Health Policy Action Brief # 2

POLICY
RECOMMENDATIONS
FOR FAMILY
PLANNING
FOR INCLUSION
IN NATIONAL HEALTH POLICY
Setting the Context
In 1952, Pakistan was the thirteenth most populous country. Pakistan
committed to control fertility by becoming a member of International Planned
Parenthood Federation and initiated its first family planning scheme in the
country’s Third Five Year Plan (1965-1970). Sixty-five years later, today
Pakistan’s population has increased by 372 percent since then, where Sri
Lanka has grown by 114 percent, and India by 239 percent since 1960s. Our
population growth has slowed down by merely 5 percent since the 1960s,
whereas India and Sri Lanka have brought it down by 41 percent and 113
percent respectively, and are below the world average growth rate. On the
other hand, today with a population of 207 million, Pakistan is the sixth most
populous country. Punjab, is the most populous of Pakistan’s provinces with a
population of 110 million. The demographic transition is disappointing specially
when the comparisons are seen with other countries of similar socioeconomic
and development standing.
Pakistan signed the FP2020 in 2012, committing to increase contraceptive
prevalence rate (CPR) by 50 percent by 2020. The Pakistan Demographic and
Health Survey recorded the CPR at 35 percent in 2012. Today we stand at
34.2 percent, with modern CPR being 25 percent. The situation is mirrored in
Punjab Province, where the CPR has come down to 38.3, from 40.7 in 2012-
13. The modern CPR for Punjab recorded in 2018 is 27.2, which is
approximately 30 percent lower than the 38.9 percent reported in the
Contraceptive Performance Report 2015-16 issued by the Pakistan Bureau of
Statistics.
This is in contrast to other health and social development targets like
immunization where there is little to no difference between figures reported by
the department, and that of third-party surveys.
While the world is coming together to review the failure of achieving Health for
All since it has been 40 years to the Alma Ata Declaration, this is a national
crisis where experts, stakeholders, academicians, program managers,
researchers and workers need to come together the discuss the widening
chiasm between our family planning commitments and performance, and the
drivers behind this constantly increasing gap.
There are challenges like unmet need, leaking buckets, minimal male and youth
engagement, access issues, provider and societal biases, supply chains and
end-user experiences that need to be resolved. Punjab specifically, housing 53
percent of the national population, is in dire need of a provincial plan of action
to accelerate family planning, developed in consensus with relevant
stakeholders.
There is a need to address this challenge on war-footings, understand the
barriers unique to our social fabric, and opportunities related to family planning
that we may be missing by design.
This action brief is a summary of policy and programmatic recommendations
put together after extensive brain-storming by sector experts, subject
specialists, leading clinicians, eminent researchers, senior colleagues from
national and international organizations who have dedicated their lives to
population control.
DISCLAIMER: The logos used on the cover of this action brief are to acknowledge all those experts and their organizations who participated in the consultative
workshop organized by the Government of Punjab.
The presentation of the material in this publication do not necessarily reflect the policies or views of the Government of Punjab, nor of any particular Program or
Office or Organization. The mention of specific departments or programs or organizations does not imply that they are endorsed or recommended by the PMU-
PPHA in preference to others of a similar nature that are not mentioned. Errors and omissions excepted. All reasonable precautions have been taken by the PMU-
PPHA to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed
or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the PMU-PPHA be liable for damages arising
from its use.
 DECLARE
POPULATION
STABILIZATION
AS
AN
EMERGENCY
Monitoring & Learning
Institute an accountability framework for effective
regulation, assuring compliance with polices and
monitoring performance against assigned FP related
KPIs
Develop a robust management information system to
improve real time reporting and monitoring of family
planning indicators
Develop and strengthen in house expertise for
undertaking demographic studies; promoting use of
information; and developing evidence-based program
interventions and policy advice
Institutionalize impact assessment to document lessons
learnt and devise appropriate corrective measures
Ensure regulation of quality and provision of FP services
in private sector health care establishments through
Punjab Healthcare Commission
Institutionalize monitoring systems for effective supply
chain management and regular supply of family planning
commodities by creating strong linkages with the
private sector
Human Resource
Develop and strengthen the capacity of all first and mid-
level community-based health workers and providers
such as LHWs, LHVs, CMWs, nurses etc., and others to
provide family planning counseling and service delivery
to 100%MWRA
Ensure training of all levels of health service providers
within each district in a phased manner
Revive the cadre of LHWs to continue effective
community outreach
Policy, Legislation and Power
Interest
Develop & promulgate law to prevent under-age
marriages
Formulate a Provincial Family Planning Task Force to
ensure implementation of family planning strategies,
with quarterly meetings chaired by the Chief Minister
Commodity Security
Devise FP commodities security policy encompassing
both public and private sector
Explore provision of financial incentives for engaging the
private sector potential for local manufacturing of
contraceptives
 Resource Mobilization
Increase financial budget of family planning to $2.4*
per capita to achieve commitment of universal health
coverage
Implement the Costed Implementation Plan to aid the
government to achieve their family planning goals
Introduce engagement avenues for corporate sector to
include FP services in CSR initiatives
Trans-sectoral Alignment
Integrate family planning in universal health coverage
package by including in national health insurance, BISP
and other similar models
Integrate multi-level FP plans of Population Welfare
Department with Department of Health at each tier of
healthcare service delivery, from primary to tertiary,
from UC to district level, with strong strategic linkages
with the academia, private sector, NGOs, donors,
development partners and other relevant stakeholders
Work with allied departments to reorient focus on
youth-centered policies and programs, including life-
skills based education in schools
*Committed by Pakistan at the 2017 Family Planning Summit in London
Program Design and Revamp
Review and restructure current FP service delivery
models make it results-oriented
Develop an aggressive multi-sectoral plan to address
the decelerating progress on FP indicators involving
both public and private sector, line departments, donors
and development partners
Provide non-financial behavior modifying
reinforcements to encourage birth spacing and family
planning
Devise comprehensive engagement strategies for
young couples on FP counseling
Design and execute an all-inclusive mass media
campaign with committed slots from PEMRA to reach
out to all segments particularly the younger couples to
create awareness on the benefits of family planning
Enhance Family Planning coverage to marginalized
communities in far flung underserved areas and urban
slums through private public partnership
Scale Up Post-Pregnancy Family Planning to reduce
unintended and closely spaced pregnancies
Map all service delivery points to avoid duplication and
waste of resources
 Info.ppha@Punjab.gov.pk

www.facebook.com/punjabpublichealth

www.twitter.com/pphaofficial

Punjab Public Health Agency

www.ppha.punjab.gov.pk