple provisio provision n of family family plannin planning g services services.. It focused focused on address addressing ing reprodu reproductive ctive health needs of women of all ages by adopting adopting life-cycle approach. In pursuance to this, Pakistan adopted National Reproductive Health Service Package in 2001 thus pursuing family planning within the comprehensive approach of reproductive health. Pakistan is on track in its pursuit to lower population growth rate and has attained a level of 1.9 percent population growth rate, however the RH Service Package remained partially implemented. The Population Welfare Programme with the support of other stakeholders achieved contraceptive prevalence rate of 30 percent in early 2000s rising from only 12 percent in 1990-91. Keeping in view the momentum, the Pakistan Poverty Reduction Strategy-I envisaged achieving CPR level of 42 percent by 2005-06, and 51 percent in 2009-10. The CPR recorded for 2006-07 shows to have remained at 30 percent – much lower than the envisaged target.

2


III.. a) Revi III Review ew of of Appro Approach ach - Eviden Evidence ce fro from m the the field field What is striking about the recent few years is the recognition and realization that family planning services have not kept up pace with the increased demand. The high unmet need for family planning services, the high levels of unwanted fertility and the large numb number er of induc induced ed abor abortio tions ns to avoid avoid havin having g and and rearin rearing g an unwa unwante nted d child child are reflection of this reality. These outcomes are largely a result of women, couples and famili families es not not havin having g easy, easy, acces accessib sible, le, affor afforda dable ble resort resort to mean means s of preven preventin ting g an unwanted unwanted pregnancy pregnancy i.e., good quality information and services. Contraceptive Contraceptive use rate too show a stalling in the same period. This stalling is substantiated by several other factors: high discontinuation in contraceptive use indicating existence of gap in service quality, while unmet need for contraception remained high and an increased proportion of wome women n record recorded ed expe experie rienci ncing ng unwa unwante nted d pregn pregnan ancie cies s result resulting ing in high high level level of abortion abortions. s. The PDHS 2006-07 2006-07 has revealed revealed that around around 10 percent percent women reported reported experiencing a miscarriage, or an abortion during five years prior to survey. A study by the Population Council, Islamabad revealed in 2004 that an estimated 890,000 induced abort abortio ions ns occur occur annu annual ally ly in Pakis Pakistan tan.. In fact, fact, one one out out of every every six pregn pregnan ancie cies s is terminated by induced abortion. This event when examined in conjunction with high unmet need for contraception, demonstrates the health risks a Pakistani woman faces during her reproductive life especially among the poor, or rural resident, or the illiterate. Poor access to contraceptives contraceptives and necessary information are two areas that continue to contribute to such stalling rates. Pakistan appears not to have focused to enhance access access to contrace contraceptiv ptive e services services as major major attentio attention n remaine remained d on facility facility based based and inst instit itut utio iona nall serv servic ice e deli delive very ry whil while e comm commun unit ity y base based d serv servic ices es rema remain ined ed weak weak.. Community based service delivery models in the past did show good results but were not fully utilized over the last several years. Family planning service coverage remained low. The trend of contraceptive contraceptive mix shows female sterilization and use of traditional traditional methods as major means of practice. This combination has contributed to lower than expected effect on fertility levels. Over the years four important issues have emerged that need recognition: decline in the use of three methods (oral pills, IUCDs, and injectables), persistent unmet need for contraception, contraception, widening gap between current and ever use of contrace contraceptio ption n indicati indicating ng drop drop outs and high high inciden incidence ce of abortion abortion (includi (including ng induced induced abortion abortion)) in Pakista Pakistan. n. Family Family plannin planning g service service delivery delivery points points were increased increased by all stake stakeho holde lders rs and and prices prices remain remained ed undis undistur turbe bed, d, but but access access to servi service ces s remain remained ed problematic. Fear of side effects especially of oral pills, injectables, and IUDs emerged as important barrier to its use. The quality of service needed improvements to attract new new clien clients ts and and enha enhanc nce e contin continuit uity y of use. use. Irreg Irregula ularr supply supply and and nona nonava vaila ilabil bility ity of contraceptives contraceptives at health facilities have also been recognized recognized as a problem especially for women residing in rural and farflung remote areas. Population Welfare Programme had over the years focused on promoting small family norm norm and and dire direct cted ed all all its its effo effort rts s to limi limiti ting ng fami family ly size size thro throug ugh h awar awaren enes ess s and and motiv motivati ation onal al campa campaig igns. ns. Progra Programm mme e used used vario various us medi media a includ including ing inter interpe perso rsona nall communications communications to educate couples regarding benefits of small family. This strategy has large largely ly been been succes successfu sfull in raisin raising g level levels s of aware awarene ness ss abou aboutt popu popula latio tion n issue issues. s. However, these efforts in the past mostly mainly focused on urban areas where rural and peri-urban population population has not been adequately adequately addressed and efforts are required to be focused on rural opinion leaders besides targeting important segments of the society in

3


the peri-urban and urban areas. Majority of rural poor could not easily internalize the same due to low literacy rate that hampere hampered d it rather rather in fact mind-bloc mind-blocks ks remaine remained d a main main hurd hurdle le in beha behavi vior oral al chan change ge proc proces ess. s. Acce Access ss to info inform rmat atio ion n rega regard rdin ing g contra contracep ceptiv tives es remai remaine ned d weak weak to effec effectiv tivel ely y addre address ss persi persiste stent nt mispe misperce rcept ption ions s regarding family planning and misinformation regarding contraceptives despite repeated surveys indicating side effects as a major barrier to the adoption and continuation of hormona hormonall contrace contraceptiv ptives. es. Furtherm Furthermore, ore, persiste persistent nt confusio confusions ns and misconc misconcept eptions ions among less educated and illiterate segment segment of population population regarding religious aspects of family planning created socio-psychological barriers. These areas though addressed by communi communicati cation on initiati initiatives ves of Popula Population tion Welfare Welfare Programm Programme, e, the messag message e could could not penetrate or influence the target audience. Mass awareness of family planning has become universal as evidenced by various surveys and studies, but the same surveys show that changes in attitudes and behaviors have lagged far behind. behind. The Programme Programme service providers are given adequate trainings trainings on IPC and IEC skills, they still lack a professional approach to convince and attract eligible couples to family planning. These skills are weak in a large segment of service providers of Ministry and Departments of Health.

III. II I. b) Rev Revie iew w of Or Organ ganiz izat atio ional nal Pu Purs rsuit uits s The Population Welfare Programme was de-federalized to provincial governments in 2002 2002 with with transf transfer er of nece necessa ssary ry admi adminis nistra trativ tive, e, finan financia ciall powe powers rs and and progra programm mme e impleme implementat ntation ion authority authority.. Federal Federal funding was ensured ensured for first first few (three) (three) years years to enable provincial governments to gradually take-over the programme – design, plan and implem implemen entt accor accordi ding ng to local local need needs, s, suppo supporte rted d out out of own own resou resource rces, s, and and evolv evolve e greater efforts to generate necessary necessary own resources to reflect programme ownership to achieve the provincial development objective. Inability of provincial governments to do the same resulted in less than desirable performance of all provincial Population Welfare Programmes. On the contrary, significant funds released by the Centre for provincial Population Welfare Departments remains stuck up with provincial finance authorities befor before e being being remitt remitted ed to the Popu Populat lation ion Welfa Welfare re Depart Departme ments nts.. This This was furth further er aggravated by the absence of much needed support from federal and provincial Health authorities to ensure provision of family planning services through all their facilities. Ministry and Departments of Health has not prioritized family planning nor considered it essential duty of its service mandate. The lady health workers that were found to be very effective in delivering family planning services in 2001 (Oxford Policy Management, 2002) 2002) were found in 2009 2009 Third Third Party Party Evaluat Evaluation ion to be faltering faltering in providing providing these these services. The focus of the LHW Programm Programme e remained diluted diluted towards FP because because of the overload on them for other duties especially polio vaccination. Absence of smooth coordina coordination tion among among federal federal and provinci provincial al Populat Population ion Welfare Welfare Offices Offices and Federal Federal Ministry of Health and Departments proved detrimental to Programme performance, as critical partners and stakeholders failed to respond positively to the programmatic and secto sectoral ral need needs. s. The The effort efforts s of civil civil societ society, y, in this this regard regard,, also also remain remained ed mode modest. st. Therefore, achieving universal access to family planning services by 2010 yet remains to be materialized. The Ministry of Population Welfare service delivery network has expanded over the years to more than 3300 facilities and outlets. Population Welfare Programme service delivery delivery to-date to-date remain remained ed focused focused on static static facilitie facilities s and limited limited out-rea out-reach ch services services

4


through through mobile mobile service service units. units. However However,, an effectiv effective e combin combinatio ation n of service service delivery delivery outlets has not been worked out. Number of service delivery outlets and its combination (mobile service units for family welfare centre and vice versa) have not been worked out scientifi scientifically cally while while keeping keeping in view the settlem settlement ent patterns patterns,, populat population ion density density and terrain. Evaluation studies on various components (FWCs, MSUs, and RHS-As) reveal numerou numerous s operatio operational nal problems problems impeding impeding optimal optimal perform performance ance.. Persiste Persistent nt vacant vacant positions, absenteeism, unmotivated field staff, unprofessional attitude towards clients, weak management marred by lack of adequate monitoring and technical supervision are well recorded for below average performance. Lack of support by provincial authorities to build staff morale and help with career building process may also have contributed to the modest modest performa performance. nce. Weak Weak monitor monitoring ing system system superim superimpos posed ed by contrace contraceptiv ptive e target achievement had prompted inaccurate reporting. Partnership envisioned under the Public-Private Sector organization initiative had tremendous potential but could not fully materia materialize lize and target target popula population tion remaine remained d under-se under-served rved.. Social Social marketi marketing ng has remained an active force in meeting the needs of urban, semi-urban and to an extent in the rural areas of Pakistan. Their support to family planning campaign through innovative promotions and outdoor publicity by private partners is acknowledged, yet sharing of accurate knowledge through inter-personal communications need to be a focus in the years to come to address individual needs, concerns and clarify to overcome inhibitions, hesitations hesitations and misperceptions. misperceptions. Programm Programme’s e’s complet complete e neglect neglect of service service delivery delivery points for males is noted. Populat Population ion Welfare Welfare Programm Programme e spent spent a significa significant nt proport proportion ion of budget budget on demand demand generati generation on activitie activities, s, however however,, interpers interpersona onall commun communicat ications ions to remove remove inaccura inaccurate te informat information ion regardin regarding g family family planning planning method methods, s, disinfor disinformati mation on regardin regarding g non-use non-use according to religious precepts, and encourage small families, etc. remained ineffective A special special cadre of male mobilizers mobilizers was establi establishe shed d to bridge bridge the prevailing prevailing social social mobilization gap especially for men, but its contribution has remained negligible due to inadequate inadequate training, poor understanding understanding of role and responsibilities, and absence of any mobility support to cover assigned communities. communities. Similarly, social mobilization aspects of Family Welfare Centres remained unattended and neglected. No doubt that community mobilization has been best done by Rural Support Organizations like NRSP, PRSP, SRSP, BRSP, etc. but with a strong focus on poverty alleviation activities. Utilization of these these commun community ity based based organiz organizatio ations ns for reprodu reproductive ctive health health and family family planning planning remained an untapped resource for service delivery and demand generation. generation. In general, weak organizational and management mechanism did not fully support the interpersonal communi communicati cations ons and demand demand generation generation.. Use of electron electronic ic media media also did not fully attend to communication needs of target audience. Apprehensions towards facilities providing family planning services continued and the number of clients attending these remained to a bare minimum. Evidence Evidence reveals high proportions of women either wants no more children or want to space their next birth. This implies that latent demand for family family plan plannin ning g is high high but but it is impo importa rtant nt to recog recogni nize ze that that the demand demand for for fami family ly planning is fragile among rural communities in addition to serious limitation to female mobility to access services. Besides services, strong social mobilization at community level and communication initiatives is envisioned to overcome the same.

5


IV.. Rejuvenating the Imperative IV As per Population Policy 2002, Ministry of Population Welfare committed itself to bring fertil fertility ity transi transitio tion n to replac replacem emen entt level level ferti fertilit lity y of 2.1 births births by 2020 2020.. This This was was an ambitious and tough challenge for Pakistan. In this regard, Population Perspective Plan (2002-12) envisaged envisaged achieving a contraceptive prevalence prevalence rate of 57 by 2012. This was to be achieve achieved d with the effective effective assistanc assistance e of all public public sector sector entitie entities s especial especially ly Ministry and Departments of Health. The goal was attainable with the coordinated and collective efforts and commitment by all the stakeholders. The servic service e deliv delivery ery of popu populat lation ion progra program m focu focused sed on promo promotin ting g few few metho methods ds especiall especially y steriliz sterilizatio ation. n. An importan importantt promoter promoter of fertility fertility transitio transition n i.e. birth spacing approach did not receive its due importance, and as such Pakistan could not benefit from the efforts in this sector. Rather Pakistan Demographic and Health Survey (200607) reveal that a significant proportion of Pakistani women continue to reproduce in serious health and life risk conditions (seven out of ten women). These risks include: (i) childbearing in teen ages; (ii) childbearing beyond ages 34 – five percent mothers; (iii) short birth interval – one in ten women had during five years prior to survey; and (iv) four or higher number of births – 22 percent women. Learning from own experiences and good examples implemented in several Muslim countries, Pakistan is now ready to place greater emphasis on pregnancy spacing also referred referred as ‘reposit ‘repositioni ioning ng family family planning planning’. ’. Demogra Demographic phic surveys surveys consiste consistently ntly reveal reveal signific significant ant reductio reduction n in neonat neonatal al and infant mortality mortality as a benefit benefit of increase increased d birth spacing of two to four years – a fact if appropriately translated into strategies strategies could bring about about necessa necessary ry fertility fertility transition. transition. Healthy Healthy timing timing and spacing spacing of pregna pregnancie ncies s is a means and a prime outcome of family planning programmes bearing immediate effect on fertility management. This approach focuses on birth spacing and timing of pregnancy in the critic critical al conte context xt of reduc reducing ing pregn pregnan ancy cy relate related d risks risks and and prom promoti oting ng bene benefit fits s of reduced reduced risks of death to mothers mothers and infants infants.. This is also consisten consistentt with Islamic Islamic traditions of infant care and minimizes minimizes chances of mothers mothers to experience experience risks related to abortion abortion.. Religiou Religious s leaders leaders and Ulema have expresse expressed d their their open open support support for this appro approac ach. h. Major Major bene benefit fit is deriv derived ed from from redu reducti ction on in high high parit parity y births births and and furth further er reduction in risks associated with frequent pregnancies which are too close too frequent, too early and too late. Findi Finding ngs s from from recen recentt intern internat atio iona nall compa comparat rative ive resea research rch studie studies s have have revea revealed led treme tremend ndou ous s bene benefi fits ts of fami family ly plan planni ning ng to mate matern rnal al heal health th and and chil child d surv surviv ival al.. International studies clearly depicted that there would have been around four million additional maternal deaths during 1985-2005 if there had been no increase in FP use over 1985 level. Similarly, 54 percent additional maternal deaths would occur during 2005-2025 2005-2025 if no increase in family planning use is recorded over 2005 level. The benefit is accrued due to decrease in incidence of births in high risk ages (below 18 and above age 35) and promotion promotion of pregnancy pregnancy spacing during ages 19-34. Furthermore, Furthermore, research finds increased use of contraception associated with reduced rates of abortion. This warran warrants ts Minist Ministry ry of Healt Health h to provid provide e fami family ly plann planning ing servic services es and and take take effect effective ive measures to ensure availability of FP commodities and service across all its outlets.

6


A robust family planning programme programme is imperative for Pakistan to regain the momentum momentum in fertility transition urgently. With a very high unmet need for contraception contraception (25 percent) severa severall barri barriers ers need need to be overco overcome me,, inclu includi ding ng misin misinfo forma rmatio tion n regard regarding ing family family planning methods, difficult access to facilities/services, facilities/services, misinterpreted religious precepts regarding use of contraception, absence of client focused quality services, disrupted flow of inform informati ation on and and avail availab abili ility ty of contr contrace acepti ptive ve metho methods ds,, etc. etc. In this this rega regard, rd, strict strict monitori monitoring ng and evaluati evaluation, on, account accountabil ability, ity, assuranc assurance e of quality quality services services at individu individual al level, level, are envision envisioned ed to play important important role. role. An effective effective communica communication tion strategy strategy to address these barriers and build demand for family planning remains a major area warranting attention. All these issues also need to be incorporated in Health Policy so that ownership ownership and collecti collective ve resolve resolve in an importan importantt cause cause is reflecte reflected. d. Quality Quality of servic service e which which includ includes es availa availabil bility ity and and choic choice e of metho methods, ds, infor informa matio tion n to clien clients, ts, technical competence competence of providers, providers, good rapport between between users and service providers, providers, cont contin inui uity ty of serv servic ices es and and a cons conste tell llat atio ion n of serv servic ices es offe offere red, d, all all need need to be comprehensively reviewed and accordingly addressed.

V. Popu Populatio lation n and Developm Development ent Goals Goals Societa Societall change changes s such as rapid rapid urbani urbanizati zation, on, increas increased ed female female achiev achieveme ements nts in education education and employment employment market, market, related expansion expansion of opportunities opportunities for women, women, proliferation of information through electronic and other media, and improvements in economic economic situation have set in a process of changes in social values. Demographic Demographic surveys show that fertility level has declined declined but has slowed during the last few years. Rural fertility continues to be significantly high and so is the proportion of women desiring to stop having additional births. It is generally recognized that Pakistan is on track with respect to various population sector indicators but is slow in achieving the targets. High population growth rate and current fertility levels remain arduous for Pakistan’s development goals. Pressure on urban centres is increasing significantly for all amenities especially for youth looking for opportunity to earn livelihood. Increased population density, rapid depletion of water resources, deforestation, and loss of arable land for urban development are recognized threats towards environmental sustainability. Furthermore, this trend is not only a major factor in environmental degradation, but also adds unprecedented demand and pressure on constrai constrained ned available available resource resources s (water, (water, natural natural gas, and land) to be diverted diverted to consumption purposes –away from its productive usage. Reductio Reduction n in poverty poverty remains the mainstay mainstay of all econom economic ic policies policies especially especially after after Pakistan became a signatory to UN’s MDGs in 2000. Over a third of population lives in poverty while the number of poor has increased dramatically during this decade. This increa increase se is closel closely y assoc associat iated ed with with high high fertil fertility ity as well well amon among g the the down down-tro -trodd dden en segments of population. Changing poverty situation across various regions of Pakistan is well recorded – as some regions have much higher proportion of poor reflecting isolation and neglect due to constrained public sector resource availability for uplift activities.

7


VI.. Na VI Nati tion onal al Po Popu pula lati tion on Po Polilicy cy - 201 2010 0 The National Population Policy 2010 focuses on timely completion of fertility transition and actualization of the emerging demographic realities. This Policy repositions family planning planning from health health perspec perspective tive – which which is to refocus refocus programm programmes’ es’ emphasi emphasis s and overall orientation – family planning plays critical role to save mothers lives and child survival. The Policy is consistent with poverty reduction strategies of Government of Pakistan, besides it intends to reduce rising pressures on available resources in the long run. The Population Policy ultimately targets to pave way for benefits of demographic dividend to be realized for Pakistan. Family planning is seen as an important part of the essen essentia tiall packa package ge of servi services ces that that is need needed ed to contri contribu bute te to the the attain attainme ment nt of Millennium Development Goal of reducing maternal mortality by two-thirds by 2015.

VISION To create a healthy, prosperous, and stable Pakistan through timely completion of demogr demograp aphic hic trans transiti ition on and and throu through gh mains mainstr tream eaming ing popu populat lation ion facto factorr in national development

GOALS The National Population Policy seeks:•

•

Pursue population stabilization goal through early completion of fertility transition. Facilitate realization of demographic dividend by linking fertility transition process with skill promotion and employment generation policies

OBJECTIVES Short Term: •

Reduce fertility level to 3 births per woman by the year 2015

•

Ensure universal access to safe family planning services by 2015

•

Reduce incidence of first birth (in ages less than 18) by two-thirds by 2015

•

•

Promote birth-pregnancy birth-pregnancy spacing (of more than 36 months) from existing 33 percent to 60 percent in year 2015 Reduce proportion of mothers giving late birth (ages beyond 34) to half by 2015

Long Term: •

Achieve replacement level fertility i.e. 2.1 births per woman by 2025

•

Minimize unmet need for family planning services from 25 to 10 percent by 2025

8


Achieve contraceptive prevalence rate of 70 percent by 2025

•

PREREQUISITES •

Full ownership of family planning programme by provincial governments by 2010

•

Ministry and Departments of Health take family planning as a priority activity by 2010

•

Provision of adequate funds and upfront, and timely releases

•

Ministries and Departments formulate Policies and Strategies consistent with the requirements of actualizing demographic dividend

GUIDING PARAMATERS Guiding parameters for the improvement of family planning in general and birth spacing in particular, are the ones stipulated in the Plan of Action of the International Conference on Population and Development and UN’s Millennium Development Goals 2000, and the Karachi Karachi Declara Declaration tion 2009 2009 for impleme implementat ntation ion of Best Best Practice Practices s for Family Family Plannin Planning, g, Reproductive Health and MNCH, with particular reference to: • •

•

•

Promoting family planning as an entitlement based on informed and voluntary choice Addressing the population issue within national laws and development priorities, while remaining within the national social and cultural norms Ensuring active participation by and accountability of all stakeholders (individuals, groups and communities, and of institutions, organizations and sectors) in the availability, accessibility and affordability of the essentials of family planning services/ information and care development Ensuring that all FP/RH services and information is based on scientific evidence.

STRATEGIES The National Population Policy 2010 attaches particular importance to enhance access to family planning information and services to achieve fertility transition as a combined outcome of all stakeholders’ efforts and contribution to a vital national cause of achieving stated goals and objectives. Furthermore, evolving consensus among all stakeholders on the policy and assuring full support to achieve stated goals and objectives will be pursued, improved and sustained.

Enhancing Access to Service Delivery and Improving Quality This Policy addresses the critical gap of access to family planning services on urgent basis, with the first priority essentially aimed at consolidating and upgrading service outlets of all major stakeholders stakeholders to actively engage them to taking birth spacing services close to those who need and in a caring and courteous mode. The prime stakeholders of family family plannin planning g service service delivery delivery include include Ministrie Ministries s and Departm Department ents s of Popula Population tion Welfare, Welfare, and Health, Health, Social Social Marketin Marketing g Organiza Organization tions, s, and civil civil society society organiza organization tions s

9


supporting population policy goals and objectives. Main initiatives in this perspective include: •

•

•

•

•

•

•

•

•

•

•

Evolving an integrated service delivery action plan for all stakeholders with revised TORs of service delivery points with a view to achieve synergy Estab Establis lishin hing g inter inter-Mi -Minis nister terial ial Coord Coordina inatio tion n Comm Commit ittee tee for for regula regularr revie review w of impl implem emen enta tati tion on issu issues es and and perf perfor orma manc nce. e. Esta Establ blis ishi hing ng a foru forum m to brin bring g the the stakeholders together to review programme and shared goals / objectives. Ministry of Population Welfare to take lead role and encourage and support activities in areas where initiatives are needed. Shift thrust of expansion of service delivery outlets from urban to rural and to outreach / community based service delivery. Urban slums will also receive greater attention to meet their service needs. In this regard, strong NGO support is essential to this policy to provide FP/ RH services using level community resources, and disseminating accurate information on family planning to clients. Furthermore, an active community based distribution programme which provides services as integral component – and probably more importantly - help legitimatize and broadly disseminate information on family planning. Enco Encoura uragi ging ng inno innovat vative ive initia initiativ tives es to enha enhanc nce e easy easy acces access s to family family plann plannin ing g services. Ensurin Ensuring g availabi availability lity of quality quality family family plannin planning g services services and products products includi including ng emergency contraception in all public and private sector facilities. Expanding contraceptive choice to include fertility awareness methods including lactational amenorrhea method (LAM) and standard days method (SDM), to improve adoption and continuation Rationalizing contraceptive methods availability at all facility consistent with clients’ requirements of pregnancy spacing i.e. promoting pregnancy spacing methods Ministry of Health to explore all avenues to operationalize family planning activities for birth spacing especially at service delivery points as part of the efforts to reduce maternal and informant mortality and that such efforts to include tetanus vaccination, antenatal and postnatal care, child immunization, etc. o Contraceptives are included in the health essential drug list. o Contraceptive services are provided as part of primary health care. NATP NATPOW OW to fram frame e its its rule rules s of busi busine ness ss to gove govern rn its its own own oper operat atio ions ns as an autonomous body and serve as a key coordinating linkage with NGOs, to help in charting a course of action through their respective expertise, and devise a system for regular feedback for exchange of information. With a new Board of Directors and full-time Chief Executive Officer in place, opening up of a grants making channel should revitalize the role of the NGOs in service delivery. Enhancing Enhancing Public-Private Partnership Partnerships s to devote more effectively effectively to extend its outreach to rural areas, while deepening the efforts in the urban areas, with focus on involv involving ing more more privat private e provid providers ers,, heal health th estab establis lishm hmen ents ts of publ public ic and and priva private te organizations and industrial concerns, in order to realize its full potential. Minist Ministry ry of Popu Populat lation ion Welfa Welfare re to stren strength gthen en netwo networki rking ng with with other other pote potenti ntial al parastatal organizations, especially those with whom MOUs are already in place.

Ministry of Population Welfare to develop partnership with rural support programmes to provid provide e treme tremend ndou ous s boos boostt to acces access s to family family plann planning ing servi services ces and and an effec effectiv tive e mechanism for social mobilization and to share accurate information on family planning

10


methods and removing existing misperceptions. Ministry of Population Welfare should build this partnership and work to enhance their capacity to manage this initiative and connect with contraceptive logistics system for supply of family planning commodities and and accur accurate ate informa informatio tion. n. Joint Joint moni monitor torin ing g mecha mechani nism sm could could be used used to asses assess s performance and outcomes of this initiative. Improving Quality of Services • • •

•

Ensure service standards protocols are adhered to and client satisfaction monitored Take measures to decrease various barriers to access to family planning Strengthen Training Institutes to address management improvement training needs and adopt / encourage interactive training methodologies. Quality of Service and Client Centered trainings to become core activities. Assist Ministry and Departments of Health in the inclusion of care for miscarriages / post abortion in policies, guidelines, protocols and standards for health facilities.

Contraceptive Need Assessment and Procurement System Regular Regular provisio provision n of contrace contraceptiv ptives es to all facilitie facilities s is the lifeline of family family planning planning services. In view of the fact that the proportion of women expected to use contraception contraception will will grow grow in the the comin coming g years, years, need need of contr contrace acepti ptives ves is antic anticipa ipated ted to increa increase se tremendously. Presence of a manual logistics system has not helped field and office manage managers rs track track contrace contraceptiv ptive e stocks stocks at facility facility and storage storage levels levels where where stock-ou stock-outs ts existed. Lady Health Workers were provided limited number of oral pills and condoms condoms to be dispensed due to limited availability of these methods. For effective management of provisio provision n of all supplies supplies at all levels, levels, an operatio operationall nally y useful useful Logistic Logistic Manage Managemen mentt System is required. In this regard, Ministry of Population Welfare will: •

•

•

• •

•

Instit Institut utio iona naliz lize e popu popula latio tion n proje projecti ction ons, s, accou accounti nting ng for for chan changin ging g trend trends s in contr contrace acepti ptive ve metho method d mix, mix, and and unde underta rtake ke foreca forecasti sting ng future future need needs s for for contraceptive supplies Arran Arrange ge adeq adequa uate te fund funds s from from Gove Governm rnmen entt or dono donors rs and and ensu ensure re timel timely y procurement of contraceptive commodities Manage the Centra Centrall Wareh Warehou ouse, se, and and ensu ensure re distr distribu ibutio tion n of contra contrace cepti ptive ve supplies to provincial and district stores, NGOs, provincial line departments, etc., according to logistics system Computerize a contraceptive logistics management information system. Develop a comprehensive reproductive health commodity security strategy for Pakistan for all stakeholders Institut Institution ionalize alize contrace contraceptiv ptive e monitori monitoring ng system system at the field field level level to minimiz minimize e wastage, pilferage, proper storage facility, and full implementation of standard operating procedures of storage and distribution.

Ministry Ministry of Popula Population tion Welfare Welfare would establis establish h and make operati operationa onall a compute computerized rized contra contracep ceptiv tive e inven inventor tory y contro controll system system at cent central ral wareh warehou ouse se and and regio regiona nall stores stores (provinces and districts) to overcome supply chain management weaknesses, maintain proper record of receipts, issues and distribution of contraceptive supplies to all outlets. It is imperative to institutionalize an uninterrupted supply of a range of contraceptives.

11


Human Human resource resource developmen developmentt to fully operationa operationalize lize and maintai maintain n the system system also requires necessary attention.

Advocacy, Communications and Demand Generation Promotio Promotion n of pregna pregnancy ncy spacing spacing perspect perspective ive of family family planning planning would would need need special special advocacy initiatives while maintaining emphasis on small family norm leading to family well-being. Promoting spacing is well recognized for maternal and child health benefits. Populat Population ion Welfare Welfare Programm Programme e will mobilize mobilize religious religious leaders leaders and media media to provide provide necessary support to overcome misperceptions regarding family planning and promote birth-pregnancy spacing initiatives. Furthermore, grassroots organizations and NGOs will be encouraged to fill service delivery and information gaps to meet the goals. Role of media in promoting birth-pregnancy birth-pregnancy spacing is integral to achieving the policy objectives objectives of this socio-behavioural change programme for adoption of small family norm on a volunta voluntary ry basis. basis. Promotin Promoting g family family plannin planning g in line with the requirem requirements ents of Healthy Healthy Timing and Spacing of Pregnancies goals, and addressing barriers related to unmet need for contraception would entail: An innovative communication communication campaign bringing birth-pregnancy birth-pregnancy spacing • at the centre centre stage stage of progra programm mmati atic c effor efforts ts throu through gh appe appeali aling ng and and insta instant nt attracting messages A vigoro vigorous us comm commun unica icatio tion n comp compon onen entt using using multi multiple ple chan channe nels ls and and media, with key messages developed on professional and scientific basis, with indi indica cato tors rs of what what to be achi achiev eved ed and and the the same same serv servin ing g the the purp purpos ose e of assessment against investment. A multi-pronged approach focusing on service delivery, greater emphasis • on intensive and quality of counseling to remove misgivings regarding various methods; and social cultural barriers through actively engaging religious leaders in the context of health and well-being of women and their off-springs viz: o Actively producing and sharing accurate information regarding contraceptive methods and overcome misperceptions prevalent at community level o Using social mobilization techniques to reach out rural communities and isolated regions for active promotion health perspective of family planning. Enhance programme visibility at all levels o Make aware public representatives, opinion leaders, civil society, press, bars, academicians, etc., on the growing population problem and build their role in promoting benefits of birth-pregnancy spacing, safe motherhood and responsible parenthood Sensitize policy/decision makers, and development planners to o mainstream population factor in national development planning and align their policies and programmes with this Population Policy 2010. o Making mandatory counseling for birth-pregnancy spacing/family planning during the antenatal, postpartum check ups and for those coming for post miscarriage care o Assisting the media to be well informed, and to take strong initiatives to enhance awareness on important family planning aspects. The media will be encouraged to find new and better ways to bring key population issues •

12


o

o

into the public domain for discourse, as it relates to family planning and healthy timing and spacing of pregnancies (HTSP). Promoting dialogue on important population issues in all media channels Engaging Religious leaders as social mobilizers will be piloted and replicated on successful outcomes. Promote use of supportive religious material on HTSP in Friday sermons, public gatherings and counseling Promote male involvement in RH/FP through innovative activities especially in rural areas

Programme Management and Efficiency Efficient management is imperative for Programme performance and achievement of objectives. Several critical avenues require focused attention to strengthen programme efficiency including: Financial Efficiency: Finalization of Annual Work Plan and Cash Plans by provincial Popu Populat lation ion Depart Departme ments nts,, and and upfro upfront nt and and timely timely relea release se of funds funds by the the fede federal ral government direct to the Population Welfare Departments till such time the Programme is taken over by the Provincial Governments. Coordination: Coordination at federal and provincial levels was not satisfactory. Serious gap existed at the district levels to support much needed functional coordination and integrat integration ion process. process. Ministry Ministry of Populat Population ion Welfare Welfare will actively actively pursue pursue concerne concerned d stakeholders to facilitate family planning service delivery with judicious use of scarce resources, minimize duplication, to build capacities/skills and commodity gaps covering the following domains: Functional coordination within MoPW Policy and Programme coordination of MoPW with Provincial PWDs Overall coordination of MoPW with MoH and other stakeholders Progra Program m coord coordina inatio tion n and and funct functio iona nall integ integrat ration ion of PWDs PWDs with with DOHs DOHs especially at the district level ad service delivery levels. • • • •

Contin Continuin uing g De-fe De-fede deral raliza izatio tion n proces process: s: Two major major steps steps toward towards s furth furtheri ering ng dedefederalization federalization remained remained unattended that impeded completion completion of the process. Continuing the process involves elaboration of terms of reference, and defining the role of Ministry and Departments of Population Welfare: • •

Actively pursue provincial governments to build ownership Encourage decentralization of program management and service delivery to district levels.

Reorganization of Ministry of Population Welfare: With the finalization of the National Finance Finance Commiss Commission ion Award Award starting starting July 2010, 2010, there there is every every reason reason for provinci provincial al gover governm nmen ents ts to take take over over Popu Populat latio ion n Welfa Welfare re Depa Departm rtmen ents ts.. In this this conte context, xt, it is imperative to revisit the role and responsibilities at federal and provincial levels to make then efficient organizations. This step is necessary to minimize duplication of role, and synchronize provincial and federal efforts. Besides, synchronization of diff dept within the Ministry is also imperative. Inter-linkages between planning, planning, financial management, management, and foreign foreign assistan assistance ce are weak. weak. The work plan through through foreign foreign assistan assistance ce should should be complementing / supplementing the overall work plan of the programme thru PSDP. Similarly Similarly,, effective effective planning planning needs needs a proper proper feedba feedback ck on release releases s and utilization utilization of

13


PSDP. Therefore, the oversight and coordination of these three Directorates should rest with one independent wing chief. Human Resource Management: Following areas will be pursued for improving human resource management: Career planning, succession planning and posting right person to the the righ rightt job. job. Prom Promotion mech mechan anism ism will will be improv improved ed by enha enhanc ncing ing progra program m supervisors involvement in Departmental Promotion Committees. A Human Resource Develo Developm pmen entt Plan Plan was was desig designe ned d in the previo previous us Polic Policy y docum documen entt but but rema remaine ined d unattended. HR Plan is considered a major step to increase staff efficiency and will be developed, while provincial Departments will be guided to evolve the same. Attention will be given to: Monitor the Monitor the availability of management training for population personnel (government • and non-government) non-government) in the system, and the level of training of professionals serving in the field. Reorgan Reorganize ize Human Human Developm Development ent and Skill Skill Enhanc Enhanceme ement nt institut institutions ions (RTIs (RTIs and • PWTIs) to use modern training methodologies and techniques Ensure resources to support necessary training and education. • Development Planning: To-date Programme planning remains devoid of evidence based scientific findings. Ministry of Population Welfare will actively promote use of research findings to evolve plans at all levels. Needed studies studies will be authorized to justify, expand or close/reduce inefficient components to minimize external influences. •

•

Instit Institut ution ionali alize ze Oper Operati ation onal al plann plannin ing g at all all level levels s to instil instilll accou accounta ntabi bilit lity y and and monitoring for timely implementation of planned activities. Overhaul program monitoring and supervisory system and regular performance reviews and putting in place a result oriented mechanism at the lower tiers.

Programme Monitoring and Evaluation In pursuit of the government’s overall approach to monitoring, Population Programme will be adopting adopting result based monitoring (RBM) mechanism under this policy. Resultsbase based d moni monito tori ring ng is a broa broad d mana manage geme ment nt appr approa oach ch by whic which h the the Mini Minist stry ry and and Departments of Population Welfare will ensure that its processes, outputs and services contribute to the achievement of its clearly stated objectives (i.e. results). RBM approach requires defining realistic expected results, monitoring progress toward the achievement achievement of expected results, integrating lessons learned into making decisions and reporting performance. The monitoring of the Policy will focus to assess achievement of benefits to target beneficiaries. All Popu Popula latio tion n Progra Programm mme e comp compon onen ents ts will will articu articulat late e their their own desir desired ed result results— s— outcomes and outputs that best capture the intended and actual results of efforts. These measu measures res are then then used used as the basis basis for assess assessin ing g perfo performa rmanc nce. e. An importa important nt consequence consequence of RBM is to reinforce the value value of partnerships. partnerships. RBM shifts the focus focus of the organization from outputs (number of contraceptives distributed, number of clients contacted and recruited), to outcomes (proportion of clients contacted, contraceptive prevalence rate, etc.) - which necessarily require a coordinated work of all components managers. Rather putting emphasis on outcomes, it becomes imperative for the Ministry to invest in engaging engaging all stakeholders stakeholders and building partnerships to achieve its objectives. Furthermore, Furthermore, the approach adds to public sector investment efficiency efficiency and effectiveness effectiveness at all levels.

14


Ministry will monitor the nature and quality of ongoing population sector activities of all stakeholders. Of particular importance is external monitoring monitoring of service delivery systems of all provider levels to ensure service quality, and compliance with quality standards. Programm Programme e evaluati evaluation on to be done on periodic periodic basis for all compon components ents to provide provide systematic analysis of experience to review the implementation, identify problems and suggest remedial actions for future directions. The purpose will be to determine the extent to which the objectives are achieved by various programme components. These evaluations should evolve necessary measures to be taken to increase the chances of atta attain inin ing g the the desi desire red d outc outcom omes es and and meet meet the the over overal alll obje object ctiv ive e of incr increa easi sing ng contraceptive prevalence rate especially those related to birth spacing. Programme Programme evaluation under this policy will be a critical tool to assess the efficiency and effectiveness of family planning and reproductive health interventions and should be included in the design of programmes from the beginning, along with suggestions for improved measurable indicators. Family Planning and reproductive health services must be measured more effectively. A list of process and outcome indicators is placed (at Annex-1) that would be used to assess achievement of family planning and reproductive health programme at various levels. levels. Monitorin Monitoring g of these these selected selected priority priority indicators indicators on regular regular interval intervals s will be produced on provincial and district levels. These Programme level indicators will be used for tracking progress and comparison across provinces and regions. All Programme components will evolve their own process, output and outcome indicators to monitor regularly. Capacity building on these aspects is important to successfully successfully implement this initiative. Ministry of Population will work with Provincial Population Departments to build capacity of field monitoring at district levels. Pilot to be initiated across all provinces focusing on district profiling, use of this data for local decision making and performance improvement as a guide guide to be replic replicate ated d acros across s all distri districts cts.. Neces Necessar sary y resou resource rces s for for all field field monitoring and supervision activities must be protected and ensured. Population Welfare Programme strategies to collect data would now include community needs assessments, sampl sample e studi studies es and and more more of clien clientt satis satisfac factio tion n survey surveys s that that provid provide e indep indepen ende dent nt information, in addition to data from programme management information system. To improve services and care two-way flow of information based on these measures is considered essential.

Research in Population and Development The Nation National al Popu Populat lation ion Polic Policy y 2010 2010 rests rests all futur future e direc directio tion n on evide evidence nce based based research and rigorous monitoring of Programme. The generation of knowledge is taken essen essentia tiall eleme element nt in strate strategie gies s to improv improve e servic service e quali quality, ty, enha enhanci ncing ng progra programm mme e efficiency and encourage self criticism. Population Policy has benefited from various researches undertaken undertaken on Pakistan in various aspects of fertility transition, transition, reproductive reproductive health and family planning activities. This Policy encourages encourages examining FP/RH research system to improve upon and strengthen capacity to establish a sound knowledge basis for policy policy and practice. practice. Limited Limited research research capacity capacity in Pakista Pakistan n calls calls for collabo collaborativ rative e research projects and strong institutional links important to build capacity and provide full

15


suppo support rt to polic policy y formu formula latio tion. n. Future Future resea research rch areas areas are to focus focus on how how fertil fertility ity trans transiti ition on can be achie achieved ved in short shortes estt perio period d with with opera operatio tions ns resea research rch need needed ed to enhance access and removal of misconceptions. Research on social mobilization, male responsibility, and innovative communications, and advocacy are needed urgently to direct programme initiatives. Translating research findings into policy options have been a major barrier, which should be addressed on priority allowing wider audience to benefit from from oppo opportu rtuni nitie ties. s. Promo Promotio tion n of resea research rch cultu culture re will will be highly highly enco encoura urage ged d and and supported. NIPS NIPS is entru entruste sted d with with polic policy y resea research rch coveri covering ng all aspe aspects cts of RH/FP RH/FP and and ferti fertilit lity y transition, population population and development. development. NIPS will continue continue to spearhead data gathering, gathering, analysis and research efforts to ensure that planners, decision makers & programmers get get up-t up-too-da date te reli reliab able le esti estima mate tes s and and more ore spec specif ific ical ally ly anal analys ysis is on the the key key interrelationships interrelationships between determinants of fertility transition and other critical indicators. indicators. Evaluation of the population welfare programme components using credible independent third party agencies is envisioned. Partnership with local and international academic agencies will be encouraged encouraged to support demographic demographic research in Pakistan. Pakistan. Research on age dynamics and urbanization is needed to support realization of demographic dividend in shortest time period. Operations research on barriers to contraceptive acceptance and fertility transition is urgently needed to guide programme managers make necessary modifica modification tions. s. Client Client satisfac satisfaction tion and feedba feedback ck is the main main stay of urgent urgent feedbac feedback k needed by all Programme components. These are to be regularly formalized to include all aspects of access to services and facilities. This This Poli Policy cy seek seeks s spec specia iall effo effort rts s to tran transl slat ate e rese resear arch ch find findin ings gs for for poli policy cy and and programm programmatic atic support support.. NIPS and Plannin Planning g Directora Directorate te will establis establish h regular regular annual annual forum to review up-to-date research done on Pakistan and translate it to support policy change and programme improvement. improvement. The forum will bring researchers and planners at all levels, especially the provincial and lower levels to build their interest and capacities. Capacity building of users including emerging policy makers needs special attention through through training training programmes programmes.. Higher Higher education education and studies studies will be encoura encouraged ged to promote promote frequen frequentt interact interaction ion among among policy policy makers, makers, academ academicia icians, ns, research researchers, ers, and programme programme managers. Promotion of demography and academic pursuits will be actively encouraged among young professionals.

Population and Development for Policy Support Supp Support ort by three three secto sectors rs is critic critical al for for realiz realizin ing g popu populat latio ion n secto sectorr goals goals.. Fema Female le educati education on is without without doubt doubt the most importan importantt and signific significant ant contribu contributor tor to achieve achieve fertility transition in any developing developing society. Neglect of female education education in Pakistan over the past did contribute to slow adoption of contraceptive methods and resultant slow fertility transition during 1970s and 1980s. To-date the full benefits of female education have yet to be embodied in the population sector dynamics. These include building stron strong g linka linkage ges s betwe between en sector sector targe targets, ts, tailor tailoring ing curri curricu culum lum to risin rising g popu popula latio tion n concerns, and use of teaching staff in promoting birth spacing agenda in the youth. Preparing youth for marketable skills also remains to be attended to enable youth to become become producti productive ve individu individuals. als. Female Female employm employment ent also exhibit exhibit positive positive associat association ion with fertility transition but has remained low key measure in Pakistan and not given adequate attention as female empowerment link to support population sector goals.

16


Urbanization in the recent past has witnessed tremendous boost and has given shocks to development planners in terms of meeting unprecedented pressure on services and amen ameniti ities. es. The projec projected ted urban urbaniza izatio tion n growth growth over over the the next next two deca decade des s which which enco encomp mpas asse ses s mass massiv ive e inte intern rnal al migr migrat atio ion n patt patter ern n seek seeks s inno innova vati tive ve popu popula lati tion on redistribution policies through building new towns and industrial parks for opportunities of livelihood and wellbeing. Urban development policies especially the urban slums are imperative to maintain fair distribution distribution of youthful population population and economic economic development development process across all urban areas besides being a way forward to protect environment and promote promote sustain sustainable able develop developmen ment. t. Ministry Ministry of Populat Population ion Welfare Welfare will take lead lead to organ organize ize Popu Popula latio tion n and and Deve Develop lopme ment nt meet meeting ings s to bring bring popu populat lation ion growth growth and and distribution centre stage of development process and help evolve effective links and sectoral policies in education, skill enhancement, urban growth, labour and manpower, social welfare align with changing demographic realities.

17


Annex Annex -1 FAMILY FAMILY PLANN PLANNING ING AND AND REPROD REPRODUCT UCTIVE IVE HEALTH HEALTH INDICATORS Indicators for Information Collection and Sources of Data

Ministry of Population/Health

FAMILY PLANNING INDICATORS 1234567-

Contraceptive Prevalence Rate Contraceptive method mix Current and ever use of contraceptives Source of availability / access Distance to source Reasons for non-use Costs and satisfaction with methods

8- Unmet need for contraception 9- Quality of family planning services

- supply aspects: staffing, lack of supplies and choice of methods, staff attitude towards clients; staff explained side effects/misperceptions

Level National Provincial and Regional

Frequency Annual “ “ “

Source National Surveys or

or special studies

“ Provincial / Regional / district levels

Annual

Bi-annual

HH Survey MIS Special Surveys

- demand aspects: availability, client satisfaction

Special HH Surveys Same

Same

Yearly

Same

Same

Same

Quarterl erly

Pop. MIS & HMIS

National/ Provincial

After 2 years

2. Couples reporting no pregnancy pregnancy during during last last 3 years years


After 2 years

3. Women reporting high risk pregnancies: pregnancies: *Pregnancy age (< 18) in last 3 years *Pregnancy age (>=35) in last 3 years *No. of births >=3 *Space between last 2 births less than 3 years 4. Proportion reporting unwanted pregnancies pregnancies (last 3 years) 5. Desir Desired ed famil family y size

National/ Provincial Regional

After 2 years

Large surveys Large surveys Large surveys


After 2 years

Same National/ Provincial

Same After 2 years

National Provincial Regional

Annual or in 2 years

10-

Drop out and reasons for drop out

Proportion women reporting contraceptives access at doorstep 12Stock out of any contraceptive method at all govt. facilities and NGO outlets 11-

13-

No. of clients served with FP: No. of current users (old and new users)

FERTILITY INDICATORS 1. Total Fertility Fertility Rate Rate and and related related indicators indicators

6. Couples desiring no more births or desiring a birth after 3 years 7. Percent of households households having having received received services services from LHW in the last two months

small survey if regional Large surveys Same Large surveys Large surveys

18


OPERATIONAL ISSUES WITH HEALTH 1. Contraceptive stock with LHW Programme 2. Contraceptive Plan in position at MoH - NP FP/PHC 3. No. of health facilities facilities with female staff (in place and present) 4. No. of health facilities facilities with female staff (in place) and trained in FP service delivery

ADMINISTRATIVE ISSUES 5. Budget allocated (revised estimates) 6. Financial releases to provinces by MoPW (dates and period) 7. Dates amount received by provincial Population Departments 8. Total Total expenditu expenditure re during the the period Salary Non-salary

9. Vacant positions

National Provincial

Quarterly

MoPWs admn.

Provincial district levels

Quarterly

HMIS / LHW MIS .

National Provincial District

Annual / Quarterly

MoPWs / PWDs admn. & FA

National Provincial

Quarterly

Same

National

(as percent of sanctioned posts) Provincial Administrative and professional posts % filled Technical (doctors and paramedics) posts % filled 10. Human Resource Development Provincia l / District HR Plan (in place and implemented) level Number of FP trained staff positioned Number of health staff trained in FP Coverage of area/ population with services No of Religious Leaders actively involved • (delivered sermons) • • •

Quarterly

Bi -annual

Same.

MoH / DoH MoPW MIS

•

19

Pakistan Population Policy

Recommend Documents