What is the Future of Pakistan’s Family Planning Program After the 18th Amendment and Decentralization?

by Noor Sabah Rakshani,  2011-2012 PRB Policy Communication Fellow and student in Health Care Management and Leadership at the Johns Hopkins Bloomberg School of Public Health.

Imagine a Pakistani woman named Saleema who has been not been able to receive family planning (FP) consultation and pills from her local Lady Health Worker (LHW) because the latter has not received her salary and has run short on supplies. This theoretical story can be the situation of hundreds of thousands of women across the 118 districts of Pakistan.  It has been almost four months and LHWs responsible for door-to-door delivery of FP services to rural women in Pakistan are still waiting to get their salaries. Neither the providers nor women like Saleema are assured of exactly when salaries and supplies will resume. The LHWs have carried out demonstrations on several occasions against the provincial government, demanding reinstatement of their salaries. During the Oct. 15 demonstration in the city of Lahore, one LHW was killed during the skirmish.  My sympathies are with the LHWs, but the point of raising this issue is to shed light on the neglected FP program in Pakistan.

A field coordinator for the Mohalla Sangat family planning outreach program in Pakistan obtains background information from a participant.

Photo:© 2007 Farah Riaz, Courtesy of Photoshare

The constitution’s 18th Amendment, implemented this past summer, has mandated decentralization of government at all levels in all the four provinces of the country. Keeping with the decentralization process, the Federal Ministry of Health and Ministry of Population Welfare & Family Planning have been abolished and their responsibilities moved to the provincial governments. The roles have been assigned and health is on the agenda of provincial governments, yet it is not clear who will take ownership of the programs from the Ministry of Population Welfare & Family Planning. FP services in Pakistan are provided by several bodies but the government is the major provider.  The transition, due to decentralization, for various programs is at different phases but it is far from smooth and uniform. The differential is seen across provinces and districts within each province. This is an issue that needs immediate attention not only to resolve current logistical deadlock but for the long-term sustainability of the FP programs in Pakistan.

Women like Saleema are among the 50 percent of female contraceptive users in Pakistan who depend on the public sector for their FP needs. The case of these women needs to be addressed immediately because during each reproductive cycle without contraceptive protection brings further risk of unintended pregnancies, unsafe abortion, and maternal mortality, not to mention the increased demand on the economic resources of the family and health of a mother with an unplanned pregnancy.

The logistics of the transition have been laid down to ensure continuity of health programs but the process is still underway with delays at various places. For government officials and policymakers this may be a minor consequence of decentralization, but for Saleema and the women in Pakistan it can spell catastrophe.

What will be the future of Pakistan’s FP program and how will it survive in the absence of a stable and committed patronage? The national ruling party, Pakistan People’s Party, and the provincial ruling party in Punjab, Pakistan Muslim Leagues (N), have declared FP as a priority in their party manifestos but this sort of commitment needs to be translated into action among all political parties, both secular and religious. The FP program in Pakistan has come a long way but still is far from a robust public health good. It needs committed patrons and effective implementers for the sake of all women like Saleema and the risks they face in its absence.

You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.