Country Team Action Plan

PAKISTAN

Where are we now? Population growth rate remains high Large population (25 Percent) has unmet need for

contraception in 2006-07 Contraceptive prevalence rate for modern methods has

stagnated around 22 percent (all methods at 30 percent) Inadequate knowledge and motivation about birth

spacing/ HTSP Health outlets offer limited BS/FP services High abortion rate related to unwanted pregnancies

Selected Best Practice for Pakistan

Integration of quality family planning

services in public health delivery system

Where do we want to be?GOAL

Increase access to quality BS/FP services through health service

delivery system

Areas of Focus

• Policy• Programmatic• Monitoring and Supervision • Commodity/Supplies • Demand Generation• Innovation

Policy Focus

Service Delivery – Ensure FP/BS services at all SDPs – Develop contraceptive uniform pricing policy

for public health system– Sustain commodity support – Improve partnership with private sector and

NGOs for provision of FP/BS information and services particularly for hard to reach areas

Policy Goal

Capacity Development – Revise pre-service curriculum for all

medics and paramedics

– Train and orient all existing medics, paramedics and out reach workers

Programmatic Level• Notify Provincial governments to ensure:

– delivery of BS/FP services through all SDPs and out reach workers – Design and institutionalize system for communication, advocacy &

mobilization – National Communication Strategy

• Involve private sector and NGOs for provision of FP/BS information and services

• Implement LMIS to improve availability rate of contraceptive commodities and sustain supply chain management

• Relevant BS/FP indicators to capture performance/progress to be incorporated in MIS systems

Guiding Principles on Delivery of

BS/ FP Services• No targets or quotas for any contraceptive method• No denial of rights on non-acceptance of birth spacing

options• No incentives for program personnel and FP acceptors• Informed voluntary consent

Monitoring and Supervision

• Notify focal persons at federal, provincial and district level

• Select indicators on BS/FP performance and Progress

• Use of Information for Operational Management and Decision Making

• Strengthen Supervision and Monitoring

What are the possible challenges to the

intervention?• Coordination between Health and Pop Welfare• Absence of warehouse at provincial and district levels• Contraceptives not part of EDL and EDL not uniform

across provinces • Inadequate capacity for management, communication

and M&E• PSDP allocations for implementing BPs• Inadequate information system for supply chain

management • Donor Coordination

Who are the possible partners, allies, and

stakeholders to scale up?– Government of Pakistan

Ministry of Health (MoH), Ministry of Population Welfare (MoPW) and People’s Primary Health Initiative (PPHI)

– Private Sector, Social Marketing & NGOs– Media and communication organizations – Pharmaceutical sector– Community and Religious Leaders– Development Partners

What is the evidence to support this best practice?

• Global and Regional evidence• National data to support scale up

• Gather local evidence on Post Partum IUCD insertion prior to scale up

What are the modifications needed to improve the

intervention’s scalability?• Revise pre-service and in-service curriculum• To implement the BP, revisit Post Partum and

Post-Abortion protocol • Joint review of BS/FP communication

strategy

What are the opportunities of scaling-up?

Opportunities • Political Commitment and Conducive environment • Infrastructure and health facilities (13,000 facilities) to

increase coverage and access • Community-Based Midwives (12,000) and Lady Health

Workers (96,000)• Integration of FP in HIV/AIDS VCT Centres • Introduction of Sino-2 Implant• Donor support

Constraints • Lack of understanding of HTSP as health initiative• Inadequate financing • Barriers to BS/FP practices• Limited Capacity at Management and Program

Implementation • Weak Coordination at all levels

What are the constraints of scaling-up?

What Policy, Regulatory, Budgetary or Other

Institutional Steps are needed• Health Policy to reflect HTSP

• Enable out reach workers to assess and provide the first and subsequent doses of injectables

• PC-I revisions to include HTSP

• PSDP allocations to support implementation

• All training curricula to include module on BP Implementation Strategy

• Add contraceptives in EDL

• Establish technical Committee of Communications, Advocacy, and Mobilization

• Joint Technical Committee on Innovations to review new technologies

Where, when and how will the best practice be

expanded • National with focus on low performing districts

How

• National Consensus already in place (Karachi Declaration) and MOH-FP road map

• Establishment of BP Secretariat• Dissemination of Country Action Plan through

Provincial and Regional Meetings

What will the cost of expansion and how will

needed resources be mobilized • Detailed costing on the following done at country

level – Training– Contraceptive commodities– Warehouse and storage – Need to cost out management and communication,

advocacy and other areas

• Resources to be provided by GoP and Development Partners

Action Step Responsible Person

Timeline

1 Finalization and Costing of Country Action Plan

BP Secretariat / Focused Implementation Committee

April 2010

2. Meetings with MoH and MoPW with Planning Commission and Min of Finance and EAD on Policy revision and PC-I incorporations

DG Health, and DG (T) Population BP Secretariat support

April - June 2010

3. Provincial / Regional Dissemination and Operationalization

DG Health, DG (T) PopulationBP Secretariat supportP Ms – MNCH and LHW Prog

July – Sept 2010

4. Programmatic changes DG Health, DG (T) PopulationBP Secretariat supportP Ms – MNCH and LHW Prog PNC / PMDC

May – Sept 2010

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““I dream of a I dream of a Pakistan, of an Asia, Pakistan, of an Asia, of a world, where of a world, where every pregnancy is every pregnancy is planned, and every planned, and every child conceived is child conceived is nurtured, loved, nurtured, loved, educated and educated and supported”. supported”.

International Conference on Population International Conference on Population & Development held at Cairo in 1994& Development held at Cairo in 1994

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