WHRAP- Arrow partnership MDG- expanding the agenda movement National Policy Dialogue Regional Policy Dialogue Provincial Policy Consultation Meetings INTRODUCTION PROCESS

Mr.Abdullah Khan Sumbul Punjab Devolved Social Services Programme $200 million intervention 65% for health, 18% for water supply and sanitation and 17% for education. Focus is on attainment of MDGs Challenges Limited capacity of local governments Lack of systems to collect relevant and credible information. Must have independent monitoring of the social service delivery sector Medical education system skewed

Kazi Afaque Hussain(Secretary, Population Welfare Dept) Components of MoPW Family welfare centers. Rep health service centers. Run by lady doctors. Mobile Service Units. Provide services at the door step. Male mobilizers. Currently have 300 in Punjab, plan to have about 1500 by the end of the year. Challenges MoPW has been shuffled b/w provincial and federal governments Budget controlled by federal, orders given my provincial govt Have a lot of funds for seminars, advocacy etc, but no people to do that Solutions Public- Private Partnerships Must get recognition of the importance of SRH at the highest levels.

Recommendations made by participants 1. Must focus on education and awareness in the rural areas 2. Sex education should be introduced 3. Focus on monitoring 4. The Ulema have the biggest influence on the population. Hence we can not ignore them. Need to find ways to involve them in population issues. 5. Find strategies to integrate HIV into PHC level

Social Determinants of Health Health influenced by many factors in the environment Community based studies to see difference in priorities of households with less burden of disease than those with more.  Economic status  Water and sanitation  Unable to access health facility  Tribal conflict  Lack of female staff  Law & order situation  Gender disparities Need to address health holistically

Media perspective Media extremely powerful tool to effect people None of the projects that have media components don’t use them Should use media to encourage public-private partnerships Private media is very open – give money to private channels to make programmes on important issues that PTV can not. Case studies can be used to make dramas, talk shows, etc. Doesn’t work with one off programmes. Need to constantly reinforce Media can be used to touch people personally.

Consumer Perspective Challenges Inequitable health and social sector systems Disparities at household level Case of Tobacco Control and how it has an effect on all the MDGs MDGs do not support economic growth models Recommendations: Strengthen PHC MDG indicators need to have systems approach.

Service Provider Perspective Challenges Collective effort lacking – bringing together various stakeholders to work for the same cause. MDGs place most responsibility on health care providers and they have no knowledge of MDGs. Project on SRHR – Of 3000 only 3 medical students knew Recommendations: Need to raise awareness on rights, MDGs, and SRHR amongst health care providers Increase discourse on sexual and reproductive rights Broaden perspectives and instill a sense of responsibility amongst today’s generation of health care providers. Special responsibility on family physicians and gynecologists Strengthen health systems Include SRHR into curriculum

Youth Perspective Challenges No information on SRH available to the curious youth Media misinforming the youth on SRH Stigma attached to discussing these issues. If even want to discuss, there is no one available to talk to Recommendations: Provide accurate information on SRH to youth Provide platforms for discussion and raising awareness on SRHR with young people.

MoH perspective Door-to-door services Free emergency services Free ambulance services – 1122 Govt offers doctors double salary to go to rural areas – but not working Board for child protection Need to look at the vulnerable populations such as street children as well.

Recommendations by Participants 1. Need to have proper and more centralized information channels. 2. Epidemic of HIV has reached second stage – sitting on a volcano, must act fast now! 3.Public wants to learn – don’t demonize or scandalize issues of SRHR. 4.Need to educate the religious leaders 5.Look at countries that are making progress, such as Indonesia and Brazil and use them as models of practice 6.Should include an indicator for assessing what percent of population has information on HIV/AIDS Participants endorse the resolution on “Universal Access to Reproductive Health Services”