It can cost as little as 50 paisas for a condom to help a couple space out their family. But in a country where the maternal and infant mortality rates from frequent births are spiralling out of control, many health professionals are dumbfounded on why the message to use this simple prophylactic is not getting through - either to the population or the government.
Despite the subsidy on contraceptives, which could save thousands of women from severe health-related issues as well as unwanted pregnancies or forced abortions, by and large the nation does not capitalise on these benefits. This is particularly true for rural women who continue to live dangerously without access to proper medical care and contraceptives, and barely any birth spacing. Family planning with a particular focus on birth spacing remains a no-go zone with many men using religion or tradition as a crutch. Their wives who end up numerous health complications are often left at the mercy of hakeems and pirs who prescribe various ‘totkas’, when all that the couple needed was a contraceptive.
On the other hand, the situation in urban centres does seem to be improving. Awareness and education on contraceptive use and a reasonably aggressive approach on the importance of family planning appears to have made some headway as the birth rate per woman in the country has halved.
Buoyed by these small successes, the government along with international non-government organisations and donor countries have launched programmes to keep the momentum going. Still, there remains a key link in the chain which is often overlooked. Between the formation of policies and the acceptance of contraceptives is an important medium of ensuring supply. After all, what use is the hard work if the contraceptive options are not available in the village market?
Taking on the partial burden of guaranteeing product availability in almost all corners of the country is the USAID’s Deliver Project and the United Nations Population Fund (UNFPA). They are working on building and maintaining a strong contraceptive supply chain. In collaboration with the government, they have launched a Contraceptive Procurement Manual and an online logistics management information system (LMIS).
The project is responsible for forecasting, projecting, warehousing and supplying contraception products. This allows government officials, healthcare professionals and suppliers to simultaneously analyse and regularly update stocks of products such as condoms, intrauterine contraceptive devices (IUCD or the coil), injections and birth control pills. Staff can get their hands on statistics to help them decide which product and how much they may want and where to get a supply.
The system also helps healthcare professionsals assess trends for any particular product’s popularity in an area. LMIS provides an accurate picture of the demand, method mix as well as a stock pile in a particular area, district, city and province at any given time.
The system works to help the government implement its programmes. While the government may understand the people it seems to lack the know-how logistical management of resources.
“Even after decisions were made to aggressively promote family planning and the use of contraceptives, making the product available was a challenge on its own, both financially and logistically,” says programme director for the Deliver Project Muhammad Tariq. The project has mobilised about $32 million worth of contraceptives thus far. Around $26 million is the demand for 2011. “It is a simple policy, no product, no plan,” Tariq adds. The project is targeting 80% use of contraceptives across Pakistan within two years. “Stock distribution is a very powerful tool. The shopkeepers seem to realise this we hope policy makers do as well.”
But like any collaboration, this project too comes with its shares of issues. The private sector believes the government suffers from ‘chronic projectitis’. As a result of the government’s inefficient use of resources, work is duplicated among simultaneously running health campaigns (e.g. polio, Aids, hepatitis, mother and child health).
Director for programmes at the National Trust for Population Welfare (NATPOW), Dr Nasser Mohiuddin, also suggests that they need to coordinate on the availability of healthcare providers to make any significant impact. “Pakistan has an unmet [contraceptive] need of over 25%, if we are able to improve the availability of healthcare professionals and contraceptives, this could be slashed to around six per cent.” Presently, he says, the supply in Swat town, for example, appears to very low. “Our offices in Swat have furniture, technical equipment and personnel. Basically everything you require for the office, but no contraceptives!” Mohiuddin added.
Public-private partnerships also ensure that corruption is kept at bay. Many donor countries and agencies don’t trust officials in the government. They want to help out but they don’t want to hand over the money. This is where the private sector comes in, explains an official associated with a donor agency.
Published in The Express Tribune, August 29th, 2011.
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