Pakistan is one of the most populous countries in the world with 168 million (Projected Population 2008) people. In Pakistan, like many other countries, poverty is intrinsically linked with poor sexual and reproductive health (SRH).
Pakistan is a signatory of conventions including International Conference on Population and Development (ICPD) 1994, the Beijing Conference 1995, and the Eight Millennium Development. At Government of Pakistan, level there is a strong commitment to work on the MDGs. AIDS Control Programs, Poverty Reduction Strategy, recently approved Youth Policy and Women Development Programs at federal and provincial levels are a few important initiatives in this regard but the situation has not improved much.
Goals (MDGs) outlined at the UN Millennium Summit 2001 that prioritize issues of sexual and reproductive health mainly include the promotion of responsible and healthy reproductive and sexual behaviors. This is a crucial instrument in reaching many of the MDGs particularly those on poverty reduction, HIV/AIDS, maternal mortality, and gender equality.
In Pakistan, the total health budget allocated in the 2010-2011 national budget is 0.56% of GDP- which is the lowest health spending in South Asia whereas as the IMR, MMR, and other health indicators are alarmingly high. Reproductive health has not been allocated as a separate line item in the national budget which makes it difficult for donors to provide specific sector budget support even if they wanted to.
In Pakistan, the prevailing government focuses through vertical programs including HIV/HIDs, Lady Health Workers, MNCH, and more precisely family planning. As a result of the Constitutional 18th Amendment – major portion of funds have been allocated to provinces in budget 2010-2011 but still there are many complexities arising in prioritizing and budget utilization at the national and provincial level. Pakistan needs to accelerate progress to translate the internationally agreed standards into a national plan of action on an urgent basis to face the emerging challenges in the field of reproductive health.
CWS-P/A strives to improve reproductive health related to MDGs and is working in capacity building and service delivery programs on RH/FP for the last thirty years. With collaboration of German Foundation for World Population (DSW), CWS-P/A is dedicated to leverage increased funds on RH/FP through European donors and through increased national budget support through the EuroLeverage Project. This project is being addressed in ten countries globally, and CWS-P/A is the focal point for the project in Pakistan.
To address these issues, effective response at the policy and program levels is needed. Accordingly, an advocacy meeting was held with National Standing Committee Health on October 07, 2010. The meeting was chaired by Dr. Nadeem Ehsaan, Chariman Standing Committee Health, and eleven members of National Standing Committee Health participated in meeting. Based on the discussions during the meeting and in the result of recommendations by honorable members of the Health Standing Committee, the following actions will help to make 2010-2011 a turning point for RH/FP in the development agenda of Pakistan:
1. Strong political will is necessary to translate the international commitments into the actions.
2. Reproductive health must be allocated as a separate line item budget in national budget.
3. Reproductive health needs to be a priority focus area in the Poverty Reduction Strategy Paper (PRSP)
4. Considering the reproductive health as a national priority and developing a holistic and sustainable approach to reproductive health.
5. Reproductive health must be taken as priority by National Standing Committee in annual review of Budget 2010-2011 in Nov-December 2010.
6. Meaningful participation of stakeholders including the Civil Society Organizations in all policy making and program implementation processes to address specific needs of each group to enhance ownership.
7. t is strongly recommended to involve CSOs in review meetings of Poverty Reduction Strategy Paper (PRSP)
8. Specific programs on mother and child health care systems are needed to achieve the MDG 4 Child Health & 5 Maternal Health.
9. Government must align with international donors including EC and negotiate with them to increase the ODA support in RH/FP
10. Increasing efficiency and coordination between various ministries and departments particularly MOPW, MOH, MOE & MOWD is indispensable need of time for efficiency and accountability.
11. Developing strong monitoring mechanisms to reduce infant, child, and maternal mortality and to review the progress of ICPD Plan of Action