Professional Documents
Culture Documents
Population Welfare
Yearbook 2009-10
Message
Rising population growth poses a serious threat to a countrys social progress, economic stability,
health, environment, law and order, and food security. According to most experts, it is the biggest
obstacle to the socioeconomic development of the people in the developing world.
Pakistan is the sixth most populous country in the world and the fourth most populous country in
Asia. The countrys population has increased from 34.0 million in 1951 to 173.5 million in 2010.
Due to increasing realization of the need for family planning, total fertility and population growth
rates have started to decline globally.
Arresting population growth is one of the top priorities of the present government, since this will
help in attaining a balance between the countrys resources and population, leading to sustainable
socioeconomic development. If the current population growth rate of 2.05% does not slow down,
Pakistans population would double in the next 34 years. Furthermore, over one-third of
Pakistans population is aged below 15 years and it would be entering the reproductive age in the
near future.
The Population Welfare Programme of the Ministry of Population Welfare (MoPW) aims at
improving the quality of peoples life by enabling couples to decide the number of and spacing
between their children, and by providing them the information and the means to do so. Since its
inception, the Programme has been focusing on family planning under the umbrella of
reproductive health as a development intervention; otherwise, the demographic scenario of
Pakistan would have not been so encouraging.
Although a fertility transition has set in, there is still an unmet need of 25% for family planning in
Pakistan. Addressing this issue requires collective efforts by the MoPW and its partners,
including the Ministry and Departments of Health, civil society and the private sector.
I hope that the users of the MoPWs Yearbook 2009-10 would be able to better understand the
demographic scenario of Pakistan, as well as know about the efforts put in by the Ministry in
collaboration with its partners.
I would like to reiterate that the MoPW alone cannot meet the challenges posed by accelerating
population growth; this requires support and cooperation of other ministries and departments,
non-governmental and civil society organizations, and the private sector.
Finally, I want to put on record my appreciation for the efforts and hard work put in by the
MoPWs staff in compiling this Yearbook.
(Dr. Firdous Ashiq Awan)
Federal Minister for Population Welfare
ii
Preface
I am pleased to present the MoPWs Yearbook 2009-10, prepared in pursuance of Sub-Rule(2) of
the Rules of Business, 1973. The document encompasses the mandate, functions, activities and
achievements of the Ministry, besides presenting an overview of the new Population Policy, the
next five-year development plan, and future strategies and initiatives.
I hope that the users of the Yearbook 2009-10 would be able to learn about the important role the
MoPW is playing in the field of population and development. The Ministry aims at ensuring
universal coverage of family planning and reproductive health with the help of its partners.
Although the Ministry has had modest success in reducing the population growth rate in Pakistan,
a fertility decline has set in, which will hopefully help us in achieving our goals.
I am convinced that, with the collaboration and active support of its partners, the MoPW will
soon achieve replacement level fertility, leading Pakistan towards the ultimate goal of population
stabilization.
(Shaukat Hayat Durrani)
Secretary, Ministry of Population Welfare
iii
Contents
PART I
Chapter 1
A. Mandate of MoPW as Per Rules of Business, 1973
Chapter 2
Overview of Population Welfare Programme and Implementing Agencies
Chapter 3
Autonomous Bodies of MoPW
Chapter 4
Draft Pakistan Population Policy, 2010
PART II
Chapter 5
Service Delivery
A. Service Outlets of Population Welfare Programme (Public)
I. Family Welfare Centres
II. Reproductive Health Services-A Centres
III. Mobile Service Units
15
15
17
20
20
Chapter 6
Other Activities
A. Training Institutes
I. Clinical Training
II. Non-Clinical Training
21
22
24
C. Population Education
29
30
E. International Cooperation
33
38
39
39
H. Special Initiatives
41
I.
43
iv
PART I
Chapter 1
A. Mandate of MoPW as Per Rules of Business, 1973
1(i).
(ii).
2.
Deal and make agreements with other countries and international organizations in
matters related to the Programme.
3(i).
(ii).
4(i).
(ii).
5.
Formulate the policy governing the manufacture, use and quality control of
contraceptives under the Programme.
6.
Conduct research on different aspects of the Programme, such as clinical, social and
demographic.
7.
8.
Oversee matters related to the National Trust for Population Welfare (NATPOW) and
the National Institute of Population Studies (NIPS).
9.
Minister
Secretary
Autonomous Bodies
NIPS
Additional Secretary
NATPOW
Joint Secretary
Director General
Technical Wing
Director General
Programme Wing
Director General
M&S Wing
Director General
PPP Wing
Director General
Planning Wing
Director (FM)
Director (FWC)
Director (CS)
Director (PM)
Director
Director (FA)
Deputy Secretary
Admn-I
Director (RHS)
Director (PE)
Director (PME)
Director
Director
(Planning)
Deputy Secretary
Admn-II
Director (TC)
Director
(Training)
Director
(SS&DP)
Director (PPP)
Director (CT)
PWTIs (Lahore
and Karachi)
Director
(CW&S)
Director
(NRIFC)
Review the Population Policy and facilitate the process of its formulation, as well as that
of other population-related strategies.
Translate the Policy into federal and provincial projects and schemes under the
Population Welfare Programme.
Procure funding for Programme projects from national and international sources.
Finalize the Annual Work Plan of the MoPWs PC-Is (both Federal Activity and
Provincial Programmes).
Serve as the secretariat for the National Commission for Population Welfare (NCPW)
and the Social Sector Coordination Committee (SSCC).
Technical Wing
Form policy to execute the technical component of the Population Welfare Programme.
Implement, monitor and evaluate the clinical training component of the Programme being
executed through the MoPWs 13 Regional Training Institutes (RTIs).
Design and conduct training programmes for medics and paramedics working in the
public sector, the private sector and NGOs.
Prepare standard operating procedures (SOPs), guidelines and protocols for the service
delivery infrastructure of the Programme.
Oversee the Provincial Population Welfare Departments (PWDs) for ensuring quality at
service delivery outlets.
Implement service delivery and training activities in Islamabad Capital Territory (lCT)
under the Programme.
Coordinate with the health sector for rendering quality family planning/reproductive
health (FP/RH) services.
Serve as focal point for the South Asian Association for Regional Cooperation (SAARC);
womens development; regional economic cooperation; the Gender Responsive
Budgeting Initiative (GRBI); the Peoples Primary Healthcare Initiative (PPHI); the
Family Advancement of Life and Health (FALAH) Project; the Pakistan Initiative for
Mothers and Newborns (PAIMAN); etc.
Provide resource persons for the College of Physicians and Surgeons Pakistan, Health
Services Academy, Pakistan Civil Services Academy, Aga Khan University, etc.
Administration Wing
The Administration Wing consists of two Administrative Units and the Directorate of Financial
Management with clearly defined functions. The two Administrative Units are responsible for
recruitments, promotions, disciplinary matters, legal issues, stores, office security, National
Assembly and Senate matters, inter-provincial meetings on the Population Welfare Programme
and coordination between different Programme units. The Directorate of Financial Management
is responsible for preparing budget proposals related to development/non-development financial
allocations and revised estimates for the Programme; ensuring timely releases of funds to
Programme units and monitoring their utilization; observing financial discipline; obtaining
expenditure statements from the PWDs and other Programme units; maintaining proper record;
submitting financial statements to the government and donor agencies; attending to audit
objections; preparing pension/gratuity claims; and coordinating with the Finance Division/
Departments of Finance and the Accountant General Pakistan Revenues (AGPR).
Build a sustainable partnership with public, private and corporate sectors for providing
quality FP/RH services.
Legislate for mandatory provision of FP/RH services in the corporate sector, and by
medics, paramedics, hakims and homeopaths.
Bring all public and private sector initiatives under the umbrella of PPP.
Steer, monitor and facilitate all PPP initiatives being carried out through the nationwide
network of NATPOW.
Programme Wing
Plan, execute and monitor advocacy activities and awareness campaigns through the print
and electronic media, and interpersonal communication.
Supervise preparation of the training policy and annual plans, and their implementation
through the MoPWs Regional and Population Welfare Training Institutes.
Manage, supervise and monitor all Directorates and Training Institutes of the MoPW.
Chapter 2
Overview of Population Welfare
Programme and Implementing Agencies
The Population Welfare Programme (hereby referred to as the Programme) is an ongoing social
development endeavour operating within the framework of the Population Policy of Pakistan,
2002. Recognizing that Pakistan has the highest population growth rate among the six most
populous countries of the world, the Programme aims at encouraging voluntary adoption of small
family norms in the country. In fact, Pakistan makes the third highest annual net addition to the
global population after India and China. The countrys high fertility rate remains a major
contributor to this situation since the mortality rate has been fairly stable over the years.
Anticipating the far reaching implications of high population growth rate for Pakistans
socioeconomic development, the then policymakers introduced family planning on a limited scale
in the First Five-Year National Development Plan (1955-1960). The related services were
provided through voluntary organizations. In the Second Five-Year Plan (1960-1965), however,
family planning services were dispensed through the health infrastructure. Family planning
gained priority in the Third Five-Year Plan (1965-1970), when an independent setup was
established for managing and executing the Programme.
The Programme witnessed a positive change and received sustained political support from 1988
to 2002. There was consistency and continuity in the operations during these years, with the
stakeholders in the public sector, the private sector (particularly social marketing companies) and
civil society playing an important role in achieving positive results. Both the budgetary allocation
for the Programme and its coverage increased, along with the expansion of and a wider role for
the social marketing sector. The private providers and retailers involved in the distribution and
dispensation of products under independent logos were enlisted, and promotional campaigns and
a whole range of follow-up communication activities were undertaken in the field.
As a result, Pakistan was referred to be entering the fertility transition phase, with contraceptive
prevalence rate (CPR) gradually rising and total fertility and population growth rates gradually
falling. However, there remained a wide gap between awareness level and CPR, and the unmet
need for family planning ranged around 33%.
The Programme has passed through different phases in terms of administrative and financial
setup. Before 2002, it had a federalized status. In February 2000, a committee was setup to review
the Programme and its interface with the health sector. The recommendations of the committee
were presented to the then Chief Executive of Pakistan on 6 April 2001 and were approved
accordingly.
In view of these recommendations, the Federal Government transferred the Programme to the
Provincial Governments along with assets, liabilities, and administrative and financial controls
through a handing over note. The latter were required to take over the Programme and start
funding it from their budgets starting 2006, but this has not yet happened. The transit
arrangements have resulted in a number of issues in terms of planning, monitoring and financial
management.
After the announcement of the 7th National Finance Commission (NFC) Award, the Executive
Committee of the National Economic Council (ECNEC) decided on 16 January 2010 that the
Population Welfare Departments (PWDs) should assume their responsibility and the Provincial
Governments should now starting providing funds for the Programme as per their commitment.
The last Five-Year Population Welfare Programme (2003-2008) set the ultimate goal of
population stabilization as a development priority to attain sustainable socioeconomic
development. There was an increasing realization of the crosscutting effect of the population
factor on the socioeconomic canvas during this period. The Programme was accorded high
priority in the overall development framework and in the Poverty Reduction Strategy Paper
(PRSP). The commitment was sustained with allocation of additional resources through the
Public Sector Development Programme (PSDP) for implementing Programme activities.
Implementing Agencies
The Population Welfare Programme is executed through the following implementing agencies:
1. Population Welfare Department, Punjab.
2. Population Welfare Department, Sindh.
3. Population Welfare Department, Khyber Pakhtunkhwa.
4. Population Welfare Department, Balochistan.
5. Population Welfare Programme, Azad Jammu and Kashmir (AJK).
6. Population Welfare Programme, Federally-Administered Tribal Areas (FATA).
7. Population Welfare Programme, Gilgit-Baltistan.
8. Population Welfare Programme, Islamabad Capital Territory (ICT).
Chapter 3
Autonomous Bodies of MoPW
National Institute of Population Studies
The National Institute of Population Studies (NIPS) is a research organization engaged in
carrying out interdisciplinary research in the field of population and development; conducting
evaluation and impact studies of the Population Welfare Programme; and developing human
resource. Data generated by NIPS are used in formulating population planning strategies.
Hold annual review of these policies in the light of actual functioning of the Programme
and the realization of its objectives.
Promote and encourage partnerships between all the actors involved in population
planning activities.
Build consensus on directions for population in general and for the MoPW in particular.
Ensure effective coordination between the Federal and Provincial Governments for the
attainment of Programme objectives.
Chapter 4
Draft Pakistan Population Policy, 2010
The Draft Pakistan Population Policy, 2010 (hereby referred to as the Policy 2010) places the
population factor at the centre stage of national development planning. It recognizes
reproductive health as a critical component of sustainable socioeconomic development having
strong linkages with the governments poverty reduction strategies. The Policy 2010 repositions
family planning as a health initiative, with a focus on MCH, by making family planning services
a vital component of the essential services package.
Within this holistic perspective, and in the wake of emerging demographic realities, the Policy
2010 re-emphasizes timely completion of fertility transition for stabilizing the population and
reaping the demographic dividend. Infused with this spirit, it is expected that the Policy 2010
would contribute meaningfully to the implementation of the Programme of Action of the
International Conference on Population Development (ICPD) and the achievement of the MDGs,
particularly reducing the maternal mortality ratio by two-thirds by 2015.
Vision
The Policy 2010 would promote a prosperous, healthy and skilled society where every pregnancy
is planned; every child is nurtured and cared for; and every citizen is provided with choices to
improve the quality of his or her life.
Goals
The Policy 2010 seeks to:
Enhance human development for capitalizing on the unique opportunities offered by the
emerging demographic scenario in the form of demographic dividend.
Increase pregnancy spacing for improving the health of women and children.
Objectives
The short-term objectives of the Policy 2010 are to:
Make available family planning services to the remotest areas of the country by 2015.
Reduce the unmet need for family planning from the current 25% to 20% by 2015.
Reduce the total fertility rate (TFR) from the current 3.6 births to 3.2 births per woman
by 2015.
Ensure contraceptive commodity security for all public and private sector outlets by
2015.
Reduce the unmet need for family planning from the current 25% to 5% by 2030.
Increase the contraceptive prevalence rate (CPR) from the current 30% to 60% by 2030.
Principles
The principles of the Policy 2010 are based on the Programme of Action of the ICPD, the MDGs
and the Karachi Declaration, 2009. These are to:
Address the population issue within national laws and development priorities, while
considering the social and cultural norms.
Assumptions
The Policy 2010 is based on the following assumptions:
Enhanced resource availability for the Programme under the NFC Award.
Centre staging of the population factor in national development planning for reaping the
demographic dividend.
Strategies
The Policy 2010 lays strong emphasis on reshaping the unprecedented demographic dividend, as
envisaged by the Planning Commissions Vision 2030 document. This necessitates adopting
human development policies that can help transform the young population into a skilled
workforce It situates reproductive health and family planning within the context of overall
economic and social development, thus creating linkages with other developmental concerns,
such as increasing the provision and outreach of primary and secondary education, empowering
women and creating employment opportunities for the people.
The Policy 2010 also stresses putting in place an effective reproductive health programme that
ensures continuation in and speeding up of the fertility transition process. It, therefore, attaches
special importance to achieving universal access to FP/RH information and services. The Policy
2010 recognizes that achieving fertility transition is a collective responsibility of all potential
providers in the public, private and NGO sector, and provides for involving all the stakeholders in
achieving the stated goals and objectives through the adoption of the following strategies:
10
11
h. Monitoring
The Policy 2010 emphasises adopting a joint monitoring framework to ensure effective
implementation by all the stakeholders. It envisages adopting the results-based monitoring (RBM)
mechanism to ensure that processes and outputs contribute to the achievement of clearly stated
objectives. This approach would shift the focus of monitoring from outputs (number of
contraceptives distributed, number of clients contacted and recruited, etc.) to outcomes (increase
in the CPR, etc.). Laying emphasis on outcomes is also important for the MoPW to engage the
stakeholders and build partnerships to achieve shared objectives.
The monitoring framework would specify the indicators of input, service delivery process and
output, which would be observed, reviewed and followed up regularly at the tehsil, district and
division level. Monitoring by the Provincial Population Welfare Departments (PWDs) would
largely be a review of the monitoring efforts at the tehsil and district level. As a step towards
activating the verification tool, the PWDs would send their monitoring reports to the MoPW.
These reports would be analyzed in regular review sessions on Programme implementation at the
national level. The monitoring process, in order to be result-oriented, would also institutionalize
the capacity to track and concurrently follow up the progress made in important aspects of the
Programme. Since the operational monitoring would rest with the PWDs, the MoPW would
maintain supportive linkages with them, as well as enhance their professional capacity and skills.
Implementation Plan
After the introduction of the 18th Constitutional Amendment, the Programme has been transferred
to the Provincial Governments; however, policy formulation and execution continue to be federal
subjects, so that continuity and consistency could be ensured in national policies. This is needed
to have an interface with United Nations agencies; to forge bilateral and multilateral agreements;
and to coordinate with international development partners. But this also entails restructuring of
the MoPW, and redefining its role vis--vis the PWDs, the Ministry of Health, the Planning and
Development Division, the Finance Division, other social sector ministries, NGOs/CSOs and the
private sector.
Considering the crosscutting nature of the population issue, participation of all the stakeholders in
implementation of the Policy 2010 would be encouraged and supported. In addition, necessary
mechanisms and institutional arrangements would be put in place to seek the support of elected
representatives and local leaders, opinion makers, religious scholars and organized communities
for efficient and effective implementation of the Policy 2010. Furthermore, academic and
research institutions would be involved in monitoring the progress made by the Policy 2010.
The implementation of the Policy 2010 would rest with the Provincial Governments, who would
collaborate with line departments, public and private sector organizations, and NGOs/CSOs in
such a way that conforms to both social values and national and provincial development
priorities. With the announcement of the 7th NFC Award, the Provincial Governments have
access to additional resources; therefore, it is expected that they would assume full ownership of
the Programme at the earliest.
Legal Framework
The Population Welfare Planning Programme (Appointment and Termination of Services)
Ordinance, 1981 regularized the services of Programme personnel through the Federal Public
Service Commission and the Departmental Selection Committee. The Transfer of Population
Welfare Programme (Field Activities) Ordinance, 1983 de-federalized the Programme by
12
International Cooperation
Pakistan is a signatory to the Programme of Action of the ICPD, as well as committed to
achieving the MDGs. The Policy 2010, therefore, encompasses not only national development
priorities but also international obligations. The MoPW envisages expanding the scope of its
activities in accordance with the recommendations of the ICPD. Precisely against this backdrop,
the Policy 2010 focuses on developing bi-lateral relations, especially with other Muslim and
South Asian countries, and forging linkages with international development agencies, particularly
for sharing best practices and seeking technical support.
The Policy 2010 seeks enhanced financial and technical cooperation from the international
community, anticipating that it would understand and appreciate the population and reproductive
health situation of Pakistan, and its implications within and beyond boundaries. It also urges the
international community to fulfil its obligations under the ICPD and the development partners to
realize their commitments with Pakistan.
13
PART II
14
Chapter 5
Service Delivery
A. Service Outlets of Population Welfare Programme (Public)
I. Family Welfare Centres
Family Welfare Centres (FWCs) are the cornerstone of Pakistans Population Welfare
Programme. They constitute the most extensive institutional network in the country for promoting
and delivering family planning services in both urban and rural areas. An FWC may operate in a
rented building or in any basic health unit (BHU)/rural health centre (RHC) where two separate
rooms are available.
As a static facility, it serves a population of about 7,000; while operating through its satellite
clinics and outreach facilities, an FWC covers a population of about 12,000. The scope of work of
the FWCs includes providing family planning and mother and child health (MCH) services, and
treating minor ailments. Post-ICPD, their scope has been expanded to include several components
of reproductive health such as safe motherhood, infant health care, and management of
reproductive tract infections (RTIs)/sexually-transmitted infections (STIs) and HIV/AIDS.
Each FWC has a staff of five: one family welfare worker/counsellor, family welfare assistant
(male), family welfare assistant (female), female attendant and guard each. Of the 2,853 FWCs of
the MoPW, as of 30 June 2010, 1,500 are located in Punjab; 590 in Sindh; 422 in Khyber
Pakhtunkhwa; 170 in Balochistan; 55 in AJK; 50 in FATA; 37 in Gilgit-Baltistan; and 29 in ICT.
No expansion of the FWCs could be undertaken during 2009-10 because of financial constraints,
since the Population Welfare Programme was implemented on anticipatory approval.
Functions
The FWCs perform the following functions:
Provide family planning information, counselling and services for all methods except
implants and contraceptive surgery; MCH services through static facilities and satellite
clinics; and infant health care, including nutritional advice, growth monitoring and
treatment of common ailments.
Conduct regular educational sessions through Mohalla Sangats to create awareness about
small family norms, female literacy, human rights and gender equality; and orientation
sessions for elected women representatives on topics such as family planning, population
and development, gender equality, and status of women in Islam.
Make available contraceptives, medicines and other supplies; and maintain equipment in
good condition.
15
the full range of services identified in the National RHS Package, including contraceptive surgery
facilities for women and men, with safe and effective backup medical support and long-term
client follow-up; MCH services; prevention and management of RTIs/STIs and HIV/AIDS;
counselling and referral for adolescents/youth; management of reproductive health problems of
the elderly women, referral for mens problems; clients education for early detection of cancer in
breast and uterus; and couple counselling and referral for treatment of infertility.
The RHS-A Centres play a vital role in raising awareness about public health, personal hygiene,
nutrition and breastfeeding during reproductive age, and preventive gynae/obstetric facilities. It is
expected that they would contribute to reduction in fertility. Furthermore, these Centres provide
treatment for minor/general aliments, particularly to women and children. Of the 182 RHS-A
Centres of the MoPW, as of 30 June 2010, 63 are located in Punjab; 60 in Sindh; 24 in Khyber
Pakhtunkhwa; 15 in AJK; 10 in Balochistan; 4 in FATA; and 3 each in Gilgit-Baltistan and ICT.
Functions
The RHS-A Centres perform the following functions:
Provide motivation and counselling to family planning clients along with a full range of
contraceptive services, with special emphasis on contraceptive surgery for both women
and men.
Deal with cases related to the management of RTIs/STIs, as well as provide MCH
services.
Arrange extension camps with operation theatre facilities at Tehsil Headquarters (THQ)
hospitals/RHCs for providing contraceptive services, including contraceptive surgery.
Enhance male participation by creating awareness about FP/RH issues, with special focus
on providing vasectomy services, preferably no-scalpel vasectomy (NSV).
Impart training to male doctors of the MoPW, the Ministry of Health and NGOs in
vasectomy procedures.
Develop training curricula, strategy, methodology and annual plan for the
abovementioned activities and undertake them after approval of the MoPW.
16
Hold orientation workshops for medics and paramedics of all categories to update their
knowledge about what is available for the clients in the way of contraceptive services.
Undertake four supervisory visits of three-day duration each every year. During these
visits to be undertaken by the Monitoring Officers of all the 15 RHS-A Training Centres,
a minimum of 4 RHS-A Centres will be covered for technical guidance and support.
17
in ICT. Each MSU has one woman medical officer and three support staff: one family welfare
counsellor, driver and female attendant each.
A training manual on specified/identified modules such as planning, supervision and
monitoring; community participation and ownership; skill development; follow-up system;
financial procedures; quality of care; logistic management along with a guide was also
developed.
Functions
The MSUs perform the following functions:
Reduce the unmet need for family planning by making services more accessible,
particularly the clinical methods such as intrauterine devices (IUDs) and injectables.
Facilitate the work of male mobilizers regarding the enhancement of mens role and
responsibilities.
Muster local support for the Programme through interaction with elected representatives
and other opinion leaders, and promote better understanding and need for reproductive
health care.
Quality of Care
The Programme has achieved international accreditation ISO 9001:2008 Certification for Quality
Services for selected Service Delivery Points (SDPs). Based on the experience gained from the
above process, various checklists have been designed whereby quality of care is ensured through
standardization and optimization of reproductive health facilities. The following SDPs and
Managerial Offices of the Ministry and Departments of Population Welfare have received ISO
accreditation/certification:
DPWO, Chakwal.
DPWO, Jhelum.
18
The Management Representative Office addressed the discrepancies raised in the audit report by
amending the relevant procedures, and the same was circulated to respective SDPs and
Managerial Offices for compliance. Moreover, the respective SDPs and Managerial Offices
strictly observed the opportunities for improvement (OFIs) and potential non-conformities
(PNCs) mentioned in the report.
Internal Audit
The internal audit of ISO Certified Outlets of the Programme was conducted in June 2009 and
January 2010. The major/minor PNCs, observations and OFIs were identified and corrective
preventive actions (CPAs) were initiated accordingly. The same was also conveyed to respective
SDPs and Managerial Offices of ICT and Chakwal District for compliance.
Thermometer.
Pressure Gauge.
Hygrometer.
BP Apparatus (Mercury).
19
20
Chapter 6
Other Activities
A. Training Institutes
I. Clinical Training
Clinical training is the key activity aimed at providing quality reproductive health services (RHS)
to the community by developing human resource for the service delivery centres of the
Population Welfare Programme, the Ministry and Departments of Health, PLDs, and other nongovernmental and private sector organizations throughout the country. Thirteen Regional
Training Institutes (RTIs) across Pakistan train personnel for delivering health care services to the
general public.
The RTIs provide skill-based training in Reproductive Health and Family Planning for all
categories of health care providers: doctors, medical students, nurses, student nurses, lady health
visitors and other paramedics. In addition to HRD, the RTIs also undertake activities focused on
raising the awareness level of hakims, homeopaths, community health workers, teachers and
college students.
The Directorate of Clinical Training is responsible for all activities held at the RTIs, as well as
building institutional capacity; developing training curricula; preparing textbooks and other
training material, such as audio-visual aids; conducting examinations for certification of
competence as service providers; assessing and improving quality of training; and ensuring
proper and timely implementation of the clinical training programme through the RTIs.
The Directorate is also the focal point for coordination with the Population Welfare Departments
(PWDs) of Punjab, Sindh, Khyber Pakhtunkhwa and Balochistan, as well as AJK, FATA and
Gilgit-Baltistan; the Population Welfare Training Institutes (PWTIs) in Karachi and Lahore, the
Health Departments, NGOs, social sector institutions, public sector health organizations and nonProgramme health outlets regarding training of their staff (both medics and paramedics) in family
planning and reproductive health.
To meet the increasing need for trained workforce, RTIs are also being established at Khuzdar
and Sialkot, and they will be fully functional by 2011. Establishing new RTIs is in line with the
government policy of womens empowerment. This will also help in creating opportunities for
women, achieving the Millennium Development Goals (MDGs) and alleviating poverty.
Moreover, the new RTIs would empower women to attain skills and be economically productive
for themselves and their families, besides meeting the Programme objectives of reducing high
population growth rate and unmet need for contraceptives, and promoting health of the
population.
The RTIs over the years have grown into excellent training centres for all categories of FP/RH
service providers, not only from the PWDs, but also from the Health Departments, the Pakistan
Army, autonomous bodies, NGOs and the private sector. They are using standardized training
curricula and modern teaching methods, backed up by a comprehensive evaluation system.
Activities
A wide range of training activities were undertaken during 2009-10, as shown in the table and
text below:
21
Target
Achieved
300
284
40
284
80
136
240
262
4,700
2,660
5,360
3,626
The Second Training of Trainers (ToT) on Client-Centred Family Planning ServicesAdvance under the Family Advancement of Life and Health (FALAH) Project was held
from 29 July-7 August 2009 in Islamabad. Women medical officers (WMOs) of six RHSA Centres from Punjab, Sindh and Balochistan attended the ToT.
Competency-Based IUCD Training was conducted under the FALAH Project from 1722 August 2009 at the RTI/RHS-A Centre, Aabpara, Islamabad. A total of 10 medics and
paramedics attended the training.
The curriculum of family welfare assistant (female) was prepared in Urdu to make
service providers proficient and capable of delivering quality health services. This was
done in consultation with senior officials of the MoPW and other sister organizations and
in collaboration with UNFPA.
World Population Day activities such as walks, quizzes, sports events and seminars were
organized at all the RTIs on 11 July 2009.
22
Programme Personnel
Sr. No. Activity
Participants
Duration
No. Held
1.
Faculty of PWTIs/RTIs
10 days
17
2.
Population Welfare
Officers/WMOs
Accountants/Assistant
Accountants
Family Welfare Assistants
(Male)
Drivers
1 week
55
2 weeks
32
2 weeks
(in batches)
4 days
(2 batches)
2 days
100
3.
4.
5.
6.
7.
BS-17&18 Officers
8.
District/Tehsil Population
Welfare Officers (TPWOs)
9.
BS-17&18 Officers
10.
11.
12.
4 weeks
(2 batches)
1 week
158
17
62
27
1 week
31
1 week
(in batches)
250
Stenographers
1 week
39
Storekeepers/Upper
Division Clerks
1 week
57
13.
Pre-Service Training
Social Mobilizers
6 weeks
161
14.
Administration Officers/
Superintendents
1 week
26
4 days
31
1 week
27
15.
16.
Female Welfare
Counsellors/Workers
Total
1,090
Non-Programme Personnel
Sr. No. Title of Seminar
Participants
Duration
No. Held
2 days/1 day
1,086
1.
Safe Motherhood
Religious Scholars
2.
Safe Motherhood
Factories/Industries Staff
1 day
113
3.
Safe Motherhood
PLDs/NBDs/NGOs
2 days
116
4.
Media
1 day
86
5.
TGIs/NBDs
2 days
266
6.
2 days
304
7.
I day
40
8.
NGOs/CSOs
1 day
88
Total
2,099
23
Promotional Campaign
The promotional campaign through the print and electronic media addressed various family
planning and population issues, such as population and development, implications of rapid
population growth, birth spacing, breastfeeding, female literacy, male involvement, removal of
misconceptions regarding side-effects of family planning methods, image enhancement of family
planning workers, early marriage, etc. The details of related activities undertaken during 2009-10
are given in the following table and text:
Sr. No. Activity
Target
Achieved
Percentage
1,000
1,618
162
1.
TV Advertisement
2.
TV Programme
20
20
100
3.
Radio Spot
800
1,155
144
4.
Radio Programme
104
68
65
5.
Press Advertisement
400
598
150
6.
IEC Material
300,000
222,500
74
7.
Conference/Workshop/Seminar/Meeting
200
24
Palna, a 90-minute tele-film, was produced to address the family planning and
reproductive health issues of newly-wed couples.
A close circuit television (CCTV) campaign was launched through major railway
stations and trains, Daewoo terminals and buses, and Passport Office, Lahore.
The Pakistan Electronic Media Regulatory Authority (PEMRA) was approached for
airing of population-related messages on complementary basis through satellite
channels as their corporate responsibility.
25
26
IEC Material
Booklets, Leaflets, Handbills, Posters, Flip Charts, Books,
Brochures, Flyers, Stickers, etc.
Newsletter
Aabadi Nama
Office Stationery
DO Pads, Letterheads, Visiting Cards, File Covers,
Envelopes, etc.
Forms and Registers
Registers, Forms, CRC Cards, Users Slips, Bin Cards, etc.
Total
MoPW, Islamabad
PWD, Punjab
159,900
4,070,000
30,000
32,225
11,100
233,225
4,070,000
27
Media Coverage
Media coverage was arranged for the following events during 2009-10:
Meetings of the Federal Minister for Population Welfare with donor agencies.
28
C. Population Education
The Directorate of Population Education has evolved a new strategy to focus on youth, the major
cohort in the population pyramid. This programmatic shift from family planning to reproductive
health rights and issues of adolescents will ensure quality of life and care. The new paradigm,
instead of talking about numbers as a population education modality, encompasses spacing,
responsible parenthood, health education and family as a unit in a holistic approach to population
and development issues.
As part of the Youth Sensitization Programme and orientation/education of different categories of
target audience under the population education component, a series of workshops/seminars was
organized. Moreover, Presentation Skills Development Workshops were organized to enhance
the capacity of newly-inducted officers in the Programme at the provincial level. The summary of
the activities undertaken during 2009-10 is given in the following table:
Sr. No Activities Undertaken
1.
2.
3.
4.
5.
Venue
Faisalabad, Gujranwala, Islamabad, Mirpur,
Muzaffarabad, Peshawar, Rawalpindi
Faisalabad, Gujranwala, Lahore, Mirpur,
Muzaffarabad, Peshawar
Lahore, Peshawar
Gujranwala
Ministry of Youth Affairs, Islamabad
New Initiatives
To meet the socioeconomic challenges faced by Pakistan, it is vital to sensitize all segments of
the society on population issues, especially opinion leaders like teachers and religious scholars.
The population as a demonstrator of all the developmental indicators and a cross-cutting issue
was highlighted at different for a by the Directorate of Population Education. However, the focus
on youth, especially students and young teachers in productive and reproductive age groups, is
the main thrust of the population education component of the Programme. In this connection, the
MoPWs plan is to sensitize both students and young teachers on population issues. In the first
phase, the Ministry plans to establish seven Population Education Information Resource Centres
(PEIRCs) in public sector universities, one in each province and AJK and ICT. These Centres
will be a major step towards sensitizing the countrys youth on the issue of population and
development.
Moreover, a number of meetings were convened with the Curriculum Wing of the Ministry of
Education to discuss recommendations on already proposed eight themes related to population
and development issues, with a view to sensitizing school students of class 9 and 10 and college
students of class 11 to 12. In addition, the Directorate of Population Education was also involved
in the vetting of the Education and Youth Policies from the population and development point of
view. For the first time in its history, the Directorate was involved not only in finalizing the
Government of Pakistan (GoP)-UNFPA related Annual Work Plan (AWP)-2010 of the Ministries
of Education and Youth Affairs, but also got one of its activities the establishment of seven
PEIRCs incorporated in the AWP-2010 of the Ministry of Education.
29
Quantity Procured
1.
120,000
2.
235,000
3.
CU-375 (Sets)
350,000
4.
CUT-380-A (Sets)
400,000
5.
NET-EN (Ampoules)
670,000
6.
Syringes (Pieces)
670,000
7.
DMPA (Vials)
240,000
30
The draft Manual is an outcome of active interventions by the officers of the MoPW/Ministry of
Health, as well as other key stakeholders such as the Central Drug Laboratory, Drug Control
Authority, Mother and Neonatal Child Health (MNCH) Programme, National Aids Control
Programme, Public Procurement Regulatory Authority (PPRA), United Nations Population Fund
(UNFPA), United States Agency for International Development (USAID) and Department for
International Development (DFID). The Manual is almost ready for government approval.
Allocation
Received
In Pipeline
USAID
2.947
1.095
1.852
UNFPA
2.130
2.130
Total
5.077
3.225
1.852
Units
Quantity
1.
Rubber Condoms
Pieces
48,960,000
2.
Oral Pills
M/cycle
3,764,093
3.
M/cycle
119,978
4.
Postinor-2
120,000
5.
Copper T (380-A)
Pieces
467,056
6.
Multiload cu-375
Pieces
260,300
7.
Norigest Injection
Amps
1,200
8.
Megestron/Depo Injection
Vials
901,000
9.
Pieces
1,500,000
10.
Sets
900
During 2009-10, consignments of various contraceptives were dispatched to Programme and nonProgramme service delivery outlets. The details are given in the following table:
31
Units
Quantity
1.
Rubber Condoms
Pieces
41,364,808
2.
Oral Pills
M/cycle
3,223,123
3.
M/cycle
119,978
4.
Exlution Tablets
M/cycle
68,817
5.
Postinor-2
48,887
6.
Copper T (380-A)
Pieces
662,887
7.
Multiload cu-375
Pieces
96,508
8.
Norigest Injection
Amps
1,336,905
9.
Megestron/Depo Injection
Vials
905,182
10.
Pieces
2,201,179
11.
Sets
2,171
In addition, the Directorate of CW&S, Karachi received various contraceptives for the National
Programme for Family Planning and Primary Health Care, Ministry of Health, and provided
storage facilities in the warehouse. Later, the same were dispatched to the Provincial Programme
Implementation Units of the Ministry of Health throughout Pakistan. The details of receipt and
dispatch of the contraceptives belonging to the Ministry of Health that were stored by the CW&S,
Karachi during 2009-10 are given in the following table:
Sr. No. Name of Contraceptive
Receipt
Dispatch
1.
Rubber Condoms
5,066,884
10,544,976
2.
3,455,500
3.
75,500
75,500
4.
75,500
75,500
In addition, the Directorate of CW&S, Karachi received 734 cartons of Rubber Condoms for the
National Aids Control Programme (NACP) and provided storage facilities in the warehouse.
32
E.
International Cooperation
Training.
Support to demographic and population studies, and support for public private sector
organizations (PPSO) working on population and development issues.
33
Ministry of Health and Greenstar Social Marketing-Pakistan is $6.2 million and $1.2 million,
respectively. The MoPW has received contraceptives worth $1.095 million and contraceptive
worth $1.85 million are in the pipeline under the DELIVER Project, which is also providing
technical support amounting to $3.0 million for forecasting, the Contraceptive Procurement
Manual, LMIS and computerization, including pallet-racking of CW&S, Karachi.
CRISP Project: The project is providing financial and technical support for expansion and
rehabilitation of Central Warehouse and Supplies (CW&S), Karachi. Currently, rehabilitation
work (flooring, ventilation, electrification and painting) of existing storage facility and foundation
work of the Administration Block is being undertaken. The estimated cost of the CRISP Project,
which would be completed by July 2011, is $2.5 million.
Pakistan Demographic and Health Survey (2011-2012): USAID has agreed to provide financial
and technical assistance to the National Institute of Population Studies (NIPS) to conduct the next
Pakistan Demographic and Health Survey (PDHS) 2011-2012.
In addition to these projects, USAID is also providing funds to Pakistani NGOs for undertaking
activities around family planning and reproductive health issues. The details are as follows:
Family Advancement of Life and Health: This five-year project, with a budget of $60 million, is
being implemented in 26 districts across the country. The implementing consortium is led by the
Population Council, a US-based research organization. The ToRs of the Family Advancement of
Life and Health (FALAH) Project are to increase demand for and practice of birth spacing;
increase access to quality of family planning services in the public sector; increase the coverage
and quality of family planning services in the private sector; and increase the coverage of social
marketing of contraceptives and provide support to the commercial sector for marketing of
contraceptives to strengthen contraceptive security. The MoPW is one of the implementing
partners of the FALAH Project. The DG (Technical) is the focal person from the MoPW
regarding formulation and implementation of the Project.
Pakistan Initiative for Mothers and Newborns: This six-year project is designed to reduce
maternal, neonatal and child mortality in Pakistan by making sure women have access to skilled
birth attendants during childbirth and throughout the postpartum period. The Pakistan Initiative
for Mothers and Newborns (PAIMAN) is working at the national, provincial and district level to
strengthen the capacity of public and private health care providers and to improve the health care
system infrastructure. PAIMAN has developed a community-based approach that provides a
continuum of care to mothers, newborns and children through supportive linkages from home
health care to hospital-based care. PAIMANs key partners are the Ministry of Health, the
Ministry of Population Welfare, Provincial and District Health/Population Departments and the
private sector. The PAIMAN consortium is led by John Snow Inc. (JSI), a US-based international
public health organization.
Proposals for Future USAID Assistance: A series of meetings were held at the MoPW and
Finance Division to discuss and prioritize project proposals for USAID support. In this
connection, the Ministry has forwarded six concept papers for USAID funding. These concept
papers were discussed during the last Pak-US strategic dialogue in New York. US authorities
showed their interest in four of the six proposals, costing $180.00 million. These include: (1)
Enhancing Outreach to FP/RH Services through Community Partnership: Family Health Homes
at Village Level (pilot project for two years costing $120.00 million, as against total project cost
of $331.76 million for five years); (2) Community Mobilization through Imams and Khateebs at
Village Level (pilot project for two years costing $28.00 million, as against total project cost of
34
$70.00 million for two years); (3) Research and Training through NIPS, NRIFC, RTIs and
PWTIs (the total project cost is $12.00 million for five years); and (4) Public-Private Partnership
for Universal Access to FP/RH Services (the total project cost is $20.00 million for five years).
35
5. Visits Abroad
The details of visits/trainings abroad undertaken by officers of MoPW during the year 2009-2010
are given in the following table:
Sr. No. Name and Designation
1.
2.
3.
4.
5.
6.
Event (Venue)
Dates
Funding Source
SAARC Parliamentarians
Conference on Advocacy to
Achieve Universal Access to
Reproductive Health Services
and Commodities Security
(Kathmandu, Nepal)
Dr. Sairah Adnan, Medical
Training Programme on
Officer/Senior Instructor, RTI, HIV/AIDS Prevention and
Abbottabad
Care for Children and
Vulnerable Young People
(Bangkok, Thailand)
28-30 July
2009
UNFPA
16-17 Sept
2009
UNFPA
27-30 Sept
2009
USAID
17-20 Oct
2009
PPD
Asia-Pacific High-Level
Forum on ICPD @15:
Accelerating Progress
Towards ICPD and the
Millennium Development
Goals (Bangkok, Thailand)
Dr. Mumtaz Esker, Director WHO Regional Workshop on
General (Technical), MoPW the Implementation of Best
Practices in Family Planning
(Amman, Jordan)
Dr. Firdous Ashiq Awan,
14th Annual Board Meeting
Federal Minister for
of Partners in Population and
Population Welfare; Major (r). Development (PPD) and 5th
Haroon Rashid, Additional
Asia Pacific Conference on
Secretary, MoPW; and Mr.
Sexual and Reproductive
Hammad Shamimi, Director Health and Rights (Beijing,
(FA), MoPW
China)
Mr. Dilshad Ahmad, Deputy
Secretary, MoPW; Ms. Tanvir
Kiyani, Director, MoPW;
Syed Muhammad Saleem,
Deputy Director, MoPW; Dr.
Asma Rana, Principal, RTI,
Lahore; Mr. Abdul Sattar,
DPWO, Naushki; Dr. Shama
Khawaja, Principal, RTI,
Islamabad; Dr. Mehjabeen
Shah, Medical Officer, RHSA Centre, Hyderabad; Mr.
Akramullah Baig, Project
Director, NA; Dr. Naila
Akhtar, Chief Medical
Officer, RHS-A Master
Training Centre, Lahore; and
Mr. Abdul Waheed, Director,
MoPW, Islamabad
UNFPA
36
8.
9.
10.
11.
12.
Event (Venue)
Dates
Funding Source
UNFPA/PPD
Greenstar Social
MarketingPakistan
USAID
UNFPA
UNFPA
37
Field Visits
During 2009-10, monitoring teams of the MoPW visited 14 districts in four provinces: Attock,
Chakwal, Okara, Pakpattan and Rawalpindi in Punjab; Karachi (East), Khairpur, Mtiari, Sukkur,
Thatta and Umarkot in Sindh; Gilgit and Diamir in Gilgit-Baltistan; and Pishin in Balochistan.
Their observations were conveyed to the concerned provinces, so that they could improve
performance, as well as the MoPW.
38
Research Projects
1. Performance Evaluation of Male Mobilizers.
2. Baseline Household Survey of District Chitral.
3. Evolution of Media Campaign of the Population Welfare Programme.
4. Gilgit-Baltistan Demographic and Health Survey.
5. District Population and Development Profile.
6. End-line Survey of the Pakistan Initiative for Mothers and Newborns (PAIMAN).
39
Research Papers
The following research papers were presented by NIPS at the Tenth Annual Population
Conference, organized by the Population Association of Pakistan in 2010.
1. Unintended Pregnancy and Antenatal Care in Pakistan.
2. Maternal Mortality.
3. The Delay in Decision-Making Process and Maternal Mortality.
4. Knowledge of Tuberculosis and its Correlates among Ever Married Women in Pakistan.
5. Media Messages Persuading Couples to Use Contraceptives: An Analysis in the
Backdrop of Socioeconomic Factors.
6. Effects of Birth Interval and Birth Size on Child Survival in Pakistan.
7. Demographic, Social and Economic Factors Influencing the Treatment-Seeking from
Health Facilities for Acute Respiratory Diseases among Pakistani Children: an Insight
into the Pakistan Demographic and Health Survey (PDHS) 2006-07.
8. Correlates of Women Mortality in Pakistan.
9. Prevalence of Traditional Contraceptive Methods in Pakistan.
Other Activities
1. Translation of key findings of the PDHS 2006-07 into Urdu.
2. Revival of news brief.
3. Research studies on Grey Areas/Weaknesses of the Performance Evaluation of Male
Mobilizers and Population Growth and its Implications.
4. Launching of the website.
5. Automation of the library.
6. Training of FCPS/MPH students of Wah Medical College.
Activities in Progress
1. Evaluation of the Regional Training Institutes (RTIs); and contraceptive surgery cases
performed at and family planning services offered by the RHS-B Centres.
2. Pilot study on Islam and Family Planning: Perceptions and Practices in Sialkot and
Chakwal Districts.
3. Study on Existing Status of Population Education at Pre-Service Level in Pakistan.
4. Azad Jammu and Kashmir (AJK) Demographic and Health Survey 2010-11.
Activities Proposed
1. Study on State of Population in Pakistan.
2. Five in-depth research papers on PDHS 2006-07 data.
3. Bi-annual research journal.
4. Evaluation and assessment of quality of care of the Family Welfare Centres (FWCs).
5. Study on Community Response to Deployment of Midwives.
40
H. Special Initiatives
PC-Is of Population Welfare Programme
The PC-Is of the Population Welfare Programme (2010-15) were considered by the Central
Development Working Party (CDWP) on 17 September 2009, wherein it was decided, inter alia,
that a Technical Committee would be set up to review and make pragmatic recommendations
about the future course of the Programme for its effective implementation. A Technical
Committee was set up accordingly by the Planning Commission under the chairpersonship of
Special Advisor to Prime Minister on Social Sector Ms. Shehnaz Wazir Ali.
The first meeting of the Technical Committee was held on 15 March 2010 at the MoPW. The
Committee made recommendations on the Programme and constituted a Core Group
comprising Mr. Muzaffar Mahmood Qureshi (Former Federal Secretary), Dr Zeba A. Sathar
(Country Representative, Population Council), Prof. Dr. Mohammad Nizamuddin (Vice
Chancellor, University of Gujrat) and Mr. Amanullah Khan (Former Senior Chief, Planning
Commission) to ensure that these recommendations were truly reflected in the PC-Is of the
Programme (2010-15).
The last meeting of the Technical Committee was held on 3 May 2010 under the chairpersonship
of Ms. Shahnaz Wazir Ali. The meeting endorsed the PC-Is of the Programme (2010-15) for
submission to the Planning Commission, for seeking approval of the competent forum (CDWP or
ECNEC). The list of PC-Is submitted to the Planning Commission is given in the following table:
Sr. No. Scheme/Project
1.
Federal Activity
5,580.505
2.
300.000
3.
825.000
4.
18,745.605
5.
12,546.016
6.
5,946.458
7.
5,208.098
8.
1116.498
9.
663.103
10.
997.254
11.
378.904
41
42
I.
The Public Sector Development Programme (PSDP) allocation, release and expenditure of the
Population Welfare Programme during 2009-10 are given in the following table:
(Rs. in Million)
Utilization
Allocation
Release
1.
Federal Setup
630.000
423.574
425.561
2.
444.189
234.436
240.043
3.
PWP-Punjab
1,600.000
1,231.400
1,576.855
4.
PWP-Sindh
1,290.000
741.500
895.565
5.
PWP-Khyber Pakhtunkhwa
606.707
413.268
503.801
6.
PWP-Balochistan
500.000
320.000
348.952
7.
New Projects
200.000
61.024
54.443
5,270.896
3,425.202
*4,045.220
Total
* The excess amount was utilized by the provinces out of the unspent balance of previous years withheld by
the concerned Finance Departments.
43