Despite injecting billions of rupees to promote the use of contraceptives in the country, progress can only be described as dismal, with the government’s role in providing family planning services continuously shrinking in the face of unmet demand.
Altogether, the government and donors have invested Rs39 billion to raise the contraceptive prevalence rate in the last decade, but it has increased by less than 1% a year, said Dr Ayesha Khan, chief executive officer of Research and Development Solutions (RADS) --- a policy research organisation.
While talking to The Express Tribune, Dr Khan said lack of expenditure on providing family planning services to married couples had created a huge gap which was currently being filled by national and international donor agencies.
The private sector is providing over 50% of family planning services out of which 15% are provided by non-governmental organisations, while the government provides only 32%.”
The government is spending 85% of its funding on paying salaries to the staff of population welfare departments, while the rest is spent on procuring and supplying family planning services and contraceptives, she added.
It is estimated that only 12% or 2.9 million of married women of reproductive age (MWRA) in Pakistan receive family planning services every year, which is worrisome, Dr Khan stated.
According to the Pakistan Demographic and Health Survey 2006-2007, in Pakistan there are around 23 million MWRA, out of which 5.5 million who want to avail family planning services and use contraceptives, but have not been able to and therefore have an unmet need, she said.
Some 5.1 million MWRA use modern contraceptive methods, while another 1.8 million using traditional contraceptive methods and 10.6 million do not use either.
“We have witnessed a shrinking role of the public sector in the delivery of family planning services that now serve 35% of users driven by inefficient supply of costly services, supply interruptions and weak governance.” Government programmes should prioritise family planning service delivery and not rely on donors who might stop funding any time, she added.
Dr Khan said population welfare clinics serve only one or two clients a week on average, mainly because lady health workers (LHWs) do not refer their clients, according to research.
They also do not ask women with more than four children if they need family planning services.
It is estimated that one LHW serves around four women a year, while community midwives who are trained for the job are not working as yet. She was of the view that population welfare departments were heavily overstaffed.
An official at the population welfare department who wished not to be named said, “The government isn’t focused on population planning and service delivery and the situation has worsened after the devolution of the Ministry of Health under the 18th Amendment.”
There is lack of coordination and communication between the concerned departments, said the official.
“The available funds and resources for improving family planning services and procurement and supply of contraceptives are not being properly utilised and lack monitoring and evaluation,” he added.
Published in The Express Tribune, August 1st, 2013.