Progress against 5As
ACCESS (Access to reproductive health services with a focus on poor, marginalized and under-served communities):
ACCESS of women, men, adults & young including the diverse groups for their SH&RH needs is the basic building block of Rahnuma-FPAP service delivery net work providing an enabling environment regarding increased usage of SH&RH services which encourages participation of men and male youth in SH&RH programs to support women’s decisions to use SH&RH services by reducing socio-cultural and economic barriers and by increasing reach of the services to them achieved by enhancement in awareness about SH&RH needs among people. IEC material up dated, developed and disseminated through all service delivery outlets.
Improvement in SH&RH program plans, behavior change activities on SH&RH and gender issues, dialogue with opinion leaders and involvement of stakeholders working for the same cause, development and strengthening of Linkages with civil society organizations, women groups, religious leaders and media people played a key role in this regard.
Orientation and mobilization of TBAs and CBDs as peer educators for SH&RH promotional activities to strengthen male involvement and condom distribution. In addition men and male youth were enrolled as partners for the promotion of male SH&RH services.
Maintenance of QOC standards through medical audits, monitoring visits and client exit interviews provided the client’s perspective about the quality of SH&RH services provided at our SDPs
Family Health Hospitals and Model Clinics provided back support to all service delivery points. Family Health Center’s network is a community oriented LHV based service delivery system offering a defined range of contraceptive services and refer clients for diagnostics as well as surgical procedures including ligation and vasectomy to FHHs and Model clinics. There is an increase in number of outlets providing ECP services.
More clients have been generated at R-FPAP outlets through bimonthly visits of LHV to communities and NGO partnership clinics for SH&RH services.
Mobile Contraceptive Services and Partnership with Private Practitioners are extending quality SH&RH&R services to the men, women and youth through referral support of Traditional Birth Attendants and Community Based Distributors.
Service delivery net work of R-FPAP has facilitated its clients in Safe Motherhood services, management of post PAC/MR complications, Immunization & vaccination against viral and communicable diseases as per GOP EPI program for adults and children, Tetanus Toxid immunization to pregnant women through antenatal care which can contribute in reduction of MMR and IMR as a whole.
Provided Counseling services on SH&RH & FP with special emphasis on expectant mother child nutrition, immunization, breastfeeding, early diagnosis regarding STIs, RTIs, VCT, HIV/AIDS, early detection of breast and cervical cancers by self examination, pap smear examination etc..
Capacity development and value clarification workshop were conducted for technical, managerial staff and volunteers.
Linkages were strengthened with other diagnostic laboratory for referral, training and advance diagnosis.
During the year 2012 all the above mentioned services are delivered with the conscious efforts to improve access to information and knowledge on SH&RH for marginalized groups and communities and the ones who are poverty stricken, displaced through natural calamities and are the children of fate like prisoners and High Risk Groups.
During 2012 the project has achieved 647727 CYPs which is 28% increase ageist 2011 PIs. Provided 2528668 SH&RH services including counseling, treatment, and referrals which is 16% increase from the last year’s Performance Indicators.
HIV/AIDS (Reduction in the global incidence of HIV & AIDS)
According to UN Report-2011-12 around the world 34 million people are now living with HIV and more than 30 million people around the world have died of AIDS-related diseases. Whereas 2.7 million people are newly infected with HIV and 1.8 million men, women and children died of AIDS-related causes in year 2010.
Sexual and reproductive health (SH&RH) is intricately connected with AIDS epidemic that continue to ravage individuals and communities around the world. The majority of HIV infections are sexually transmitted or associated with pregnancy, childbirth and breastfeeding. Among reported infections, according to UNAIDS, US Census Bureau, UNAIDS, WHO/UNAIDS/UNICEF towards Universal Access (April 2007), heterosexual sex is the primary mode of transmission (67%) followed by contaminated blood and blood products (18 %), homosexual or bisexual sex (6 %), injecting drug use (4 %), and mother-to-child transmission (1.3%). In order to prevent heterosexual spread of HIV/AIDS now the strategic focus is on High Risk Groups and their clients to promote safe sexual practices and to recognize that High Risk Groups as one of the most vulnerable groups among key populations in society.
A comprehensive HIV/AIDS program has been implemented in Lahore and Quetta to carry forward the strategic direction of FPAP to reduce sexual transmission of HIV by improving the health seeking behavior of High Risk Groups/HSWs/HIGH RISK GROUP(M). 4470 copies of IEC materials on positive prevention and management of HIV&AIDS were distributed at project locations through the involvement of vulnerable groups, PLHIV and stakeholders.
Orientation sessions coupled with VCT with jail inmates were conducted at Kot Lakhpat Jail, Lahore and Central Jail, Quetta to create awareness on HIV & AIDS prevention, reduction of stigma and discrimination.
Meetings were conducted with general population, key population, vulnerable groups and stakeholders to reduce socio-cultural barriers that make people vulnerable to HIV for support on HIV & AIDS prevention, reduction of stigma and discrimination of key population and prevention of GBV at project locations. World AIDS Day was celebrated in collaboration with active participation of partner organizations, High Risk Groups and transgender groups.
Seminars were conducted to strengthening the linkages to promote positive attitude and practices towards HIV & AID with service providers, community functionaries, youth groups, media and public & private organizations at project locations.
Value clarification sessions were conducted with stakeholders for strengthening Care and Support of PLHIV, meetings were conducted with individuals, organizations.
MoUs were signed to develop linkages with Legend Society, National Welfare Organization, SHEED Organization, and Sathi Foundation.
Meetings were conducted with T.B Chet Clinic Association to develop linkages and share the experiences and best practices for care and support for PLHIV. DIC and VCT centers regarding care and support of people living with HIV&AIDS were further strengthened at both project locations. Training on PMTCT+4 was provided to 18 service providers., 123 Medical Camps were conducted to provided services to transgender with collaboration of Sathi Foundation and 2754 clients/patients were catered through these camps. To ensure 19520 condoms were distributed through both project locations.
PAC/MR (The Elimination of Unsafe PAC/MR)
It is estimated that globally about 20 million unsafe PAC/MRs take place each year, which is one in ten pregnancies (WHO-2008). Around 13% of maternal deaths globally are due to PAC/MR, 95% of these occur in developing countries (RaiNK-2008).
In Pakistan, according to the Population Council Survey 2004 about 197,000 women are treated each year for complications resulting from unsafe induced PAC/MRs where as complications of miscarriages/PAC/MR account for 10-12% of maternal deaths. These include spontaneous and induced PAC/MR as well. The number of women seeking PAC/MR services for unwanted pregnancies is also high as indicated in the survey by Population Council which is estimated as 890,000 induced PAC/MRs annually, which means that 1 out of 6 pregnancies is terminated by induction mostly in an unsafe manner (Pop Council-2004).
R-FPAP recognizes that holding of a pregnancy or not is a right of a woman, therefore an active campaign for minimizing the incidence of unsafe PAC/MR involving advocacy among decision makers through PAPAC forum was conducted. PAC/MR holds a central place with a goal of universal recognition of a woman’s right to choose and have access to safe PAC/MR, and a reduction in the incidence of unsafe PAC/MR. Complications of unsafe PAC/MR and provision of expanded family planning services including emergency contraception leading to responsible parenthood was highlighted at project locations of Lahore, Karachi, Peshawar, Islamabad, Quetta and Faisalabad..
IEC material related to unsafe PAC/MR and EC was reviewed, printed and disseminated across the system to reduce stigma around PAC/MR and to increase awareness to generate public support for early detection of pregnancy, PAC, MR, TIA and EC services at project locations. Therefore Community stakeholders were sensitized by conducting sessions and a media kit focusing PAC/MR related issues was also developed and disseminated in these sessions.
The legislators and government officials supportive for PAC/MR policies were clued-up/ updated with the recommendations of these FGD conducted with identified media people to assess the understanding of the imparted gender and rights based knowledge and its application. Media kits were developed and provided to the media representatives during FGDs to sensitize media persons through dissemination of authenticated dependable information on unsafe PAC/MR. Mapping of 16 public and private organizations working on safe PAC/MR and for the reduction of complications of unsafe PAC/MR were carried out to strengthen the partnership and linkages with public and private (NGOs) organizations working to improve access to quality comprehensive PAC/MR services and for the reduction of unsafe PAC/MR.
Meetings were conducted to sensitize Policy makers, service providers, opinion leaders and community functionaries, public and private organizations supporting MR & PAC/MR related services on consequences of unsafe PAC/MR, unwanted pregnancy, post PAC/MR complications, importance of FP & EC etc.
Value clarification sessions were conducted to voice the deeply held assumptions and myths on PAC/MR related issues with Doctors, LHVs (FPAP) and PPs regarding PAC/MR management and to help discover or potentially transform their values on PAC/MR as well as assist participants to express their intentions to act in a manner consistent with their affirmed values. Refresher training was conducted for values clarification of PP, FPAP medical and paramedical staff in post PAC/MR management services, counseling and provision of MVA kits. MR and post PAC/MR management Modules were developed and placed at all SDPs including referral and counseling. Quality accessible, affordable PAC/MR, contraceptive services including emergency contraception were provided to underserved and marginalized women. At 6 SDPs a total of 6656 PAC/MR related services were provided through MVA including 4512 counseling services, 2022 treatment and 122 cases were referred. Provided 49764 quality post PAC/MR contraceptives including 4967 EC services.
Advocacy (Advocacy for Family Planning and Reproductive Health Rights)
Rahnuma-FPAP endeavored policy advocacy and action advocacy a cross cutting thematic focus during the year 2012 like preceding years . During this year it remained at the forefront to enhance the level of knowledge and information of policy makers, opinion leaders, volunteers, NGOs/CBOs and media people on the impact on the changes resulting from imposition of 18th Amendment. The post devolution scenario made where provincial governments become more independent and responsible. Rahnuma-FPAP strengthen and parliamentarians reinforced its policy advocacy along with parliamentarians through a dedicated group of parliamentarians known as “ Champions of Right Agenda in the Parliament” and “National parliamentary Caucus”. Another main activity during the year 2012 was the historic Pakistan visit of DG IPPF in the backdrop of International London Summit on Family planning. Rahnuma- FPAP being a champion of SH&RH in Pakistan undertook robust advocacy and lobbying campaign along with leading national and internationals SCOs for enhanced political and financial commitment of Pakistani leadership for population welfare program. Another main advocacy hallmark achieved during the year 2012 was inclusion of MISP in the SOPs of National Disaster Management Plans and Provincial Disaster Management Plans to better protect the maternal mothers and new born.
Rahnuma-FPAP being cognizant of the systematic advocacy approach for population welfare program at the provincial level after its devolution from federal government, undertook National and Provincial Government Budget Analysis 2012-13 to ascertain the level of political and financial resource allocations through national and provincial government annual budgetary plans. Rahnuma-FPAP conducted managed SCOs alliances and Coalitions like MDG 5b Alliance, Child Marriage Consortium, Life Skill Based EducationAlliance remained instrumental and focal in streamlining and strengthening Advocacy and Lobbying endeavores at the national and provincial/ regional levels.
Advocacy section exclusively and inclusively organized multiple national and provincial/ regional level consultative workshops, meetings on SH&RH, FP, child Marriage, inclusion of MISP in SOPs of NDMPs and PDMs. Advocacy section organized national and provincial Consultative Workshops under the auspices of MDG 5 b Alliance at Lahore, Islamabad. These media workshops were conducted in backdrop of DG IPPF visit, to augment GOP support for population welfare program at London Summit on Family Planning.
Advocacy section developed Resource Mobilization Training Manual for Master Trainers and it was rolled out in two days TOT workshop, organized in 2012 for Rahnuma- FPAP volunteers and Staff. These trained Master Trainers also finalized the Draft Resource Mobilization Manual and workshops at regional levels were organized on SH&RH (with special focus on sexuality, gender and sexual rights) for capacity building of Volunteers and regional staff. Rahnuma-FPAP advocacy section further strengthened and reinvigorated engagement with prominent political parties, CSO and media houses for the protection of SH&RH of marginalized and vulnerable sections of society.
Project Title :Stakeholders consultation on FP situation in Pakistan with DG IPPF
Rahnuma-FPAP endeavored policy advocacy and action advocacy a cross cutting thematic focus during the year 2012 like preceding years . During this year it remained at the forefront to enhance the level of knowledge and information of policy makers, opinion leaders, volunteers, NGOs/CBOs and media people on the impact on the changes resulting from imposition of 18th Amendment. The post devolution scenario made where provincial governments become more independent and responsible. Rahnuma-FPAP strengthen and parliamentarians reinforced its policy advocacy along with parliamentarians through a dedicated group of parliamentarians known as “ Champions of Right Agenda in the Parliament” and “National parliamentary Caucus”. Another main activity during the year 2012 was the historic Pakistan visit of DG IPPF in the backdrop of International London Summit on Family planning. Rahnuma- FPAP being a champion of SH&RH in Pakistan undertook robust advocacy and lobbying campaign along with leading national and internationals SCOs for enhanced political and financial commitment of Pakistani leadership for population welfare program.
Project Title: Ensuring SH&RH component in SOPs of National Disaster Management Plans
Another main advocacy hallmark achieved during the year 2012 was inclusion of MISP in the SOPs of National Disaster Management Plans and Provincial Disaster Management Plans to better protect the maternal mothers and new born. Rahnuma-FPAP being cognizant of the systematic advocacy approach for population welfare program at the provincial level after its devolution from federal government, undertook National and Provincial Government Budget Analysis 2012-13 to ascertain the level of political and financial resource allocations through national and provincial government annual budgetary plans. Rahnuma-FPAP conducted managed SCOs alliances and Coalitions like MDG 5b Alliance, Child Marriage Consortium, Life Skill Based EducationAlliance remained instrumental and focal in streamlining and strengthening Advocacy and Lobbying endeavores at the national and provincial/ regional levels.
Stakeholder’s Consultative Workshops and Seminars:
Advocacy section exclusively and inclusively organized multiple national and provincial/ regional level consultative workshops, meetings on SH&RH, FP, child Marriage, inclusion of MISP in SOPs of NDMPs and PDMs. Advocacy section organized national and provincial Consultative Workshops under the auspices of MDG 5 b Alliance at Lahore, Islamabad. These media workshops were conducted in backdrop of DG IPPF visit, to augment GOP support for population welfare program at London Summit on Family Planning.
These Consultative Workshops were successful in highlighting the budget and policy analysis outcomes and developed/ ascertained the present condition of SH&RH in each five province. MDG 5b National Consultative Meeting and Provincial Consultative meetings were organized and it was made more broad based and informative. It also helped to develop a combined strategy in term of targets of MDG 5b in each province with provincial chapters of MDG 5b alliance. These provincial chapters has been mandated to monitor and coordinate with provincial governments under the initiatives taken for this MDG goal.
Project Title: Building Momentum for Sexual and Reproductive Health SH&RH and HIV Integration”
In the Project “Building momentum for sexual and reproductive health SH&RH and HIV integration” organized some key activities and trainings. Rahnuma-FPAP published and distributed posters which were developed according to the recommendations of Rapid Assessment report of Pakistan. The posters got very popular in Pakistan. Training workshop of CSOs on SH&RH and HIV integration, Proposal Development, Gender, and Budgeting and Financial Management were organized in Lahore. The selected CSOs from all 4 provinces of Pakistan participated in the training workshops. These CSOs are working on SH&RH or HIV and on PLHIV, HIGH RISK GROUP(M), HSW, HIGH RISK GROUP, IDU and TGs. There is a growing need in youth regarding SH&RH and HIV integration. The CSOs working for youth also remained engaged in the capacity building activities under the project of SH&RH and HIV integration. We developed relationship with different govt. stakeholders and donors. The managers of AIDS Control Program of Punjab, KPK, Sindh and Balochistan have close liaised with us. The officials of health department participated in our training workshop with youth. Some parliamentarians also participated in our training workshop with youth. The consultants of technical hub are useful for facilitating training workshops, preparation of hands out, agenda, presentations and modules.
Capacity Building of Rahnuma-FPAP Staff and Governance Volunteers.
Advocacy section developed Resource Mobilization Training Manual for Master Trainers and it was rolled out in two days TOT workshop, organized in 2012 for Rahnuma- FPAP volunteers and Staff. These trained Master Trainers also finalized the Draft Resource Mobilization Manual and workshops at regional levels were organized on SH&RH (with special focus on sexuality, gender and sexual rights) for capacity building of Volunteers and regional staff.
Engagement with Political Parties, CSOs and Media
Rahnuma-FPAP advocacy section further strengthened and reinvigorated engagement with prominent political parties, CSO and media houses for the protection of SH&RH of marginalized and vulnerable sections of society. Individual level meetings and advisory level meetings were held in Lahore, Islamabad, Quetta, Peshawer and Karachi.
Adolescent and Women Empowerment
Increasing access to an essential package of youth-friendly services: Standardized guidelines for the provision of Youth Friendly Services were developed through a consultative process with the Government Ministries of Education, Youth Affairs, Health and Population Welfare; Civil Society members working on SH&RH&R like World Health Organization, Plan Pakistan, Aahung, Rozan, United Nation Population Fund (UNFPA), Sahil, WPF- Rutgers, Chanan Development Association, Care International in Pakistan, and youth volunteers from Rahnuma- National Youth Network (RNYN).
Service providers and volunteers were trained on youth friendly SH&RH service guidelines. Based on these guidelines, protocols and handbooks were also developed and printed for service providers. Posters developed and printed on the guidelines, are being visibly displayed in all clinics, youth resource centers (YRCs) and youth friendly areas in the clinics. A capacity building workshop was conducted on youth friendly services for service providers. The purpose of this training was to strengthen the skills and understanding of staff regarding Youth Friendly Services. A 5-days capacity building training on Counseling Skills for adolescent & young people was conducted to enhance the capacity of Services Providers on appropriate counseling methods and techniques specifically while responding to adolescents/ young people through youth helpline counseling. Consultations with the government to institutionalize youth-friendly guidelines within the public health care system aligning with national protocols, is continued.
In order to cater to the needs of young people, Rahnuma-FPAP expanded its youth friendly services in three new districts namely, Mardan, Muzaffarabad and Chakwal. A separate waiting area has been established for young people, in one static clinic at each location. The waiting area is equipped with TV/DVD to show documentaries/videos on youth SH&RH issues. IEC material on SH&RH, child marriage, youth SH&RH issues, youth rights, magazines/ journals and newsletters are also made available for youth. For the benefit of young people Rahnuma-FPAP’s child and youth protection policy, no refusal policy, youth SH&RH rights and referral lists are displayed in each youth friendly space. Suggestion boxes are also placed visibly for the young people where they drop in their suggestions and queries.
Provision of doctors and youth counselors for comprehensive SH&RH services was also ensured as part of outreach program. Different activities including focus group discussions, need based skills trainings, awareness raising sessions on LSBE, child marriage, youth SH&RH issues were conducted by peer educators at YRCs linked to the static clinics in the targeted districts. Young people hold their own activities e.g. international days, cultural festivals, religious events and birthday parties at the YRCs as well, depicting a strong sense of ownership. Youth friendly spaces are contributing effectively in increasing youth clientele at clinics.
Increasing access to comprehensive, gender-sensitive, rights- based sexuality education: For the adaptation of “It’s All in One Curriculum” framework according to Pakistani context, Rahnuma-FPAP developed sustainable Alliance with the key partner organizations, government officials (education, health, population and youth) along with Rahnuma National Youth Network members to advocate LSBE at national and provincial level. A taskforce has also been formed with the key organizations working on youth SH&RH in country which includes UNFPA, WPF, Aahung, Rozan, Oxfam, Plan Pakistan and Women Empowerment Group. A series of consultative meetings on framework were conducted with LSBE Alliance and Taskforce members for the finalization of the LSBE framework for Pakistan. The Framework “Comprehensive Health and Rights Education in Pakistan” has been developed and printed. The purpose of such detailed deliberation for a year was to develop a comprehensive and acceptable framework that all stakeholders agree to and will together advocate for the public institutions.
To provide the Life Skill Based Educationto the secondary school children based on framework for Pakistan, training manual for the teachers and gender segregated handbooks for students in Urdu and English have been developed and printed. The manual and handbooks have also been reviewed by the LSBE Alliance and LSBE Taskforce members as well as by the teachers and education departments in Chakwal and Muzaffarabad, and feedback was incorporated in the material. To provide the Life Skill Based Educationto out-of-school youth, training manual for peer educators and gender segregated peer-educators tool kits in Urdu have been developed and printed.
In order to solicit community support and advocate for inclusion of LSBE as an essential part of education curriculum major efforts have been made. A comprehensive training on the LSBE framework has been imparted to National Youth Network (NYN) members to build their capacity as advocates of LSBE and spread the message in the communities through peer education.
Interactive dialogue with young people and parliamentarians on SH&RH &R
Program Planning Division has shown their concern about the development community of Pakistan which has lately paid attention to the youth, the number of youth is at massive rise and they are unprepared and under-groomed for future roles, unemployed and are isolated from the development process then the nation will have to compromise its well-being rather than transform the youth potential into a driving force of development. Thus it is important to pay attention to the youth as a distinct group whose interests have to be incorporated in national development agenda they also concerned with the world population surpassed 7 billion and now presents an opportunity to spark actions related to the opportunities and challenges regarding the large young population in the country.
Rahnuma-Family Planning Association of Pakistan (FPAP) has been working on young people sexual and reproductive health issues through a myriad of interventions including youth friendly services, creation of youth lad groups, dialogues and trainings on youth issues with relevant stakeholders. FPAP does not only for provide SH&RH services to young people but also advocates for the use of the guidelines developed to set minimum standards of practice for the services in the public health system. Bringing to the forefront, the need for providing services to young people regarding SH&RH issues was set as an important advocacy agenda, post defederalization and with each provincial department setting priorities and planning for the years ahead.
The Program Planning Division Government of Pakistan and Rahnuma-FPAP share the common interest in investing in young people SH&RH thus with the support of Program Planning Division, Rahnuma-FPAP and United Nation Population Fund (UNFPA) an interactive dialogue between federal, provincial parliamentarians and Young people on Tuesday January 24th, 2012 in Islamabad. The objectives were:
• To sensitize the parliamentarians and population policy makers on the importance of Youth concerns with respect to their reproductive health.
• To generate discussion on the challenges and opportunities regarding the emerging large young population and utilizing this demographic dividend
• To highlight to the stake holders that Youth potential is a driving force for the development of the country whose interest has to be incorporated in the national development agenda
• To draw attention of Youth being major segment of population on the gravity of the rapid population growth and its impact on their lives
Policy advocacy to prioritize the sexual and reproductive health needs of young people
Rahnuma FPAP is undertaking extensive policy advocacy for SH&RH rights and services at national and provincial level with policy makers and key stakeholders. The focus of policy advocacy for young people has been on child marriage, Life Skill Based Educationand SH&RH and rights.
The first national consultative meeting on child marriage was held in Lahore, to develop a national alliance of civil society organizations for joint advocacy efforts against child marriage. A National Alliance comprising of 15 members representing 11 civil society organizations included Action aid, Bedari, Plan Pakistan, UNFPA, WPF, Blue Vein ,Sahil, UNICEF ,Aahung, Shirkat Gah, 2 media houses, Rahnuma-National Youth Network and MGD5b Lahore chapter, has been developed.
In order to mobilize and involve policy makers in advocacy against child marriages and to mobilize public support, an advocacy kit, highlighting real life stories of survivors, factors that reinforce child marriage, traditions that promote child marriage in Pakistan, health cost of early sexual initiation and early pregnancy and prevailing situation of Pakistan’s legal framework, has been developed and printed.
An Interactive dialogue between youth and policy makers on Child Marriage was conducted in Lahore. This dialogue was organized with the objectives of exposing the youth to the parliamentarians, to share suffering of victims of child marriage and highlighting the inadequacies of the existing law and the lack of implementation thereof and solicit commitment from the policy makers for the revision in the child marriage law to make it more punitive and ensure gender equality.
A media workshop on child marriage was conducted for mobilization and involvement of media in advocacy against child marriage for mobilizing public support and pressurizing policy makers to address this neglected issue.
Life Skill Based Education(LSBE):
Rahnuma-FPAP developed sustainable Alliance with the key partner organizations, government officials from different ministries and Rahnuma National Youth Network members to advocate LSBE at national and provincial level. In this regard first consultative meeting was held in Lahore. The meeting focused on developing of sustainable advocacy network with key stakeholders to promote LSBE and undertake national and provincial advocacy activities.
A number of lobbying meetings with National Education Curriculum wing, Provincial Education Departments and Parliamentarians of Punjab and Sindh to advocate for LSBE and make it a priority on their agenda. As a result commitments have been solicited from the parliamentarians for putting forward the question of LSBE in-front of policy makers and demand positive action.
A comprehensive documentary based on interviews of adolescent and young people, community stakeholders and policy makers regarding LSBE has been developed to use as an effective advocacy tool.
Youth Health and Rights:
The concept and status of adolescent and young people’s sexual and reproductive health is always ignored and is at preliminary stage at policy level. Rahnuma-FPAP is continuously advocating for strengthening commitment to SH&RH Rights, needs of young people and address discrimination and barriers to SH&RH Services. For the same purpose, based on comprehensive desk review of national policies and international commitments; a gap analysis report highlighting policy situations and existing gaps in terms of adolescent and young people sexual and reproductive health concerns has been conducted. Advocacy kits for Punjab and Sind provinces as well as the policy briefs, indicating policy and program recommendations have been developed for capacity building of policy makers and community stakeholders. Champions have been developed in youth, parliament and media for Adolescent and Youth sexual and Reproductive Health and Rights.
The advocacy efforts has resulted in the commitment of provincial health, population, and other relevant departments addressing the issue of adolescent and young people sexual and reproductive health in provincial health policies of Punjab and Sindh. Moreover, technical section on SH&RH concerns of young people for provincial health polices is being developed and organization is actively engaged in the process of provincial health polices development by providing technical assistance.
MNH & SH&RH policy and practice for adolescent girls and young mothers:
Advocating for improved MNH & SH&RH policy and practice for adolescent girls and young mothers (AIMS) project is aimed at research based policy advocacy at national and provincial level for inclusion of MNH & SH&RH specific policies for adolescent girls and young mothers. The project methodology included intensive lobbying and consultative process with the stakeholders at district, provincial and national level.
During 2012, the project held eight (8) consultative workshops with the community leaders and eight (8) consultative workshops with the District Government departments for improving MNH & SH&RH situation young women in Muzzafargarh, Mardan, Badin and Quetta. District Working Groups, comprising of relevant district government departments have been formed in the target districts to carry forward the efforts of improving SH&RH & MNH status of young women. At provincial level eight (8) consultative workshops with the electronic and print media representatives were held to sensitize them and solicit their support for policy and program improvement regarding MNH & SH&RH of adolescent girls and young mothers, in Punjab, Sindh, Khyber Pakhtunkhwa and Balochistan. Provincial Chapters of Rahnuma Media Network have been established in the afore mentioned provinces for motivating and mobilizing policy makers for improved policy making regarding SH&RH & MNH of young women.
Four provincial workshops with the Parliamentarians, Government Departments and CSOs were held in Lahore, Karachi, Peshawar and Quetta to advocate for adolescent specific MNH & SH&RH policies and programs at provincial level. All these advocacy efforts were then consolidated in a National Consultative workshop in Islamabad in November with the participation of parliamentarians from the four provincial assemblies, Provincial and Federal Governments’ officials, Media representatives and CSOs. A National Parliamentary Caucus was formed during the consultative workshop to advocate for improving SH&RH & MNH policies and programs for adolescent girls and young mothers. The project has achieved an extraordinary success and contacted 1100 stakeholders against the given target of 500, during its advocacy activities.
1. Empowering women through improved livelihood and Gender Based Violence (GBV) services.
Multiple programs aimed at empowerment of women are underway by Rahnuma FPAP. Three Kato Women Development Centers are serving as a hub to provide a variety of skill development initiatives to young girls and women. In addition, need based skills trainings were conducted in all Youth Resource Centers for young married girls to empower them and to sensitize them regarding sexual and reproductive health concerns. International Women Day was celebrated in all regional / PMO level in Rahnuma FPAP, in which 1345 women participated.
Poverty Alleviation Program (PAP) is operative at seventeen locations across the country. The program has achieved 74% of targets by providing micro-credit facility to 18,613 beneficiaries across the network, in 2012. Integration with core activities is an integral component of this program, thus 72 medical camps were organized in PAP working areas, where 7,253 beneficiaries availed the services of FP, RH and general health. As part of program planning awareness raising sessions on FP/SH&RH were conducted with all 18,613 beneficiaries at the time of program introduction and group formation meetings. Fifty two awareness raising sessions were conducted with 1,565 beneficiaries on FP/ SH&RH in PAP working areas.
A technical and vocational training project has initiated for youth and women, in Tando Allahyar, Mirpur Khas and Thatta districts of Sindh, with the coordination of Sindh Technical Education and Vocational Training Association (STEVTA). The program aims at sustainable empowerment of women by providing government certified vocational trainings and link them to the markets through internships and job placements with the local industries.
Gender based violence is an ugly menace that has distorted the social fabric of society by subjugating women. In line with its vision to create an enabling environment for empowering women, Rahnuma FPAP has started GBV counselling services in Balochistan region through twenty four hour telephonic help line and providing medico-legal referral information and services to combat gender based violence.
Youth Resource Center/ Youth Help Lines:
Rahnuma-Youth Helpline (YHL) aims to provide counseling services to young people and create awareness on sensitive issues of sexual and reproductive health among young people. A computerized MIS system has been installed for Rahnuma- Youth helpline at existing six Rahnuma-FPAP operated YHL locations. The software is designed to improve the quality of data collection from all six YHL locations by simplifying the process. It will facilitate timely reporting, validation and analysis of data at Head Office.
Promotional materials such as brochures, mugs with SH&RH and helpline information were also developed and used as awareness raising tools. YHL’s Toll free number has been printed on all IEC material to broadly disseminate the information to young people at mass level and increase their access to services. Promotional radio messages were developed for the YHL and aired through different radio channels, all over the country to publicize the Helpline number and increase awareness
Fifty Youth Resource Centers (YRCs) are working under Rahnuma FPAP throughout Pakistan. In 2012, twelve YRCs, two each at Islamabad, Peshawar, Lahore, Gilgit, Karachi and Quetta were up-graded and further strengthened by providing different educational and recreational material like in-door games, books, documentaries etc. YRCs are linked with Family Health Clinics (FHCs) and Family Health Hospitals (FHHs) for services of counseling, Family Planning, Reproductive Health issues, STIs, Screening & testing for HIV/AIDS etc. Telephone connections were installed at all the YRCs and privacy was ensured, so that youth could easily access the helpline.
For publicizing the youth friendly services, wall paintings, flax and sign boards regarding availability of youth friendly services have been displayed at youth friendly clinics and youth resource centers. Youth leaders and advocates developed local youth committees for publicity of youth friendly services available at Rahnuma-FPAP service delivery points. Radio messages and messages on local cable TV were developed and aired. Dramas produced on local TV promoting youth rights have also been linked to the program.
Report on Federal and Provincial/ regional Governments for 2010-11 to 2012-13 Budget Allocations for Population Welfare Program and its Aligned Departments/ Ministries
Nazar Abbas Naqvi
Consultant/ Budget Analyst
AAN Associates, Islamabad
The contents of this report reflect the views of the author and do not necessarily reflect the official views or policy of the FPAF.
1. Executive Summary
Rahnuma-Family Planning Association of Pakistan (FPAP) assigned the task of budget analysis at national and provincial levels for the financial years 2010-11to 2012-13 to analyze the Government’s Commitments towards citizens get realization through its financial allocation in programmes and schemes. The current budget analysis of the resource allocation in public sector budgeting focused on Reproductive Health, Sexuality/ Sexual Heath, Health, Women’s Health, Youth Reproductive Health, Gender, HIV & AIDS (Ministry of Health and National Aids Programme), Post PAC/MR Care, Women Empowerment (Ministry of Social Welfare and Women Development) and Youth Sexual Health.
The study included budgets of federal government, Government of Punjab, Government of Sindh, Government of KPK, Government of Balochistan, Government of AJK and Government of Gilgit Baltistan. The study covered current development budget allocations of health and population welfare departments at federal and provincial level.
The consultant collected budget documents of national and provinces/ regions. The study focused on the financial years 2010-11to 2012-13 and thus a comprehensive comparative analysis of budgetary trends has been undertaken. Background and purpose of the assignment has been given in section 2 and 3. Section 4 explains the methodology adopted to carry out the research and analysis. Section 5 covers budget allocations (current and development) at federal level for the years 2010-11 to 2012-13. Specific allocations for Punjab have been given in section 6. Budgetary allocation for Sindh have been provided and analyzed in section 7. Section 8 covers budgetary allocations for KPK and section 9 indicates these allocations for Balochistan. Budgetary allocations for AJK and GB have been covered in sections 10 and 11.
The report presents province wise budgetary allocations and a comparison (recurring and development) in Section 12. The allocations for prioritized health program for 2010-11 to 2012-13 have been provided in section 13 which cover National Program for Family Planning and Primary health care, Enhanced HIV/AIDS control, National Maternal Neonatal & Child health program. PSDP allocations of funds to Population Welfare for these 3 years for Federal, Punjab, KPK, Balochistan, GB and AJK have been for covered in section 14. Physical and conceptive users targets for 2010-11 to 2012-13 at Section 15 cover Family Planning Welfare Centers, Reproductive Health Services Centre A&B. The conclusion of the current analysis has been provided in section 16.
Rahnuma Family Planning Association of Pakistan (FPAP) has been working on various innovative programs to increased access of people to quality and affordable health services, advocate for a right-based agenda, empowering the communities, especially the women and young girls, and strengthen the civil society in Pakistan. To meet these ends, the organization widened its scope to cover sexual and reproductive health of the whole family as an offshoot of organizational concern for the total well being of women, children, families and communities. Rahnuma is also working on its poverty alleviation program, as the health and wellbeing of people are directly linked with the socio-economic conditions. Currently, Rahnuma is working on its strategic framework of 5 A’s that include: Adolescents and catering to their needs; combating HIV/AIDS; minimizing the risk of unsafe PAC/MRs; increasing Access to services, particularly for the poor and the marginalized; and Advocacy for the Rights.
After the Devolution population Welfare Program is still struggling to sustain. All provincial governments plagued by inadequate financial, technical and administrative capacity are unable to effectively roll it down in their respective provinces. Federal government has promised to provide financial support till 2014 to facilitate the administrative and managerial cost and asked provincial governments to provide support for program related cost. Present and previous budgetary allocations by the provinces are not so encouraging especially for the Population Welfare Department. Owing to these circumstances Population Welfare Department is the hardest hit by this devolution and further more different provinces have diverse approaches and assessments for the future functioning of this department. Rahnuma-FPAP will further endeavor to enhance and strengthen political and financial commitments of provincial governments for family planning and SH&RH. This budget analysis of all provincial /regional and federal governments provide a basis for advocacy, lobbying at appropriate forums for adequate resource allocations by the respective governments for population welfare program and its aligned departments/ ministries.
Budget is not merely an economic document but an indicator of nation’s priorities and intent. Government’s Commitments towards citizens get realization through its financial allocation in programs and schemes. Budget analysis, when added to field data, strengthens advocacy and lobbying work. Hence this Budget Analysis intends to study the National and provincial Budgets.
The current budget analysis of the resource allocation in public sector budgeting for the years 2010-11, 2011-12 and 2012-13 has been undertaken at federal and provincial/ regional level for Rahnuma-FPAP to analyze the trend of resource allocation. The analysis will provide an opportunity for advocacy at appropriate forums for equitable resource allocation.
This remains primarily an exploratory and secondary sources research, for which the researcher collected budget documents at national and provincial level. The Consultant collected budget documents for the years 2010-11, 2011-12 and 2012-13 and reviewed these for analysis. Extensive literature or secondary sources review was undertaken to understand the budgeting dynamics and analyze the budgetary allocations for relevant ministries and departments in the public sector. The literature review includes federal and provincial budget documents, national and provincial research reports and others Budget documents were also consulted through websites of provincial governments. The study remained focused on relevant ministries/ department, as per Terms of Reference agreed with FPAP. The sector wise trends of current and development budget in current perspective were analyzed. The current and development budget estimates for the years 2010-11 to 2012-13 were used for the purpose of analysis. The budgets of Health and Population Welfare were studied with focus on the following sectors:
• Reproductive Health
• Sexuality/ Sexual Heath
• Women’s Health
• Youth Reproductive Health
• HIV & AIDS (Ministry of Health and National Aids Programme)
• Post PAC/MR Care
• Women Empowerment (Ministry of Social Welfare and Women Development)
• Youth Sexual Health
The research employed primary researching techniques whereby selected financial documents / reports were reviewed.
4.1 Constraints and Challenges
The scope of study was to focus on the budgetary allocations of Health and Population Welfare Departments at Federal Government and Provincial Governments for the years 2010-11 to 2012-13. The researcher felt constrained for lack of desegregated budgetary data in general and for the sample ministries and departments. For example, the budgetary allocations for Health don’t offer breakup in terms of apportioned allocations for reproductive sexuality/ sexuality health, youth reproductive health and youth sexual health. In other ministries and departments, the situation is not much different than health.
Find below the description of budget analysis, performed across different indicators. The report is structured as such where it elaborates on budgetary allocations for financial year, 2010-11 to 2012-13 for federal and provincial/regional governments, followed by inter-provincial comparison and finally offers the conclusion.
5. Sector specific budget allocations at federal level for 2010-11 to 2012-13
The Federal Government budgets showed a total outlay of Rs.1,997,982, Rs.2,631,911 and Rs. 2,611,941 millions for the years 2010-11, 2011-12 and 2012-13 respectively. Allocations for 10 major sectors are given in the below table:
The percentage wise budget allocation remained at 0.36%, 0.25% and 0.30% for the years 2010-11, 2011-12 and 2012-13.
The year wise breakup of recurring allocations for Health Affairs & Services is as follows:
During the year 2010-11, 88% funds were allocated for hospital services, 7% for public health products, 4% for health administration, 2% for medical products and 1% for R&D health.
Major increase took place for hospital services. The other major increase was case in case of public health services. There was not significant change in allocation of R&D Health as it remained constant in these years.
During the year 2011-12, 86% funds were allocated for hospital services, 10% for public health services, 2% each for health administration and medical products and 1% for R&D health.
During the year 2012-13, 84% funds were allocated for hospital services, 11% for public health services, 3% for health administration and 2% for medical products.
Allocations for Public Sector Development Program are as follows. No allocations were made for 2011-12 and 2012-13 since health was devolved in June 2011.
PSDP 2010-11 2011-12 2012-13
Health share 16,945 0 0
Population Welfare 41,016 0 0
Total 167,578 156,522 206,563
Note: Health devolved in June 2011
The allocations for health sector and population welfare are given in the below chart.
(Source: Federal Government Budgets 2010-11to 2012-13)
Separate allocations for sexual health, youth reproductive health, Post PAC/MR care and youth sexual health are not provided for. These services are taken care of from general budgets of the departments and covered under hospital services etc.
6. Sector specific budget allocations in Punjab for 2010-11 to 2012-13
The Government of Punjab had a total outlay of Rs.386,796.957, Rs.434,749.818 and Rs.532,859.871 for the years 2010-11, 2011-12 and 2012-13 respectively. Health Sector got a share of 7.40%, 6.73% and 6.60% whereas Population department had a share of 0.95%, 1.30% and 1.20% for these years. Major allocations were made for general Public Services and Public Safety. The allocation for general public services increased from Rs.222,145,898 million (2010-11) to Rs 305,300.357 million (2012-13). The allocations for environment protection were the lowest priority in the budgets for these years.
(Source: Punjab Government Budget 2010-11 to 2012-13)
If we look at percentage share of different sectors in chart below, major allocations were made for general public services (57%) and public Safety (16%) whereas health got about 6% in the budget allocation for 2010-11
During 2011-12, General public services got highest share of 57%, public safety 16% and health about 6%.
During the financial year 2012-13, general public services got highest share of 57%, public safety 15% and health 7%. There is not much change in budgetary trends during these years.
Health services include Hospital Services, Public Health Services (laboratories and health related population welfare activities), and Health Administration. The major allocations are for Hospital Services which include current expenditures on autonomous medical institutions. The allocation for major Teaching/ Tertiary Care Hospitals has been increased to Rs. 20,135.792 million in FY 2010-11 as against Rs. 17,038.711 million in FY 2009-10. In line with the policy of the present government to provide free medicines, disposables and provision of dialysis facilities in public sector hospitals, an increase of approximately Rs. 3,000.000 million has been adopted in FY 2010-11 in comparison with budget estimates for FY 2009-10. The budget allocation for health sector was increased to the volume of Rs.434,749.818 and Rs. 532,859.871 in years 2011-12 and 2012-13.
Health services include Hospital Services, Public Health Services (laboratories and health related population welfare activities), and Health Administration. Major allocations are for Hospital Services which include current expenditures on autonomous medical institutions. Allocation for major Teaching/Tertiary Care Hospitals has been increased to Rs. 32,819.201 million in FY 2012-13 as against Rs. 23,535.538 million in FY 2011-12. In line with the policy of the present government to provide free medicines, disposables and provision of dialysis facilities in public sector hospitals, an increase of approximately Rs. 9,283.663 million has been adopted in FY 2012-13 in comp
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