A Roadmap to Address Population & Development Challenges

After the independence of Pakistan, it has been noted that the decades of 1950, 60s and much of 70s can be regarded as spearheading towards global initiatives for eradication of diseases like malaria, small pox etc. However, the Alma Ata Conference on primary healthcare in 1978 marked the beginning of worldwide efforts on prevention and primary healthcare. These efforts got further impetus with convening of International Conference on Population and Development (ICPD) in September, 1994 at Cairo that pushed the agenda of integrating population issues with development.

That landmark Conference concluded that the reproductive health and gender equality are essential for achieving sustainable development. Thus, there is a link between socio-economic development and men’s and women’s reproductive health rights and access to services. The 2019 completes 25 years of declaration of International Conference on Population & Development (ICPD). Hence, this year’s World Population Day theme is “25 Years of ICPD: Accelerating the promise”.

Thus, the World Population Day comes with a new resolve to implement ICPD pledges in letter and spirit. Furthermore, Millennium Development Goals (MDGs) agreed upon in the year 2000 brought into the limelight the agenda of overall development. The Family Planning has always remained at the mainstay of such international commitments. However, after a decade of pursuing MDGs it was noted that several developing countries could not be able to achieve MDGs by the year 2015.

In that very context, the world leaders gathered in London on July 11, 2012 and discussed the ways and means to accelerate the progress in countries those left behind on MDGs in terms of family planning. Pakistan was one amongst those countries.

At the London Summit, Pakistan made few significant commitments. The commitments included that Pakistan will achieve Contraceptive Prevalence Rate (CPR) of 55% (later revised to 50%) by the year 2020 which was 35% by 2012-13; financing for family planning programs and procurement of contraceptives will be enhanced; all public and private facilities will offer birth spacing services; Lady Health Workers (LHWs) will be re-focused on their original mandate of family planning.

At the time of those commitments, Pakistan had already introduced landmark Constitutional Amendment popularly known as 18th Amendment. As per the Amendment, health and population along with other social sectors were devolved to the provinces. Therefore, it became the responsibility of provinces to contribute towards international commitments of Pakistan.

The province of Sindh took the lead in this regard and became the first province to come up with a roadmap or a Plan for achieving FP2020 goals set in the London Summit. This Plan is known as “Costed Implementation Plan (CIP)” Other provinces are in process of developing or near to complete their respective CIPs. The CIP Sindh was launched by the then Chief Minister in December 2015. It was concluded that Population Welfare Department shall be the lead agency in implementing the CIP. Government of Sindh also set up Sindh FP2020 Working Group – a Task Force to oversee and provide policy guidelines on CIP implementation and review progress on family planning in Sindh. The Minister for Health and Population chairs the Working Group.

The CIP is result of an in-depth process of consultation between public and private sectors including Department of Health and its programs like LHWs, MNCH; Education; Planning & Development (P&D). The CIP is based on proven practices and lessons learnt. The main objective of CIP is to increase Contraceptive Prevalence Rate (CPR) from 30% in 2012-13 to 45% by the year 2020 by generating 1.2 Million Additional Users.

There are six strategic areas of CIP that include: better coordination between Departments of Health and Population through functional integration at sub-district level; ensuring quality through enforcement of Standards and trainings; ensuring availability of quality contraceptives; expanding services for the poor and young people through vouchers. Life Skills Based Education (LSBE) for adolescents; satisfying demand and creating awareness; accountability for performance and systems strengthening. The Government of Sindh had set aside funds to implement the CIP.

The CIP Sindh is coordination, technical and financing mechanism for FP2020. At the eve of the World Population Day, 2019 we need to pledge for new vigor. Because evidence suggest, birth spacing has the potential to reduce poverty, enhance literacy, and improve prosperity of households and communities. And that is the objective of Sustainable Development Goals (SDGs) pledged for 2030.

Sindh FP2020 Working Group led by the Minister for Health and Population has introduced fundamental reforms at policy, programmatic and legislation level. Following are achievements of Sindh:

— Sindh is the only province in Pakistan with one Minister for both Health and Population Departments since these two subjects are interlinked. This initiative is in line with global best practices in health sector

— All relevant stakeholders related to family planning are at one platform of Sindh FP2020 Working Group

— In response to CCI recommendations, the Chief Minister has set up “Sindh Population Taskforce” under his chair.

— After 18th Amendment, Sindh has increased eight folds its financing for population

— LHWs are now allowed to administer first dose of 3 months birth spacing injection

— Family Welfare Workers (FWW) are allowed to administer long acting methods like Jadelle

— Manual of Standards for Family Planning Services has been developed to ensure quality of FP services

— NGOs are being provided contraceptives free of cost by the PWD

— 256 private hospitals and clinics are declared Reproductive Health Services Centers (RHS B) in collaboration with PWD Govt, of Sindh

— Life Skills Based Education (LSBE) has been made part of curriculum and 54000 teachers are being trained on LSBE so as to equip children and young people with skills to shape their lives for betterment

— Grassroots NGOs are hired to work with volunteers called “SukhiGhar Counselors” in 10 districts of Sindh

As per latest PDHS, during last five years, CPR in rural parts of Sindh has increased to 4 percentage points. However, overall CPR of the province increased from 30% to 31% during this period. This incremental change has been due to decrease of CPR in urban parts of the province. It is envisaged that due to above mentioned reforms there will be rapid increase in CPR over the next few years that would include a significant increase by the year 2020.

(Writer is Technical Advisor, CIP Population Welfare Department Government of Sindh Focal Person, FP2020 Sindh)