Dr. Adnan A. Khan Research and Development Solutions

  USAID Small Grant (2011) to RADS  Partners – Punjab and Sindh DOH and PWDs  Areas – Family Planning and Immunization in the context of MNH  Purpose - Institutionalize information generation and use and actions The Evidence to Policy and Action Grant Initiative

  Analysis- existing datasets, LHW, EPI data (Punjab and Sindh)  Research on models of services  Working with DoH/PWD to understand their programmatic data and connect to program improvements  Informed Advocacy to Politicians, communities  Work with donors to address their information needs/efficiency What is RADS doing

  FPAP started in 1953  GoP programs in 1966  Many phases and approaches FP in Pakistan: The History

 Family Planning in Pakistan Source: PDHS MWRA: 23 million

 Modern Methods Total Users: 5.1 Million

 Services for Modern Methods Total Users: 2.9 Million (12% of MWRA)

 Connecting CPR to Services CPR 30% of MWRA 7.1 Million Users Modern Methods 22% of MWRA 5.1 Million Users Services 12% of MWRA 2.9 Million Users

 Costs of FP in the Public Sector Per Women served CYP MoH BHUs LHWs MoPW 4,3471,032 Total for MoH and MoPW 2,414 (USD 40) 937 (USD 16) In PKR Regional Costs: PKR (USD 4-6)/ CYP

 Inferences of Costs  Pakistan public sector costs are 4 fold higher than regional costs (USD 4-5/CYP)  4% of costs in public sector are for commodities  If regional efficiency was to be achieved, public sector FP funding alone can allow >80% CPR

 Trends in Services In Millions Women Served

 Services by Sectors Private 1.9 M 67% Public 1 M, 33% 2.9 million (12%) of MWRA receive FP services per year

Age when Information Received JhelumPak Pattan Time Lag (in years) RH/Puberty months Menstruation months Marriage 23 2 Child bearing Birthing options Family Planning Source: Khan et al, Study of Information Processing by Young Women. RAF/ DFID

  Overall CPR has increased at <1% per annum  12-14% of MWRA receive FP services each year  Government services only account for 33% of all services or around 1 million women.  Nearly half of couples buy FP supplies from stores. Markets serve ~50%. These are poorly understood  Despite investments and programs, the number of users has not increased above secular trends  Young women are a major potential user group that is largely being ignored What does it all mean

  While supply side programming is useful, demand must be created  Spacing messages must be incorporated into common narrative  Address Young women – soon to be married, newly married  Government programs must be held accountable to the investments that go into them. This may mean that unless they produce results, facilities and sections of programs may be closed down  Markets for FP are crucial, better understanding and used Lessons

 Thank You