Country Team Action Plan
PAKISTAN
Where are we now?
 Population growth rate remains high
 Large population (25 Percent) has unmet need for
contraception in 2006-07
 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
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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)
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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
What are the constraints of
scaling-up?
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 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
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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 Step
1 Finalization and Costing of
Country Action Plan
Responsible
Person
BP Secretariat / Focused
Implementation
Committee
Timeline
April 2010
2. Meetings with MoH and MoPW DG Health, and
with Planning Commission and
DG (T) Population
Min of Finance and EAD on Policy BP Secretariat support
revision and PC-I incorporations
April - June
2010
3. Provincial / Regional
Dissemination and
Operationalization
DG Health,
DG (T) Population
BP Secretariat support
P Ms – MNCH and LHW
Prog
July – Sept
2010
4. Programmatic changes
DG Health,
DG (T) Population
BP Secretariat support
P Ms – MNCH and LHW
Prog PNC / PMDC
May – Sept
2010
“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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