Ministry of Population Welfare Yearbook 2009-10

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Message Rising population growth poses a serious threat to a country’s social progress, economic stability, health, environment, law and order, and food security. According to most experts, it is the biggest obstacle to the socioeconomic development of the people in the developing world.

Pakistan is the sixth most populous country in the world and the fourth most populous country in Asia. The country’s population has increased from 34.0 million in 1951 to 173.5 million in 2010. Due to increasing realization of the need for family planning, total fertility and population growth rates have started to decline globally.

Arresting population growth is one of the top priorities of the present government, since this will help in attaining a balance between the country’s resources and population, leading to sustainable socioeconomic development. If the current population growth rate of 2.05% does not slow down, Pakistan’s population would double in the next 34 years. Furthermore, over one-third of Pakistan’s population is aged below 15 years and it would be entering the reproductive age in the near future.

The Population Welfare Programme of the Ministry of Population Welfare (MoPW) aims at improving the quality of people’s life by enabling couples to decide the number of and spacing between their children, and by providing them the information and the means to do so. Since its inception, the Programme has been focusing on family planning under the umbrella of reproductive health as a development intervention; otherwise, the demographic scenario of Pakistan would have not been so encouraging.

Although a fertility transition has set in, there is still an unmet need of 25% for family planning in Pakistan. Addressing this issue requires collective efforts by the MoPW and its partners, including the Ministry and Departments of Health, civil society and the private sector.

I hope that the users of the MoPW’s Yearbook 2009-10 would be able to better understand the demographic scenario of Pakistan, as well as know about the efforts put in by the Ministry in collaboration with its partners.

I would like to reiterate that the MoPW alone cannot meet the challenges posed by accelerating population growth; this requires support and cooperation of other ministries and departments, non-governmental and civil society organizations, and the private sector.

Finally, I want to put on record my appreciation for the efforts and hard work put in by the MoPW’s staff in compiling this Yearbook.

(Dr. Firdous Ashiq Awan) Federal Minister for Population Welfare

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Preface I am pleased to present the MoPW’s Yearbook 2009-10, prepared in pursuance of Sub-Rule(2) of the Rules of Business, 1973. The document encompasses the mandate, functions, activities and achievements of the Ministry, besides presenting an overview of the new Population Policy, the next five-year development plan, and future strategies and initiatives.

I hope that the users of the Yearbook 2009-10 would be able to learn about the important role the MoPW is playing in the field of population and development. The Ministry aims at ensuring universal coverage of family planning and reproductive health with the help of its partners. Although the Ministry has had modest success in reducing the population growth rate in Pakistan, a fertility decline has set in, which will hopefully help us in achieving our goals.

I am convinced that, with the collaboration and active support of its partners, the MoPW will soon achieve replacement level fertility, leading Pakistan towards the ultimate goal of population stabilization.

(Shaukat Hayat Durrani) Secretary, Ministry of Population Welfare

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Contents PART I Chapter 1

A. Mandate of MoPW as Per Rules of Business, 1973 1 B. Organogram/Organizational Chart of MoPW 2 C. Functions of Different Wings of MoPW 3

Chapter 2 Overview of Population Welfare Programme and Implementing Agencies 5

Chapter 3 Autonomous Bodies of MoPW 7

Chapter 4 Draft Pakistan Population Policy, 2010 8 PART II Chapter 5 Service Delivery

A. Service Outlets of Population Welfare Programme (Public) I. Family Welfare Centres 15 II. Reproductive Health Services-A Centres 15 III. Mobile Service Units 17

B. Service Outlets of Population Welfare Programme (PPP) I. Reproductive Health Services-B Centres 20 II. Public-Private Partnership 20

Chapter 6 Other Activities

A. Training Institutes I. Clinical Training 21 II. Non-Clinical Training 22

B. Communication and Advocacy 24 C. Population Education 29 D. Contraceptive Commodity Security (Procurement and Performance) 30 E. International Cooperation 33 F. Monitoring and Supervision 38 G. Research and Evaluation

I. National Research Institute of Fertility Care 39 II. National Institute of Population Studies 39

H. Special Initiatives 41 I. PSDP Allocation and Utilization 43

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PART I

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Chapter 1 A. Mandate of MoPW as Per Rules of Business, 1973

1(i). Develop policies for implementing the Population Welfare Programme in the country.

(ii). Monitor population activities and evaluate the Programme.

2. Deal and make agreements with other countries and international organizations in matters related to the Programme.

3(i). Collect, maintain and analyze demographic and population statistics. (ii). Acquire, store and dispatch supplies for the Programme.

4(i). Manage information and educational services for the furtherance of Programme objectives.

(ii). Conduct training in the field of population planning.

5. Formulate the policy governing the manufacture, use and quality control of contraceptives under the Programme.

6. Conduct research on different aspects of the Programme, such as clinical, social and demographic.

7. Promote population planning activities through public sector agencies and institutions, hakims, non-governmental organizations (NGOs), etc

8. Oversee matters related to the National Trust for Population Welfare (NATPOW) and the National Institute of Population Studies (NIPS).

9. Coordinate with other Ministries and Departments for systematic introduction of population education, and financial and regulatory incentives and disincentives favouring population planning.

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B. Organogram/Organizational Chart of MoPW

Minister

Secretary

Additional Secretary Autonomous Bodies

NIPS NATPOW

Joint Secretary Director General Technical Wing

Director General Programme Wing

Director General M&S Wing

Director General PPP Wing

Director General Planning Wing

Chief F&A Officer

Deputy Secretary Admn-I

Deputy Secretary Admn-II

Director (FWC)

Director (RHS)

Director (TC)

Director (CT)

Director (CS)

Director (PE)

Director (Training)

PWTIs (Lahore and Karachi)

Director (PM)

Director (PME)

Director (SS&DP)

Director (FA)

Director

Director

Director (PPP)

Director (NRIFC)

Director (FM)

SO (F&A)

Director (Planning)

Director (CW&S)

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C. Functions of Different Wings of MoPW Planning Wing Review the Population Policy and facilitate the process of its formulation, as well as that

of other population-related strategies.

Translate the Policy into federal and provincial projects and schemes under the Population Welfare Programme.

Procure funding for Programme projects from national and international sources.

Finalize the Annual Work Plan of the MoPW’s PC-Is (both Federal Activity and Provincial Programmes).

Conduct strategic monitoring to facilitate effective implementation of the MoPW’s PC-Is.

Serve as the secretariat for the National Commission for Population Welfare (NCPW) and the Social Sector Coordination Committee (SSCC).

Technical Wing Form policy to execute the technical component of the Population Welfare Programme.

Implement, monitor and evaluate the clinical training component of the Programme being executed through the MoPW’s 13 Regional Training Institutes (RTIs).

Design and conduct training programmes for medics and paramedics working in the public sector, the private sector and NGOs.

Prepare standard operating procedures (SOPs), guidelines and protocols for the service delivery infrastructure of the Programme.

Oversee the Provincial Population Welfare Departments (PWDs) for ensuring quality at service delivery outlets.

Monitor implementation of the clinical training component of the Programme in the provinces to ensure that they are in line with the Population Policy.

Provide guidance to the National Research Institute of Fertility Care (NRIFC) in implementing the latest contraceptive Technology.

Implement service delivery and training activities in Islamabad Capital Territory (lCT) under the Programme.

Coordinate with the health sector for rendering quality family planning/reproductive health (FP/RH) services.

Coordinate with international agencies and development partners for implementation of donor-funded projects.

Serve as focal point for the South Asian Association for Regional Cooperation (SAARC); women’s development; regional economic cooperation; the Gender Responsive Budgeting Initiative (GRBI); the People’s Primary Healthcare Initiative (PPHI); the Family Advancement of Life and Health (FALAH) Project; the Pakistan Initiative for Mothers and Newborns (PAIMAN); etc.

Provide resource persons for the College of Physicians and Surgeons Pakistan, Health Services Academy, Pakistan Civil Services Academy, Aga Khan University, etc.

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Administration Wing

The Administration Wing consists of two Administrative Units and the Directorate of Financial Management with clearly defined functions. The two Administrative Units are responsible for recruitments, promotions, disciplinary matters, legal issues, stores, office security, National Assembly and Senate matters, inter-provincial meetings on the Population Welfare Programme and coordination between different Programme units. The Directorate of Financial Management is responsible for preparing budget proposals related to development/non-development financial allocations and revised estimates for the Programme; ensuring timely releases of funds to Programme units and monitoring their utilization; observing financial discipline; obtaining expenditure statements from the PWDs and other Programme units; maintaining proper record; submitting financial statements to the government and donor agencies; attending to audit objections; preparing pension/gratuity claims; and coordinating with the Finance Division/ Departments of Finance and the Accountant General Pakistan Revenues (AGPR). Monitoring and Statistics (M&S) Wing Manage contraceptives for Population Welfare Programme and non-Programme service

outlets.

Store and supply contraceptive commodities.

Conduct field monitoring of Programme activities.

Ensure inter-provincial coordination for Programme activities.

Maintain contraceptive data bank and issue performance statistics report. Public-Private Partnership (PPP) Wing

Build a sustainable partnership with public, private and corporate sectors for providing quality FP/RH services.

Legislate for mandatory provision of FP/RH services in the corporate sector, and by medics, paramedics, hakims and homeopaths.

Bring all public and private sector initiatives under the umbrella of PPP.

Steer, monitor and facilitate all PPP initiatives being carried out through the nationwide network of NATPOW.

Facilitate government and donor assistance for PPPs. Programme Wing Guide and supervise preparation of communication, advocacy and media policy/strategy

for the Population Welfare Programme.

Plan, execute and monitor advocacy activities and awareness campaigns through the print and electronic media, and interpersonal communication.

Guide and monitor the Production and Printing Unit, Lahore.

Supervise preparation of the training policy and annual plans, and their implementation through the MoPW’s Regional and Population Welfare Training Institutes.

Facilitate inter-sectoral linkages for highlighting population as a crosscutting theme.

Manage, supervise and monitor all Directorates and Training Institutes of the MoPW.

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Chapter 2 Overview of Population Welfare Programme and Implementing Agencies The Population Welfare Programme (hereby referred to as the ‘Programme’) is an ongoing social development endeavour operating within the framework of the Population Policy of Pakistan, 2002. Recognizing that Pakistan has the highest population growth rate among the six most populous countries of the world, the Programme aims at encouraging voluntary adoption of small family norms in the country. In fact, Pakistan makes the third highest annual net addition to the global population after India and China. The country’s high fertility rate remains a major contributor to this situation since the mortality rate has been fairly stable over the years.

Anticipating the far reaching implications of high population growth rate for Pakistan’s socioeconomic development, the then policymakers introduced family planning on a limited scale in the First Five-Year National Development Plan (1955-1960). The related services were provided through voluntary organizations. In the Second Five-Year Plan (1960-1965), however, family planning services were dispensed through the health infrastructure. Family planning gained priority in the Third Five-Year Plan (1965-1970), when an independent setup was established for managing and executing the Programme.

The Programme witnessed a positive change and received sustained political support from 1988 to 2002. There was consistency and continuity in the operations during these years, with the stakeholders in the public sector, the private sector (particularly social marketing companies) and civil society playing an important role in achieving positive results. Both the budgetary allocation for the Programme and its coverage increased, along with the expansion of and a wider role for the social marketing sector. The private providers and retailers involved in the distribution and dispensation of products under independent logos were enlisted, and promotional campaigns and a whole range of follow-up communication activities were undertaken in the field.

As a result, Pakistan was referred to be entering the fertility transition phase, with contraceptive prevalence rate (CPR) gradually rising and total fertility and population growth rates gradually falling. However, there remained a wide gap between awareness level and CPR, and the unmet need for family planning ranged around 33%.

The Programme has passed through different phases in terms of administrative and financial setup. Before 2002, it had a federalized status. In February 2000, a committee was setup to review the Programme and its interface with the health sector. The recommendations of the committee were presented to the then Chief Executive of Pakistan on 6 April 2001 and were approved accordingly.

In view of these recommendations, the Federal Government transferred the Programme to the Provincial Governments along with assets, liabilities, and administrative and financial controls through a handing over note. The latter were required to take over the Programme and start funding it from their budgets starting 2006, but this has not yet happened. The transit arrangements have resulted in a number of issues in terms of planning, monitoring and financial management.

After the announcement of the 7th National Finance Commission (NFC) Award, the Executive Committee of the National Economic Council (ECNEC) decided on 16 January 2010 that the

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Population Welfare Departments (PWDs) should assume their responsibility and the Provincial Governments should now starting providing funds for the Programme as per their commitment.

The last Five-Year Population Welfare Programme (2003-2008) set the ultimate goal of population stabilization as a development priority to attain sustainable socioeconomic development. There was an increasing realization of the crosscutting effect of the population factor on the socioeconomic canvas during this period. The Programme was accorded high priority in the overall development framework and in the Poverty Reduction Strategy Paper (PRSP). The commitment was sustained with allocation of additional resources through the Public Sector Development Programme (PSDP) for implementing Programme activities. Implementing Agencies The Population Welfare Programme is executed through the following implementing agencies:

1. Population Welfare Department, Punjab.

2. Population Welfare Department, Sindh.

3. Population Welfare Department, Khyber Pakhtunkhwa.

4. Population Welfare Department, Balochistan.

5. Population Welfare Programme, Azad Jammu and Kashmir (AJK).

6. Population Welfare Programme, Federally-Administered Tribal Areas (FATA).

7. Population Welfare Programme, Gilgit-Baltistan.

8. Population Welfare Programme, Islamabad Capital Territory (ICT).

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Chapter 3 Autonomous Bodies of MoPW National Institute of Population Studies The National Institute of Population Studies (NIPS) is a research organization engaged in carrying out interdisciplinary research in the field of population and development; conducting evaluation and impact studies of the Population Welfare Programme; and developing human resource. Data generated by NIPS are used in formulating population planning strategies. National Trust for Population Welfare The National Trust for Population Welfare (NATPOW) is an autonomous, not-for-profit organization established in 1994 under the umbrella of the Ministry of Population Welfare (MoPW). It is mandated to develop partnerships between the government and the donors, NGOs and the private sector. NATPOW provides technical and financial assistance to its affiliated NGOs, numbering 600, for improving the reproductive health status of women and men, as well as mother and child health (MCH), with special emphasis on community mobilization and participation, advocacy and awareness raising, capacity building/human resource development (HRD), and FP/RH service delivery, so as to meaningfully contribute to the implementation of the Population Policy. NATPOW’s health interventions are merged with education and poverty alleviation, as well as crosscutting interventions of HRD and research; monitoring and evaluation; and information, education and communication (IEC). The need for specialized services provided by NATPOW has been felt in public and private sector organizations aiming at developing their capacity to achieve the Millennium Development Goals (MDGs). National Commission for Population Welfare The Population Welfare Programme was de-federalized in 2002, and all administrative and fiscal powers were transferred from the Federal Government to the Provincial Governments. During operationalization of the Programme under the new arrangement, many issues cropped up. To oversee and review performance of the Federal and Provincial Governments, NGOs and the private sector, the National Commission for Population Welfare (NCPW) was set up under the chairmanship of the Prime Minister of Pakistan on 20 September 2005. The NCPW comprises 24 permanent and nine guest members. Its first meeting was held on 1 July 2006 and the decisions taken have been implemented. No further meeting of the Commission has so far been convened. The NCPW’s terms of reference (ToRs) are to:

Formulate policies for the implementation of the Population Welfare Programme.

Hold annual review of these policies in the light of actual functioning of the Programme and the realization of its objectives.

Muster political, financial and administrative support for the Programme.

Promote and encourage partnerships between all the actors involved in population planning activities.

Build consensus on directions for population in general and for the MoPW in particular.

Ensure effective coordination between the Federal and Provincial Governments for the attainment of Programme objectives.

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Chapter 4 Draft Pakistan Population Policy, 2010 The Draft Pakistan Population Policy, 2010 (hereby referred to as the ‘Policy 2010’) places the ‘population factor’ at the centre stage of national development planning. It recognizes reproductive health as a critical component of sustainable socioeconomic development having strong linkages with the government’s poverty reduction strategies. The Policy 2010 repositions family planning as a health initiative, with a focus on MCH, by making family planning services a vital component of the essential services package.

Within this holistic perspective, and in the wake of emerging demographic realities, the Policy 2010 re-emphasizes timely completion of fertility transition for stabilizing the population and reaping the demographic dividend. Infused with this spirit, it is expected that the Policy 2010 would contribute meaningfully to the implementation of the Programme of Action of the International Conference on Population Development (ICPD) and the achievement of the MDGs, particularly reducing the maternal mortality ratio by two-thirds by 2015. Vision The Policy 2010 would promote a prosperous, healthy and skilled society where every pregnancy is planned; every child is nurtured and cared for; and every citizen is provided with choices to improve the quality of his or her life. Goals The Policy 2010 seeks to:

Accelerate the completion of fertility transition for achieving population stabilization.

Enhance human development for capitalizing on the unique opportunities offered by the emerging demographic scenario in the form of demographic dividend.

Increase pregnancy spacing for improving the health of women and children. Objectives The short-term objectives of the Policy 2010 are to:

Make available family planning services to the remotest areas of the country by 2015.

Reduce the unmet need for family planning from the current 25% to 20% by 2015.

Reduce the total fertility rate (TFR) from the current 3.6 births to 3.2 births per woman by 2015.

Ensure contraceptive commodity security for all public and private sector outlets by 2015.

Improve maternal health by encouraging pregnancy spacing of more than 36 months, reducing the incidence of first birth among those mothers aged below 18 and discouraging the trend of mothers giving birth after age 34 and above, thus contributing to the achievement of the MDGs 4 and 5.

The long-term objectives of the Policy 2010 are to:

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Attain replacement level fertility by 2030.

Achieve universal access to family planning services by 2030.

Reduce the unmet need for family planning from the current 25% to 5% by 2030.

Increase the contraceptive prevalence rate (CPR) from the current 30% to 60% by 2030. Principles The principles of the Policy 2010 are based on the Programme of Action of the ICPD, the MDGs and the Karachi Declaration, 2009. These are to:

Promote reproductive health as an entitlement, based on voluntary and informed choice.

Address the population issue within national laws and development priorities, while considering the social and cultural norms.

Ensure active, responsible and accountable participation by all the stakeholders.

Promote programmatic interventions on the basis of scientific evidence. Assumptions The Policy 2010 is based on the following assumptions:

Sustained political commitment at the federal and provincial level.

Full ownership of the Programme by the Provincial Governments by 2015 and programmatic interventions by them to reduce the unmet need for family planning.

Enhanced resource availability for the Programme under the NFC Award.

Mandatory provision of family planning services by the Health Departments and adoption of family planning as an essential health intervention by the Ministry of Health.

Centre staging of the population factor in national development planning for reaping the demographic dividend.

Broad-based multi-sectoral support. Strategies The Policy 2010 lays strong emphasis on reshaping the unprecedented demographic dividend, as envisaged by the Planning Commission’s Vision 2030 document. This necessitates adopting human development policies that can help transform the young population into a skilled workforce It situates reproductive health and family planning within the context of overall economic and social development, thus creating linkages with other developmental concerns, such as increasing the provision and outreach of primary and secondary education, empowering women and creating employment opportunities for the people.

The Policy 2010 also stresses putting in place an effective reproductive health programme that ensures continuation in and speeding up of the fertility transition process. It, therefore, attaches special importance to achieving universal access to FP/RH information and services. The Policy 2010 recognizes that achieving fertility transition is a collective responsibility of all potential providers in the public, private and NGO sector, and provides for involving all the stakeholders in achieving the stated goals and objectives through the adoption of the following strategies:

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a. Mainstreaming Population in Development Planning A population policy impacts all spheres of socioeconomic life. It is evident from the inter-linkages between population and development that demographic trends are, on the one hand, determinants of socioeconomic development and, on the other, are determined by it. Broad-based sectoral and inter-sectoral support is, thus, critical to realizing the goals of the Policy 2010. This includes building strong linkages between population and other social sector areas.

Female education, in particular, is vital for achieving fertility transition. This is evident from the fact that the lack of emphasis on female education in Pakistan in the past has adversely affected the pace of fertility transition. Similarly, limited female employment has not allowed the country to accrue the benefits of women’s positive association with fertility transition. Adequate investment in young people so that they could develop marketable skills has also remained an unattended area in Pakistan, limiting the youth’s productive involvement in the society.

In addition, rapid urbanization is putting an unprecedented pressure on the policymakers to cater to the growing need for services and amenities. The projected urbanization growth over the next two decades encompasses massive internal migration patterns and necessitates innovative population redistribution policies, such as building new towns and industrial zones. To address these issues, the institutions of the Programme would be strengthened, and all the stakeholders would be brought on one platform for reviewing the Programme and monitoring the progress made on goals and objectives. This would help evolve an integrated service delivery strategy to achieve synergy and facilitate reaping of the demographic dividend.

b. Advocacy and Demand Generation The Programme has achieved a universal level of awareness, but there still exists a wide gap in the knowledge (of at least one method) and practice of family planning. The communication approach has to take this into consideration, and develop evidence-based, audience-specific and vibrant campaign to bring about necessary changes in attitudes and behaviour. The promotion of pregnancy spacing perspective of reproductive health needs special communication initiatives that emphasize its positive impact on maternal and child health.

Pregnancy spacing is also in line with religious precepts and, thus, it provides a strong framework to solicit support of the religious community. The media – with its fast growing role in disseminating information, building public opinion and shaping societal behaviour – would be used to play a vital role in projecting and promoting voluntary adoption of small family norms and responsible parenthood. A strategy would also be devised to bring about positive changes in attitudes and behaviour towards the use of male contraceptives.

c. Enhancing Access to and Improving Quality of FP/RH Services The Programme’s service delivery network of 3,416 centres (2,853 Family Welfare Centres, 271 Reproductive Health Service Centres and 292 Mobile Service Units) hardly covers 35.0 million people or slightly over 20% of the country’s population. The goal of achieving universal access to FP/RH services by 2030 and reaching out to the remotest areas of the country by 2015 cannot be realized through the efforts of the Ministry of Population Welfare (MoPW) alone; it calls for collective resolve and efforts by all the stakeholders.

The Policy 2010, therefore, emphasizes filling the critical gap in access to FP/RH services through upgrading, expanding and integrating service outlets managed by different stakeholders: the Ministry and Departments of Population Welfare, the Ministry and Departments of Health, the Planning and Development Division, the Ministry of Finance, provincial line departments (PLDs), social marketing companies (SMCs), private sector health professionals, population experts, NGOs and civil society organizations (CSOs).

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d. Contraceptive Commodity Security Ensuring commodity security to cater to national needs for at least five years and uninterrupted availability of a complete range of contraceptives at affordable prices at all facilities is the lifeline of family planning services. In view of the projected increase in contraceptive uptake, additional contraceptive requirements are anticipated in coming years. Both commodity security and supply chain management system would be improved to avoid overstocking and stock outs at any level and any time.

e. Training and Human Resource Development One of the major responsibilities of the MoPW under the Policy 2010 would be to implement the Programme professionally, so as to keep pace with other stakeholders and maintain national service standards while providing FP/RH services. This would require professional human resource to carry out a wide range of specialized functions. The Policy 2010, therefore, focuses on HRD in line with the emerging role of the Ministry and Departments of Population Welfare vis-à-vis other stakeholders.

Managerial inefficiency and low quality of care and services are often cited as the major reasons for ineffective implementation of the Programme. However, they are not the cause; rather, they are an outcome of the cause: lack of capacity. For capacity building, the Programme has two Population Welfare Training Institutes (PWTIs) in Karachi and Lahore and 13 Regional Training Institutes (RTIs) across the country, but the outcome leaves a lot to be desired. Measures ranging from revamping these institutes to revisiting their supervisory structure and control mechanisms are, therefore, a prerequisite for bringing about a positive change in the situation.

f. Research and Evaluation Drawing on research on different aspects of reproductive health, family planning and fertility transition, the Policy 2010 recommends an evidence-based approach for the Programme. It also encourages institutionalization of research on family planning and reproductive health to enhance the knowledge base for improved policies and programmes. Future research would focus on how fertility transition could be accelerated in the shortest possible time.

Research on improving access to services and addressing socio-cultural barriers would also be carried out to improve implementation of the Programme. Similarly, clinical and biomedical research would also be conducted to introduce new family planning methods. Furthermore, research on social mobilization, male involvement and innovative communications would be promoted.

g. Public-Private Partnership Extending support to public-private partnership (PPP) initiatives is critical to expanding FP/RH services, both horizontally and vertically. The Policy 2010 envisages replacing the existing focus of the Programme on the private sector with an innovative approach, so that collaboration could be enhanced in those areas where family planning and reproductive health services are required. The approach would focus on extending outreach to rural areas and deepening efforts in urban slums.

It would bring into its fold public sector organizations, corporate bodies, industrial concerns, private medical practitioners, NGOs/CSOs. Furthermore, the community-based service delivery model – partnering with the community for setting up village-based service facilities – would be adopted. Efforts would also be made to enlarge the social marketing network so as to encourage healthy competition. The vast social network of Rural Support Programmes (RSPs) and other NGOs/CSOs would also be involved in social mobilization.

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h. Monitoring The Policy 2010 emphasises adopting a joint monitoring framework to ensure effective implementation by all the stakeholders. It envisages adopting the results-based monitoring (RBM) mechanism to ensure that processes and outputs contribute to the achievement of clearly stated objectives. This approach would shift the focus of monitoring from outputs (number of contraceptives distributed, number of clients contacted and recruited, etc.) to outcomes (increase in the CPR, etc.). Laying emphasis on outcomes is also important for the MoPW to engage the stakeholders and build partnerships to achieve shared objectives.

The monitoring framework would specify the indicators of input, service delivery process and output, which would be observed, reviewed and followed up regularly at the tehsil, district and division level. Monitoring by the Provincial Population Welfare Departments (PWDs) would largely be a review of the monitoring efforts at the tehsil and district level. As a step towards activating the verification tool, the PWDs would send their monitoring reports to the MoPW.

These reports would be analyzed in regular review sessions on Programme implementation at the national level. The monitoring process, in order to be result-oriented, would also institutionalize the capacity to track and concurrently follow up the progress made in important aspects of the Programme. Since the operational monitoring would rest with the PWDs, the MoPW would maintain supportive linkages with them, as well as enhance their professional capacity and skills. Implementation Plan After the introduction of the 18th Constitutional Amendment, the Programme has been transferred to the Provincial Governments; however, policy formulation and execution continue to be federal subjects, so that continuity and consistency could be ensured in national policies. This is needed to have an interface with United Nations agencies; to forge bilateral and multilateral agreements; and to coordinate with international development partners. But this also entails restructuring of the MoPW, and redefining its role vis-à-vis the PWDs, the Ministry of Health, the Planning and Development Division, the Finance Division, other social sector ministries, NGOs/CSOs and the private sector.

Considering the crosscutting nature of the population issue, participation of all the stakeholders in implementation of the Policy 2010 would be encouraged and supported. In addition, necessary mechanisms and institutional arrangements would be put in place to seek the support of elected representatives and local leaders, opinion makers, religious scholars and organized communities for efficient and effective implementation of the Policy 2010. Furthermore, academic and research institutions would be involved in monitoring the progress made by the Policy 2010.

The implementation of the Policy 2010 would rest with the Provincial Governments, who would collaborate with line departments, public and private sector organizations, and NGOs/CSOs in such a way that conforms to both social values and national and provincial development priorities. With the announcement of the 7th NFC Award, the Provincial Governments have access to additional resources; therefore, it is expected that they would assume full ownership of the Programme at the earliest. Legal Framework The Population Welfare Planning Programme (Appointment and Termination of Services) Ordinance, 1981 regularized the services of Programme personnel through the Federal Public Service Commission and the Departmental Selection Committee. The Transfer of Population Welfare Programme (Field Activities) Ordinance, 1983 de-federalized the Programme by

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transferring its field activities to the Provincial Governments. Importantly, institutional arrangements for the Programme attained the status of an independent ministry on 12 June 1990.

After an extensive review, the Programme was again de-federalized through the Population Welfare Programme Ordinance, 2001, and all administrative and fiscal powers were transferred from the Federal Government to the Provincial Governments. Resultantly, the administrative and financial control over the service delivery infrastructure (including Family Welfare Centres, Reproductive Health Services-A Centres and Mobile Service Units) was transferred to the PWDs.

The institutions of the MoPW – NIPS, the NATPOW and the NCPW – have been established through executive resolutions and need to be provided a legal cover. Partnerships with the private sector are also without any formal legal cover, which creates uncertainty among Programme personnel and partners. Therefore, there is a need to develop a legal framework to strengthen and support PPP initiatives. International Cooperation Pakistan is a signatory to the Programme of Action of the ICPD, as well as committed to achieving the MDGs. The Policy 2010, therefore, encompasses not only national development priorities but also international obligations. The MoPW envisages expanding the scope of its activities in accordance with the recommendations of the ICPD. Precisely against this backdrop, the Policy 2010 focuses on developing bi-lateral relations, especially with other Muslim and South Asian countries, and forging linkages with international development agencies, particularly for sharing best practices and seeking technical support.

The Policy 2010 seeks enhanced financial and technical cooperation from the international community, anticipating that it would understand and appreciate the population and reproductive health situation of Pakistan, and its implications within and beyond boundaries. It also urges the international community to fulfil its obligations under the ICPD and the development partners to realize their commitments with Pakistan.

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PART II

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Chapter 5 Service Delivery A. Service Outlets of Population Welfare Programme (Public) I. Family Welfare Centres Family Welfare Centres (FWCs) are the cornerstone of Pakistan’s Population Welfare Programme. They constitute the most extensive institutional network in the country for promoting and delivering family planning services in both urban and rural areas. An FWC may operate in a rented building or in any basic health unit (BHU)/rural health centre (RHC) where two separate rooms are available.

As a static facility, it serves a population of about 7,000; while operating through its satellite clinics and outreach facilities, an FWC covers a population of about 12,000. The scope of work of the FWCs includes providing family planning and mother and child health (MCH) services, and treating minor ailments. Post-ICPD, their scope has been expanded to include several components of reproductive health such as safe motherhood, infant health care, and management of reproductive tract infections (RTIs)/sexually-transmitted infections (STIs) and HIV/AIDS.

Each FWC has a staff of five: one family welfare worker/counsellor, family welfare assistant (male), family welfare assistant (female), female attendant and guard each. Of the 2,853 FWCs of the MoPW, as of 30 June 2010, 1,500 are located in Punjab; 590 in Sindh; 422 in Khyber Pakhtunkhwa; 170 in Balochistan; 55 in AJK; 50 in FATA; 37 in Gilgit-Baltistan; and 29 in ICT. No expansion of the FWCs could be undertaken during 2009-10 because of financial constraints, since the Population Welfare Programme was implemented on anticipatory approval. Functions The FWCs perform the following functions:

Provide family planning information, counselling and services for all methods except implants and contraceptive surgery; MCH services through static facilities and satellite clinics; and infant health care, including nutritional advice, growth monitoring and treatment of common ailments.

Conduct regular educational sessions through Mohalla Sangats to create awareness about small family norms, female literacy, human rights and gender equality; and orientation sessions for elected women representatives on topics such as family planning, population and development, gender equality, and status of women in Islam.

Make available contraceptives, medicines and other supplies; and maintain equipment in good condition.

Refer cases of family planning, infertility, HIV/AIDS and contraceptive surgery/implants to appropriate facilities.

II. Reproductive Health Services-A Centres Reproductive health services (RHS), one of the major clinical components of the Population Welfare Programme, are provided through RHS-A Centres and RHS-B Centres. The RHS-A Centres are hospital-based service delivery units established under the Programme. They provide

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the full range of services identified in the National RHS Package, including contraceptive surgery facilities for women and men, with safe and effective backup medical support and long-term client follow-up; MCH services; prevention and management of RTIs/STIs and HIV/AIDS; counselling and referral for adolescents/youth; management of reproductive health problems of the elderly women, referral for men’s problems; clients’ education for early detection of cancer in breast and uterus; and couple counselling and referral for treatment of infertility.

The RHS-A Centres play a vital role in raising awareness about public health, personal hygiene, nutrition and breastfeeding during reproductive age, and preventive gynae/obstetric facilities. It is expected that they would contribute to reduction in fertility. Furthermore, these Centres provide treatment for minor/general aliments, particularly to women and children. Of the 182 RHS-A Centres of the MoPW, as of 30 June 2010, 63 are located in Punjab; 60 in Sindh; 24 in Khyber Pakhtunkhwa; 15 in AJK; 10 in Balochistan; 4 in FATA; and 3 each in Gilgit-Baltistan and ICT. Functions The RHS-A Centres perform the following functions:

Provide motivation and counselling to family planning clients along with a full range of contraceptive services, with special emphasis on contraceptive surgery for both women and men.

Deal with cases related to the management of RTIs/STIs, as well as provide MCH services.

Arrange extension camps with operation theatre facilities at Tehsil Headquarters (THQ) hospitals/RHCs for providing contraceptive services, including contraceptive surgery.

Enhance male participation by creating awareness about FP/RH issues, with special focus on providing vasectomy services, preferably no-scalpel vasectomy (NSV).

Impart training to male doctors of the MoPW, the Ministry of Health and NGOs in vasectomy procedures.

RHS-A Training Centres The 15 RHS-A Centres located in teaching hospitals with the highest contraceptive surgery performance have been upgraded to RHS-A Training Centres, including three RHS-A Master Training Centres, for ensuring availability of trained medics/paramedics to provide quality RHS under the Programme. To achieve this end, the RHS-A Training Centres have been provided with additional staff and logistics. They perform the following functions:

Provide basic/refresher training to Programme/non-Programme doctors from NGOs, target group institutions (TGIs) and provincial line departments (PLDs), in contraceptive surgical techniques, counselling, interpersonal communication, implant insertion/removal techniques and asepsis; and for enabling them to provide comprehensive RHS, to identify difficult surgical cases and deal with them, to assess and diagnose abnormal gynae/ obstetric problems, and to diagnose/manage infertility cases.

Provide basic/fresher training to Programme/non-Programme paramedics in operation theatre management and other techniques with emphasis on asepsis/infection prevention.

Develop training curricula, strategy, methodology and annual plan for the abovementioned activities and undertake them after approval of the MoPW.

Organize family planning and health education programmes at educational institutions and PLDs.

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Hold orientation workshops for medics and paramedics of all categories to update their knowledge about what is available for the clients in the way of contraceptive services.

Provide on-the-job technical monitoring and supervision for strengthening the institutional setup of RHS-A Centres and for improving service delivery.

Undertake four supervisory visits of three-day duration each every year. During these visits to be undertaken by the Monitoring Officers of all the 15 RHS-A Training Centres, a minimum of 4 RHS-A Centres will be covered for technical guidance and support.

Men’s Advisory Centres To address reproductive health needs of men, the Population Welfare Programme has re-designated its NSV Centres as NSV/Men’s Advisory Centres (MACs) and it envisages expanding their number in the near future. At MACs, reproductive health advice and services for male adolescents and men are provided by male doctors/surgeons of the Ministry and Provincial Departments of Population Welfare. Institutional Reimbursement Cost for Contraceptive Surgery Cases The RHS Centres receive an institutional reimbursement cost (IRC) for contraceptive surgery cases performed by them. The payment is made to the surgeon/gynaecologist for backup support, medical superintendent of the hospital for supervision, operation theatre staff, referrer and client, as well as spent on physical facilities, including medicines, linen, bandages and condoms for post-vasectomy clients.

Currently, static RHS-A Centres receive an IRC of Rs. 1,060 for each case of tubectomy performed by them; extension camps of RHS-A Centres receive Rs. 1,100; static RHS-B Centres receive Rs. 1,400; and extension camps of RHS-B Centres receive Rs. 1,550. However, the IRC payment for each case of casectomy is Rs. 1,550, whether it is performed at static RHS-A or RHS-B Centres or their extension camps. Of the total reported contraceptive surgery cases, 5% and 10% cases are validated before making IRC payments to the RHS-A and RHS-B Centres, respectively. III. Mobile Service Units Mobile Service Units (MSUs) are the flagship of the Population Welfare Programme, since they provide a package of quality FP/RH services to the people of those remote villages and hamlets where no other health facilities exist. The MSUs operate from specially-designed vehicles which carry within them all the facilities of a mini clinic, ensuring complete privacy for simple gynaecological procedures. Moreover, they carry tents that can be unfolded to make rooms for outpatients and staff.

The idea behind MSUs is to provide health facilities, particularly RHS, to the people of rural areas in such a way that each village or community is visited on a rotational basis at least once a month. For this, the MSUs organize two to three camps each week at different places and return after one month to every village.

The component of MSUs was initiated during the 7th Five-Year Plan to increase the availability of family planning services in underserved and un-served areas. Each MSU provides services to a population of around 30,000 (about 5,000 couples) in 15-20 villages. On average, an MSU holds 10-12 camps each month to offer family planning/MCH services to the people of remote areas.

Of the 292 MSUs of the MoPW, as of 30 June 2010, 117 are stationed in Punjab; 72 in Sindh; 55 in Balochistan; 30 in Khyber Pakhtunkhwa; 7 in AJK and FATA each; 3 in Gilgit-Baltistan; and 1

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in ICT. Each MSU has one woman medical officer and three support staff: one family welfare counsellor, driver and female attendant each.

A training manual on specified/identified modules – such as planning, supervision and monitoring; community participation and ownership; skill development; follow-up system; financial procedures; quality of care; logistic management – along with a guide was also developed. Functions The MSUs perform the following functions:

Make family planning information and services accessible in underserved/un-served rural communities.

Reduce the unmet need for family planning by making services more accessible, particularly the clinical methods such as intrauterine devices (IUDs) and injectables.

Provide reproductive health, including curative, services to women.

Facilitate the work of male mobilizers regarding the enhancement of men’s role and responsibilities.

Muster local support for the Programme through interaction with elected representatives and other opinion leaders, and promote better understanding and need for reproductive health care.

Quality of Care The Programme has achieved international accreditation ISO 9001:2008 Certification for Quality Services for selected Service Delivery Points (SDPs). Based on the experience gained from the above process, various checklists have been designed whereby quality of care is ensured through standardization and optimization of reproductive health facilities. The following SDPs and Managerial Offices of the Ministry and Departments of Population Welfare have received ISO accreditation/certification:

RHS Directorate, MoPW, Islamabad.

District Population Welfare Office (DPWO), Islamabad.

RHS-A Centre, Federal Government Services Hospital, Islamabad.

FWC, Noor Pur Shahan, Islamabad.

DPWO, Chakwal.

MSU, Talagang, Chakwal.

DPWO, Jhelum.

RHS-A Centre, Jhelum.

FWC, Dina-I, Jhelum.

MSU, Sohawa, Jhelum. External Surveillance Audit The external surveillance audit of Year 2009 for ISO Certified Outlets of the Programme was conducted by external auditors from United Registrar of Systems Ltd. from 20-22 August 2009.

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The Management Representative Office addressed the discrepancies raised in the audit report by amending the relevant procedures, and the same was circulated to respective SDPs and Managerial Offices for compliance. Moreover, the respective SDPs and Managerial Offices strictly observed the opportunities for improvement (OFIs) and potential non-conformities (PNCs) mentioned in the report. Internal Audit The internal audit of ISO Certified Outlets of the Programme was conducted in June 2009 and January 2010. The major/minor PNCs, observations and OFIs were identified and corrective preventive actions (CPAs) were initiated accordingly. The same was also conveyed to respective SDPs and Managerial Offices of ICT and Chakwal District for compliance. Calibration of Equipment for ISO Certified Outlets In 2010, the calibration of the following equipment for ISO Certified Outlets of ICT and Chakwal District was done through Era Lab, Lahore.

Weighing Machine (Adult and Baby).

Thermometer.

Pressure Gauge.

Hygrometer.

BP Apparatus (Mercury). Special Initiatives of Federal Minister for Population Welfare Two projects titled ‘Establishment of Two Safe Mother Homes’ and ‘Establishment of Eight Multipurpose Service Centres’ were launched on pilot basis during 2009-10 as special initiatives of the Federal Minister for Population Welfare. The first project is being implemented in Larkana and Sialkot with a budget of Rs. 33.0 million; while the second in Badin, Bajaur Agency, Islamabad, Loralai, Nowshera, Sialkot and Skardu with a budget of Rs. 39.7 million. The Director (FWCs) has been given the additional charge of Project Director for both the projects since the Directorate of FWCs is handling them. The spadework on the projects, such as recruitment of staff and procurement of goods, has already been done and they will be inaugurated soon.

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B. Service Outlets of Population Welfare Programme (PPP) I. Reproductive Health Services-B Centres Well-established hospitals and clinics with fully-equipped operating facilities (operation theatre facilities, beds for admission, post-operative care, sterilization and emergency resuscitation equipment, etc.) and trained workforce (gynaecologist/surgeon/doctor trained in Mini-Laparotomy techniques, no-scalpel vasectomy (NSV) and occupational therapy, as well as qualified ward staff), which are interested in performing contraceptive surgery, are enlisted with the Population Welfare Programme as RHS-B Centres. These include District and Tehsil Headquarters hospitals of provincial line departments (PLDs) and the Health Departments, surgical centres of NGOs, private hospitals, etc. Of the 113 RHS-B Centres of the MoPW, as of 30 June 2010, 54 are located in Punjab; 38 in Sindh; 8 in Khyber Pakhtunkhwa; 4 in Balochistan; 8 in ICT; and 1 in Gilgit-Baltistan. II. Public-Private Partnership The public-private partnership (PPP) component of the Population Welfare Programme envisages focusing on those men and women in the reproductive age group, numbering about 47.0 million, who remained untapped in the past. This objective will be achieved by evolving a sustainable and mutually win-win partnership with public-private sector organizations (PPSOs), with a view to meeting the unmet needs of these men and women, and motivating them to adopt best practices in reproductive health and family planning as part of responsible parenthood/rationalized family norms and structures.

In Pakistan’s context, PPP interventions have a vast potential due to the large workforce employed in the public, private and corporate sector, as well as community-based, non-governmental and civil society organizations. The MoPW envisages reaching out to this workforce for raising awareness, inducing motivation and extending FP/RH services. For this purpose, both public and private sector organizations are approached, especially through chambers of commerce and industries, labour unions, traders associations, etc.

The focus of this collaboration is on providing comprehensive FP/RH information and services through the social and physical infrastructure of respective organizations. The approach is to integrate FP/RH component into their setup, though some input may be required to equip Programme outlets for providing these services. This input reflects a symbolic partnership, and encourages PPSOs to carry forward the activities for having a healthy workforce, responsible parenthood and enlightened citizenship. The main indicators of this initiative are the number of organizations approached, orientation sessions held, doctors and paramedics trained, and health outlets activated for FP/RH services.

With a view to bring the public and private sector on board for supplementing the efforts of the MoPW in providing FP/RH services, 10 sensitization seminars were organized during 2009-10. As a result, 204 memoranda of understanding (MoUs) were signed by the partners with the Ministry, with a pledge to support the Programme. Moreover, 140 FWCs/RHC-B Centres/FP Counters have been established since 2006 on the premises of PPSOs. In addition, 478 medics/paramedics from private and public sectors were imparted training on ‘Population and Development’. The MoPW also held meetings with seven Chambers of Commerce and Industries (AJK, Islamabad, Karachi, Quetta, Rawalpindi, Sialkot and Tribal Areas), wherein the former agreed to continue their efforts for achieving Programme objectives.

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Chapter 6 Other Activities A. Training Institutes I. Clinical Training Clinical training is the key activity aimed at providing quality reproductive health services (RHS) to the community by developing human resource for the service delivery centres of the Population Welfare Programme, the Ministry and Departments of Health, PLDs, and other non-governmental and private sector organizations throughout the country. Thirteen Regional Training Institutes (RTIs) across Pakistan train personnel for delivering health care services to the general public.

The RTIs provide skill-based training in ‘Reproductive Health and Family Planning’ for all categories of health care providers: doctors, medical students, nurses, student nurses, lady health visitors and other paramedics. In addition to HRD, the RTIs also undertake activities focused on raising the awareness level of hakims, homeopaths, community health workers, teachers and college students.

The Directorate of Clinical Training is responsible for all activities held at the RTIs, as well as building institutional capacity; developing training curricula; preparing textbooks and other training material, such as audio-visual aids; conducting examinations for certification of competence as service providers; assessing and improving quality of training; and ensuring proper and timely implementation of the clinical training programme through the RTIs.

The Directorate is also the focal point for coordination with the Population Welfare Departments (PWDs) of Punjab, Sindh, Khyber Pakhtunkhwa and Balochistan, as well as AJK, FATA and Gilgit-Baltistan; the Population Welfare Training Institutes (PWTIs) in Karachi and Lahore, the Health Departments, NGOs, social sector institutions, public sector health organizations and non-Programme health outlets regarding training of their staff (both medics and paramedics) in family planning and reproductive health.

To meet the increasing need for trained workforce, RTIs are also being established at Khuzdar and Sialkot, and they will be fully functional by 2011. Establishing new RTIs is in line with the government policy of women’s empowerment. This will also help in creating opportunities for women, achieving the Millennium Development Goals (MDGs) and alleviating poverty. Moreover, the new RTIs would empower women to attain skills and be economically productive for themselves and their families, besides meeting the Programme objectives of reducing high population growth rate and unmet need for contraceptives, and promoting health of the population.

The RTIs over the years have grown into excellent training centres for all categories of FP/RH service providers, not only from the PWDs, but also from the Health Departments, the Pakistan Army, autonomous bodies, NGOs and the private sector. They are using standardized training curricula and modern teaching methods, backed up by a comprehensive evaluation system. Activities A wide range of training activities were undertaken during 2009-10, as shown in the table and text below:

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Sr. No. Activity Target Achieved 1. Basic Training Course for Family Welfare

Workers (24 months) 300 284

2. Advance Training for FTOs, ASTs and Family Welfare Counsellors (3-5 months)

40 284

3. Pre-Service Training for Family Welfare Assistants (3 weeks)

80 136

4. Refresher Training for Paramedics (1-2 and 4 weeks)

240 262

5. Miscellaneous Training and Orientation for Non-Programme Personnel (1 and 2 days)

4,700 2,660

Total 5,360 3,626 A 14-Day Crash Training Programme in ‘Contraceptive Surgery’ was conducted for

registered medical practitioners (RMPs). A total of 101 RMPs were trained in Mini-Laparotomy techniques through the Programme, for which financial assistance was provided by the United Nations Population Fund (UNFPA) under Annual Work Plan 2009.

The Second Training of Trainers (ToT) on ‘Client-Centred Family Planning Services-Advance’ under the Family Advancement of Life and Health (FALAH) Project was held from 29 July-7 August 2009 in Islamabad. Women medical officers (WMOs) of six RHS-A Centres from Punjab, Sindh and Balochistan attended the ToT.

‘Competency-Based IUCD Training’ was conducted under the FALAH Project from 17-22 August 2009 at the RTI/RHS-A Centre, Aabpara, Islamabad. A total of 10 medics and paramedics attended the training.

A Training Programme on ‘Sharing of Technical Updates on Mini-Laparotomy Procedures’ was conducted under the FALAH Project at three RHS-A Master Training Centres: Lady Wellington Hospital, Lahore; Jinnah Postgraduate Medical Centre, Karachi; and Nishtar Hospital, Multan. A total of 33 participants from the Population Welfare and Health Departments attended the programme.

A Training Programme on ‘Updates on NSV Training and Service Provision’ was organized under the FALAH Project from 1-3 April 2010 at the NSV Centre, Faisalabad. Three doctors and paramedics each from the PWDs attended the programme.

The curriculum of family welfare assistant (female) was prepared in Urdu to make service providers proficient and capable of delivering quality health services. This was done in consultation with senior officials of the MoPW and other sister organizations and in collaboration with UNFPA.

World Population Day activities such as walks, quizzes, sports events and seminars were organized at all the RTIs on 11 July 2009.

II. Non-Clinical Training The MoPW has two Population Welfare Training Institutes (PWTIs) in Lahore and Karachi for imparting training to Programme and non-Programme personnel on ‘Population and Development’ and other related issues. The following activities were undertaken by the PWTIs during 2009-10:

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Programme Personnel

Sr. No. Activity Participants Duration No. Held

1. Training of Trainers Workshop Faculty of PWTIs/RTIs 10 days 17

2. Workshop on ‘Financial and Office Management’

Population Welfare Officers/WMOs

1 week 55

3. Training Course on ‘Financial Management’

Accountants/Assistant Accountants

2 weeks 32

4. Basic Training Course Family Welfare Assistants (Male)

2 weeks (in batches)

100

5. Course on ‘Skills in Driving and Personality Development’

Drivers 4 days (2 batches)

158

6. Workshop on ‘Revision of Curriculum for Initial Service Training’

BS-17&18 Officers 2 days 17

7. Initial Service Training BS-17&18 Officers 4 weeks (2 batches) 62

8. National Workshop on ‘Supervision and Monitoring’

District/Tehsil Population Welfare Officers (TPWOs)

1 week 27

9. Course on ‘Managerial Leadership’ BS-17&18 Officers 1 week 31

10. Training Course on ‘Interpersonal Communication Skills’

Family Welfare Assistants (Female)

1 week (in batches)

250

11. Course on ‘Computing Skills’ Stenographers 1 week 39

12. Course on ‘Contraceptive Logistic System’

Storekeepers/Upper Division Clerks

1 week 57

13. Pre-Service Training Social Mobilizers 6 weeks 161

14. Training Course on ‘Office Management’

Administration Officers/ Superintendents

1 week 26

15. Training Course on ‘Office Security’ Naib Qasids 4 days 31

16. Course on ‘Communication and Advocacy’

Female Welfare Counsellors/Workers

1 week 27

Total 1,090 Non-Programme Personnel

Sr. No. Title of Seminar Participants Duration No. Held

1. Safe Motherhood Religious Scholars 2 days/1 day 1,086

2. Safe Motherhood Factories/Industries Staff 1 day 113

3. Safe Motherhood PLDs/NBDs/NGOs 2 days 116

4. Population and Development Media 1 day 86

5. Population and Development TGIs/NBDs 2 days 266

6. Population and Development Male and Female Ulemas 2 days 304

7. Population and Development District and Tehsil Nazims I day 40

8. Population and Development NGOs/CSOs 1 day 88

Total 2,099

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B. Communication and Advocacy The Directorate of Communication Strategy is mandated to develop and implement media campaign to promote small family norms and bring about attitudinal change in the masses. A comprehensive promotional campaign was launched during 2009-10 through the print and electronic media with a special focus on advocacy for population welfare to achieve the goal of population stabilization. The messages of the media campaign were blended into educational and recreational TV and radio programmes sponsored by the Ministry of Population Welfare (MoPW). Moreover, seminars, workshops, meet-the-press sessions, and orientation programmes for community, youth and policymakers were organized. Also, advertisements and articles were published in the press to disseminate information about family planning and reproductive health. Promotional Campaign The promotional campaign through the print and electronic media addressed various family planning and population issues, such as population and development, implications of rapid population growth, birth spacing, breastfeeding, female literacy, male involvement, removal of misconceptions regarding side-effects of family planning methods, image enhancement of family planning workers, early marriage, etc. The details of related activities undertaken during 2009-10 are given in the following table and text:

Sr. No. Activity Target Achieved Percentage 1. TV Advertisement 1,000 1,618 162 2. TV Programme 20 20 100 3. Radio Spot 800 1,155 144 4. Radio Programme 104 68 65 5. Press Advertisement 400 598 150 6. IEC Material 300,000 222,500 74 7. Conference/Workshop/Seminar/Meeting 3 6 200

a. Enter-Educate Programme ‘Aabadi Nama’

This ongoing programme is broadcast every Tuesday through the Pakistan Broadcasting Corporation (PBC) network. A total of 34 programmes of ‘Abadi Nama’ were telecast during 2009-10. This enter-educate programme includes various segments on population-related news, issues, information and activities. A special segment of the programme has been assigned to the involvement of parliamentarians and coverage of population-related news in their constituencies/ areas.

b. ‘Online Family Clinic’ through FM Radio This programme of 25-30 minutes duration was aired on rotational basis from different FM radio stations during 2009-2010. The host of ‘Online Family Clinic’ was a medical doctor who responded to the live calls of audiences. The programme focused on use and side-effects of family planning methods, mother and child health (MCH), male involvement, age at marriage, service outlets, general health problems, etc.

c. Other Activities Four thematic songs on population issues were produced in regional languages, and

aired on complementary basis from terrestrial and satellite channels.

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‘Palna’, a 90-minute tele-film, was produced to address the family planning and reproductive health issues of newly-wed couples.

A close circuit television (CCTV) campaign was launched through major railway stations and trains, Daewoo terminals and buses, and Passport Office, Lahore.

Coverage of the launching ceremony of UNFPA’s ‘State of World Population 2009’ report was arranged through the print and electronic media.

The Pakistan Electronic Media Regulatory Authority (PEMRA) was approached for airing of population-related messages on complementary basis through satellite channels as their corporate responsibility.

World Population Day 2009 The following activities were undertaken in connection with the World Population Day (WPD) on 11 July 2009:

a. Pre-Event Press Conference A pre-event press conference was arranged in the Media Centre of the Press Information Department (PID) on the eve of the WPD 2009 to highlight population issues. The Federal Minister for Population Welfare briefed the media about the importance of the World Population Day and the programme chalked out by the MoPW in this connection.

b. Curtain Raiser A curtain raiser was telecast on 10 July 2009 on PTV, PTV News and ATV. Moreover, special messages were aired on various satellite channels on the eve of the WPD 2009.

c. National Population Convention A National Population Convention was held on 11 July 2009 at the Prime Minister’s Secretariat, Islamabad. The event was chaired by the Prime Minister of Pakistan and attended by a large number of federal and provincial ministers, diplomats, parliamentarians, civil servants, journalists, and representatives of national and international organizations in the public and private sector.

d. Coverage in Electronic Media PTV, the national channel, gave special coverage to the WPD 2009 in its ‘Khabarnama’ besides airing hourly bulletins on 11 July. Exclusive programmes on family planning and population issues were telecast on different TV channels – ‘Maizban Pakistan’ on PTV News, ‘News Morning’ on PTV Home, ‘Rise and Shine’ (Khawateen Programme) on PTV and ‘Morning with Farah’ on ATV to name just a few – in connection with the WPD 2009. Parliamentarians, celebrities and experts in the field of population were invited to these programmes as guests. Similar programmes were also broadcast from different FM radio stations. Moreover, TV channels gave appropriate coverage to the National Population Convention.

e. Coverage in Print Media Special promotional advertisements were published in 18 national and regional dailies for imparting awareness to the general public regarding the WPD 2009. Exclusive reports and supplements were also published in selected leading newspapers. Messages of the President, Prime Minister, Federal Minister for Population Welfare, Secretary to the MoPW and UNFPA Country Director were also published in selected leading newspapers to highlight the importance of the WPD 2009.

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f. Special Issue of ‘Aabadi Nama’ A special issue of ‘Aabadi Nama’ was published on the occasion of the WPD 2009 and distributed among the participants of the National Population Convention, as well as parliamentarians, district nazims, college/university libraries, NGOs and other stakeholders. The special issue included messages of the President, Prime Minister, Federal Minister for Population Welfare, Secretary to the MoPW and UNFPA Country Director on the occasion of the WPD 2009. Moreover, it included special articles, reports, editorials and interviews on the theme of the WPD 2009. Involving Ulema in Family Planning Activities The following activities were organized during 2009-10 to enhance the involvement of ulema (religious scholars) in the Population Welfare Programme:

a. National Ulema Seminar A National Ulema Seminar was held on 2 July 2009. The Directorate of Communication Strategy arranged its coverage through the print and electronic media and more than 100 journalists attended the event. At the end of the seminar, they interviewed the Federal Minister for Population Welfare, Secretary to the MoPW and selected religious scholars for their news reports. A positive hype about the event was created through news reports on TV and radio and in the press.

b. Seminars on ‘Role Of Religious Leaders in Population Welfare Programme’ These seminars were held in the six cities of Abbottabad, Karachi, Lahore, Muzaffarabad, Peshawar and Quetta; and chaired by the Federal Minister for Population Welfare. Their main objective was to share the activities of the Programme and seek opinion of the religious leaders regarding their role in its implementation. About 700 local religious leaders and khateebs, including women, participated in the seminars, during which in-depth group discussions were held on topics such as role of religious leaders in advancing the goal of family wellbeing, role of gender from Islamic perspective, socio-cultural barriers to family planning, remedial measures in promoting MCH, etc.

c. Seminar on ‘Interfaith Harmony and Role of Religious Leaders for Promoting Mother and Child Health in Population Welfare Programme’

This one-day seminar, held on 24 December 2009 in Sialkot, was inaugurated by the Federal Minister for Population Welfare. The main objective of the seminar on ‘Interfaith Harmony and Role of Religious Leaders for Promoting Mother and Child Health in Population Welfare Programme’ was to share the activities of the Programme and seek opinion of the religious leaders regarding their role in its implementation.

d. Finalization of ‘Manual for Orientation of Religious Leaders’ The MoPW is implementing a project titled ‘Mobilizing Religious Leaders for RH/FP in Pakistan’ with the technical and financial assistance of the United States Agency for International Development (USAID) since July 2009. The former is being provided by a consultant under the Extended Service Delivery (ESD) arrangement. A consultative meeting of the Curriculum Advisory Group was held on 30 April 2010 to evolve consensus on the compendium of the ‘Manual for Orientation of Religious Leaders’. The Training Sub-Group held its first meeting from 8-10 May 2010. Senior officials of the MoPW also participated in the meeting aimed at reviewing the generic ESD Manual in the light of the Curriculum Advisory Group’s directions. The relevant material was selected from the revised compendium and inserted at appropriate places in the Manual.

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e. Master Training Workshop on ‘Mobilizing Religious Leaders for RH/FP in Pakistan’ A Master Training Workshop was conducted from 3-8 June 2010 on the ‘Mobilizing Religious Leaders for RH/FP in Pakistan’ Project. 18 master trainers, associated with the PWTIs as instructors, attended the workshop. The Provincial Focal Persons were also engaged in helping them understand their role as coordinators between the MoPW and the district management. Female trainers from the RTIs were also asked to join the workshop in the light of their role in evolving training module for family welfare workers (FWWs) for their pre-service and in-service training. The master trainers will represent the core trainers associated with the PWTIs, and will provide orientation to trainers selected form 26 FALAH Project-focused districts through Training of Trainers (ToT). Subsequently, the district-level trainers will provide orientation to community-level religious leaders, including imams, khateebs and nikah khwans. Production and Printing Unit The MoPW maintains a Production and Printing Unit in Lahore since 1962, which caters to its needs by printing professional, motivational, clinical and informational materials. It is an in-house economical printing facility where assignments are executed irrespective of time constraints. The Production and Printing Unit undertakes assignments for the MoPW, as well as the Population Welfare Departments of Punjab, Sindh, Khyber Pakhtunkhwa and Balochistan. In addition, the Unit also facilitates the printing matters of AJK, NIPS and other allied units of the Ministry. The achievements of the Production and Printing Unit, managed by the Directorate of Communication Strategy, during 2009-10 are given in the following table:

Quantity Printed

MoPW, Islamabad PWD, Punjab IEC Material Booklets, Leaflets, Handbills, Posters, Flip Charts, Books, Brochures, Flyers, Stickers, etc.

159,900 4,070,000

Newsletter ‘Aabadi Nama’ 30,000 -

Office Stationery DO Pads, Letterheads, Visiting Cards, File Covers, Envelopes, etc.

32,225 -

Forms and Registers Registers, Forms, CRC Cards, Users Slips, Bin Cards, etc. 11,100 -

Total 233,225 4,070,000 Seminar on ‘Population and Development Issues’ for AJK Parliamentarians

A one-day seminar on ‘Population and Development Issues’ was organized for parliamentarians and elected representatives from AJK on 23 November 2009 in Muzaffarabad. A comprehensive presentation was made on ‘Implications of Population Growth and Response Strategy’ during the seminar, which was chaired by the Prime Minister of Azad Jammu and Kashmir. The participants included members of the AJK Legislative Assembly, secretaries of line departments and representatives of NGOs. Production and Dissemination of IEC material A large quantity of IEC material, including booklets, brochures and handbills highlighting family planning services/methods, was produced and disseminated during 2009-10. The fatwa in favour of family planning was also disseminated to all the parliamentarians to gain their support.

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Media Coverage Media coverage was arranged for the following events during 2009-10:

National Assembly Standing Committee Meeting.

Visit of the Federal Minister for Population Welfare to India.

Meetings of the Federal Minister for Population Welfare with donor agencies. Essay and Slogan Writing Competition In order to involve the youth and general public in population issues and highlight the implications of high population growth rate, a National Essay and Slogan Writing Competition was organized. The competition was announced through the national press. 298 entries were received in the category of slogan writing, while 393 entries in the category of essay writing. The same were assessed by a committee and cash prizes were awarded to the winners in both the categories. Monthly Newsletter ‘Abadi Nama’ The MoPW’s quarterly newsletter ‘Aabadi Nama’ was published regularly during 2009-10; and disseminated among the Provincial Population Welfare Departments (PWDs), other ministries and departments, colleges, universities, media persons, libraries, MNAs, Senators, district nazims and other stakeholders. ‘Aabadi Nama’ highlights special events organized by the MoPW and PWDs, besides publishing interviews of experts in the field of population and development.

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C. Population Education The Directorate of Population Education has evolved a new strategy to focus on youth, the major cohort in the population pyramid. This programmatic shift from family planning to reproductive health rights and issues of adolescents will ensure quality of life and care. The new paradigm, instead of talking about numbers as a population education modality, encompasses spacing, responsible parenthood, health education and family as a unit in a holistic approach to population and development issues.

As part of the Youth Sensitization Programme and orientation/education of different categories of target audience under the population education component, a series of workshops/seminars was organized. Moreover, ‘Presentation Skills Development Workshops’ were organized to enhance the capacity of newly-inducted officers in the Programme at the provincial level. The summary of the activities undertaken during 2009-10 is given in the following table:

Sr. No Activities Undertaken Venue

1. Presentations on ‘Population and Development’ in Colleges and other Educational Institutions

Faisalabad, Gujranwala, Islamabad, Mirpur, Muzaffarabad, Peshawar, Rawalpindi

2. 2-Day ‘Teacher Sensitization Workshops on Population Issues’

Faisalabad, Gujranwala, Lahore, Mirpur, Muzaffarabad, Peshawar

3. 4-Day ‘Presentation Skills Development Workshops’ for Field Officers of the Provincial Population Welfare Departments

Lahore, Peshawar

4. 2-Day Orientation Workshops on ‘Population Issues’ for Religious Scholars

Gujranwala

5. Focus Group Meetings to finalize projects to be launched by the Ministry of Youth Affairs

Ministry of Youth Affairs, Islamabad

New Initiatives To meet the socioeconomic challenges faced by Pakistan, it is vital to sensitize all segments of the society on population issues, especially opinion leaders like teachers and religious scholars. The population as a demonstrator of all the developmental indicators and a cross-cutting issue was highlighted at different for a by the Directorate of Population Education. However, the focus on youth, especially students and young teachers in productive and reproductive age groups, is the main thrust of the population education component of the Programme. In this connection, the MoPW’s plan is to sensitize both students and young teachers on population issues. In the first phase, the Ministry plans to establish seven Population Education Information Resource Centres (PEIRCs) in public sector universities, one in each province and AJK and ICT. These Centres will be a major step towards sensitizing the country’s youth on the issue of population and development.

Moreover, a number of meetings were convened with the Curriculum Wing of the Ministry of Education to discuss recommendations on already proposed eight themes related to population and development issues, with a view to sensitizing school students of class 9 and 10 and college students of class 11 to 12. In addition, the Directorate of Population Education was also involved in the vetting of the Education and Youth Policies from the population and development point of view. For the first time in its history, the Directorate was involved not only in finalizing the Government of Pakistan (GoP)-UNFPA related Annual Work Plan (AWP)-2010 of the Ministries of Education and Youth Affairs, but also got one of its activities – the establishment of seven PEIRCs – incorporated in the AWP-2010 of the Ministry of Education.

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D. Contraceptive Commodity Security (Procurement and Performance)

Annual Contraceptives Requirement The annual contraceptives requirement for the Ministry of Population Welfare (MoPW) was approved to the tune of Rs. 150.000 million, against the allocation of Rs. 150.000 million for 2009-10. As per the pro-forma invoice provided by UNFPA, funds of Rs. 146.000 million in foreign exchange were transferred to UNFPA through the Ministry of Finance/AGPR/State Bank of Pakistan. Besides, oral pills (235,000 cycles) worth Rs. 3.995 million were procured locally from M/s. ZAFA Pharmaceutical Karachi through open competitive process by issuing tender in the press. The details of the contraceptives procured through UNFPA during 2009-10 out of GoP budget (Rs. 146.000 million equivalent to $1.7 million) is given in the following table:

Sr. No. Contraceptive Quantity Procured

1. Oral Pill EC (Boxes) 120,000

2. Oral Pills COC (Cycles, locally procured) 235,000

3. CU-375 (Sets) 350,000

4. CUT-380-A (Sets) 400,000

5. NET-EN (Ampoules) 670,000

6. Syringes (Pieces) 670,000

7. DMPA (Vials) 240,000 Central Warehouse and Supplies, Karachi The Directorate of Central Warehouse and Supplies (CW&S), Karachi is an important part of the Population Welfare Programme. It is responsible for storage and smooth supplies of contraceptives to Programme units and non-Programme family planning service delivery outlets. There will be no family planning programme if contraceptives are not available in services delivery outlets. That is why the Directorate of CW&S plays a vital role in the entire Programme by ensuring continued availability of contraceptives to Programme and non-Programme outlets.

During 2009-10, direct supply from CW&S, Karachi to People’s Primary Healthcare Initiative (PPHI) district managers was introduced. Moreover, with the technical and financial support of USAID’s DELIVER and CRISP Projects, rehabilitation work of the CW&S, Karachi – construction of a new Administration Block, expansion of the existing store and introduction of a pallet-racking system – is currently in progress and will hopefully be completed during 2010-11. The physical verification of the CW&S, Karachi was carried out from 29-31 March 2010. After approval of the report, follow-up action is in process for implementation of the recommendations. ‘National Contraceptives Procurement Manual’ The DELIVER Project is also facilitating the development of a ‘National Contraceptives Procurement Manual’ as a tool for MoPW/Ministry of Health personnel. The Manual addresses the key phases of the procurement cycle, from procurement planning and issuing invitations to bid evaluation, supplier selection and contract award and management. It will also provide step-by-step instructions for desk officers and other hands-on procurement staff who are tasked with the responsibility of procuring quality contraceptives. The ‘National Contraceptives Procurement Manual’ will also ensure compliance with the Public Procurement Rules 2004.

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The draft Manual is an outcome of active interventions by the officers of the MoPW/Ministry of Health, as well as other key stakeholders such as the Central Drug Laboratory, Drug Control Authority, Mother and Neonatal Child Health (MNCH) Programme, National Aids Control Programme, Public Procurement Regulatory Authority (PPRA), United Nations Population Fund (UNFPA), United States Agency for International Development (USAID) and Department for International Development (DFID). The Manual is almost ready for government approval. Commodity Support from UNFPA And USAID UNFPA and USAID have donated contraceptives to the MoPW. UNFPA’s consignments have been received, while the majority of USAID consignments are yet in the pipeline. The details are given in the following table:

($ in Million) Donor Allocation Received In Pipeline

USAID 2.947 1.095 1.852

UNFPA 2.130 2.130 -

Total 5.077 3.225 1.852 Logistic Management Information System The DELIVER Project is providing technical assistance to develop a logistic management information system (LMIS) for improving quantification, forecasting and inventory management of contraceptives. Once this LMIS is in place, all necessary data will be accessible by a click from top to the service provider-level. Contraceptives Receipt and Dispatch During 2009-10, 1,816 consignments of various contraceptives were received, got cleared from the Customs and stored in the warehouse. Of these consignments, 1,117 belonged to DPWOs, 346 to RHS-A Centres, 196 to EDOs, 51 to RTIs/NRIFC, 36 to AJK, 31 to the PPHI, 20 to NGOs and 19 to TGIs/Gilgit-Baltistan.

Sr. No. Name of Contraceptive Units Quantity

1. Rubber Condoms Pieces 48,960,000

2. Oral Pills M/cycle 3,764,093

3. Norgestril (Overette) PoP M/cycle 119,978

4. Postinor-2 Box into 2 tabs 120,000

5. Copper ‘T’ (380-A) Pieces 467,056

6. Multiload cu-375 Pieces 260,300

7. Norigest Injection Amps 1,200

8. Megestron/Depo Injection Vials 901,000

9. Disposable Syringe with Needles Pieces 1,500,000

10. Implanon (one single rod implant) Sets 900 During 2009-10, consignments of various contraceptives were dispatched to Programme and non-Programme service delivery outlets. The details are given in the following table:

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Sr. No. Name of Contraceptive Units Quantity

1. Rubber Condoms Pieces 41,364,808

2. Oral Pills M/cycle 3,223,123

3. Norgestril (Overette) PoP M/cycle 119,978

4. Exlution Tablets M/cycle 68,817

5. Postinor-2 Box into 2 tabs 48,887

6. Copper ‘T’ (380-A) Pieces 662,887

7. Multiload cu-375 Pieces 96,508

8. Norigest Injection Amps 1,336,905

9. Megestron/Depo Injection Vials 905,182

10. Disposable Syringe with Needles Pieces 2,201,179

11. Implanon (one single rod implant) Sets 2,171 In addition, the Directorate of CW&S, Karachi received various contraceptives for the National Programme for Family Planning and Primary Health Care, Ministry of Health, and provided storage facilities in the warehouse. Later, the same were dispatched to the Provincial Programme Implementation Units of the Ministry of Health throughout Pakistan. The details of receipt and dispatch of the contraceptives belonging to the Ministry of Health that were stored by the CW&S, Karachi during 2009-10 are given in the following table:

In addition, the Directorate of CW&S, Karachi received 734 cartons of Rubber Condoms for the National Aids Control Programme (NACP) and provided storage facilities in the warehouse. Development of National Contraceptive Procurement Table With the technical assistance of the DELIVER Project, a National Contraceptive Procurement Table for 2010-11, 2011-12 and 2012-13 has been prepared on the basis of logistic data, which include contraceptive requirement for the Population Welfare Programme and other stakeholders. Outstanding Sale Proceeds The monitoring exercise on district-specific basis has started to clear off the outstanding sale proceeds from the concerned District Population Welfare Offices (DPWOs).

Sr. No. Name of Contraceptive Receipt Dispatch

1. Rubber Condoms 5,066,884 10,544,976

2. Oral Pills (M/cycles) - 3,455,500

3. Depo Provera Injections (Vials) 75,500 75,500

4. Disposable Syringes with Needles (Pieces) 75,500 75,500

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E. International Cooperation United Nations Population Fund (UNFPA) The Ministry of Population Welfare (MoPW), in consultation with the stakeholder, including the line ministries/departments, finalized the GoP-UNFPA 7th Country Programme in January 2004 for five years duration (2004-2008) with a total cost of $34.9 million. It was extended twice; the first extension was approved by the UNFPA/UNDP Executive Board during the meeting held in Geneva in June 2008. The Programme was later extended until 2012. The purpose of these extensions was to implement the One Programme under the ‘One UN’ pilot exercise in Pakistan (2008-2012), and to synchronize the United Nations programme cycle with the national Medium-Term Development Framework (2005-2010).

The goal of the UNFPA Country Programme is to contribute to the improvement of reproductive health status of Pakistan leading towards population stabilization and sustainable human development, with focus on reducing fertility and improving maternal health. The allocation under the Annual Work Plan (AWP) is for the Ministries of Population Welfare, Health, Education and Women Development, as well as the Statistics Division, so that they can address RH/FP issues following a multi-sectoral approach. In the MoPW, four Director Generals/Project Directors are responsible for implementing the AWP at the federal, provincial and district level.

The UNFPA Country Programme focuses on 10 districts: Chaghi, Chakwal, Jacobabad, Kohat, Kotli, Muzaffarabad, Mansehra, Muzaffargarh, Qila Saifullah and Thatta. For implementation of the Programme, the MoPW and other line ministries – Health, Education, Women Development and Youth Affairs, as well as the Statistics Division – sign their AWP with UNFPA every year. Annual Work Plan 2010: The Annual Work Plan for 2010 amounting to $ 2.75 million was signed between UNFPA and the MoPW on 10 February 2010. The funds will be used for implementing reproductive health and family planning throughout Pakistan. The AWP is in line with the MDGs and ICPD objectives. The major activities of the AWP 2010 include:

Training.

Integrated primary health care/reproductive health/family planning services through Mobile Service Units in remote areas.

Advocacy and community awareness.

Improved management system for programme delivery.

Support to demographic and population studies, and support for public private sector organizations (PPSO) working on population and development issues.

Procurement of contraceptives for social marketing in Pakistan. 2. United States Agency for International Development (USAID) USAID is currently supporting in contraceptive commodity security through its DELIVER and CRISP Projects. DELIVER Project: The project, running from August 2009 to September 2011, is providing financial and technical support to Pakistan in the field of forecasting, international procurement of contraceptives, computerization of warehouse, logistic management information system (LMIS) and contraceptive commodity security. Under the DELIVER Project, USAID is providing $10.3 million support for commodity supplies for the MoPW, Ministry of Health and Greenstar Social Marketing-Pakistan. Of this amount, the share of the MoPW is $2.9 million, while that of the

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Ministry of Health and Greenstar Social Marketing-Pakistan is $6.2 million and $1.2 million, respectively. The MoPW has received contraceptives worth $1.095 million and contraceptive worth $1.85 million are in the pipeline under the DELIVER Project, which is also providing technical support amounting to $3.0 million for forecasting, the ‘Contraceptive Procurement Manual’, LMIS and computerization, including pallet-racking of CW&S, Karachi. CRISP Project: The project is providing financial and technical support for expansion and rehabilitation of Central Warehouse and Supplies (CW&S), Karachi. Currently, rehabilitation work (flooring, ventilation, electrification and painting) of existing storage facility and foundation work of the Administration Block is being undertaken. The estimated cost of the CRISP Project, which would be completed by July 2011, is $2.5 million. Pakistan Demographic and Health Survey (2011-2012): USAID has agreed to provide financial and technical assistance to the National Institute of Population Studies (NIPS) to conduct the next Pakistan Demographic and Health Survey (PDHS) 2011-2012. In addition to these projects, USAID is also providing funds to Pakistani NGOs for undertaking activities around family planning and reproductive health issues. The details are as follows: Family Advancement of Life and Health: This five-year project, with a budget of $60 million, is being implemented in 26 districts across the country. The implementing consortium is led by the Population Council, a US-based research organization. The ToRs of the Family Advancement of Life and Health (FALAH) Project are to increase demand for and practice of birth spacing; increase access to quality of family planning services in the public sector; increase the coverage and quality of family planning services in the private sector; and increase the coverage of social marketing of contraceptives and provide support to the commercial sector for marketing of contraceptives to strengthen contraceptive security. The MoPW is one of the implementing partners of the FALAH Project. The DG (Technical) is the focal person from the MoPW regarding formulation and implementation of the Project. Pakistan Initiative for Mothers and Newborns: This six-year project is designed to reduce maternal, neonatal and child mortality in Pakistan by making sure women have access to skilled birth attendants during childbirth and throughout the postpartum period. The Pakistan Initiative for Mothers and Newborns (PAIMAN) is working at the national, provincial and district level to strengthen the capacity of public and private health care providers and to improve the health care system infrastructure. PAIMAN has developed a community-based approach that provides a continuum of care to mothers, newborns and children through supportive linkages from home health care to hospital-based care. PAIMAN’s key partners are the Ministry of Health, the Ministry of Population Welfare, Provincial and District Health/Population Departments and the private sector. The PAIMAN consortium is led by John Snow Inc. (JSI), a US-based international public health organization. Proposals for Future USAID Assistance: A series of meetings were held at the MoPW and Finance Division to discuss and prioritize project proposals for USAID support. In this connection, the Ministry has forwarded six concept papers for USAID funding. These concept papers were discussed during the last Pak-US strategic dialogue in New York. US authorities showed their interest in four of the six proposals, costing $180.00 million. These include: (1) Enhancing Outreach to FP/RH Services through Community Partnership: Family Health Homes at Village Level (pilot project for two years costing $120.00 million, as against total project cost of $331.76 million for five years); (2) Community Mobilization through Imams and Khateebs at Village Level (pilot project for two years costing $28.00 million, as against total project cost of

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$70.00 million for two years); (3) Research and Training through NIPS, NRIFC, RTIs and PWTIs (the total project cost is $12.00 million for five years); and (4) Public-Private Partnership for Universal Access to FP/RH Services (the total project cost is $20.00 million for five years). 3. Partners in Population and Development (PPD) The Partners in Population and Development (PPD) PPD is an inter-governmental alliance of 25 developing countries: Bangladesh, Benin, China, Colombia, Egypt, Ethiopia, India, Indonesia, Pakistan, Jordan, Mexico, Gambia, Morocco, Ghana, Tunisia, Yemen, Nigeria, Kenya, Mali, Thailand, Vietnam, Senegal, South Africa, Uganda and Zimbabwe. The PPD was established during the International Conference on Population and Development (ICPD), held in Cairo in 1994, with the specific purpose of promoting and improving the transfer of knowledge/expertise and skills in population and reproductive health through South-South collaboration. Pakistan joined the PPD, whose headquarters is located in Dhaka, Bangladesh, in 1997.

Members of the PPD believe that by sharing their expertise, they can transform reproductive health goals outlined in the ICPD into reality. Partners’ Board, comprising senior officials or ministers for Family Planning/Population Programme of each member country, is the governing body of the PPD and its meeting is held annually. The Federal Minister for Population Welfare is on the Partners’ Board from Pakistan. This year, the Partners’ Board meeting will be held in Indonesia from 25-28 October 2010.

The MoPW is facing an acute shortage of demographers; however, being a member of the PPD, it is offered one or two slots every year for attending the one-year General Diploma Course in ‘Demography’ at Cairo Demographic Centre, Egypt. Nine officers of the Ministry or Provincial Departments of Population Welfare have so far attended the course, while two are currently enrolled. Being a member of the PPD, the GoP does not have to bear any expenses in this regard. However, UNFPA shares the expenses incurred on this course.

The MoPW organized three media workshops in 2004, 2006 and 2009 in Islamabad on the request of the PPD for creating awareness about its activities. These workshops were attended by parliamentarians, senior government officials, legal experts, and national and international print and electronic media, besides representatives of UN agencies, international development partners, diplomatic missions, professional bodies and NGOs/CSOs,. The Executive Director of the PPD also attended these workshops. 4. Development Bank of Germany (KfW) Social marketing was introduced in Pakistan in 1985-86 with the financial assistance of USAID. KfW (Kreditanstalt für Wiederaufbau or Development Bank of Germany) entered the field in January 1995 to sustain condom distribution through a five-year agreement (1995-1999) with a grant assistance of DM30 million. The assistance provided by KfW covered procurement of commodities like contraceptives, advertisement/promotional campaign, training, research, management, monitoring and consultancy.

For enhancing and expanding the Social Marketing Programme, particularly in the North-West Frontier Province or NWFP (now Khyber Pakhtunkhwa), an MoU was signed between the GoP and KfW in September 2006. Under the MoU, KfW agreed to provide Euros 6.1 million for the Social Marketing Programme for three years (2006-09) under the project titled ‘Improved Reproductive Health Services in NWFP’. The project ended in 2009.

Recently, KfW has made a fresh commitment through the External Affairs Division (EAD) to provide an amount of Euro 8.00 million for Social Marketing Programme under the project titled ‘Improved Reproductive Health Services in NWFP’ from 2010-12.

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5. Visits Abroad The details of visits/trainings abroad undertaken by officers of MoPW during the year 2009-2010 are given in the following table: Sr. No. Name and Designation Event (Venue) Dates Funding Source

1. Dr. Firdous Ashiq Awan, Federal Minister for Population Welfare; and Dr. Mumtaz Esker, Director General (Technical), MoPW

SAARC Parliamentarians Conference on ‘Advocacy to Achieve Universal Access to Reproductive Health Services and Commodities Security’ (Kathmandu, Nepal)

28-30 July 2009

UNFPA

2. Dr. Sairah Adnan, Medical Officer/Senior Instructor, RTI, Abbottabad

Training Programme on ‘HIV/AIDS Prevention and Care for Children and Vulnerable Young People’ (Bangkok, Thailand)

24 Aug-4 Sept 2009

Royal Thai Government

3. Mr. Abdul Ghaffar Khan, Director General (Projects), MoPW

Asia-Pacific High-Level Forum on ICPD @15: Accelerating Progress Towards ICPD and the Millennium Development Goals (Bangkok, Thailand)

16-17 Sept 2009

UNFPA

4. Dr. Mumtaz Esker, Director General (Technical), MoPW

WHO Regional Workshop on the Implementation of Best Practices in Family Planning (Amman, Jordan)

27-30 Sept 2009

USAID

5. Dr. Firdous Ashiq Awan, Federal Minister for Population Welfare; Major (r). Haroon Rashid, Additional Secretary, MoPW; and Mr. Hammad Shamimi, Director (FA), MoPW

14th Annual Board Meeting of Partners in Population and Development (PPD) and 5th Asia Pacific Conference on ‘Sexual and Reproductive Health and Rights’ (Beijing, China)

17-20 Oct 2009

PPD

6. Mr. Dilshad Ahmad, Deputy Secretary, MoPW; Ms. Tanvir Kiyani, Director, MoPW; Syed Muhammad Saleem, Deputy Director, MoPW; Dr. Asma Rana, Principal, RTI, Lahore; Mr. Abdul Sattar, DPWO, Naushki; Dr. Shama Khawaja, Principal, RTI, Islamabad; Dr. Mehjabeen Shah, Medical Officer, RHS-A Centre, Hyderabad; Mr. Akramullah Baig, Project Director, NA; Dr. Naila Akhtar, Chief Medical Officer, RHS-A Master Training Centre, Lahore; and Mr. Abdul Waheed, Director, MoPW, Islamabad

Observational Study Tour on ‘FP/RH Quality of Care Programme’, organized by the National Population and Family Planning Commission of China

10-18 Nov 2009

UNFPA

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Sr. No. Name and Designation Event (Venue) Dates Funding Source 7. Mr. Nayyar Agha, Secretary,

MoPW United Nations High-Level Conference on ‘South-South Cooperation’ (Nairobi, Kenya)

1-3 Dec 2009 UNFPA/PPD

8. Dr. Firdous Ashiq Awan, Federal Minister for Population Welfare

Study Visit to Syria to learn about success stories and best practices in the field of RH/FP

3-7 Dec 2009

9. Mr. Nayyar Agha, Secretary, MoPW; and Mr. Abdul Ghaffar Khan, Director General (Projects), MoPW

Study Visit to the US, the UK and Germany to ensure commodity security for Greenstar Social Marketing-Pakistan

26 Jan-4 Feb 2010

Greenstar Social Marketing-Pakistan

10. Dr. Badaruddin Abbasi, Director (TC), MoPW

2nd USAID-WHO Technical Meeting on ‘Reconvening Bangkok 2007-2010: Progress Made and Lessons Learned in Scaling-Up FP/MNCH Best Practices in the Asia and Middle East Region’ (Bangkok, Thailand)

6-11 March 2010

USAID

11. Dr. Firdous Ashiq Awan, Minister for Population Welfare, Islamabad

Study Visit to India to observe best practices, success stories and experiences for sharing knowledge in the area of RH/FP and to replicate the same in Pakistan, which would help in reducing population growth and fertility rates and increasing contraceptive prevalence rate

15-2 April 2010.

UNFPA

12. Mr. Shaukat Hayat Durrani, Secretary, MoPW

43rd Session of the Commission on Population and Development (New York, USA)

12-18 April 2010

UNFPA

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F. Monitoring and Supervision

Monitoring of Population Welfare Programme activities in the field is an important management tool to ensure smooth implementation of policies and decision-making, and is thus a regular activity of the MoPW. The performance of each Programme component is gauged through performance indicators. The key input indicators include workforce, availability of reproductive health commodities, capacity building activities, availability of equipment and furniture, and funding; while the key output indicators include family planning services, antenatal/prenatal/ MCH services, coverage, quality of care, counselling techniques, registration of eligible couples and client satisfaction. The monitoring is undertaken through:

Analysis of periodic reports received from the field.

Field visits the to service delivery outlets.

Review sessions at regular intervals.

Experience-sharing workshops with the service providers and other stakeholders. Field Visits During 2009-10, monitoring teams of the MoPW visited 14 districts in four provinces: Attock, Chakwal, Okara, Pakpattan and Rawalpindi in Punjab; Karachi (East), Khairpur, Mtiari, Sukkur, Thatta and Umarkot in Sindh; Gilgit and Diamir in Gilgit-Baltistan; and Pishin in Balochistan. Their observations were conveyed to the concerned provinces, so that they could improve performance, as well as the MoPW. Workshops on Field Monitoring Monitoring of Population Welfare Programme activities is also done at the provincial and district level. In order to enhance the capacity of district monitoring officers, two-day training workshops were conducted for Deputy DPWOs (Tech) and TPWOs in Hyderabad, Muzaffarabad, Peshawar, Quetta and Sukkur. The focus of the workshops was on the use of tools and indicators during field monitoring. Fields visit were also arranged for the participants to practically apply these tools and indicators.

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G. Research and Evaluation I. National Research Institute of Fertility Care The following studies were undertaken by the National Research Institute of Fertility Care (NRIFC) during 2009-10:

1. Increasing Access to Emergency Contraceptive Pills through Family Welfare Workers and Community Women Volunteers.

2. Post-Operative Menstrual Changes in Mini-Laparotomy Cases.

3. Impact of Strengthening of Counselling Skills of Service Providers and Enhancing Quality of Care of Service Outlets.

4. Comparative Study of Norigest and Megesterone to Determine Bleeding Pattern and Acceptability.

5. Role of Leptin in Infertile Males.

6. Pre-Introductory Clinical Trial of Latest Intra-Uterine Device ‘Yuangong 220’.

7. Condom Brands Available in Pakistan: Quality and Client Satisfaction. Research Advisory Committee Meeting A meeting of the Research Advisory Committee (RAC) was held at the NRIFC, Karachi to discuss new research proposals. Representatives of the Ministry of Population Welfare (MoPW), the Provincial Welfare Department (PWD) Sindh and other research institutes attended the meeting and approved the following research proposals:

1. Using Innovative IT Approaches for Improvement of Family Planning/Mother and Child Health (MCH) Services in Pilot Districts.

2. Assessing Burden of STIs/RTIs in MoPW and Ministry of Health Facilities/Outlets in Selected Districts.

3. Knowledge, Attitude and Practices of Fishermen Community of Rehri Goth, Karachi regarding Family Planning.

4. Causes of Male Fertility in Our Society. II. National Institute of Population Studies The following activities were undertaken by the National Institute of Population Sciences (NIPS) during 2009-10:

Research Projects 1. Performance Evaluation of Male Mobilizers.

2. Baseline Household Survey of District Chitral.

3. Evolution of Media Campaign of the Population Welfare Programme.

4. Gilgit-Baltistan Demographic and Health Survey.

5. District Population and Development Profile.

6. End-line Survey of the Pakistan Initiative for Mothers and Newborns (PAIMAN).

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Research Papers The following research papers were presented by NIPS at the Tenth Annual Population Conference, organized by the Population Association of Pakistan in 2010.

1. Unintended Pregnancy and Antenatal Care in Pakistan.

2. Maternal Mortality.

3. The Delay in Decision-Making Process and Maternal Mortality.

4. Knowledge of Tuberculosis and its Correlates among Ever Married Women in Pakistan.

5. Media Messages Persuading Couples to Use Contraceptives: An Analysis in the Backdrop of Socioeconomic Factors.

6. Effects of Birth Interval and Birth Size on Child Survival in Pakistan.

7. Demographic, Social and Economic Factors Influencing the Treatment-Seeking from Health Facilities for Acute Respiratory Diseases among Pakistani Children: an Insight into the Pakistan Demographic and Health Survey (PDHS) 2006-07.

8. Correlates of Women Mortality in Pakistan.

9. Prevalence of Traditional Contraceptive Methods in Pakistan. Other Activities

1. Translation of key findings of the PDHS 2006-07 into Urdu.

2. Revival of news brief.

3. Research studies on ‘Grey Areas/Weaknesses of the Performance Evaluation of Male Mobilizers’ and ‘Population Growth and its Implications’.

4. Launching of the website.

5. Automation of the library.

6. Training of FCPS/MPH students of Wah Medical College. Activities in Progress

1. Evaluation of the Regional Training Institutes (RTIs); and contraceptive surgery cases performed at and family planning services offered by the RHS-B Centres.

2. Pilot study on ‘Islam and Family Planning: Perceptions and Practices in Sialkot and Chakwal Districts’.

3. Study on ‘Existing Status of Population Education at Pre-Service Level in Pakistan’.

4. Azad Jammu and Kashmir (AJK) Demographic and Health Survey 2010-11. Activities Proposed

1. Study on ‘State of Population in Pakistan’.

2. Five in-depth research papers on PDHS 2006-07 data.

3. Bi-annual research journal.

4. Evaluation and assessment of quality of care of the Family Welfare Centres (FWCs).

5. Study on ‘Community Response to Deployment of Midwives’.

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H. Special Initiatives

PC-Is of Population Welfare Programme The PC-Is of the Population Welfare Programme (2010-15) were considered by the Central Development Working Party (CDWP) on 17 September 2009, wherein it was decided, inter alia, that a Technical Committee would be set up to review and make pragmatic recommendations about the future course of the Programme for its effective implementation. A Technical Committee was set up accordingly by the Planning Commission under the chairpersonship of Special Advisor to Prime Minister on Social Sector Ms. Shehnaz Wazir Ali.

The first meeting of the Technical Committee was held on 15 March 2010 at the MoPW. The Committee made recommendations on the Programme and constituted a Core Group – comprising Mr. Muzaffar Mahmood Qureshi (Former Federal Secretary), Dr Zeba A. Sathar (Country Representative, Population Council), Prof. Dr. Mohammad Nizamuddin (Vice Chancellor, University of Gujrat) and Mr. Amanullah Khan (Former Senior Chief, Planning Commission) – to ensure that these recommendations were truly reflected in the PC-Is of the Programme (2010-15).

The last meeting of the Technical Committee was held on 3 May 2010 under the chairpersonship of Ms. Shahnaz Wazir Ali. The meeting endorsed the PC-Is of the Programme (2010-15) for submission to the Planning Commission, for seeking approval of the competent forum (CDWP or ECNEC). The list of PC-Is submitted to the Planning Commission is given in the following table:

Sr. No. Scheme/Project Cost (Rs. in Million)

1. Federal Activity 5,580.505

2. National Institute of Population Studies 300.000

3. National Trust for Population and Welfare 825.000

4. Population Welfare Programme, Punjab 18,745.605

5. Population Welfare Programme, Sindh 12,546.016

6. Population Welfare Programme, Khyber Pakhtunkhwa 5,946.458

7. Population Welfare Programme, Balochistan 5,208.098

8. Population Welfare Programme, Azad Jammu and Kashmir 1116.498

9. Population Welfare Programme, Gilgit-Baltistan 663.103

10. Population Welfare Programme, Federally Administered Tribal Areas 997.254

11. Population Welfare Programme, Islamabad Capital Territory 378.904 Presentation on Population Welfare Programme to Federal Cabinet A presentation on the Population Welfare Programme was made to the Federal Cabinet on 24 February 2010. In response, the Cabinet decided that the National Commission for Population Welfare (NCPW), headed by the Prime Minister, shall hold an early meeting, taking on-board the Provincial Chief Ministers, to address the issues related to the Programme. Accordingly, a summary was moved to the Prime Minister for convening meeting of the NCPW. The meeting was first scheduled on 21 June, but then postponed until 5 July. The Draft Pakistan Population Policy 2010 was to be placed in the NCPW’s meeting for its endorsement before submission to the Federal Cabinet for approval. Since the processing of the Policy is under question in the wake of the 18th Constitutional Amendment, the meeting has been temporarily postponed.

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New Website of MoPW In order to make use of the IT for spreading its message among the general public and attracting other stakeholders, including international donors, the Federal Minister for Population Welfare ordered for the development of a new dynamic website of the MoPW. It was decided that the existing website be replaced with a new multi-faceted website. After fulfilling the codal formalities, the contract for developing new website of the MoPW was awarded to M/s Avenier Technologies (Pvt.) Ltd. Public Sector Development Programme (2010-11) The Public Sector Development Programme (PSDP) proposals for 2010-11 received from all Wing Chiefs of the MoPW, its allied units and the Provincial Population Welfare Departments (including AJK, FATA and Gilgit-Baltistan) were compiled and sent to the Planning and Development Division. The meeting of the Annual Plan Coordination Committee (APCC) on the PSDP (2010-11) was held 21 May 2010 with the Deputy Chairman of the Planning Commission in the chair, while the meeting of the National Economic Council (NEC) for the PSDP 2010-11 was held on 28 May 2010. For 2010-11, the PSDP amounting to Rs. 4115.546 million was approved for the Population Welfare Programme. De-Federalization of Population Welfare Programme A meeting, co-chaired by the Federal Ministers for Population Welfare and Finance, on de-federalization of the Population Welfare Programme was held on 19 February 2010. Provincial Ministers and Secretaries of Population Welfare, Planning and Finance also attended the meeting, besides the Deputy Chairman of the Planning Commission and the Secretary, Finance Division. The purpose of the meeting was to seek response of the Provincial Governments on the de-federalization of the Programme. The Finance Minister said that the Federal Government would continue to fund the Programme for the next five years.

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I. PSDP Allocation and Utilization

The Public Sector Development Programme (PSDP) allocation, release and expenditure of the Population Welfare Programme during 2009-10 are given in the following table:

(Rs. in Million) Sr. No. Name of the Project Allocation Release Utilization

1. Federal Setup 630.000 423.574 425.561

2. Federal Projects (AJK, FATA, Gilgit-Baltistan, ICT)

444.189 234.436 240.043

3. PWP-Punjab 1,600.000 1,231.400 1,576.855

4. PWP-Sindh 1,290.000 741.500 895.565

5. PWP-Khyber Pakhtunkhwa 606.707 413.268 503.801

6. PWP-Balochistan 500.000 320.000 348.952

7. New Projects 200.000 61.024 54.443

Total 5,270.896 3,425.202 *4,045.220

* The excess amount was utilized by the provinces out of the unspent balance of previous years withheld by the concerned Finance Departments.

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