Country Team Action Plan PAKISTAN

Where are we now?  Population growth rate remains high  Large population (25 Percent) has unmet need for contraception in  Contraceptive prevalence rate for modern methods has stagnated around 22 percent (all methods at 30 percent)  Inadequate knowledge and motivation about birth spacing/ HTSP  Health outlets offer limited BS/FP services  High abortion rate related to unwanted pregnancies

Selected Best Practice for Pakistan Integration of quality family planning services in public health delivery system

Where do we want to be? GOAL Increase access to quality BS/FP services through health service delivery system

Areas of Focus Policy Programmatic Monitoring and Supervision Commodity/Supplies Demand Generation Innovation

Policy Focus Service Delivery –Ensure FP/BS services at all SDPs –Develop contraceptive uniform pricing policy for public health system –Sustain commodity support –Improve partnership with private sector and NGOs for provision of FP/BS information and services particularly for hard to reach areas

Policy Goal Capacity Development –Revise pre-service curriculum for all medics and paramedics –Train and orient all existing medics, paramedics and out reach workers

Programmatic Level Notify Provincial governments to ensure: –delivery of BS/FP services through all SDPs and out reach workers –Design and institutionalize system for communication, advocacy & mobilization –National Communication Strategy Involve private sector and NGOs for provision of FP/BS information and services Implement LMIS to improve availability rate of contraceptive commodities and sustain supply chain management Relevant BS/FP indicators to capture performance/progress to be incorporated in MIS systems

Guiding Principles on Delivery of BS/ FP Services No targets or quotas for any contraceptive method No denial of rights on non-acceptance of birth spacing options No incentives for program personnel and FP acceptors Informed voluntary consent

Monitoring and Supervision Notify focal persons at federal, provincial and district level Select indicators on BS/FP performance and Progress Use of Information for Operational Management and Decision Making Strengthen Supervision and Monitoring

What are the possible challenges to the intervention? Coordination between Health and Pop Welfare Absence of warehouse at provincial and district levels Contraceptives not part of EDL and EDL not uniform across provinces Inadequate capacity for management, communication and M&E PSDP allocations for implementing BPs Inadequate information system for supply chain management Donor Coordination

Who are the possible partners, allies, and stakeholders to scale up? –Government of Pakistan Ministry of Health (MoH), Ministry of Population Welfare (MoPW) and People’s Primary Health Initiative (PPHI) –Private Sector, Social Marketing & NGOs –Media and communication organizations –Pharmaceutical sector –Community and Religious Leaders –Development Partners

What is the evidence to support this best practice? Global and Regional evidence National data to support scale up Gather local evidence on Post Partum IUCD insertion prior to scale up

What are the modifications needed to improve the intervention’s scalability? Revise pre-service and in-service curriculum To implement the BP, revisit Post Partum and Post-Abortion protocol Joint review of BS/FP communication strategy

What are the opportunities of scaling-up? Opportunities Political Commitment and Conducive environment Infrastructure and health facilities (13,000 facilities) to increase coverage and access Community-Based Midwives (12,000) and Lady Health Workers (96,000) Integration of FP in HIV/AIDS VCT Centres Introduction of Sino-2 Implant Donor support

Constraints Lack of understanding of HTSP as health initiative Inadequate financing Barriers to BS/FP practices Limited Capacity at Management and Program Implementation Weak Coordination at all levels What are the constraints of scaling-up?

What Policy, Regulatory, Budgetary or Other Institutional Steps are needed Health Policy to reflect HTSP Enable out reach workers to assess and provide the first and subsequent doses of injectables PC-I revisions to include HTSP PSDP allocations to support implementation All training curricula to include module on BP Implementation Strategy Add contraceptives in EDL Establish technical Committee of Communications, Advocacy, and Mobilization Joint Technical Committee on Innovations to review new technologies

Where, when and how will the best practice be expanded National with focus on low performing districts How National Consensus already in place (Karachi Declaration) and MOH-FP road map Establishment of BP Secretariat Dissemination of Country Action Plan through Provincial and Regional Meetings

What will the cost of expansion and how will needed resources be mobilized Detailed costing on the following done at country level –Training –Contraceptive commodities –Warehouse and storage –Need to cost out management and communication, advocacy and other areas Resources to be provided by GoP and Development Partners

Action StepResponsible Person Timeline 1 Finalization and Costing of Country Action Plan BP Secretariat / Focused Implementation Committee April Meetings with MoH and MoPW with Planning Commission and Min of Finance and EAD on Policy revision and PC-I incorporations DG Health, and DG (T) Population BP Secretariat support April - June Provincial / Regional Dissemination and Operationalization DG Health, DG (T) Population BP Secretariat support P Ms – MNCH and LHW Prog July – Sept Programmatic changesDG Health, DG (T) Population BP Secretariat support P Ms – MNCH and LHW Prog PNC / PMDC May – Sept 2010

21 “I dream of a Pakistan, of an Asia, of a world, where every pregnancy is planned, and every child conceived is nurtured, loved, educated and supported”. International Conference on Population & Development held at Cairo in 1994

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