Since 1950 several major steps have been taken to control population growth in Pakistan but none of them proved to be successful on a large scale.
The reasons are far more deep than initially anticipated. Any kind of birth control programme is considered a taboo subject in Pakistan due to religious beliefs and lack of awareness. Besides that, inadequate mother/child healthcare delivery systems, increasing mortality rate and improper provision of basic health facilities along with disempowering women by not letting them have an equal say in reproductive decisions — all play a key role in the Pakistan’s population crisis.
Global perspective Pakistan is not facing this alone, instead; the entire world is on its way to a massive population rise. However, most developing countries today have national population policies but the sad part is that the implementations are quite low and need not only financial, but human resource investment as well. As there is a rising global commitment to control population growth in developing and under-developed nations, it is imperative that the public and private sector come together for the implementation of the policies formulated at national levels.
What they need to realise is the fact that population is not a standalone subject; rather it is essential that focus be given to women’s needs, access to high quality spacing pregnancy and HTSP (health timing and spacing pregnancy) services and most importantly women’s rights and their reproductive health. What is required in Pakistan In a country like Pakistan, a participatory approach is required to tackle this issue.
However, the dissolution of the Ministry of Population recently by the federal government is being considered as a significant step as far as this issue is concerned. The responsibility being shifted to the provinces individually can result in a positive outcome if the focus is prioritised to a more programmatic approach while dealing with issues like education, health and youth development.
Need of the hour: public-private partnership Taking the current situation of population growth into account, an organisation at the federal level is mandatory, which can build public-private partnerships and provide excellent linkages to the donors. This way the funding available in the domain of reproductive health can be fully utilised. There is an immediate need for repositioning of the publicprivate partnerships and most importantly the role of private sector will have to be reconsidered.
Public resources are not enough or rather cannot work in isolation for population and health related issues at large. More than half of the population benefits from public health providers and the private sector can increasingly give its input as far as infrastructure, products and expansion of health delivery systems are concerned as it is contributing 51 per cent to the health sector. The government has to also play its role by regulating, strengthening and expanding affordable health delivery mechanisms via private sector.
Since the private sector in Pakistan (in the case of population related, Mother and Child Health related issues) are involved in the shape of for-profit and nonprofit organisations, where it receives funding through non-governmental channels, it is necessary that the government facilitate them in their endeavour of improving family health.
Private sector infrastructure and networks are more compatible in providing services and possibly on a large-scale in remote areas because of their presence and working in other fields such as education, water and sanitation etc. Private sector involvement in the health sector has to be ensured by the government, which is actually responsible and accountable to the United Nations for its performance as far as the millennium development goals (MDGs) of ensuring better reproductive health services are concerned.
Government’s role Post-devolution there has been a lot of work on the administrative level by repositioning of the population ministries but the key element is to centralise attention to policy-making and consequently devising mechanisms as to who will take the ownership of these policies. In such a case, the federation has to intervene to provide specific directions towards policy-making in order to comply with health issues at large. The federation needs to decide what policy initiatives have to be taken and then the provinces should be delegated accordingly.
Furthermore, the challenge for the government is to identify the mechanisms and plan of action required for implementing these policy initiatives. However, implementation should be surely done through the provincial administrative structure. Once a decision on policies and its implementation are decided, it’s the responsibility of the government to get the concerned authorities to implement them on the grassroots level.
Areas to work on A tactical and planned approach is necessary for implementation of better services in order to reduce high rates of unwanted pregnancy, continued recourse to unsafe abortions, increased child and maternal mortality and faster spread of the pandemic diseases. In the wake of other economic and social issues gripping the country, it is important that the underlying tight spots are identified and worked upon. Also, sustainable long-term provision of services managed by a national organisation must be arranged and approved. With the presence of one such organisation working at the federal level, which operates in collaboration with donors and civil society organisations, responsibilities are enhanced.
Direct management of such services by a government organisation at a national level will not only ensure provision of services but will also be able to focus on a more pragmatic approach to accelerate work in the direction of the neglected targets given out by the UN. The said organisation should be empowered and given a status to work independently and mobilise the funding at the right places through its partner civil society organisations. National policies regarding reproductive health and targets proposed by the UN have to be implemented by such an organisation where there is a close correspondence of institutional structure to policies for better management and implementation.
Moreover, commitment to the realities of quality reproductive health provision at the grass root level should also be ensured. This organisation will undoubtedly have the responsibility to effectively use its resources; however, this would require tremendous government support and commitment and will of the political and bureaucratic managers and other stakeholders involved in this exercise.
Published in The Express Tribune, February 13th, 2011.
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