Costed Implementation Plan (CIP) on Family Planning for Sindh, Pakistan

To increase access and uptake of family planning in Sindh, there are quite a number of areas of concern that need to be addressed. Through a consultative process with key stakeholders, Population Welfare Department (PWD) and Department of Health (DOH) identified broad priorities to develop six strategic areas for investment in family planning. This costed implementation plan (CIP) presents the strategic areas and the rationale for their selection, along with associated costs. The strategic areas are:

  • Strategic Area 1 – Functional Integration:Enhancing strategic coordination and oversight between the population and health sectors at the provincial, district and subdistrict levels regarding functional integration of services at the subdistrict level.
  • Strategic Area 2 – Quality of Care:Ensuring quality of services by enforcing standards, improving providers’ skills and ensuring client satisfaction.
  • Strategic Area 3 – Supply Chain Management:Improving contraceptive security to the last mile, including distribution and availability of contraceptives at service delivery points.
  • Strategic Area 4 – Expansion of services:Expanding services with supply- and demand-side interventions for enhancing access, especially to urban slums, peri-urban and rural areas, and creating space and linkages for public-private partnerships to reach vulnerable segments of the population including the poor and youth.
  • Strategic Area 5 – Knowledge and Meeting Demand:Increasing knowledge and meeting the demand for FP services by focusing on MWRA, emphasizing male engagement and young people.
  • Strategic Area 6: – Governance, Monitoring and Evaluation:Strengthening the health and population systems by streamlining policy planning, governance and stewardship mechanisms, and performance monitoring and accountability.

These strategic areas are guided by three principles: (1) strengthening existing systems and services; (2) accelerating interventions; and (3) innovating proving ideas, bearing high-impact practices and modern technologies, in order to achieve the following three objectives:

  1. Enhance CPR from 30 percent in 2015 to 45 percent by 2020.
  2. Reduce unmet need for FP from 21 percent in 2015 to 14 percent by 2020.
  3. Ensure contraceptive commodity security up to 80 percent for all public sector outlets by 2018.

In order to facilitate implementation of the CIP, a detailed implementation plan with outputs, activities and subactivities, with an annual break up, and roles and responsibilities of stakeholders, has been developed. The Provincial Oversight and Coordination Cell for Public Health Programmes of the Government of Sindh and the PWD will oversee its implementation. The CIP Cell of PWD shall be responsible for the implementation. In addition, a Technical Support Unit will be established to provide technical support in the implementation (i.e., monitoring and evaluation [M&E]; research and report writing). The district health and population management team (DHPMT) and district technical committee (DTC) at the district level shall manage the implementation, and a mechanism of functional integration (i.e., setting up roles and responsibilities of various stakeholders, necessary notifications and memoranda of understanding) shall be developed at the subdistrict level. A CIP coordinator shall be made responsible to coordinate implementation in the district, while working closely with the district officers of DOH, PWD and PPHI.

It is estimated that implementing the CIP over the next five years will have a significant impact on health, demographic and economic activities. As a result of determined action on the proposed interventions, an estimated 1,848 maternal deaths and 29,470 child deaths will be averted by the year 2020. Regarding demographic impact, an estimated 1,774,367 unintended pregnancies and 193,332 unsafe abortions will be averted, while PKR 12.187 billion will be saved by implementing the CIP, as an estimated 3,963,060 couple years of protection will be generated. The total cost of the CIP during 2015–2020 is PKR 79.12 billion (US$ 781 million), which includes an infrastructure upgrade and mass media campaign2 . The Government of Sindh has already allocated PKR 998 million (US$ 98 million) towards implementing the CIP3 . It will spend approximately PKR 52.238 billion (US$ 513 million) during 2015–2020 on FP-related activities through PWD; LHW Programme; Maternal, Neonatal and Child Health Programme; PPHI; and hospital services. Development partners will spend PKR 10.287 billion (US$ 101 million) over the next three to five years. Thus, the total cost of FP interventions in Sindh during 2015–2020 will be PKR 140.647 billion. A preliminary analysis shows a financing gap of PKR 78.1 billion (US$ 767 million). This figure is calculated by deducting Government of Sindh and other partners’ allocations (PKR 62.526 billion) from the overall CIP cost of PKR 140.647 billion.