1 .

IN R D C IO TOUT N
Population is central to all development pursuits for improvement of quality of life, but at the

same time, the galloping rate of its growth poses a challenge to the socio-economic development process due to ever increasing consumption needs of additional population. The progress made on the economic front has been neutralized to a considerable extent by inescapable basic need of the burgeoning population. This is amply demonstrated by the fact that population of the area that constitutes Pakistan today has increased from 32.5 million in 1947 to 160 million in 2007, which reflects a five-fold increase in just 60 years time span. The many facets ramification of this are self-evident in the living conditions of the peoples at almost all levels. Pakistan foresaw these far reaching implications of high population rate for the social and economic development undertakings and recognized that prospects for improvements, among other things, depended on volitional fertility moderation measures which lead to the introduction of family planning in the country for voluntary adoption of small family norm. The programme has continued and sustained, with spells of ups and downs along with changes and adjustments in the institutional set-up and

operational strategy, with little effect on population growth rate, total fertility rate and contraceptive use prevalence. The overall strategic thrust of the programme is on:

Reducing population growth rate to 1.3 percent per annum by the year 2020.

Reducing fertility through enhanced voluntary contraceptive adoption to replacement level of 2.1 births per woman by 2020. Having universal access to safe family planning methods by 2010. After the de-federalization of Population Welfare Programme in July, 2002, the Ministry of Population Welfare has retained the mandate of policy planning and programme coordination; information, education and communication (IEC); standardization of service delivery protocols; demographic goals setting; human resource development (clinical & non-clinical training programme and non-programme personnel); seeking foreign assistance and donor support; procurement and warehousing of contraceptives and its distribution; and research, monitoring and evaluation. The provincial governments including AJK, Northern Areas and FATA are implementing the programme, through federal funding, with full administrative and financial autonomy. The provinces also coordinate with various stakeholders at provincial level and monitor field activities for effective implementation of the Programme.

The scope of the Programme has been enlarged to strengthen outreach through enhanced and improved service delivery strategies with particular attention focus on rural under served areas. A broader reproductive health approach pursued with emphasis on mother and child health care while taking into consideration social, religious, ethical and cultural values of the country. Doctors and their clinics have been involved more effectively and net-working with NGOs streamlined and reinforced. Private medical practitioners, private hospitals, nursing homes, hakeems and homeopaths, PLDs and PPSOs are used as catalyst to supplement programme service delivery framework. The information, education and communication campaign has been refined to address focussed target audience with special emphasis on male participation, gender-equity and attitudinal change for adoption. For meeting the un-met demand, the Ministry of Population Welfare supports projects of Private Sector Social Marketing initiatives through donor funding in the country. These projects include Key Social Marketing (KSM) and Green Star Social Marketing Pakistan (GSM) for broadening service delivery base by using commercial distribution network of the private sector for provision of contraceptives in the country.

2.

S R IC D L E Y E V E E IV R

(A) I.

Programme Service Outlets Family Welfare Centre (FWC)

Family Welfare Centre (FWC) is the cornerstone of Pakistan population Welfare programme. It constitutes the most extensive institutional network in the country to promote and deliver family planning services in the urban and rural areas. FWC operates in a rented building and serves as a static facility to about 7,000 people, whereas operating through its satellite clinics and outreach facilities it covers a population of around 12 thousands. The scope of work of the FWC includes provision of family planning, maternal, child health (MCH) services and treatment of minor ailments Post ICPD, the scope of the FWC was expanded to include several elements of Reproductive Health, like Safe motherhood, Infant health care, Management of RTIs / STIs, HIV & AIDS. Currently there are 2712 functioning FWCs in the country, about 60 percent of which are located in the rural areas. Status of FWCs (2006-2007) Province / Sector Punjab Sindh NWFP Balochistan Islamabad AJK NA FATA Total Functions of FWCs. The FWC is entrusted to perform following functions : Family Planning information, counseling, services and follow-up for all family planning methods except implants and contraceptive surgery. MCH services through static facility as well as through satellite clinics. Infant health care including nutritional advice, growth monitoring and treatment of common ailments. Regular health education sessions on topics according to the communitys needs through Mohallah Sangat to create awareness on small family norm, female literacy, human rights and gender equity. Orientation sessions for elected female Councilors on topics such as family planning, population and development, gender equity and status of women in Islam. Availability of contraceptives, medicines, other supplies and maintaining equipment in good working condition. Total No. as of 30th June 2006 1202 490 394 148 27 48 32 32 2373 Target Expansion by 30th June 2007 1400 584 408 160 28 55 55 40 2730 Expansion undertaken in 2006-07 198 94 14 12 1 7 5 8 339 Total number as of 30th June, 2007 1400 584 408 160 28 55 37 40 2712

Referrals of hardcore cases of family planning, infertility, HIV & AIDS and those seeking contraceptive surgery / implants to appropriate facility.

Staffing Pattern : Sl. No. 1. 2. 3. 4. 5. Position FW Worker / FW Counselor FWA (Male) FWA (Female) Female Attendant (Aya) Chowkidar Total BS 9 / 11 5 5 1 1 Number 1 1 1 1 1 5

Following specific measures for up-gradation of Family Welfare Centres have been adopted: Baseline Data of household in catchments area Every centre prepares following baseline data in its area of operation; like Total population No. of eligible couples No. of old and new acceptors (contraceptive methods wise)

Visibilities of Family Welfare Centres are ensured through display of signboards and direction boards at appropriate location with complete addresses indicating the services available in the Family Welfare Centres. Every Family Welfare Centre is provided with adequate IEC material consisting of posters, pamphlets, leaflets and brochures dealing with Know-how of family planning. Training / Orientation Every family welfare worker receives in-service training of two weeks at least every two years. In addition, Deputy District Population Welfare Officer (DDPWO) (Technical) ensures on-job technical guidance through field visits Satellite Clinics The Incharge of each centre holds satellite clinics twice a week in the nearby villages on fixed days. A minimum of 6 camps are held during a month in the identified village where no other service outlet exists. During the camp days, Aya attached to the clinic accompanies the centre Incharge for assistance. Both of them visit the village on public transport and are given fixed TA/DA/conveyance charges @ Rs.400/- to Incharge and Rs.250/- to Aya. Family Welfare Assistant (Male) visits the identified places prior to clinic days to make arrangements for holding the clinics and to carry out motivation and counseling among the eligible couples. He is also given Rs.250/- as fixed TA/DA/conveyance charges for each satellite clinic. Family Welfare Assistant (Female) stays in the centre on the days of satellite clinics to look after the centre and attend to FP clients/patients in the absence of the Centre Inchrge. Male Involvement

Male involvement is vital not only to promote small family norms but also to curb violence against women and raising womens status in family and society. Male participation is enhanced by directly involving the male community leaders, elected representatives and other opinion leaders, seeking their support for Population Welfare Programme. Coordination with other Government Departments and Civil Society Organizations Coordination with line departments and civil society organizations is being strengthened. The Department of Health is specifically involved through LHWs programme. Management Committees at the level of the centre Every Family Welfare Centre has a committee consisting of satisfied clients, wives of local influential, social workers, and teachers etc. to generate community support to improve its working. This had been strengthened as Management Committee of the centre, which includes besides others, LHWs/ LHVs, representatives of NGOs, TBAs, women councilors etc. The involvement of the elected female leadership facilitates institutionalization of greater political commitment and support for activities of the centre. Friends of FWC For enhancing the outreach of service Delivery through Friends of FWC a forum of Friends of FWC had been revitalized comprising the Postal Department, volunteers from National Commission for Human Development (NCHD) of National Volunteer Movement (NVM). Volunteers of National Commission for Human Development (NCHD), National Volunteer Movement (NVM) were also approached through staff of Family Welfare Centre and through satellite camps. The FWA (Male), Male Mobilizer are used as agents to mobilize the support of the said volunteers and supply of Protective contraceptives (condom) through volunteers of NCHD/ NVM. In this Activity of Friends of FWC the value payable parcels (VPP) consisting of condoms and IEC Materials are to be delivered to the Service Providers of eight pilot districts residing in the far flung areas through Pakistan Post Office. After successful implementation of this initiative it will be replicated throughout the country. Monitoring/ Supervision Monthly visits are paid by the District Managers to monitor / supervise the staff of the centre. DDPWO (Technical) provides on the job training during such supervisory visits. Contraceptive Performance (FWC), 2006-2007

Province/ Sector Punjab Sindh NWFP Balochistan Islamabad Pakistan

Condom (Units)
15,260,769 9,096,842 5,184,468 1,417,936 266,441 31,226,456

Oral Pill (Cycles)

681,567 410,858 343,427 90,878 14,791 1,541,521

IUD (Insertions)
428,016 143,888 98,050 11,959 4,383 686,296

Injectable (Vials)
453,8 10 320,2 18 303,3 39 28,8 50 8,9 32 1,115,1 49

Couple Years of Protection (CYP)

1,740,233 658,215 462,741 63,532 19,963 2,944,684

FWC

Reproductive Health Services (RHS) Centres Reproductive Health Services (RHS) are one of the major clinical components of the overall Population Welfare Program with its hospital based service outlets (RHS A-Centres) in teaching hospitals, major hospitals of big cities, all DHQ and selected THQ hospitals. Facilities for Contraceptive Surgery (CS) alongwith full range of contraceptives i.e. IUCDs, Injectables, condoms, oral pills, Norplant (in selected RHS A-Centre) etc. are available to FP clients. There are 2 categories of Reproductive Health Services (RHS) Centres as under:RHS A-Centres RHS B-Centres RHS-A Centres The Reproductive Health Services (RHS) A-Centres are hospital-based service delivery units established by the Ministry of Population Welfare. The RHS A-Centres provide full range of services identified in the National RH Services Package comprising comprehensive Family Planning (FP) services including Contraceptive surgery (CS) facilities for female & male as out-door procedure with safe & effective back-up medical support and long-term client follow-up, Mother & Child Health (MCH) care, prevention & management of RTIs/ STDs and HIV/AIDS, counseling and referral for adolescent/ youth, management of RH problems of elderly women, referral for mens problems clients education for early detection of Cancer in breast & uterus, and couple counseling & referral for treatment of infertility. These Centres play a vital role in raising awareness on public health issues, personal hygiene and nutrition & breastfeeding during reproductive age and preventive Gynae. /Obstetric facilities. These services would contribute to reduction in fertility. Further, the RHS A-Centres provide treatment for minor/ general aliments, especially to the women & children.

Status of RHS A-Centres (2006-07)

Province/Sector Punjab Sindh NWFP Balochistan Islamabad AJK FATA NAs Total Function of RHS A-Centres RHS A-Centre performs the following major functions:RH & Family Planning including CS at Static Centre: RHS A-Centers provide motivation, counseling and education for family planning clients alongwith full range of contraceptive services with special emphasis on contraceptive surgery. In addition to this, Number of Centres 54 47 20 08 03 15 02 03 152

facilities for training HIV/AIDS as well as management of STIs/ RTIs cases are offered at RHS ACentres. The Centres provide MCH services, also. Extension Service Camps All RHS A-Centres hold extension camps/ activity for provision of contraceptive services including CS, nearest to the clients door steps. Camps are arranged at THQ hospitals/RHC, with operation theatre facilities for provision of Contraceptive surgery services. Vasectomy Services To enhance the male participation by creating awareness on FP/ RH issues and motivation with special focus on provision of vasectomy services, preferably by Non-Scalpel Vasectomy (NSV), training of male doctors from M/o PW, MoH and NGOs is imparted in vasectomy procedure. Efforts are being made for provision of vasectomy services at most of the RHS A-Centres, as an innovative project for Reproductive Health Services for adolescent and men which is being processed at Mo PW. Norplant Services Since 1997 Norplant has been added into the available contraceptive mix after successful trial by the National Research Institute of Fertility Care (NRIFC). RHS Master Training Centres Out of the existing 130 RHS A-Centres, 14 Centres located in the teaching hospital and with highest contraceptive surgery performance, have been upgraded to RHS Training Centres, including 3 Master RHS Training Centres for ensuring availability of trained medical/ paramedical staff to manage/ provide quality reproductive health services in the program. To achieve this objective, the Master Training/ Training Centres are provided with additional staff and logistics. Functions of RHS Master/ Training Centers Training (basic/refresher) of program and non-program doctors including those form NGOs, Target Group Institutions (TGIs) and Provincial Line Departments (PLD) in contraceptive surgical techniques, counseling, interpersonal communication, Norplant insertion/ removal techniques, asepsis, MIS and for provision of Comprehensive RHS Package, Identification of difficult surgical cases and to be able to deal with surgical problems, assessment and diagnosis of abnormal obstetric/ gynecological problems and diagnosis/ management of infertility cases. Training (basic/fresher) of Program/ non-program paramedics in operation theatre

management and other techniques with particular emphasis on asepsis/ infection prevention. Development of training curricula, strategy, methodology and annual training plan for all

the above mentioned training activities, after approval from the M/O PW, also be responsible for undertaking all training activities as planned. Undertake FP/Health education programs at educational institutions and PLDs.

Hold orientation workshops for doctors and paramedics for all categories to update

knowledge of what is available for the clients in the way of contraceptive services. Responsible for providing on the job technical monitoring/supervision and

guidance/assistance for strengthening the institutional set up of RHS Centres and improvement in the quality of services provision. M.O. Incharge form each RHS Training Centre will undertake four supervisory visits (of 3

days duration) every year. During each visit a minimum of 4 RHS A-Centres will be covered for technical guidance and support. Contraceptive Performance (RHS-A), 2006-2007

Province/ Sector Punjab Sindh NWFP Balochistan Islamabad Pakistan

Condom (Units)
530, 467 353, 221 273, 249 63, 175 55, 651 1,275, 763

Oral Pill (Cycles)

41,398 38,631 22,873 4,697 3,249 110,848

IUD (Insertions)
31,648 12,241 9,222 2,080 1,180 56,371

Injectable (Vials)
34,101 40,727 29,792 4,330 2,404 111,354

CS Cases
69,175 30,066 4,482 1,657 1,598 106,978

Couple Years of Protection (CYP)

988,719 431,842 97,683 29,610 25,189 1,573,044

RHS - A

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Enhancement of Institutional Re-imbursement Cost (IRC) Enhancement of IRC rates for RHS A&B Centres was discussed with detailed break-up with Chief (P&SP Section), P&D Division during a meeting chaired by Secretary, MoPW on 17th January, 2007. The draft of above meeting was shared with Chief P&D Division on 9th and 10th February, 2007 After series of meetings in this regard & Notification of revised Institutional Reimbursement Cost (IRC) was issued separately for RHS A&B Centres on 17th February, 2007 as per following details:RHS-A Centres TUBECTOMY Static Existing Rates 700 Revised Rates 1060 Extension Camps Existing Rates 750 Revised Rates 1100 Existing Rates 920 Static Revised Rates 1550 VASECTOMY Extension Camps Existing Rates 920 Revised Rates 1550

RHS-B Centres TUBECTOMY Existing Rates 850 Static Revised Rates 1400 Extension Camps Existing Revised Rates Rates 750 1550 Existing Rates 920 VASECTOMY Static Revised Rates 1550 Extension Camps Existing Revised Rates Rates 920 1550

III.

Mobile Service Unit (MSU) Mobile Service Units is a flagship of the Ministry of Population Welfare which provides quality

package of Reproductive Health and Family Health Services to the Population of remote villages and hamlets where no other health facilities are available. The MSU comprises a mini clinic operating from specially designed vehicles with all facilities of a mini clinic ensuring complete privacy for simple gynecological procedures. Furthermore, it carries within it tents that can be unfolded to provide rooms for OPD purposes as well as waiting staff. The idea behind each MSU is that the remote rural population without access to health facilities are provided health coverage focusing on RH in such a manner that each village or community is visited on a rotation basis at least once a month. This done by each MSU by conducting 2-3 camps each week in such a manner that they return after one month to every village. Each MSU has one Woman Medical Officer and three support staff. The component was initiated during the 7th Five-year plan to increase the availability of Family Planning Services in rural-underserved areas. Each MSU provides services to a population of 30,000 (about 5,000 couples) in 15-20 villages. Annual 10-12 camps are held to offer FP/ MCH services in the remote-underserved areas. Its main functions are: To make Family Planning information and services accessible in underserved/ un-served rural communities. To reduce the unmet need of Family Planning by making services more accessible, particularly the clinical methods including IUD and Injectables. To provide RH including curative service to women and children. To facilitate the work of Male Mobilizers with regard to enhancing mens role and responsibilities.

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 To muster local support for programme through interacting with elected councilors and other opinion leaders and promoting better understanding and need for reproductive health care. UNFPA-MSU Project-Pak-01/P03 UNFPA-MSU Project PAK-01/P03 started under UNFPA Sixth Country Programme continued in 10 selected districts (02 in each province including AJK) during the financial year 2003-2004. This project will continue during 7th Country Programme (2004-2008) of UNFPA. The MSUs of these 10 target districts are being upgraded in terms of logistic support, training of staff, supervisory role of MSUs and community involvement. Number of Mobile Service Units Sr. # 1. 2. 3. 4. 5. 6. 7. 8. Location Punjab Sindh NWFP Balochistan AJK FATA NAs IBD Total Bench Mark (with old Vehicle) 70 34 19 22 02 01 148 Additional MSUs (with new vehicles) 115 64 28 53 05 07 03 275 Total 185 98 47 75 07 07 03 01 423

MSU Incharge is trained in clients oriented friendly behavior. The staffs have the basic training and receive periodic refreshers to update their knowledge. A training manual on specified/ identified modules (such as planning, supervision and monitoring, community participation/ ownership, skill development for contraceptive management, follow up system, financial procedure, quality of care, logistic management) coupled with training guide/ plan has been developed. Each MSU is manned by following strength: Sr. # 1. 2. 3. 4. Position Women Medical Officer Family Welfare Counsellor Driver Female Attendant (Aya) Total BPS 17 11 04 01 Number 01 01 01 01 04

The expansion Plan (Naitona-wide) of MSU Component for the next five year plan would be as under: Mobile Service Units (MSU) 2008-2009 434 2009-2010 800 2010-2011 810 2011-2012 820 2012-2013 830

Contraceptive Performance (MSUs), 2006-2007 Province/ Sector Punjab Sindh NWFP Balochistan Islamabad Pakistan Condom (Units)
659,994 654,275 222,200 265,753 7,128 1,809,350

Oral Pill (Cycles)

43,409 33,026 18,229 16,047 383 111,094

IUD (Insertions)
53,582 16,129 7,212 4,700 501 82,124

Injectable (Vials)
53,780 27,148 22,052 11,384 388 114,752

Couple Years of Protection (CYP)

205,770 68,626 32,411 21,642 1,906 330,356

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MSU

13

IV.

Male Mobilizer Cadre

Family Planning Programme of Pakistan has a long history and is replete with both success stories as well as failures. Many lessons have been learnt from this long standing and rich experience. The most important of which is that lack of male targeted activities with subsequent poor male participation is the missing link in the Population Welfare Programme efforts. In order to rectify this omission, the programme introduced Male Village Based Family Planning Workers Project on a pilot basis in 25 districts of the country in the later half of 1998, with the following objectives: Objectives norm. Selection Criteria Should be a local resident of the Union Council, within the age group 25-40 years. Married with not more than 3 children. Graduate, intermediate where graduate candidates are not available. Should be willing to hold group meetings at previously identified contact points and to Strengthen the family as the social unit of society through responsible parenthood. Help women and men to communicate about their family roles and responsibilities. Reduce gender inequality and abuse of women & girls. Increase the male acceptance of family planning and use of male contraceptive methods. Support social change in the patriarchal super-ordination of men and create the small family

install a signboard (depicting his position, logo of the program and name of the department) outside his residence in order to facilitate visibility, identification and contact by the programme officials and the community. Recently the Population Welfare Programme has undertaken programme review of Male Mobilizer Cadre. Certain inputs have been added with renewed objectives. The salary of the Male Mobilizers has also been enhanced from Rs. 3000/- p.m. to Rs.4000/- p.m. These workers will be placed at each union council level. The current number of 3435 Male Mobilizers will be increased to 6272 by the end of current five-year plan (2003-2008). Status of Male Mobilizers, 2006-2007 Province/ Sector Punjab Sindh NWFP Balochistan Islamabad AJK N.As / FATA Total: Bench mark as of 30th June 2006 1947 332 441 550 25 120 20 3435 Expansion undertaken in 2006-07 313 350 27 8 62 760 Total number as of 30th June, 2007 2260 682 468 550 33 120 82 4195

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Contraceptive Performance (Male Mobilizer) Province/ Sector Punjab Sindh NWFP Balochistan Islamabad Pakistan Condom (Units)
6,419,223 1,489,559 2,952,245 590,102 56,349 11,507,478

Oral Pill (Cycles)

233,549 72,899 176,568 49,001 216 532,233

IUD Injectable Couple Years of (Insertions) (Vials) Protection (CYP)

49 49 379 379 60,148 15,451 32,273 7,365 406 115,643

(B)
I.

Non-Programme Services Outlets.

RHS-B Centres (I32 Centres) Hospital of Provincial Line Departments (PLDs) including Health, NGOs and private sector with

operation theatre facilities interested in performing contraceptive surgery are registered as RHS BCentres and provide fee per case basis for provision of CS services, in addition to contraceptive surgery counseling and complete range of family planning methods are also provided. Hospitals registered as RHS B-Centres are provided training in contraceptive surgery for their doctors and paramedics at the RHS Training Centres. Quality of services is ensured through periodic supervisory visits by Senior Doctors from RHS Training Centres. Province-wise total number of registered Hospitals/ Clinics as RHS B & the number of functional Centres is as follows:Province wise break up of RHS B-Centres Registered Functional 66 31 30 22 28 06 03 03 08 06 135 65

Province Punjab Sindh NWFP Balochistan Islamabad AJK FATA NA Total

Contraceptive Performance (RHS-B), 2006-2007 Province/ Sector Punjab Sindh NWFP Balochistan Islamabad Pakistan Condom (units)
3 ,057 2 ,361 2 ,658 144 15 ,756 23 ,976

Oral pill (cycles)

750 158 2, 061 21 470 3, 460

IUD (insertions)
1,094 32 424 14 176 1,740

Injectable (vials)
1,6 59 4 06 3,0 28 43 3 10 5,4 46

CS (cases)
35,295 12,846 2,025 412 379 50,957

Couple Years of Protection (CYP)

445,420 160,795 27,558 5,210 5,556 644,539

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RHS B

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II.

Registered Medical Practitioners (RMPs) & Hakeems / Homeopaths Registered Medical Practitioners (RMPs) Component The Registered Medical Practitioners (RMPs) being an important source of health care provision

in both the urban and rural areas of the country has vast potential for promotion of family planning services. Those RMPs who are interested in promotion of small family norm through their clinics have been involved and the enlistment continued both in major cities and smaller towns. There are 26080 RMPs registered with Population Welfare Programme on the criteria that they have their own clinics with operation theatre facilities or without operation theatre facility. They are identified by Tehsil Population Welfare Officers in their respective areas. Province wise break up of RMPs as on 30-06-2007 is as under: Province/Sector Punjab Sindh NWFP Balochistan Islamabad AJK FATA NAs Total Contraceptive Performance (RMPs) Category of Service outlets / province Punjab Sindh NWFP Balochistan Islamabad Pakistan Condom (units)
489,205 448,673 91,561 181,958 86,820 1,298,217

NumberoRMPs 13,100 8,060 3,455 1,150 115 150 75 50 26,080

Oral pill (cycles)

29,998 34,084 8,456 11,383 5,393 89,314

IUD Injectable (insertions) (vials)

41,056 2,951 1,094 2,713 47,814 45 ,344 22 ,576 24 ,930 2 ,105 7 ,560 102 ,515

Couple Years of Protection (CYP)

158,162 20,232 10,015 2,443 11,970 202,822

Hakeems / Homoeopaths Hakeems and Homoeopaths are influential groups in the society. Acknowledging their important position and linkage with the community, they have been involved in the Programme for provision of family planning information and services with an understanding that they would enhance the coverage for Family Planning as well as provide mother and child health (MCH) services. However, their involvement was not encouraging due to many factors. In order to overcome some of the shortcomings, it was decided in the 9th plan that only those Hakeems and Homeopaths would be involved who were interested in promotion of small family norm through their clinics.

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Presently, there is a need to review the input versus output of the component and to suggest remedial measures. In this regard, necessary guidelines have been developed to strengthen the component. The major areas of concern are: i. ii. iii. iv. v. vi. vii. Training of Hakeems and Homoeopaths in counseling skills 1-2 day orientation training of Hakeems and Homoeopaths 3-days Training of MoPW & PWDs Programme Managers on Management & Supervision of Hakeems and Homoeopaths project Training Incentives Supply of IEC Material Provision of neon sign boards Supply of condoms.

Contraceptive Performance ((H&H) Province / Sector Condom (Unit)

329,2 14 148,8 20 41,0 74 5,1 25 524,2 33

Oral Pill (Cycles)

14,2 09 11,6 68 4,4 94 5 90 30,9 61

IUD (Insertions )
45 38

Injectable (Vials)
10 666 676

Couple Year of Protection (CYP)

3,235 2,102 585 75 5,997

Punjab Sindh NWFP Balochistan Pakistan III.

Provincial Line Departments (PLD) The Health Outlets of Provincial Line Departments (PLDs) have been involved in the Population

Welfare Programme for provision of services in order to improve access and expand coverage of facilities for promotion of family planning. The staff of the identified and involved outlets have been provided specific as well as refresher training on the management of family planning services, given IEC material, necessary equipment and linked to the logistic and distribution system of the Programme for supply of contraceptives / replenishment. Currently, there are around 7000 outlets of Provincial Line Departments that have been enlisted for dispensation of services. Most of these are the Health Outlets while less than 5% are owned by other PLDs such as Labour, Social Welfare, Local Government and Frontier Constabulary in Balochistan. Following inputs and services are offered by this component: i. days). ii. iii. iv. v. Training of WMOs in minilap technique at RHS-A Centers. Provision of IUD kits to female staff. Signboard to service outlets. Contraceptives. Training of doctors and paramedics in FP at RTIs (Doctors 6 days, Paramedics 12

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vi.

One day orientation workshop at Divisional Headquarters. These outlets provide FP information and services to clients who attend BHUs, RHCs, MCH

Centers and Dispensaries of different Provincial Line Departments e.g. Social Welfare, local bodies and Frontier Constabulary in Balochistan.

Contraceptive Performance ((PLDs), 2006-2007 Province / Sector Condom (Unit)

68,3 31 23,7 67 20,1 24 1,1 32 11,5 02

Oral Pill (Cycles)

5,0 16 1,6 04 2,2 86 5 51 7 65

IUD (Insertions )
32,541 84 227 52 424

Injectable (Vials)
40 ,851 1 ,292 2 ,826 46 2 ,405

Couple Year of Protection (CYP)

122,873 824 1,652 236 2,096

Punjab Sindh NWFP Balochistan Islamabad IV

Social Marketing of Contraceptives (SMC) Public-private partnership in family planning is promoted through social marketing approach,

whereby resources and expertise of the private sector are used to advance the social goal of making family information and services available more widely. The approach applies marketing techniques and involve the existing commercial distribution network to dispense contraceptive products at subsidized rates. Social marketing programme is executed by two private sector firms under independent logos of Key and Greenstar in urban and peri-urban areas of the country. The activities are built around two models termed as branded and manufacturer models. The distinction is that in the branded model contraceptives are procured, branded and dispensed at subsidized rates. For the manufacturers model, contraceptives are not procured, rather an agreement is reached with the pharmaceutical firm(s) to manufacture, pack and distribute the products at agreed retail price. In return, the firm is supported by way of advertisement, promotional activities and training, thereby providing a ready-made market for the product. This model also included provision for local manufacturing component, which is supported by quality assurance technical assistance. Nevertheless, in both the models common elements, which operate as linchpin for the social marketing programme, are advertisement, training and use of existing private sector network for dispensation of products. Social marketing supplement the efforts of population welfare programme in the dispensation of contraceptives through the private providers with the involvement of commercial distribution network and retailers. The projects are funded outside PSDP with grant foreign assistance. The principal activities undertaken during 2006-2007 included training, comprehensive promotional campaign and dispensation of contraceptives. These are summarized below:-

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Training SMP and KSM have trained and given orientations to 2514 doctors (male/female), and 3322 paramedics/LHVs during the year. The products, were provided through a net work of 53000 retail outlets (for condoms) and for all methods through 22090 doctors 14,556 paramedics and Chemists/druggists) etc. Promotional Activities SMP & KSM have undertaken a variety of promotional activities through mass media. Seminars were held and IPC activities under taken at community and household levels. Print material was produced and distributed, messages were transmitted through Magazine, Press sessions held on special occasion and outdoor publicity billboard installed at important points. Special sale promotion seminars organized and point of sale publicity material distributed. These activities were reinforced and followed-up by work place intervention in industrial establishments, through mohallah group meetings, Mohallah Sangat programme and Clinics Saholat, which reinforced interface and discussions amongst providers and clients at community level for promotion of child spacing and quality services though franchise network. The mass media campaign has been termed as innovative in family planning business by the USAID-sponsored Midterm Assessment of the Social Marketing Program undertaken in 2006. Some specific activities carried out during the period under review included:-

Over 962 female providers attended family planning basic workshops in 24 towns in 19 districts which included 191 doctors and 771 LHVs/Midwives.

A dissemination seminar was organized by Constella Futures in February, 2007 to share findings from the study Ulemas views on family planning with policy makers and stake holders. The Honorable Minister, MOPW was the Chief Guest, while the discussion was chaired by the Secretary MOPW. panel

A study was conducted on Mohalla Sangat , which revealed that had a definitive impact in improving attitudes; decreasing fears about family planning and modern contraceptive methods; increasing awareness; increasing inter-spousal communication; and contributing to increasing use and continuation of modern methods

Under the guidance of Ministry of Population Welfare, KSM helped sponsor a major public private sector event, which resulted in signing of a number of MOUs between the MOPW and private sector industries in order to strengthen private sector contribution to the national population welfare program. The Honorable Prime Minister, Mr Shaukat Aziz was the Chief Guest on the occasion.

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Over 50,000 family planning audio cassettes were supplied to the provinces for distribution through Family Welfare Centers and other public sector programs. These cassettes contained of information on various contraceptive methods, which was dubbed in three different languages namely, Urdu, Pushto and Seraiki.

Social Marketing Program included a number of innovative public-private partnerships that has involved over the last few years to expand the impact of its programs. Greenstar being a large Private Sector Partner of the Ministry of Population Welfare is the first and only Pakistani Health NGO to have at signed an MOU with the Ministry of Healths National Program for Family Planning and Primary Health Care (LHW Program).

A pilot operation of two Family Welfare Centers of the Population Welfare Department (PWD) of Punjab arranged to gain in sight and understanding of management aspects.

Distribution of condoms through the GOPs Utility Stores was introduced Referrals by LHWs to Greenstar franchise providers for VSC and other services was specifically targeted.

In partnership with the Ministry of Railways, Greenstar products are promoted through kiosks at railway stations.

Discussions have been initiated with some industrial companies both in rural and urban areas to forge partnership around provision of family planning services and products through work site clinics. Facilitation and support by MoPW.

o The MoPW has constituted a Steering Committee to facilitate the SMC

activities in the country. The Committee had reviewed the progress on quarterly basis Plan. o MoPW endorsed 171 exemptions for local procured consignments to support on going operations and extended guidance for incorporation in the respective Annual Work

o Acted as a focal for meeting with EAD relating to Mid Term Review of
performance of SMC project funded by USAID, DFID and UNFPA.

o Coordinated and consolidated the performance data for reflection in the

Monthly, quarterly and annual progress reports of the Ministry. o Social Marketing has added Intense, Happy Life, Sparke, condom in the market during the period under review. Additional Assistance/Support for SMP

21

o Mid Term Assessment of Social Marketing Programme (2003-2008) under taken by USAID Team has reviewed and the Ministry endorsed their recommendations continued support to Social Marketing. o Agreement for KFW assistance about RH in NWFP for Euro 6.135 million has been signed and the project has entered the implementation phase January 2007.

o USAID assistance award for US $ 60 million has been given to Population

Council, with the Social Marketing Programme to be implementation by the existing firm as the sub-awardees. The implementation frame time is 2007-2012. o Greenstar has formulated its five year strategic Plan covering the targets and objective was alongwith a financial, projections. This has been agreed to in principle by the Ministry and EAD requested to explore donors to meet the requirement to sustain Social Marketing operations till 2012. Sale of contraceptives/products The social marketing activities have contributed to distribution/sale of following contraceptive products during 2006-2007. Method/Products Condoms (units) Oral pill (cycles) Injectable (Vials) IUD (units) CS (cases) Couple Year of Protection (CYP) V. Performance (in million) 114,147,439 6,261,345 1,279,396 272,584 23,477 2,713,499

Public Private Sector Organizations (PPSOs)/ Target Group Institutions (TGIs) PPSOs is a component of ADB-RH project since 2005. Major thrust of the initiative is to forge

partnership with formal public and private corporate sector organization. The implementation of this component in the past has contributed to establish family planning facilities and a special focus on male involvement for arousing the male sense of responsible parenthood as well as prevailing concern for the family health. The component has vast potential as it involve both public and private sector institutions with renewed emphasis and innovative approach for awareness raising, motivation and extending FP/RH services. A seminar on Leadership Initiative on Public and Private Sector Collaboration in Reproductive Health and Family Planning was held on 13 January, 2007 to highlight the importance of public-private organization and their collaboration for achieving shared goals. The Prime Minister of Pakistan graced the occasion and 91 MOUs were signed for the provision of Family Planning and Reproductive Health. Objectives: 1. Reduce Total Fertility Rate 2.1 by 2020. 2. Increase Contraceptive Prevalence Rate to 64 percent by 2020. 3. Reduce Population Growth Rate to 1.3 by 2020.

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Strategies: A three pronged strategic thrust has been worked out, i.e. (i) (ii) (iii) Capacity Building through orientation and training Service Delivery Advocacy/Information Education and Communication. The salient features of this intervention are:-

i. Institutional Sustainability through Capacity Building:

Under sustainability, efforts are made to: o o

Sustaining social sector

Programmes is difficult and is therefore recognized as an important feature of the project.

Internalize activities in the set up and infrastructure of the selected institutions. Impart orientation and training to personnel at all levels including key trainers

so that activities are integrated into their process and system.

ii.Cost Effectiveness: The selected institutions have a well established health and social
infrastructure where reproductive health and family planning programme can be integrated into the system with good planning, high commitment and perseverance. The intervention therefore requires very little extra cost for personnel, venues, facilities, administration or other overheads. With this important feature it seems to be one of the most cost effective undertakings.

iii. Role Model: The partnership between MoPW and PPSOs is an important initiative not
only because of the expected outcome itself, but also for its far reaching effects since the experience gained could be gainfully replicated in other male intensive organizations.

iv. Spin off Effect: Capacity building of the service providers and making use of the existing
infrastructure of the PPSOs benefit the families and dependants of the work force of respective departments. Major Activities: The major activities include the following: Capacity Building through Orientation and Training; The philosophy of the project revolves around the concept of capacity building of the selected PPSOs using their existing infrastructure leading to institutional sustainability. Orientation sessions have conducted for Board members, senior management and for doctors on FP/RH issues. Technical training in clinical and surgical contraceptives has also been arranged for doctors and paramedics. Orientation with cadres who have close interaction with shopkeepers, trade union members and religious leaders in the respective departments have held for

23

motivation purposes. The direct beneficiaries in turn reach out to a large number of indirect beneficiaries with a spin off effect. PPSO has conducted the trainings of doctors and paramedics, and orientation courses for employees and mid level manager on regular basis. Participatory workshops are organized by involving key stakeholders including the PPSOs, PWDs, Donor Agencies supporting the project and NGOs working in the area to share the experience for improvement.

Achievements The following achievements have been made during the year 2006-2007. i. ii. iii. iv. No. of follow-up meetings between MoPW with Stake holders of Public Private Sector Organizations No. of Presentation made to the mid/top level Management of PPSOs Capacity Building of Medics, Doctors, Gynecologists Orientation/Training of Paramedics 17 14 96 225

Capacity Building of Medics, Doctors, Gynecologists and orientation/Training of Paramedics held in different cities i.e. Lahore Karachi, Multan, and Hydrabad. The technical training mostly held through the RTIs and RHS Training Centers of the Programme. For the specialized community interventions like involving religious leaders and youth, the activities are outsourced, wherever required. Service Delivery: PPSO provide FP/RH services using its medical and social infrastructure through the District Population Offices and provide contraceptives on need basis. The non-clinical contraceptives are placed in the shops of the residential colonies for easy accessibility. The following achievements have been made during the year 2006-2007. i. ii. iii. iv. No. of organizations in the fold of partners with MoPW No. of FWCs/RHS-B Established No. of FWC/RHS-B to be established (in pipe line) Establishment of Family Planning Counters/Kiosks (Under process with Provinces) 113 90 39 10

Advocacy/Information, Education and Communication; Advocacy campaign has been executed to emphasize promotion of birth spacing for the health and well being of workers and their families. The project also target young people and religious leaders in the respective organizations with the object of promoting responsible parenthood that help to invest time and resources of young people and remove myths and misconception about family planning. The development of relevant IEC material with right message for dissemination amongst the respective population is strongly needed. Hence accurate and relevant information on FP/RH issues are disseminated using the social and medical infrastructures of the PPSO.

24

Private & Public Sector Partners: The list of current Public & Private Sector Partners is as under: 1. CUP Community uplift Programme, Islamabad

2. Action Aid NGO, Islamabad.

3. Shelter, Islamabad

4. Tehzeeb Enterprises, Rawalpindi.

5. 6. 7. 8. Family Health International, Islamabad World Population Foundation, Islamabad MCH Centre, Islamabad. Hasna Welfare, Rawalpindi

9. Insaniat Welfare Trust, Girja Road, Rawalpindi.

10. Mari Stopes society, Rawalpindi 11. Social Welfare Society, Rawalpindi 12. Behbud Association of Pakistan, Rawalpindi 13. Land Mark International, Rawalpindi

14. Aahung NGO, Clifton, Karachi

15. Women Welfare Organization, Poonch, AJK

16. Good Life, Green Star Social Marketing, Islamabad.

17. Al-Qaim, Rawalpindi 18. Army Welfare Trust, Islamabad 19. Pakistan German Business Forum, Karachi 20. Sahara Hospital, Narawal

21. D. Watson Chemist, Islamabad.

22. M/s Leads Pharmaceutical Pvt., Islamabad 23. Medi Pak Group of Companies, Lahore 24. M/s Bayer Pakistan Ltd. Karachi 25. Pakistan chemist and Drugist Association, Karachi 26. Organon Pvt. Ltd. Karachi

27. Zafa Pharmaceutical, Laboratories Pvt. Ltd., Karachi.

28. Sarhad Board & Chemicals Pvt. Ltd. Peshawar 29. Pakistan Readymade Garments & Exporters Association (PRGMEA),Faisalabad

30. All Pakistan Bed sheets & pholstery Manufactures Association, Multan.
31. Leather Field (Pvt), Sialkot 32. Abdullah Leather, Sialkot 33. K.R.L., Islamabad

34. Social Security Hospital, Islamabad.

35. NTISB, Islamabad

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36. Ameen Medical Centre, Rawalpindi 37. Pakistan Medical Association, Rawalpindi 38. Bilal Foundation(Bilal Hospital), Rawalpindi 39. Shajar Welfare Society/Qureshi Hospital, Sahiwal 40. H.M.C. Taxila 41. Talon Sports Pvt. Ltd, Sialkot 42. Baglay Sports Pvt. Ltd., Sialkot 43. Ali Trading Co Pvt. Ltd, Sialkot 44. Zaman Sons Industry, Jhelum 45. Royal and Sarhad Textile Mills, Swabi 46. All Pakistan Textile Mills Association (APTMA) 47. Nishat Mills, Faisalabad 48. Tribal Textile Mills Ltd. Bacha Road, D.I. Khan 49. Fazal Kareem Textile Mills, Mirpur, AJK

50. Pak. Veterniary Medical Council, Islamabad.

51. Sui Gas Islamabad 52. Capital Food Industries, Islamabad 53. Al-Saleem Flour Mills, Jhelum 54. Coronet Foods Pvt. Ltd, Haripur 55. Metro Fan, Gujrat 56. Haier Pakistan Pvt. Ltd, Lahore 57. Kashmir Electric Industry, Jhelum 58. Pakistan Electronics Association 59. Azad Group of Companies 60. Naeedero Sugar Mills, Larkana 61. Chashma Sugar Mills, University Road, D.I. Khan

62. Gujrat Chamber of Commerce & Industry, Gujrat.

63. Karachi Chamber of Commerce & Industry, Karachi

64. Sahiwal Chamber of Commerce and Industry, Sahiwal 65. Shikarpur Chamber of Commerce and Industry, Shikarpur 66. Mirpur Khas Chamber of commerce & Industry, Mirpur Khas.
67. Lakson Tobacco Co. Islamilia, Swabi

68. Pakistan Tobacco Co. Ltd, Islamabad.

69. Sargodha University, Sargodha 70. Muhammad Medical College, Mirpur Khas 71. Popular Marble Industry, Jhelum 72. Al-Noor Plaster of Paris, Jhelum 73. P.I.A. 74. Pakistan Petroleum Ltd., Karachi 75. Towel Manufactures Association of Pakistan, Karachi

26

76. Pakistan Mining & Exploration Inc., Chitral 77. Olympic Socks, Haripur 78. Pak. ARAB Fertilizer, Pvt. Ltd. Khanewal Road, Multan 79. Ministry of Labour & Social Security, Islamabad 80. WAPDA, Lahore 81. Pakistan Mineral Development Corporation (PMDC), Islamabad 82. Utility Store Corporation, Islamabad 83. Allied Engineering, Jhelum 84. Fine Engineering Works, Jhelum 85. Medical Engineering Pvt. Sialkot 86. Hilbro Pvt. Ltd., Sialkot 87. Towny Brother Pvt. Ltd., Sialkot 88. Industrial Association, Peshawar 89. CSD, Rawalpindi

90. Task Force on Trade & Industry, Lahore.

91. SKMCH Sheikhupura

92. TAGMA Pharma, Lahore.

93. Social Security, Gujrat 94. University of Gujrat

95. National Council of Homeopathic, Gujrat. 96. Young Fellow Line Club, Gujrat 97. Service Textile Industry, Gujrat 98. Service Academy, Gujrat 99. Service Shoe, Gujrat
100.Barbar Association, Gujrat 101.Tehsil Municipal Corporation, Gujrat 102.Labour Welfare Society, Gujrat 103.Agricultural Association, Gujrat 104.Rural Welfare Society, Gujrat 105.National Furniture, Gujrat 106.Post Office, Gujrat 107.State Life Insurance, Gujrat 108.Blood Donor, Gujrat 109.EFU, Gujrat 110.PBKLU, Gujrat 111.Supra Welfare, Gujrat 112.Save Liver, Gujrat 113.EDO, Health, Gujrat Established Centers under PPSOs

27

The list of Centres established under PPSOs is as under: Islamabad 1. PNS Hafeez, Islamabad

Province Of Punjab 1. 2. 3. Combined Military Hospital Lahore Combined Military Hospital, Chunian Pakistan Army, Medical Reception Centre 114 Brigade, Lahore

4. Pak Army, Troop Family Welfare Centre52 Brigade, Lahore.

5. 6. 7. 8. 9. Double Dispensary (DD-3), POF Wah Double Dispensary(DD-4), POF Wah Double Dispensary(DD-5), POF Wah Railway Dispensary, Raiwind Railway dispensary, Transit Cantt, Rawalpindi

10. Carriage Factory, Rawalpindi 11. Railway Dispensary, Raiwind 12. Railway Dispensary Gujranwala 13. Railway Dispensary Wazirabad 14. Cairns Hospital, Lahore 15. Alya Sultana CWC, Lahore 16. WAPDA Hospital, Lahore 17. Pakistan Railway Hospital, Pakpattan 18. Cairns Hospital Railway Head Quarter, Lahore 19. Transit Camp Rawalpindi, Pak Railways 20. PESSI Hospital Islamabad 21. Cantonment General Hospital, Rawalpindi 22. Arafat Medical Cenetre, Kahuta 23. PESSI Hospital Islamabad 24. Izzat Ali Shah, POF Wah 25. CMH Murree 26. Sahara Trust/Sughra Shafi Hospital, Narowal 27. CWC Army Centre Walton Road, Lahore 28. PAF Hospital Lahore 29. Troops Family Welfare Centre, Tufail Road Lahore 30. Mehfooz Shaheed Garison Lahore 31. Mayo Hospital Lahore 32. Munshi Hospital Lahore 33. Nawaz Shareef Hospital Lahore 34. Social Security Hospital Multan Road, Lahore 35. UnitedChristian Hospiatal, Gulberg, Lahore

28

36. Ahbab Hospiatal, Ravi Road, Lahore 37. Khamini Hospital, Mochi Gate, Lahore 38. Packages Factory, Lahore 39. Gulshan-e-Ravi, Bu-Ali-Sena Hospital, Lahore 40. Railway Dispensary Alia Sultana, Lahore 41. Garrison Health Centre, Shami Road, Lahore 42. Garrison Health Centre, Munir Road Lahore Province of Sindh 1. 2. 3. 4. 5. 6. 7. 8. 9. PAF Base Masroor Family Wing, Karachi APSMA,Village Tando Iqbal Tehsil Malti,District Badin Malir Cantt, Pak. Army, Karachi PAF, PAF Base Faisal, Karachi Military Lines Area 602 Workshop, Pakistan Army, Karachi CMH Hyderabad PAF Korangi Creek, Karachi KPT Hospital, Karachi PNS Karsaz, Family Wing Hospital, Karachi

10. Sindh Police:Police Hospital,Shikarpur 11. Pakistan Railway Hospital, Larkana 12. Pakistan Railway Hospital, Kotri 13. CWC Hyderabad, Pak Railways 14. CWC Mirpur Khas, Pak Railways 15. Pakistan Railway Hospital, Dadu

16. Pakistan Railway Hospital, Barori Road, Karachi.

17. Railway Hassan Hospital, Karachi city 18. PIA outlet OPD Karachi 19. Police Head Quarter, Naval Colony, CCP, Karachi

20. Pakistan Steel Mills, Workers Colony, Karachi

21. Khalid Medical Centre, Saudi Colony, Karachi 22. City Welfare Medical Centre, Model Colony, Karachi 23. Norani Welfare Hospital Ranchor Lane, Karachi 24. Labour Department, District West, Karachi Province Of NWFP 1. 2. 3. 4. 5. 6. Pakistan Railway Hospital Peshawar Pakistan Railway Hospital Noshera Fauji Foundation Hospital, Peshawar Mandoni Gate Bannu Tehseen Welfare society, Mardan CMH Abbottabad

29

7. 8. 9.

POF Havelian Ayub Medical Complex, Abottabad CMH Peshawar

10. (CUP) Community Hospital, Niazi chowk, Main, Indus Highway, Karak 11. Railway Hospiatal Kohat 12. Mohar Kalan Abbottabad Province Of Balochistan 1. 2. 3. 4. 5. 6. 7. 8. 9. PAKISTAN RAILWAY Hospital, Quetta WAPDA Hospital, Quetta Mari Stopes Society, Quetta PAKISTAN RAILWAY Hospital, Quetta Green Strar Quetta FPAP Quetta Lady Differen Hospital Quetta Quetta Cantonment Board Social Security Hospital, Quetta

10. PTCL Quetta 11. Social Security Hospital, Hub Family Planning Counters 1. 2. 3. 4. Railway Hospital Noshera CMH Abbottabad Ayub Medical Comlex Abbottabad Lakson Tobbacco Company, Ismaila Railway Station, Jamshoro Railway Station, Tando Muhammad Khan Railway Station, Umer Kot Railway Station, Sukkur Railway Station, Larkana Railway Station, Mitthi

5. 6. 7. 8. 9. 10.

Karachi Chamber of Commerce and Industry Agreed to provide utilities and facility to operating places, in the premises of PW/RHB Centre, Five focal points in Karachi are as follows: KCCI Hospital F.B. Area Association Hospital Noorani Hospital Mother and Child Health Care Hospital

30

Inshun Memorial Teaching Hospital

Earthquake Reconstruction and Rehabilitation Authority (ERRA) ERRA agreed to provide space and utilities for the provision of FP/RH and establishment of FWCs/RHS Centers in the health outlet of Earthquake affected areas i.e. AJK and NWFP. Comprehensive Evaluation Framework: A continuous monitoring of results is carried out to ensure that the project management optimizes valuefor-money and that project implementation is focused on the achievement of results. Directorate of PPSOs is responsible for maintaining and compiling detailed service statistics that reflect the output and outcome indicators visualized in the project. An RH / MIS for record keeping at service outlets are introduced accordingly. The indicators for monitoring include:i. ii. iii. iv. v. vi. vii. VI Number of PPSOs brought into the fold of partnership. Number of orientation sessions conducted for senior management. Number of interactions with social institutions such as trade unions, employees unions, officers association, colony associations, canteen/cafeteria, retail-shops. Number of health outlets activated for provision of information and FP/RH services. Number of FP acceptors enlisted by method. Number of schools and number of teachers provided orientation on FP/RH. Number of doctors and paramedics of PPSOs and their colonies provided training of FP/RH. National Trust for Population Welfare (NATPOW) The National Trust for Population Welfare (NATPOW) was established under charitable and Endowment Act in 1994 as a statutory body to help NGOs and private sector in the field of Population Welfare, particularly family planning and mother & child health. The mandate of NATPOW is to improve the involvement of NGOs with emphasis on issues such as program sustainability, institutional strengthening, technical assistance, training, IEC, community participation and development. The role of NATPOW is to create an effective partnership between GoP, Donors, NGOs and private sector organizations in the implementation of National Population Policy and the Pakistan Poverty Reduction Strategy Paper (PRSP). NATPOW is also responsible for promoting the Population Welfare Programme including reproductive health agenda of the ICPD-94. Since it is inception in 1994, NATPOW has been providing reproductive health services including family planning, mother and child health care through its affiliated service outlets all over the country including AJK and NAs through NGOs Sector with the financial assistance of UNFPA and World Bank upto December 1999. After discontinuation of financial support by the donors during the past six years, number of service outlets, serving all over the country were affected and unmet demand for family planning and reproductive health services has increased. Major program activities during 2006-2007 are summarized as follow: S.No 1. Activity Seminar/Conference Place Peshawer No. 1 Beneficiaries 100

31

Focus on RH/FP and Safe Motherhood

2. 3. 4. 5.

6. 7.

Orientation Training Workshop for NATPOW Staff Orientation Training Workshop for Service Providers of NGOs 24-months training course of FWWs at RTIs of MoPW. Candidates from affiliated NGOs under NATPOW Mobile Medical Camps Service Delivery of RH/FP and Safe Motherhood at the door steps of the Community Community Mobilization Workshops Monitoring and Evaluation Backstopping Visits

Lahore Faisalabad Multan Hyderabad Larkana Islamabad Islamabad Islamabad, Faisalabad, Lahore, Multan, Hyderabad, Larkana, Abbottabad Country wide in Urban Slums and Rural Areas Country wide in Urban Slums and Rural Areas Country wide in Urban Slums and Rural Areas Total

1 1 1 1 1 1 1 7 14

300 125 100 100 100 14 Field Staff 25 34 Trainees 6509

14 13 56

558 70 NGOs, SOL and Activities 8035

The Contraceptive Performance Report of NATPOW for the financial Year 2006-2007 is given below: S# 1. 2. 3. 4. 5. 6. VII Methods Condoms (Units) Oral Pills (Cycles) IUD (Insertions) Injectable (vials) Contraceptive Surgery (Cases) Couple Years of Protection (CYP) Achievements 773,268 90,951 69,543 260,648 5,444 375,013

Population Welfare Programme in FATA The population of FATA is 3.536 million. The Population Welfare Program was extended to this

region in the Year 1993. Initially the program was introduced into three agencies i.e. Khyber Agency, Kurram Agency & North Waziristan. During the10th Five Year Plan (2003-08) the Population Welfare Program in FATA has been approved to cover all seven agencies (Khyber Agency, Kurram Agency & North Waziristan Agency, South Waziristan Agency, Bajaur Agency, Mohmand Agency & Orakzai Agency) The scheme is included in National Perspective Plan for Population Welfare in 2001-2011 with an allocation of Rs. 250.316 million with the following Service Delivery Infrastructure: S# 1. 2. 3. 4. 5. 6. Service Outlets Directorate of Population Welfare Program, FATA Agency Population Welfare Offices Reproductive Health Services-A Centers Family Welfare Centers Mobile Service Units Male Mobilizers Total Physical Quantity 01 07 04 50 07 41 120 Total Sanctioned Posts 10 28 40 160 21 41 300

The Contraceptive Performance Report for the financial Year 2006-2007 is given below: S# Methods Achievements

32

1. 2. 3. 4. 5. 6. VIII

Condoms (Units) Oral Pills (Cycles) IUD (Insertions) Injectable (vials) Contraceptive Surgery (Cases) Couple Years of Protection (CYP)

76,409 9,491 2,699 10,906 02 12,816

Population Welfare Programme in AJK Azad Jammu and Kashmir has a population of 3.2 million where family planning services were

introduce in 1983 and have been continued since then. A full fledged-Directorate of Population Welfare Program headed by Director and supervised by a Secretary of the AJK Government assisted by a Section Officer was established in 9th Five Year Plan. The Directorate is responsible for planning, execution, monitoring & implementation of the Population Welfare Program in AJK. The Population Welfare Program, AJK is a part of the Federal Activity of the Population Welfare Program 2003-2008, with an allocation of Rs. 303.18 million with the following Service Delivery Infrastructure:
S# 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Service Outlets Directorate of Population Welfare Program, AJK District Population Welfare Offices Reproductive Health Services-A Centers(Dist level) Reproductive Health Services-A Centers(Tehsil level) Family Welfare Centers Mobile Service Units Male Mobilizers Regional Training Institute(RTI) District Training Centers VBFPWs Physical Quantity 01 07 07 08 55 07 120 01 05 57 Total Total Sanctioned Posts 16 52 71 80 275 28 120 37 17 57 753

The Contraceptive Performance Report for the financial Year 2006-2007 is given below: S# 1. 2. 3. 4. 5. 6. IX Methods Condoms (Units) Oral Pills (Cycles) IUD (Insertions) Injectable (vials) Contraceptive Surgery (Cases) Couple Years of Protection (CYP) Achievements 224,985 13,013 5,153 17,052 359 28,363

Population Welfare Programme in Northern Areas Northern Areas has a Population of 1.2 million. Population Welfare Program, NA has been

under implementation since 1986-87. The program was initially launched through the Directorate of Health Services, NA and successive Directors of Health Services, NA served as Project Director, Population Welfare Program, NAs till May 2002. The Directorate remained actively involved in program planning, execution and monitoring of Population Welfare Activities in Northern Areas. The Population Welfare Program, NA is also providing

33

different trainings and workshops to posts of various categories in developing/presentation skills. Efforts are underway to acquire state land for construction of Regional Training Institute (RTI) at Gilgit. Five Year plan PC-1 (2003-2008) of Population Welfare Program, Northern Areas stands approved by the Central Development Working Party (CDWP) at a cost of Rs.161.358 million with the following Service Delivery Infrastructure: S# 1. 2. 3. 4. 5. 6. Service Outlets Directorate of Population Welfare Program, NA District Population Welfare Offices Reproductive Health Services-A Centers Family Welfare Centers Mobile Service Units Male Mobilizers Physical Quantity 01 05 03 37 03 55 Total Total Sanctioned Posts 18 35 33 192 12 55 325

The Contraceptive Performance Report for the financial Year 2006-2007 is given below: S# 1. 2. 3. 4. 5. 6. Methods Condoms (Units) Oral Pills (Cycles) IUD (Insertions) Injectable Contraceptive Surgery (Cases) Couple Years of Protection (CYP) Achievements 24,663 5,081 779 11,659 5,568

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3 .
I.

C P C YB IL IN A A IT U D G
Clinical Training Clinical training is the key activity aimed at providing quality reproductive health services to the

community by developing human resource to work at the service delivery centers of the Ministry of Population Welfare (MoPW), Ministry of Health (MoH), Provincial Line Departments, and other nongovernmental and private sector organizations throughout the country. This is achieved by trainings at 12 Regional Training Institutes (RTIs) across Pakistan, where a number of trainings are conducted round the year for the personnel delivering health care services to the general public. In addition awareness raising seminars are also conducted to increase the demand for services being provided at the health care facilities. Directorate of Clinical Training is responsible to develop uniform and standardized training curricula, prepare text books, training modules, develop teaching material, conduct examination for certification of competence as service provider, assess and improve quality of training and ensure proper implementation of clinical training programme for human resource development and institutional capacity building. Clinical Training has played an important role in the Population Welfare Program since its inception and is recognized as a core ongoing activity. With the introduction of multi-sectoral approach massive training activities are designed and implemented to ensure that program personnel and those connected with it are equipped with the required knowledge and skills to perform their jobs effectively in the delivery of quality family planning and reproductive health services. So many new initiatives have been undertaken which include Public Private Sector Organization (PPSO). Accordingly 90 MoUs so far have been signed between MoPW and the Corporate Sector Organizations (PPSO) for the provision of FP/RH services through private sectors outlets, 35 new centers have been established through PPSO under Army, Navy, Air force, Railways and Pakistan Steel Mills etc which are staffed by Programme Personnel, however to meet the additional requirement of trained staff new RTIs are being established at Gilgit, Bannu, D.G Khan, Nawabshah & Khuzdar. The manpower trained at these training centers would empower women to attain skills and be able to economically productive themselves and their families and also for the Population Welfare Programme to combat high Population Growth Rate unmet need fertility and training of trainer. These new RTIs are in line with Govt. policy of women empowerment and aim at opening opportunities for females. Establishment of 5 new RTIs are planned to achieve Millennium Development Goals (MDGs) and is a step forward for poverty alleviation. In addition to the above the RTIs conduct training of non program service providers on FP & RH issues and orientation trainings of other cadres such as factory workers, chemists, prisoners, school & college teachers as well as university & college students.

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During the year 2006-2007, a wide range of following trainings and related activities were undertaken for the development of manpower and institutional capacity building of employees of Population Welfare Programme: i. ii. Training of Line Departments, Organizations & Pakistan Army Jawans on RH/FP and communicable infections. Additional batches of Family Welfare Workers (FWWs) were accommodated and trained at RTIs on large scale on regular basis, considering the fact that HRD among female is vital for their skill development, to gain economic opportunities and women empowerment for the alleviation of poverty among the masses at large alongwith special emphasis to include RMPs in the programme. iii. iv. v. Seven seminars of RMPs were organized, one each at Quetta, Lahore, Islamabad, Faisalabad, Karachi, Abbottabad & Lahore. FWW textbook has been revised and is being updated. Modules for Teaching Methodology and Training Evaluation have been developed for training of trainers at RTIs. Details of training undertaken during the year are as under: Component Basic Training Course of FWWs Advance Training for FTOs ASTs & FWCs Pre Service Training for FWAs Refresher Training for Paramedics Miscellaneous Training & Orientation of NonProgram Personnel Total II. Non-Clinical Training PWTI, Lahore (Programme Personnel) Training of Trainers for Male Mobilizers Three-weeks training of trainers (TOT) was held for Male Mobilizer. The contents of the course were difference between training and Evaluation, Training Process, training need Assessment, Presentation Skill, Preparation of lesson plan, Male Mobilizer Project, Basic demographic Measurement, Population and Development, Population Welfare Programme (past, present, Future), Health Education. First Aid, Communications Skill, Motivation Skill, Islam and Family Planning, works with communities, Record keeping and report writing, Responsibility of Male Mobilizers, Monitoring of Male Mobilizers. These Master Trainers will provide/facilitate Pre-service training to male Mobilizer. Duration 24 months 3 5 months 3 weeks 1-2 & 4 weeks 1 & 2 days Target 350 35 35 500 2100 3020 Achievement 285 112 106 682 3947 5132

36

National Workshop on Financial Management and Control One-week workshop on Financial management and control for BS-18/19. The training emphasized philosophy and importance of Public Policy, Budget Making, Distribution and control, Govt accounting, Philosophy features and use, Internal controls, Philosophy of auditing, Budget as tool of Management, NAM, MTDF/MTBF Manuals. IT of office for Medical Professional One-week training on IT office for Medical Professional for WMOs of RHSC. The training provided opportunity for hands on learning in MS windows, MS word, MS Access, MS power point, Internet and Email. Revision of curriculum of Male Mobilizers. One-week workshop on Revision of Curriculum of Male Mobilizers. 19 participants from all PWDs specially DPWO, Doctor, Director Trainings attended the workshop. The purpose of the workshop was to condense the curriculum of Male Mobilizers from 12 weeks to 6 weeks and review the contents in line with their jobs. Basic Training Course for Field Functionaries. Two-week Basic Training course for field functionaries FWAs (Female) at Lahore and Peshawar were held. The contents of the course were Job description of FWA (Female), Brief history of PWP On Pakistan, Past, Present, future, Organization structure, Population Policy, Population and Development, Demographic Measures, Registration of eligible couple. Service Delivery Outlets, Behavior Charges Communication, Communication Process, The KAP GAP, Islam and such Family Norms, IDPD. Pre-Service Training for Male Mobilizer. Six-weeks Initial Training for Male Mobilizers was held at district Islamabad, Gujranwala, Jhang, Rajanpur, Mandi Bahawoodin, Okara, Gujrat, Faisalabad, Sawabi, Peshawar, Sheikhpur and Lahore. The contents of the course were Male Mobilizer Project, Demographic Measures, Impact of over Population on Socio-Economic Development, Population Welfare Programme in Pakistan, Conception and Contraceptives, ICPD Plan of Action, Health Education, First Aid, Communication Skills Working with Community, Record Keeping & Report Writing, IDPD/MDGs. Initial Training course for FWAs (Male) Two-week Initial training course for FWAs (Male) was held in batches. The contents of the course were Job description of FWA, Brief history of PWP On Pakistan, Past, Present, future, Organization structure, Population Policy, Population and Development, Demographic Measures, Registration of eligible couple. Service Delivery Outlets, Behavior Charges Communication, Communication Process, The KAP GAP, Islam and such Islam Family Norms, IDPD.

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Training course on Financial Management and Control One-week Training course on Financial Management and control for BS-17/18. The training emphasized philosophy and importance of Public Policy, Budget Making, Distribution and control, Govt accounting, Philosophy features and use, Internal Control and rule of DDO, New Accounting Model (NAM), Rules of Business, Civil Secretariats Rules, Filing System. Training course on Geographical Managerial System for Statistical Assistant One week Training course on Geographical Managerial System for Statistical Assistant. In all 31 out of 30 participants attended the course. The training provided completion in Geographical Managerial System, Management Information system at district level, Monitoring and Evaluation, Graphic presentations designing sample survey. Training Course on Skills Development in Secretariat Practices for General Assistant. One-week Training Course on Skills Development in Secretariat Practices was held for General Assistant. The contents of the course were Rules of Business, Secretariat Instructions, Civil Service Rules, Filing System, Noting and drafting, Official correspondence, Professional Ethics, Leave Rules, Pension Rules. Training course on Developing Managerial Competencies for Officers BS-17/18. One week Training course on Developing Managerial Competencies was held for Officers BS-17/18. The contents of the course were Basic Demographic Concepts, Determinants of fertility, Practices and Skills in Management Principals, Effective Communication Skills, Civil Service Rules, Service Rules, 1974, Secretariat Instructions, noting and Drafting, Filing System, Monitoring of the PC-I activities. Urdu desktop presentation course for PAs/Urdu Stenotypist Six days Urdu Desktop Presentation course was held for PAs/Stenotypist. The contents of the course were Inpage, Corel Draw, MS Power Point. Training on Advance MS Office for PAs/Stenos/General Assistants One week training course on Advance MS Office was held for PAs/Stenos/General Assistants. The course contents were MS Word, MS Excel, MS Power Point, Internet and E-mails. Maintenance of Account Records for Accountant and Accounts Assistants One-week training course on Maintenance of Account Records was held for Accountants and Accounts Assistants at Lahore & Peshawar. The course contents include General Financial Rule, Role of responsibility of DDO, Internal Audit/physical verification, Maintenance of Cash Book, Pre-audit, Budget presentation, New accountant module (NAM), Cash Follow/Work Plan.

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Training course for Projectionists on A.V Equipment One week Training course was held for Projectionists on A.V Equipment. The course contents were Maintenance of record and use of Multi Media, Use of Public address system, Photographs and use of camera, making slides, Maintenance of Photocopier. Preparatory Workshop for Annual Training Plan 2007-2008 Preparatory Federal Training Coordination Workshop was held to prepare proposal for annual training plan, for the consideration of Federal Training Coordination Committee for 20072008. Non-Programme Personnel Orientation and Sensitization Training course for Imams/Khateebs/Female Reglious Scholars. Two days Orientation and Sensitization Training course was held for Imams/Khateebs/Female Scholars at Mandi Bahwaldine, Hafizabad, Norowal, Bhakkar, Mianwali, Sargodha, Faisalabad, Rawalpindi, Attock, Gujranwala, Sialkot, Sheikhupura Chakwal, Jhelum, Gujrat, Jhang, T.T. Singh, Khushab, Multan, Khenewal, Muzaffargarh, Okara, Kasur, Sahiwal, Vahari, Rahim Yar Khan, Bahawalpur, Bahawarnager, Pak Patten, Lodhran, Muzaffarabad, Nelam, Kotli, Plandri, Mirpur, Bagh, Rawalakot, Bhimber, Bunar Mianwali Bhakkar, Layah, Nowsherah & Bunair. In all 5759 Imam/Khateeb/Female Scholar out of 5560 attended the Orientation Orientation for Nazim/Naib Nazim/Councilor/Lady Councilor One day Orientation and Sensitization was held for Nazmeens, Naib Nazmeen, Councilor and Lady councilor on Advocacy for Elected Representative Nazmeen/Naib Nazmeen/Councilors at District Hafizabad, Mandi Baha-ud-Din, Chakwal, Attock, Swabi, Mardan, Nowshera, Bannu, Khushab, Sargodha, Faisalabad, Jang, T.T Singh, Lodhera, Vehari, Gujrat, Bahawalpur, R.Y. Khan. The contents of the orientations were Population & Development, Role of Elected Representative, Advocacy & Coordination between DDPWO and Elected Representative.

Two Days Orientation and Sensitizations for LHWs. Two days Orientation and Sensitizations course on Motivations for Such Family Norms was held for LHWs at Districts Headquarter Punjab and NWFP (Gujranwala, Sialkot, Multan, Muzaffargarh, Jhelum, Qasoor, Sheikhpura, Lahore, Saihwal, Okara, Pak Pattan, Gujrat, Rawalpindi & Islamabad. The contents of the course were Population & Development, Reproductive of Health and Family Planning, Hygiene and cleanliness, Anatomy and Physiology of Human Reproductive, Conception and Contraceptive etc.

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PWTI, Karachi (Programme Personnel) Master Trainers for Male Mobilizers 3 weeks training of Master Trainers was held for male Mobilizers for Sindh and Balochistan. The contents of the course were difference between training and Evaluation, Training Process, training need Assessment, Presentation Skill, Preparation of lesson plan, Male Mobilizer Project, Basic demographic Measurement, Population and Development, Population Welfare Programme (past, present, Future), Health Education. First Aid, Communications Skill, Motivation Skill, Islam Family Planning, works with communities, Record keeping and report writing, Responsibility of male Mobilizer, Monitoring of Male Mobilizer. These Master Trainers will provide/facilitate Pre-service training to Male Mobilizers.

Initial Training course for FWA (Male) Ten days Initial Training course for FWA (M) was held in batches at Hyderabad, Karachi & Sukkar. The contents of course were Job description of FWA (Male), Brief History of PWP in Pakistan, Past, Present, Future, Demographic Measures, Organization Structure, Registration of eligible couple, The KAP Gap, Communication Process, Basic Skills of Interpersonal Communication, Overview of the vasectomy in Pakistan (NSV), Anatomy and Physiology Pre-vasectomy evaluation. Initial Training course for FWA (Female) Ten days Initial Training course for FWA (Female) was held in batches. The contents of course were Job description of FWAs, Brief History of PWP in Pakistan, Past, Present, Future, Demographic Measures, Organization Structure, Registration of eligible couple, The KAP GAP, Communication Process, Basic Skills of Interpersonal Communication, Overview of the vasectomy in Pakistan (NSV), Anatomy and Physiology Pre-vasectomy evaluation.

Training on Financial Management/New Accounting Model (NAM) for Accountant/Account Assistant. One week training course on Financial Management/New Accounting Model (NAM) was held for Accountant/Account Assistant in two batches. The contents include Philosophy and importance of Public Policy, Budget Making, distribution and control, Govt. Accounting, Philosophy features and use, Internal controls, Philosophy of auditing, Budget as tool of Management, NAM, Manuals Accounting/Auditing Cash Plan/Workshop.

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Training on Leadership and Negotiations Skills for DPWOs /DDPWOs One week training course on Leadership and Negotiations Skills was held for DPWOs/DDPWOs at IBM Karachi. The course contents were Principals of Management, Management Tools, Qualities of a good Manager, Relationship between leadership and Management, Population Policy, DDO responsibilities, Report Writing, Communication Skills, Monitoring system of MoPW, Monitoring System of Social Sector ministries, monitoring Formats. Six weeks Pre-service Training for Male Mobilizers Six weeks Pre-service training was held for Male Mobilizers in the month of February, March 2007 at district Thatta, Jaffarabad, Kalat, Pishin. The course contents were Male Mobilizer Project, Demographic measures, Impact of over population on socio-economic development, Population Welfare Programme in Pakistan, Conception and Contraceptives, ICPD Plan of Action, Health Education, First Aid, Communication Skills, Working with Community, Islam and Family Planning, Record Keeping & Report writing. Communication Skills & Record Keeping for FWW/FWCs Ten days training course on Communication Skills & Record Keeping was held for FWW/FWCs in two batches at Karachi and Sukkar. The course contents were Job of FWWs/FWCs, Population Dynamics, Comprehensive approach to FP, Contraceptive Technology for RH/FP, The KAP GAP exercise, Professional Ethics, Elements of quality service, Recouping the Imprest money, Office Procedure, General Financial rules, Counseling Skills. Four weeks Pre-service Training of Officers at NIPA, Karachi Four weeks Pre-service training was held for new entrants at NIPA, Karachi. The course contents include Demography, Leadership and Programme Management, Advocacy & Communication, Financial management, Pakistans Population Policy, ICPD, IDPD, PRSP, MDGs, Computer Literacy, Conception & Contraceptives, Contraceptives logistic System, MIS-Supervision, Monitoring & Evaluation, Filling System/Noting/Drafting, Programme History, Record Keeping, DDO Handbook, E&D Rules, Secretariat Instructions. One week Training course on Record Keeping and Contraceptive Logistic for Store Keeper One week Training course on Record Keeping and Contraceptive Logistic was held for Store Keeper. The course contents include Contraceptive Logistic System, Primary Function, Secondary Function, Principals of Warehousing, Inventory Management, Filling the CLR 4,5,6, Sales Proceeds, Disposal of unusable contraceptive, Contraceptive methods. One week Computer Training for Officers One week computer training was held for officers. Microsoft Power Point and disaster Recovery etc. The contents of the training were Microsoft Word, Word Basics, Tools and Printing, Microsoft Excel, Getting start, Formatting,

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Financial Management for WMOs/DDWO/DDO One week training course on Financial Management was held for women Medical Officers/DPWOs/DDOs. The course contents include Philosophy and Importance of Public Policy, Budget Making, Distribution and Control, Internal Control, NAM etc. Computer Training for Steno/PAs/UDCs/LDCs One week computer training was held for stenos/PAs/UDCs/LDCs. The contents of the training were introducing of main screen of Opening new file, Export files, Master Page. Formatting the text, Draw the title box, Draw the text box. Select the inpage table, Formatting the table etc. Back Office Management One week Training course on back Office management was held for Assistants, UDCs and LDCs at Sukkur. The contents of the course were Filing system, Diary Dispatch, Maintenance of office Record, Basic Computer hard Ware, General Office Rule, Operating System, MS Excel, Power Points, E-Mailing, Data backup techniques etc. Office Management One week Training course on Office Management was held for Officers and Doctors at Quetta. The contents of the course include Rules of Business 1973, Planning, Govt Servant Conduct Rules, 1964, E&D Rules, 1973, TA/DA Rules, Service book, Service Statements, Monitoring System of MoPW, Monitoring Formats etc. Career Planning & Grooming of Officers One week Training course on Career Planning & Grooming of Officer was held for BS-16/17/18 at Sukkur. The contents of the course were Demographic concepts (CBR. CDR, TFR, IMR) Population growth trends in Pakistan, Fertility decline/determinants, Population Welfare Programme in Pakistan, Contraceptive method, Reproductive health Package, General Knowledge, Human Resource Development (HRD) etc.

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PWTI, Karachi (Non-Programme Personnel) Master Trainer Workshop for Imam/Khateeb Three days Master trainer workshop was held for Imam/Khateeb. The contents were Population Dynamic, Training Technique, Mother and Child Care, Responsible father hood, Concept of Family Planning, Removal of misconceptions rumors. Orientation and Sensitization Training course for Imams/Khateebs/Female Scholars. Two days Orientation and Sensitization Training course was held for Imams/Khateebs/Female Scholars at Hyderabad, Sukkar, Shikar Pur, Larkana, Mir Pur, Karachi (South), Umar Kot, Tando Allah yar, Dadu, Jamshoro, Sangar, Mutari, Nawab shah, Khair Pur, , Badden, Karachi (Eash), Karachi (West) Noshoro feroze, Tando Mohammad Khan, Jafarabad, Kala Safullah, Pasin, Kallah Abdullah, Kalat, Mustong, Lasbalah, Jacobabad, Kashmoor, Mir Pur Khas, Kingri district Kharpur, Thatta, Ghotki, Sanghar, Quetta, Shikar Pur, Karachi. The contents of the orientation were Population Dynamic, Islam & Family Planning, Advocacy for such Family Norms, Role of Imam/Khateebs.

Orientation on Population and Development for Nazim/Naib Nazim/Lady Councilor. One day Orientation on Population and Development, Islam and Family Planning was held for Nazim/Naib Nazim/Lady Councilor at Khairpur, Quetta, Shikarpur, Nawabshah, Karachi, Gawadar, Jacobabad & Badine.

Orientation on Population and Development for LHWs. Two days Orientation on Population and Development, Islam and Family Planning, Service Delivery outlets, was held for LHWs at district level.

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4.

C M U IC T N A DA V C C O M N A IO S N D O A Y
A comprehensive campaign was launched during the year by covering all channels of

communication with special focus on advocacy for population and development issues to facilitate the efforts of Population Welfare Programme to achieve the goal of Population stabilization. The messages in the media campaign were blended into educational and recreational programmes like drama series, comedy shows, melodies, panel discussions, interviews, programmes in TV, Radio & FM, sponsorship of MoPW stalls at industrial exhibitions and Lok Virsa seminars, workshops, meet the press sessions, orientation programmes for community / youth / policy makers were organized during this course of time. Print material was produced and widely distributed. Press articles, ads were published regularly to sustain knowledge about family planning / reproductive health to highlight the service centers and demand creation for the services. Electronic Media The overall media campaign addressed various family planning / population related themes / issues including population and development, implications of rapid population growth, breast feeding, female literacy, male involvement, removal of misconceptions/side effects of contraceptives, image enhancement of family planning workers, highlighting the services and service centers, discouraging early marriage and emphasis on spacing for health of the mother and child. Channel-wise detail of activities undertaken during the year 2006-2007 is as under. Television The promotional campaign continued through T.V (PTV-I, PTV World, ATV) telecasted various spots during different TV programs such as, morning transmission, dramas, musical programs and time slot before khabernama. In addition, the campaign was also telecasted during some popular supports events. PBC Spots during Agricultural Programme and before 8:00 pm news were sponsored on alternate days basis through broadcast of MoPW messages on selected themes. In addition, focused covered messages were also broadcast on the different themes of Population Welfare Programme. FM Radio Programme Dil Ki Baat on PBC

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The program continued through PBC national network. 52 programmes have been broadcast in the financial year 2006-07 under reporting. The prime target audience of the program are females of reproductive age group. The program has been scheduled to capture the maximum number of target audience i.e. suitable time when females tune their radio sets or available in the vicinity. A renowned gynecologist is responding to direct calls to address the audience concerns. The program also includes entertainment through songs, jokes and various health/beauty/household related tips and advices. Print Media Printed Material A large quantity of print material was produced / printed and distributed which included: Booklets on various Population Welfare related themes/issues. Brochures/handbills highlighting FP Services/methods. Information kit covering Population Stabilization related themes/issues etc.

Press In order to solicit the support of influential, opinion leaders and policy makers the publication of favorable articles will different national dailies and magazines. The articles by the renowned journalists and columnists highlighting population/FP and reproductive health related issues appeared in major national dailies; Dawn, News, Times, Nation, Observer, Khabrain and Mashriq. The print media campaign also launched by floating promotional Ads in national and regional daily newspapers. Press Conferences To highlight the theme of World Population Day, the Minister for Population Welfare addressed a press conference on 9th July 2006. The Minister highlighted the achievements of the Ministry to create awareness and to get the support of opinion/community leaders and influential. The Minister for Population Welfare and Secretary, MoPW also briefed the reporters about the importance to observe the World Population Day. Various questions raised by press were responded accordingly. Aabadinama Three issues of MoPW monthly newsletter Aabadinama were designed and published during the year 2006-07 distributed to officers of MoPW, PWDs, Ministries, Colleges, Universities, Media persons, Libraries, MNAs, Senators, District Nazims and other stakeholders and also distributed at special events organized by MoPW. Employment of Fresh Media Agencies on Panel of MoPW

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CS Directorate also initiated the process of selection of new media agencies on panel of MoPW. The short-listing exercise of private media agencies who applied in response to MoPW press ad has been completed. So far the meeting of final selection committee also held under chairmanship of Secretary, MoPW. The recommendations of committee are also under process.

Advocacy Activities In order to involve planners, policy makers and programme managers and soliciting their support for the programme, presentations were made to National Assembly Standing Committees on Health, Social Welfare and Special Education and the senior civil servants of the Ministry of Education and Establishment Division. Celebration of World Population Day, 2006 Pakistan along with international community observed World Population Day on 11th July, 2006. A set of activities were planned and undertaken with reference to WPD, 2005 highlighting this years World Population Days theme YOUNG PEOPLE. The detail of the activities is as follows: National Population Convention MoPW organized National Population Convention to commemorate the day on 11th July, 2006. The Prime Minister of Pakistan presided over the function. The Minister for Population Welfare Ch. Shahbaz Hussain and a number of dignitaries including Cabinet Members, Senior Civil Servants, Diplomats, and members of the Donor Community, representatives of the Private Sector and NGOs / CBOs attended the convention. A detailed presentation on the salient features and achievements and future strategy of Population Welfare Programme were made highlighting the implications of rapid population growth on socio-economic development. A group of youth performed a show to highlight the Implications of rapid population growth in the country and youth response. Various national songs were also performed. The various public social sector departments and national/international organizations displayed and distributed IEC material and give aways. The Programme Managers and service providers from the public and private sectors were conferred performance awards by the Minister for Population Welfare Ch. Shahbaz Hussain in recognition of their meritorious services and support to the Population and Development agenda of the GoP. Awards were also conferred to the nominees of MoPW, PWDS, NGOs and private sector. South-South Collaboration Workshop

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Partners in Population and Development Bangladish is an inter government development agency for south south development. A collaborative workshop was organized a south-south collaboration on 6th September, 2006. MoPW along with its partners on reviewed the implementation status of the activities being implemented through the forum which formed the basis for designing a comprehensive further Plan of Action. MoPW organized this workshop to seek advice of national and international experts on population concerns, building broad-based partnerships and to strengthen inter-sectoral coordination. The CS Directorate carried out the following media activities in this regard: Seminar on Public Private Sector Collaboration in Reproductive Health and Family Planning To highlight the importance of PPSO Seminar, a comprehensive pre & Post event media campaign was launched. A pre event press conference was arranged on 11th January, 2007 as curtain raiser while the post event conference was also arranged at the closing of the conference i.e. on 13th January, 2007 to inform the media about the out come of the conference. Various interviews were arranged for delegates of the conference and broadcast/telecast on PBC, FM Radio Stations, terrestrial and Satellite channels. Special interview were also conducted including Federal Minister, Federal Secretary, Provincial Secretaries and prominent figures of the conference beside two exclusive radio programmes. A Special edition of MoPWs news letter Aabadinama was dedicated to this event. Advocacy Seminar on Population and Development for Media To sensitize and mobilize national and regional media persons representatives, an advocacy seminar was arranged in Rohtas Fort at District Jhelum, on 19th January, 2007. More than 100 representative of electronic and print medium of Rawalpindi, Islamabad, Jhelum, P.D. Khan, Sohawa and Dinna participated in the Seminar. District and Tehsil Nazims also participated in the seminar. During the Seminar representatives of electronic and print media appreciated the efforts of Ministry of Population Welfare for holding a day long activity at an historical place in a recreational manner and seeking their support for sensitization and mobilization of general public and opinion leaders and policy makers on this issue of vital national importance. Interviews of Federal Minister and Nazims were conducted and broadcast/telecast by the electronic channels. A special feature highlighted the event in various newspapers of Islamabad as well as in MoPWs news letter Aabadinama January February issue 2007. Review of Communication and advocacy Strategy A review of Communication & Advocacy Strategy was carried out during this financial year 2006-07. The draft Communication & Advocacy Strategy submitted by International & National Consultants first reviewed at CS Directorate/Programme Wings level and was presented in 02 days Consultative Workshop held on 11-12, May, 2007 attended by various stakeholders. The comments/recommendations of the various groups have been incorporated and the final draft is submitted for approval of competent authority.

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Review/preparation of IPC/Communication Manual The National Consultant prepared the draft IPC/Communication Manual and submitted to CS Directorate which was thoroughly reviewed and discussed in 01-days consultative workshop held on 11th June, 2007 at Islamabad involving non-Clinical Directorate of MoPW, PWTIs and selected RTIs. The draft finalized in the light of the participants comments/recommendations is submitted for perusal/approval of the component authority.

Review of IEC Print Material The National Consultant reviewed and categorized the currently available/distributed IEC print material of MoPW. As approved, the material was reviewed / discussed in 02 days consultative workshop held on 12-13 June, 2007. The report in the light of comments/recommendations of various stakeholders from MoPW, PWDs, Social Sector Ministries, NGOs/Private sector is submitted for perusal/approval of the competent authority. Achievements of the media campaign during 2006-07 are shown in following table: Activities TV spots Radio Spots Radio Programme Press Ads Print Material Workshops Outdoor Target 900 900 65 500 275,000 03 This 05 acti
ity is b

Achievement 1020 810 104 644 356,000 15

This activity is being undertaken under ADP Project. In this regard the locations for 8 bill boards Sites have been identified and the contract has also been awarded. The confirmation for the completion of this activity will be reported in the next quarter.

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5 .

P p la nE u a n(P ) o u tio d c tio E

Directorate of Population Education has continued the activities in the scenario of its broader

role calling a shift in its strategy to bring it inline with the broader MoPW objective of Population Stabilization under the new holistic approach to Population and Development. The focus of these activities is to sensitize the policy and decision makers of the National Building Departments as well as to initiate the public private partnership for the adoption of small family norms and to enhance the quality of life of the employees of their organizations. In this context, the following activities were carried out by the Directorate during the year 2006-2007. Workshops on Presentations Skill Development: As part of youth sensitizing program and orientation/ education of other categories of the target audience under Population Education Component, Directorate of Population Education launched a series of workshops as specified/ approved in the annual Cash/work Plan. In this regard, 7 four days workshops on Presentation Skill Development for midlevel program managers including District Population Welfare Officers, Dy. District Population Welfare Officers, Dy. District C&T Officers, Tehsil Population Welfare Officers, RHS Doctors from all the provinces including PWDs of AJK and Northern Areas. The objectives of the workshops were: To enhance the knowledge and the skill of the mid-level program/field officers regarding actual communication of demographic indicators, current theme and issues of population welfare program and strategy response. To enable them to design the presentation on the above lines, on power point. To enable them to make presentation in actual field like situation. In these workshops the following topics were covered; Population and development Need for communication and advocacy. Qualities of a good advocate and presentation. How to make an effective presentation Understanding the Demographic Indicators Population Policy/Goals/Objectives Adolescent Health Issues Personal Hygiene Sensitization Seminars for Youth, Lady Councilor, Ulema, Nchd and Nvm Volunteers Directorate of Population Education has conducted 11 seminars for Youth, Lady Councilor, Ulema, NCHD and NVM Volunteers in different districts of Pakistan. In these seminars 2100 participants were sensitized as per detail below:

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Type of activities Youth Forum Gender Sensitization Sensitization of Ulema Collaboration with NCHD Collaboration with NCM

Location /s of seminars Kohat ,Chakwal Nawabshah, Gujranwala Karak, Sibi Mardan, Gujrat Haripur, Rawalpindi,Narowal

No. Of participation 400 120 381 467 732

Sensitization Workshops on Population and Development for High School and College Teachers. A total No. of 745 teachers were sensitized duing14 workshops on Population and Development which were organized in different districts as per detail below: S.No 1. 2. 3. 4. 5. Province Sindh Punjab NWFP Balochistan AJK Districts Locations of Workshops Sukkur, Jaccobabad. Jamshoro and Hyderabad Multan , Muzaffargarh , Jhang and Faisalabad Peshawar , Abbottabad Quetta , Qila Saifullah Muzaffarabad, Bagh

Presentations in Universities/Colleges: Directorate of Population Education delivered Presentations on Demographic Trends and Implication of Rapid Population Growth in the 09 universities and 04 colleges in connection with the youth sensitization program of Ministry of Population Welfare. The students took keen interest and asked various questions as well as put forward some suggestions for the better implementation of the program. The details of universities \ colleges are as under: Universities: Kohat University of Science & Technology, Hazara University, Mansehra NWFP The University of Faisalabad University of Arid Agriculture of Rawalpindi The Islamia University of Bahawalpur Federal Urdu University of Art & Science and Technology G-7 Islamabad Government college of Faisalabad Sardar Badhur Khan Women University Quetta Balochistan University of information Technology & management Science Quetta. Colleges: 1. Federal college for boys F-11/3 Islamabad 2. Federal college for boys I-8/3 Islamabad 3. Federal college for girls F-10/3 Islamabad 4. Federal college for girls I-8/3 Islamabad

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Presentations at Different Departments: Directorate of Population Education arranged the presentation on Population and Development in the following seminars and organizations: A presentation on population and development was held at Global change Impact Centre, Saudi Pak Tower on 6th June 2007, where 25-30 mid level and senior managers were present. This presentation was made by the Secretary of MoPW. A presentation on Population and Development was made by the Secretary MoPW in the organization PAIMAN at its office on 15th June 2007.The Secretary MoPW explored possible avenues of the collaboration between Ministry of Population Welfare and PAIMAN for controlling population growth through effective measures. A presentation was given by Director PE in the Seminar on population & development for midlevel management on 30th May 2007 at Faisalabad. A presentation was made by Director PE on Population and Development in a seminar organized by the DPWO Rawalpindi on 28th June, 2007. Review of the Revised Curricula to Determine the Degree of Retention of the Population Development Education Contents: The Directorate of Population Education continued the technical coordination and collaboration with Curriculum Wing of M/o Education during the FY 2006-07 for the development and review of the curriculum for the classes of IX-XII. The new National Curricula 2006 was once again revised to determine the degree of retention of Population Education related contents, in this regard a meeting of Curriculum Review Committee under Population and Development Education for Youth Project was held 18-21 April 2007 at Ministry of Education, Curriculum Wing, H-9 Sector, Islamabad. The Director (PE), MoPW attended the meeting as a member of the committee and provide technical input in identifying the Concept related to various subjects included in National Curriculum 2006.

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6 .

A PA L C T NA DE P N IT R D L O A IO N X E D U E
The expenditure on Federal and Province component during 2006-07 has been Rs. 657.089

million and Rs.2364.501 million respectively. The over all utilization was 67.58 percent. Further details are given in Annex-I

7 . P O U E E TO C N R C P IV S R C R MN F O T A E T E/ M C IN R &E U M N AH EY Q IP E T
The Directorate of PME plays a pivotal role in the logistics of contraceptives. All efforts were made to ensure that supply of contraceptives remains smooth and uninterrupted through out the year 2006-2007. Following activities in this regard were carried out during the reporting period. For the year 2006-2007 Rs.171.942 million were earmarked for CRD component. The table below gives the details of utilization of this fund:(In million) Percentage Achievement 99%

Source of Funding GOP

ADP Allocation 171.942

Funds utilized 170.122

Annual Contraceptives Requirement: Annual contraceptives requirement for MOPW for the year 2006-2007 were approved to the tune of Rs.170.122 million against allocation of Rs. 171.942 million by the Committee for Forecasting of (In million) Quantities 30,000 0.218 0.067 1.170 0.529 1.445 0.001 Contraceptives Requirements. Detail is as under:S. No. 1. 2. 3. 4. 5. 6. 7. Contraceptive Condom (Pieces) Oral Pills (POP) (Cycles) E.C (Pack of 2-tablets) Net-En Injection (Ampoules) DMPA Injection with syringes (Vials) Syringes (Numbers) Implant-Rod-I (Implanon) (sets)

As per Proforma Invoice provided by UNFPA funds of Rs.170.122 million in foreign exchange were transferred to UNFPA through Ministry of Finance/AGPR/State Bank of Pakistan. Workshop on Procurement Procedures: A workshop on procurement procedures under PPRA Rules, 2004 with participation of the representatives of PPRA, NAB and Auditor General was held at Lahore on 27-28 Feb, 2007. Twenty five Programme Managers from MOPW and Allied Units attended the workshop. It mainly covered Public Procurement Rules, 2004 and Purchase Manual designed in consultation with the Public Procurement Regulatory Authority Islamabad. Physical Verification: The physical verification of store of CW&S, Karachi was done on 23rd to 25th January, 2007 and after approval of the report, follow up action is in process for implementation of the recommendations.

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Procurement of Vehicles for Additional -RHS-A in Punjab: PWD Punjab had requested this Ministry for purchase of 65 foreign assembled vehicles for the project Establishment of Additional-RHS-A in Punjab against their PSDP 2006-2007. After thorough examination of the case in the PME Directorate a summary to Screening Committee of P&D Division was moved. The Screening Committee formally approved the proposal of PWD Punjab for procurement of 65 foreign assembled vehicles during 2006-2007 under the above project. The PWD Punjab was informed by this Ministry to do further necessary action in this respect at their end. Technical input/opinion: Technical input/opinion was also offered by the PME Directorate in getting approval of seven foreign assembled vehicles of ADB RH Project as well as PPSO for PWP N.A. Certificate of Condemnation of Unserviceable Vehicles: The cases of three unserviceable vehicles (RTIs Quetta, Karachi and PWTI Lahore) were processed with relevant quarters including Cabinet Division and Certificate of Condemnation of these vehicles were obtained from Cabinet Division. These vehicles will be auctioned in the next financial year. Outstanding Sale Proceeds: A statement showing outstanding sale proceeds against all Districts of four provinces and AJK was sent to PWDs for recovery of the outstanding sale proceeds under intimation to the CW&S and the Ministry. Summary for sale proceeds exemption to Pak Army for contraceptive was approved by Prime Minister, which enables this Ministry to provide free of condoms to Pak Army.

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8 .

F R IG T A IN O E N R IN G
Details of foreign training / visits abroad by the officials of the Population Welfare Programme are as under: Details are given in the following table: Foreign training/Visits/Seminars abroad availed by MoPW for the Year 2006-2007

S# 1.

Name of Officers/Officials with Designation Dr. Talat Jabeen, Principal, RTI, Islamabad. Syed Amin Ali Zaidi, Director-IT, MoPW. Ch. Shahbaz Hussain, Minister for Population Welfare. Mr. Hafeez ur Rehman, Additional Secretary, MoPW, Islamabad.

2. 3. 4.

5. 6.

Malik Amanat Rasul, Director (FA), MoPW. Syed Muhammad Saleem, Deputy Director (Per-S), Ministry of Population Welfare, Islamabad Mr. Shahzado Shaikh, Secretary, MoPW. Mr. M. Mumtaz Raza Khan, Assistant Director (Services), Ministry of Population Welfare, Islamabad Mr. Shahzado Shaikh, Secretary, MoPW. Mr. Ibrahim Sajjid, Principal, PWTI, Lahore Mr. Sarfraz Hussain Shah, Deputy Director, Ministry of Population Welfare, Islamabad Mr. Shahzado Shaikh, Secretary, MoPW. Dr. Bushra Amjad, Chief Medical Officer Incharge, Reproductive Health Services-A Centre, General Hospital, Lahore

Title/Purpose of the foreign Visit/Training Two Weeks Training Course Research Method in Reproductive Health & Development. Workshop on e-Application of ICT in Population related fields: e-learning and e-health. Highlight the issue of Kashmir in the European countries especially in Britain. Achieving the Millennium Development Goals: Poverty Reduction, Reproductive Health and Health Sector Reform Thailand 11th Partners Board Meeting. One Year General Diploma in Demography First regular session Executive board UNDP/UNFPA. - do International Conference of Muslim Leaders on Population, Reproductive Health and Gender Workshop on Islam and RH/FP Training Course on Population and Reproductive Health 40th Session of the Commission on Population and Development. Workshop on Maternal and Child Health Care Services of of

Duration & Country Mid June-July 2006 at Summer Institute, USA. 4-6 July 2006, Lanzhou, China 13-19 July 2006. August 14-25, 2006

Funded Agency Bill and Melinda Gates Institute. UNESCAP GOP UNFPA

7. 8.

7-13 November 2006 at Beijing, China. January to December 2007 at Cairo Demographic Centre (CDC) 19-26 January 2007 New York, USA. -do12-16 February 2007 at Bali, Indonesia. February 1-19, 2007, Alexandria, Egypt. March 25 to April 9, 2007, Korea April 9-13, 2007 at New York, USA. 28 May-11 June 2007 Taicang, China

UNFPA UNFPA

GOP -do-

9.

UNFPA

10. 11. 12. 13.

Packard Foundation Korean International Cooperation Agency GOP Government of China.

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9 .

O H RS E IA A T IT S T E P C L C IV IE
The main activities undertaken by the Planning Directorate during 2005-2006 are summarized below:

ISO 9001: 2000 Certification Service Delivery Points of District Jehlum were approved for ISO Certification and the process was initiated from 14th July 2006 with financial assistance from UNFPA and is envisaged in Annual Work Plan UNFPA 2006. PWD Punjab oversaw the activities pertaining to ISO Certification of District Jehlum. The process of ISO Certification of the Service Delivery Points of Jehlum was completed by the end of March, 2007 and following outlets of District Jehlum: District Population Welfare Office, Jehlum RHS A-Centre Jehlum FWC, Dina-I, Jehlum MSU, Sohawa, District Jehlum

Based upon the observations of annual surveillance audit report, the RHS Directorate chalked out a plan to impart training to all Service providers & Managers of ISO Certified Service Delivery Points in fallowing areas; QMS awareness. Internal Audit. Calibration.

The two days trainings is planned to be held during of July-August, 2007 in Committee Room of MoPW, Islamabad where all relevant personnel from District Islamabad, Chakwal and Jhelum are expected to participate. The managers from MoPW are also invited for orientation of this process. Service Delivery Quality Assurance Workshop: Service Delivery Quality Assurance workshop was organized with the participation of all stakeholders from PWDs M&S Wing based on lessons learnt for Quality Assurance from ISO Certification process by the RHS Directorate on 15th September 2006 in which SOPs + Checklists for Technical Monitoring of Service Delivery Points and the revised Client Follow-up Card were finalized. TORs with TAMA RHS Directorate prepared TORs on the following TAs through TAMA: i) ii) Addressing RH needs of Adolescents and Men. Revision of manual of standards of FP & other service protocols.

Consultant for both the Projects were selected by Selection Committee of MoPW on 17th January, 2006. The project of Addressing RH needs of Adolescents & Men is successfully completed on 18th September

55

2006. The NSV Curriculum and the Curriculum on RH issues of Male Adolescents & Men are submitted for printing to P&P, Lahore. After the successful completion of Curriculum on RH issues of Male Adolescents & Men, Revision of Services and Protocols (S&P) Documents for family planning was taken up with TAMA in the meeting held in the office of DG (Tech.) on 13th December, 2006. Training on Laparoscopic Surgery Laparoscopic Minilaprotomies were performed by the outlets of MoPW optimally up till 1998. After that most of the surgeons were lost without passing on their skills. Realizing the deficiency of laparoscopic tubaligation and to provide additional choice of surgery to the clients, Training on this vital activity were organized by the RHS Directorate in RHS-A Master Training Center, Nishtar Hospital, Multan for 12nominated doctors from MoPW, all PWDs including AJK in three batches for 10-days each batch. The training of all the 3-batches has been successfully completed with the financial assistance from AWP UNFPA 2006. Collaboration with Pak. Army With reference of series of meetings of MoPW on collaboration with Pakistan Army in pursuance to Secretarys directives on Plan of Action. The RHS Directorate has extended collaboration by providing training in Non-Scalpel Vasectomy (NSV) at NSV Centre at Lahore, Faisalabad and Moro (Sindh) to medical staff from GHQ, the nomination for Vasectomy training requested from GHQ are awaited. Seminars on Family Planning / Reproductive Health Seminars on FP/RH issues for private sector service providers were organized by the RHS Directorate on the following topics, from AWP UNFPA (NIPS) 2006, on the given schedule: a. b. Seminar on Reproductive Health, Family Planning Issues for Private Sector Service Providers. Workshop on Communication Skill of Male Workers of Population Welfare Program.

Province Punjab Sindh NWFP Balochistan AJK

District Muzaffargarh Thatta/ Hyderabad. Kohat Mansehra Qilla Saifullah Kotli

Date 18th November, 2006 24 & 25th November, 2006 18th November, 2006 8th & 9th December. 2006 23rd November, 2006 18th November, 2006

Review of Projects on RHS A-Centres with PWDs As per perfoma developed by Directorate of Planning, the periodic review on the following has been closely undertaken by RHS Directorate with PWDs:1. Establishment of RHS A-Centres included in PC-I. 2. Establishment of Additional RHS A-Centres at THQ Hospitals. 3. Statement on vacancy positions.

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4. Statement on procurement of furniture/ fixture, equipment/ machinery. Public Sector Development Programme (PSDP) 2007-08: Preparation of PSDP 2007-08 was initiated in November, 2006 and the process continued till its approval on 31st May, 2007. Planning Directorate collected, consolidated and compiled the requirements of the programme and prepared overall proposal. The PSDP proposal was considered at the 1st Stage by the Priority Committee for setting up the ceiling. A series of meetings with Project Directors have been held before the finalization of the Proposal. The APCC was the next forum for the approval of the Proposal. Before going to APCC detailed consultation was made with all concerned. PSDP was finally considered by the NEC on 31st May, 2007. During the process series of revisions and adjustments in the financial outlay were made in light of the decisions at each forum. Briefs and summaries were prepared for the consideration. The PSDP finally approved at the cost of Rs.4327.597 million including Project Foreign Assistance (PFA) of Rs.204.216 million through ADB Loan. The approved PSDP (2007-08) was issued to P&D Division, Provincial Secretaries, Wing Chiefs and all Directors of MoPW on 23rd June,2007. PSDP Review Meetings: Planning & Development Division (PIP) Section asked for information on prescribed proforma on 1st Quarter Review of PSDP 2006-07, Mid Year Review of PSDP 2006-07 and 4th Quarter Review (final review) of PSDP 2006-07. All Wings of MoPW and Provincial PWDs were requested to provide the information. On receipt, these information were compiled and sent to P&D Division which was discussed in a meeting chaired by Deputy Chairman, Planning Commission. Priorities Committee Meeting: It is an initial forum for the approval process of PSDP for setting budget ceiling for next year. A series of meetings with project directors were undertaken for finalization of this exercise. The folders of relevant material were constituted and given to all concerned. This meeting was attended by Joint Secretary, MoPW with Director (Planning) wherein size of PSDP for the year (2007-08) at Rs.4158.909 Million was got recommended. APCC Meeting: APCC is the next forum of approval of PSDP after Priorities Committee. Recommended PSDP and proposed PSDP (2007-08) by the APCC was finalized in-consultation with all concerned. The meeting was attended by Secretary, MoPW and Director (Planning). An amount of Rs.4827.597 was earmarked in the PSDP (2007-08) which is 16% increase over the Priorities Committee recommendation. NEC Meeting: It is the Final forum of approval of PSDP. Brief alongwith the relevant material was prepared for the NEC meeting and the meeting was attended by Secretary, MoPW on 31-5-2007. The PSDP finally approved at the cost of Rs.4327.597 million including Project Foreign Assistance (PFA) of Rs.204.216 million through ADB Loan. New Monitoring System:

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Prepared monitoring report under new system of monitoring on the basis of monthly progress report and actual releases and utilization in line with prescribed P&D Division (Project wing). The monitoring report was prepared on the basis of information received from the provinces wing chief of MoPW and FM Directorate. National Commission for Population Welfare (NCPW): The 1st meeting on National Commission for Population Welfare was held on 1st July, 2006 in the Prime Ministers House under the chairmanship of Prime Minister of Pakistan. The decision of the meeting were circulated to the all concerned quarters. The implementation status on the decisions for the quarter (July-September 2006), (Oct-Dec 2006) and Quarter (Jan-Mar 2007) have been forwarded to P.M Secretariat. Letter has been written to all concerned for forwarding implementation status on the decisions for 4th Quarter (April-June 2007). Departmental Development Working Party (DDWP) DDWP Meetings: Two Departmental Development Working Party (DDWP) meeting were convened by the Planning Directorate on 24th February, 2007 and 13th March 2007 respectively to discuss following projects. S.No 1. 2. 3. 4. Name of the Schemes Establishment of RHS-A & Male Advisory Center Institutional Reforms in Planning Wing, MoPW, Islamabad. Establishment of Pakistan Communication Center for Programme (PCCP) (1-07-2007 to 30-06-2009) Construction of Conference/Cum Semenar Hall in RTI Quetta (2006-07) Cost 27.019 Million 12.730 Million 16.981 million 3. 813 Million

Modified PC-I for the Acquisition of Land and Construction of RTIs: The following PC-Is have been modified in the light of Pre-CDWPs decision and sent to P&D Division on 31st December,2006 for placing at the agenda of the next CDWP for the approval. Name of the Scheme PC-I for acquisition of land and construction of RTI, Larkana. PC-I for acquisition of land and construction of RTI, Sukkur. PC-I for acquisition of land and construction of RTI, Sahiwal. PC-I for acquisition of land and construction of RTI, Abbotabad. Scrutiny of PC-Is: Following schemes were scrutinized in the Planning Directorate. These PC-Is were considered in the DDWP meeting held on 19th May, 2007 in the committee Room of MoPW under the chairmanship of Secretary. The DDWP approved the projects. S.# 1. 2. 3. Name of the Schemes PWTI Peshawar PWTI Multan PWTI , Quetta Cost (Rs in Million) 28.535 27.696 28.485 Cost (Rs in Million) 73.079 70.884 86.789 109.800 Period of Implementation 2006-2009

58

Acquisition of Land and Construction of Building for RTI Faisalabad:

A letter has been written to

P&D Division on 16th June, 2007 requesting Authorization for the issuance of the Administrative Approval of the Subject Scheme. This Project has been approved by the Central Development Working Party (CDWP) in its meeting held on 16th August, 2006. Material for Economic Survey (2006-07): A write-up on Population Welfare Programme based on actual/anticipated achievements of the Programme was prepared for reflection in Economic Survey of Pakistan (2006-07) in line with prescribed Finance Divisions format. For incorporating the relevant information in the write-up all the Wing Chiefs of the Ministry of Population Welfare were consulted for their valuable inputs. Material for Budget Speech of Finance Minister (2007-08): Material for the Budget Speech of the Finance Minister for the year 2007-08 was prepared on the basis of information received from the Wing Chiefs of MoPW. The material included the Physical, Financial and Contraceptive Performance of current year and target for the next year. The material was sent to Finance Division after approval of the Secretary MoPW. Administrative Approval of Population Welfare Projects The administrative approval of the following projects had been issued on dates mentioned against the projects. S.NO 1. 2. 3. 4. 5. 6. 7. Name of the Project Population Welfare Training Institute (PWTI), ADB-RH funded. RHS-A Type Expansion Programme, NWFP. Construction of Mens Advisory Center (MAC) at NIH Islamabad.(2007-2008) Construction of Conference/ Cum seminar Hall in RTI Quetta (2006-2007). Establishment of Camp Office of PWTI, Lahore at Multan. Establishment of Camp Office of PWTI, Lahore, at Peshawar. Establishment of Camp Office of PWTI, Karachi at Quetta. Cost In Million Rs.73.910/Rs.88.189/Rs. 12.730/Rs. 3.813/Rs.6.880/Rs.6.020/Rs.6.782/Date of Meeting 26th June,2007 2nd June,2007 19th May, 2007 13th March, 2007 19th May, 2007 19th May, 2007 19th May, 2007

Reply to the Starred National Assembly Question no. 235 Asked by Mr.Sher Akbar Khan Advocate, MNA: Prepared reply to the starred National Assembly Question moved NO. 235 asked by Mr. Sher Akbar Khan Advocate, MNA on the total number of Projects launched during the last three years The reply included list of Projects launched launce during the years (2004-05), (2005-06) and (2006-07) alongwith comprehensive supplementary material. Interviews of Consultant (Policy Experts) for strengthening the Planning Directorate: MoPW felt to review the population policy 2002, for which it needed the services of policy expert and for this purpose TAMA has offered a TA. In this quest TAMA and planning Directorate were in coordination to provide the TOR of Policy Expert.

59

Finally, TAMA had forwarded the following three short listed names for the policy expert. 1. 2. 3. Dr. Abdul Razzaque Rukannudin Dr. Naushin Mahmood Dr. Mahbub Ahmed With the permission of Secretary, MoPW, the selection committee was constituted and notified to select the appropriate incumbent from the above. To expedite the selection process an interview was held on 16th May,2007 in the committee room of MoPW at 11.00 a.m. under the chairmanship of Additional Secretary MoPW. Two of the applicants i.e. Mr. Razzaque Rukannudin and Mr. Mahbub Ahmed appeared before the committee, whereas Dr. Noushin Mehmood did not turn up before the committee. None of them was selected and resultantly TAMA was requested to send fresh names. Population Welfare Program Vision/ Plans Beyond -2008: PC-I of Federal Activity Beyond 2008 is in the process of preparation. chiefs containing current plan progress and future targets for 2008-13. Processing of New PC-Is to P&D Division: 45 copies of the each PC-I were sent to Chief (PIA) with the Date, Cost and implementation Period given as under for their placement at the next CDWP agenda. S.# 1 2 3 Name of the Scheme RTI, Jehlum Additional FWCs -NWFP PC-I for Establishment of Additional 100 family welfare centers (FWCs) in Punjab. Meeting with TAMA: A meeting with Country Director (TAMA) was held under the Chairmanship of the Secretary MoPW on July 19, 2006 in the Committee Room of MoPW. The purpose of the meeting was to discuss the status of TAs. Further a follow-up meeting with TAMA was also held on August 3, 2006 under the Chairmanship of the Secretary MoPW. As per decision of the meetings, TORs for placement of consultants for various components have been sent to TAMA for their consideration and further necessary action. Date 05-05-2007 31-05-2007 30-06-2007 Cost (Rs in Million) 95.000 252.820 Rs.93.240 Period of Implementation 2007-10 2006-08 2007-08 In this regard the several meetings were arranged by the Planning Directorate. Directorate has invited write up from all wing

One day Workshop on South-South Cooperation and Sustainable Development: FA Directorate of MoPW and Partners in Population and Development jointly organized a one day workshop on south-south cooperation and sustainable development on 5th September, 2006 at Hotel Margala, Islamabad. The event was attended by Senior Government Officials, Parliamentarians, NGOs, Civil Society Organizations, UN Agencies, Diplomatic Mission etc. The Minister for Population Welfare was the Chief Guest during the said event. The Executive Director, PPD Secretariat, Dhaka also attended the same. The objectives of the workshop were to:

60

Generate greater understanding at national level on how south-south collaboration can effectively contribute towards attainment of sustainable development; Demonstrate the national commitment of the member state to south-south collaboration which will create a positive image of PPD in the national and international area; Provide a common platform for the key players in the national development from different sectors to exchange views on how they can benefit from south-south collaboration.

Series of Steering Committee Meetings of GOP-UNFPA Annual Work Plan-2006: FA Directorate organized a series of meetings of the Steering Committee of GOP-UNFPA funded Projects in the Committee Room of Ministry of Population Welfare on 30-10-2006, 07-12-2006 and 2612-2006. These meetings were attended by concerned officers of MoPW and Line-ministries such as MOH, MOWD, Statistics Division, P&D Division and UNFPA. Representatives from Population Welfare Departments also participated in the meetings. Representative of line ministries and PWDs made presentations about utilization of funds in their ministries/departments. The overall objective to hold such meetings were to assess the utilizations status of funds under UNFPA Annual Work Plan-2006, and to discuss the draft Annual Work Plan-2007 alongwith COE. The minutes of the meetings have been issued accordingly for necessary action/implementations of decisions. Participation of Director (FA) in Workshop on Capacity Building and Partners Annual Board meeting in Beijing China: Director (FA) in the capacity of partners Country Coordinator (PCC) represented Pakistan in the workshop on capacity building in programme management on Generic Reproductive Health Commodity Supply among Development Countries and 11th Annual Board meeting of partners in Population and Development held from 7-13 November 2006 in Beijing China. Accordingly visit report in this regard was submitted by Director (FA). GOP-UNFPA Annual Work Plan-2007 Signing Ceremony: A meeting of the UNFPA Steering Committee was held on 24th January, 2007 under the chairmanship of Additional Secretary MoPW in the Committee Room of Ministry of Population Welfare. The purpose of the meeting was to formally sign the GOP-UNFPA Annual Work Plan-2007 document by each Ministry. The concerned officers of MoPW, UNFPA and line Ministries such as MoH, MoE, MoWD and Statistic Division have attended the meeting and singed the AWP-2007 document on behalf of their respective Ministry/Division. DFID 8th Joint Review of the National Health and Population Welfare Facility: The 8th Joint Review of the National Health and Population Facility DIFD was held on 28th Feb.-2nd March 2007 and attended by Director (FA), Director (FM), Director (PME) and Deputy Director (FA). The specific session was attended by Secretary and D.G (T). Director (FA) has made a presentation on Challenges to Population Welfare Programme. The purpose of the meeting was to review the commitments to be completed for release of eight tranche of 7.5 million under the NHF project. Piloting One UN in Pakistan: A note titled Key steps and Milestones received from UNFPA shows that Population has not been included in the five thematic working groups (i.e. Health, Education, HIV/AIDS, Poverty Reduction and Disaster Management), although population is an overriding and cross cutting issue.

61

FA Directorate took up the issue at high level and a D.O letter dated 23rd February 2007 was sent from Secretary, MoPW to additional Secretary, EAD with a copy to Principal Secretary to the Prime Minister and Additional Secretary to P&D Division for consideration of Population as a sixth important thematic area, as it would help to attain a balance between resources and population growth within the broad parameters of the ICPD paradigm and following Population Policy of Pakistan, approved by the Cabinet in July 2002 which visualizes to achieve replacement level by 2020 through expenditures completion of demographic transition that entails declines both in fertility and mortality rates. In this context, EAD hold a first meeting of the High Level Committee (HLC) on UN Reform on 17th April 2007 in EAD under the chairmanship of Minister of State for Economic Affairs. It was attended by representatives of various Ministries, UN agencies and donors. From the MoPW, Director (FA) participated in the meeting. He supported the UN Reforms and realized that population is a cross cutting issue that effects all others sectors like health, education, poverty and economic development, as such this area may consider as a separate thematic area. Now the minutes of the first meeting of the HLC of UN Reform held on 17th April 2007, are received and following is recorded about the MoPW:HIV & AIDS should be considered under health. Population is a cross cutting area and needs to be seen and considered as a separate thematic area. Meeting with Dr. Thoraya Ahmed Obaid, Executive Director UNFPA Islamabad: Dr. Thoraya Ahmed Obaid, Executive Director United Nations Fund for Population (UNFPA) visited Pakistan from 26-28 April 2007. She was accompanied by Ms. Mari Simonen, Deputy Executive Director, Mr. Sultan A. Aziz, Director Asia and Pacific Division and Ms. Janie MeCuster. In this context, FA Directorate in consultation with UNFPA arranged a meeting with Dr. Thoraya Ahmed Obaid on 27th April 2007 in Islamabad. From the MoPW, this was attended by Minister for Population Welfare, Parliamentary Secretary, Secretary, Additional Secretary and Wing Chiefs of MoPW, DirectorFA. The representative from UNFPA also attended the meeting. The purpose of the meeting was to discuss population and development related matters and issues of mutual interest with the officials of the Government and Heads of various NGOs, UN agencies and Donors etc. Visit of UNFPA Goodwill Ambassador to Pakistan: Ms. Yuko Arimori, UNFPA goodwill ambassador visited Pakistan from 8-14 June 2007. During her stay in Pakistan, and apart from her others engagements, she showed keen interest to meet Secretary MoPW. In this connection, FA Directorate organized a meeting of UNFPA goodwill Ambassador to Pakistan on 11th June 2007 in the committee room of MoPW. The issue of mutual interest related to population, family planning and RH have been discussed in details in the meeting. The Secretary MoPW briefed the goodwill Ambassador about the new initiatives being taken by the MoPW to promote FP & RH Services in Pakistan. Administrative Matters:

62

The Administration Wing is responsible for all administrative matters, which include recruitment, promotions, disciplinary matters, legal issues, stores, office security, national assembly and senate maters, inter-provincial meetings on programme and coordination. Besides routine activities, the prominent activities of Admn. Wing during the financial year 2006-2007 details are given in the following table

Details of Cases disposed during 2006-2007 S.No. 1. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. Leave Cases Disciplinary Cases Posting Transfer Retirement Re-imbursement of Medical Charges Official Passport/NOC Departmental Permission Payment of Advances Charge Assumption Memo Issue Current Charge/Additional Charge Promotion Cases Appointments Offer of appointment Representation Total Receipts Cases Moved Letter Issued LPR/Encashment TA/DA Bills Misc. Cases Show Cause Notice Name of cases No. of Cases 129 04 59 03 199 45 13 15 120 09 31 02 70 29 01 2757 2757 5786 09 13 206 06

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22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36.

Resignation Seniority lists issued of BS-17 non-technical officers Requisitions to FPSC Applications Forwarded Relieving of Officers Leave Without Pay Personal Hearing Ex-Pakistan Leave Warnings issued Service Certificate issued National Assembly Question Medical Proforma issued to different hospital in respect of BS-16/17 officers Nomination of Departmental Representatives Summary for Prime Minister Order of Inquiries

03 01 05 10 33 03 03 03 09 03 04 22 02 01 02

Internal Audit on the Accounts of MOPW: Internal audit on the accounts of MOPW (HQ) and its 19 Formations, in & outside, Islamabad, is required to be conducted in terms of para-13 of GFR Vol-I. Internal Audit on the Accounts of 14 Allied Units: Internal audit on the accounts of 14 Allied Units has since been completed, whereas, internal audit on the accounts of MoPW (HQ), Islamabad RTIs Quetta, Faisalabad, Abbottabad & Peshawar would be conducted in the next financial year 2007-08 with the approval of competent authority.

Construction of Population House: Presently the Ministry of Population Welfare is housed in scattered hired commercial buildings i.e. Jamil Mohsin Mansion Building and Haroon Chamber Building. Huge rent is being paid for the buildings accordingly, it was deemed appropriate to construct a Population House. Hence the Ministry approached Capital Development Authority which allotted a plot measuring 2218.66 square yards. The Prime Minister laid its foundation stone on 12-03-2005 in an specially arranged ceremony for the occasion. For the construction of Population House, NESPAK is the consultant while Pak. PWD is (the executing agency. The construction work commenced on 29th September, 2005. The cost of the project was initially

64

Rs. 102.984 million which was revised in the CDWP meeting on 27-01-2007) in view of the fact that due to earthquake disaster in various parts of the country, the drawings were revised. Revised PCs-I for Rs. 217 million has been approved. Presently Ground Floor/two stories have been constructed in C Block of the Population House. Future provision for six floors exists. The covered area of building for offices in Population House is 28630 sq.ft. Presently the Ministry requires an area of 56,955 sq.ft. In order to expedite the completion of Population House on time, Monthly Review Meetings are held on regular basis. The two Wings of the Ministry i.e. M&S Wing and PPSOs/NGOs Directorate already have shifted in to Population House and the rest of the offices will hopefully be shifted on completion of the this project in October, 2007. 10 interns under National Internship Programme were placed at the disposal of different Directorates/ Sections for a period of one year w.e.f. 31-3-2007. Training facility was provided to 30 employees of M/o Population Welfare at NIPA Karachi and STI, Islamabad

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1. 0

M N O IN &S P R IS N O IT R G U E V IO
Field Monitoring Visits had been a regular activity of the M&S wing to review and monitor the The exercise of Field monitoring is undertaken through

programme implementation in the field.

monitoring teams comprising of officers / officials from M&S Wing, Programme Wing and Technical Wing to observe implementation and quality of services through service delivery network of the programme. Monitoring reports generated through these visits are submitted to Secretary, MoPW and also forwarded to Secretaries of PWDs for addressing the issues highlighted in these reports. A comprehensive follow-up mechanism has been developed by MoPW to have feedback from PWDs on these reports. This mechanism includes: Submission of reports of PWDs for response on specific Performa on the salient points of the

field monitoring reports. (PWDs are submitting their response on the Performa which would be verified during follow-up visit.) Discussion on salient features of the field monitoring reports with the provincial authorities A formal meeting with concerned provincial authorities on annual basis on monitoring plans and Follow-up field visits to observe improvements. during Inter-Provincial Review Meetings (IPRMs). as well as on mechanism for improvement.

During the period July, 2006 June, 2007, Field Monitoring of following 35 districts were undertaken: S.# 1. 2. 3. 4. 5. 6. 6. 7. Province Punjab NWFP Sindh Balochistan AJK Northern Areas FATA Federal Area Total Districts 12 7 5 5 2 2 1 1 35

A brief resume of field monitoring visits in each province is given as under: PWD Punjab The Population Welfare Programme Punjab is administratively headed by administrative provincial Secretary whereas field operations are looked after by Director General. Population Welfare Department Punjab has 34 programme districts where District Population Welfare Officers are mainly responsible for the implementation of the programme. The province has following service infrastructure for providing Reproductive Health / Family Planning services: o o Family Welfare Centers (FWCs) Mobile Service Units (MSUs) 1400 185 54 66 2260

o Reproductive Health Services Centres A (RHS-As) o Reproductive Health Services Centres B (RHS-Bs)
o Male Mobilizers

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The status of the programme implementation is also observed by field monitoring teams of provincial headquarter. The monitoring teams of the Ministry visited 12 districts during the previous financial year. It was observed that the District Population Welfare Officers are sensitizing and involving intelligencia, opinion leaders and youth on population concerns through seminars and presentations on Population & Development issues which is very encouraging sign. The young and enthusiastic district and tehsil managers are giving a dynamic shape to the programme despite various socio-political odds. These efforts are further supplemented by provincial headquarters and federal Ministry through media campaign for providing information on reproductive health issues. The vast variety of promotional material was also printed and disseminated. Generally the position with regard to location, hygienic condition, cleanliness of facility building, availability of medicines and contraceptives, was quite satisfactory. However there were certain issues, with reference to programme implementation which needed immediate attention of PWDs/DPWO. Some of those are highlighted as below: 1. 2. 3. 4. 5. 6. Filling of vacant posts, particularly of service providers. Training of service providers to improve their communication / counseling skills. Proper maintenance of vehicles. . Organization of population education activities on regular basis. Regular maintenance of equipments. Strengthening linkage with Health Department for provision of reproductive heath / family

planning services. PWD Sindh The Population Welfare Programme Sindh is headed by administrative provincial Secretary whereas field operations are looked after by Director General. Population Welfare Department Sindh has 25 programme districts where District Population Welfare Officers are mainly responsible for the implementation of the programme. The province has following service infrastructure for providing Reproductive Health / Family Planning services:

o Family Welfare Centers (FWCs) o Mobile Service Units (MSUs) o Reproductive Health Services Centres A (RHS-As) o Reproductive Health Services Centres B (RHS-Bs)
o Male Mobilizers

584 98 47 30 682

The monitoring teams of the Ministry visited 05 districts during the previous financial year. The contraceptive commodities and medicines were generally available. Vacant positions were required to be filled for providing RH / FP services.

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The salient observation of the visits are as under: Areas Identified as Good 1. 2. 3. 4. 5. 6. 7. All contraceptive and required medicines were available. Salaries and contingencies were paid in time. Most of the service providers were willing worker with required initiative. Direction / sign board were displayed at proper location. IEC material available and displayed except Aabadinama. Satellite Camps are being organized and Contraceptive Surgery clients properly referred. Required instruments, equipments and furniture were in place.

Areas Identified for Improvement. 1. Filling of vacant posts, particularly of service providers. 2. 3. 4. 5. 6. 7. Training of service providers to improve their communication / counseling skills. Organization of community mobilization and advocacy activities. Regular remittance of sale proceeds of contraceptives. Regularity and punctuality of staff to avoid absenteeism. Validation of CS cases referred by RHS-B centre. Strengthening linkage with Health Department for provision of reproductive heath / family

planning services. PWD NWFP The Population Welfare Programme NWFP is administratively headed by administrative provincial Secretary whereas field operations are looked after by Director General. Population Welfare Department NWFP has 24 programme districts where District Population Welfare Officers are mainly responsible for the implementation of the programme. The province has following service infrastructure for providing Reproductive Health / Family Planning services: o o Family Welfare Centers (FWCs) Mobile Service Units (MSUs) Reproductive Health Services Centres A (RHS-As) Reproductive Health Services Centres B (RHS-Bs) Male Mobilizers 408 47 20 28 468

o o
o

The monitoring teams of the Ministry visited 07 districts during the previous financial year. It was observed during these visits that the service centers are providing Reproductive Health / Family Planning services to the eligible couples. The contraceptive commodities and medicines were generally available. Vacant positions were required to be filled for providing RH / FP services. The vast variety of promotional material was also printed and disseminated. The salient observation of the visits are as under:

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Areas Identified as Good 1. 2. 3. 4. 5. 6. 7. All contraceptive and required medicines were available. Direction / sign board were displayed at proper location. Sale proceeds of contraceptives are being deposited regularly. Salaries and contingencies were paid in time. IEC material available and displayed except Aabadinama. Satellite Camps are being organized and Contraceptive Surgery clients properly referred. Required instruments, equipments and furniture were in place.

Areas Identified for Improvement. 1. 2. 3. 4. 5. 6. 7. 8. Filling of vacant posts, particularly of service providers. Training of service providers to improve their communication / counseling skills. Organization of population education activities on regular basis. Relocation of FWCs. Regularity and punctuality of staff to avoid absenteeism. Proper maintenance of vehicles. Validation of CS cases. Strengthening linkage with Health Department for provision of reproductive heath /

family planning services. PWD Balochistan Population Welfare Department Balochistan has 26 programme districts where District Population Welfare Officers are mainly responsible for the implementation of the programme. The province has following service infrastructure for providing Reproductive Health / Family Planning services: o o Family Welfare Centers (FWCs) Mobile Service Units (MSUs) Reproductive Health Services Centres A (RHS-As) Reproductive Health Services Centres B (RHS-Bs) Male Mobilizers 160 75 8 3 550

o o
o

The status of the programme implementation is also observed by field monitoring teams of provincial headquarter. The monitoring teams of the Ministry visited 05 districts during the previous financial year. It was observed during these visits that the service centers are providing Reproductive Health / Family Planning services to the eligible couples. The contraceptive commodities and medicines were generally available. Vacant positions were required to be filled for providing RH / FP services. Moreover, as per prevailing law and order situation, monitoring and smooth implementation of Population Welfare Programme are observed to be weak. It was also observed that frequent posting/transfer of DPWOs disturbed smooth implementation of the Population Welfare Programme.

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The salient observation of the visits are as under:

Areas Identified as Good 1. 2. 3. 4. Direction / sign board were displayed at proper location. Salaries and contingencies were paid in time. All contraceptive and required medicines were in place. District Technical Committee Meetings were held regularly.

Areas Identified for Improvement. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Filling of vacant posts, particularly of service providers. Training of service providers to improve their communication / counseling skills. Organization of population education activities on regular basis. Recruitment of Women Medical Officer (WMOS) for MSUs. Regular remittance of sale proceeds of contraceptives.. Regularity and punctuality of staff to avoid absenteeism Provision / display of IEC material. Relocation of FWCs. Proper maintenance of vehicles. Strengthening linkage with Health Department for provision of reproductive

heath / family planning services. Population Welfare Programme FATA The Population Welfare Programme FATA is administratively headed by Secretary, A&C FATA whereas field operations are looked after by Project Director Population Welfare Programme FATA has 07 agencies where Agency Population Welfare Officers are responsible for the implementation of the programme. FATA has following service infrastructure for providing Reproductive Health / Family Planning services: o o Family Welfare Centers (FWCs) Mobile Service Units (MSUs) 2 27 40 7

o Reproductive Health Services Centres A (RHS-As) o Reproductive Health Services Centres B (RHS-Bs)
o Male Mobilizers

The monitoring teams of the Ministry visited 01 district during the previous financial year. It was observed during this visit that the service centers are providing Reproductive Health / Family Planning services to the eligible couples. The contraceptive commodities were available. Some vacant positions of service providers particularly Female were not filled due to problems in recruitment rules which are being finalized at FATA.

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The salient observation of the visits are as under: Areas Identified as Good 1. 2. 3. 4. Building condition and general display is satisfactory. Staff is trained and well motivated. Recording and reporting system was observed up-dated / satisfactory. All contraceptive commodity were available.

Areas Identified for Improvement. 1. 2. 3. 4. 5. 6. 7. Filling of vacant posts of service delivery outlets, particularly medical officer and Non-existence of operation theatre at RHS-A Centre and no separate room for Non-availability of medicines. Proper Storage arrangements of contraceptives / medicines. Low clientele level at all service delivery points. Provision / display of IEC material to all service delivery outlets. Weak lineage of BHU Hospital management with Family Welfare Centres. technical staff at RHS-A Centre. insertion at all service delivery outlets.

Population Welfare Programme AJK The Population Welfare Programme AJK is administratively headed by Secretary, Population Welfare, where as field operations are looked after by Director Population Welfare Programme. AJK has 07 districts where District Population Welfare Officer (DPWO) are responsible for the implementation of the programme. The monitoring team of Ministry of Population Welfare visited 02 districts (Bagh and Muzaffarabad) randomly in previous financial year. It was observed during the visit that basic infrastructure of both district was badly effected in the earthquake of October, 2005. However FWC of population programme has been activated to provide Reproductive Health / Family Planning services to the eligible clients. Where as RHS-A Centres are presently functioning under temporary arrangement in tents. MSU vehicle provided for mobile service was not considered appropriate keeping in the hilly terrain. The contraceptive commodities, medicines & necessary equipment was available. Vacant positions were required to be filled for providing R.H / F.P services. Population Welfare Programme Northern Areas The Population Welfare Programme Northern Areas is looked after by Project Director, Population Welfare Programme. There are 05 districts where District, Population Welfare Officers (DPWOs) have been recently engaged. The monitoring team of Ministry of Population Welfare visited 02 districts (Sakurdu and Gilgit). It was observed during the visit that service delivery outlets are located within the premises of Health Department for providing Reproductive Health / Family Planning services to the eligible couples. The contraceptive commodities however found short. Vacant positions of service providers were required to be filled for providing R.H / F.P services. Moreover, it was observed that

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FWCs shifted in BHU building were running in a single room and have no separate space for insertion. A good working relationship with Health Department was observed in district Sakurdu. Bottlenecks Experienced in Implementing the Programme. The programme has some inherent difficulties and constraints which effected its implementation to the optimum level. These include: Population Welfare Programme is basically a behavioural change programme which mainly involves the mind set of the people keeping in view their religions, social and cultural norms. Low literary rate has roused a problem to break this mind set. In fact this mind-block remained a main hurdle in behavioural change process. Mass awareness was universal as brought-out by various surveys and studies, however the change in attitude and behavioural lagged for behind. A gap in counseling has been noted. The counseling and motivating a couple to small family norms in general and to adopt family planning techniques in particulars needs highly skilled and professional approach, which should break centuries old mind set. Though the programme service providers are given adequate trainings on Inter Personal Communication (IPC) and Information Education & Communication (IEC) skills, yet there are still gaps in their professional approach to convince and attract eligible couple for family planning. There is also a need to reinforce provision at grass root for interface of community level. The Male Mobilizer Project aimed at motivating male segment of society was believed to be helpful in moulding the male dominated society. However the placement of Male Mobilizer on proper place with adequate monitoring system has yet to be fully implemented. As a result, the expected results from component could not be achieved. The programme ownership by the Provinces appeared less proactive, soon after defederalization. It has not been fully recognized either by programme Officers/ Officials or by the Provincial Government. This lack of ownership has proven to be a set-back for advancement in programme implementation as an undertaking crucial for the socio-economic process on the provinces. Perhaps Population Welfare Programme is the only programme which has not been devolved at district level. Therefore, the district governments do not own this programme at district level. The anomaly between two sets of Administration at district level has certainly affected the orientation and focus of programme personnel. The operational aspects of the programme suffered from persistent ban on recruitment in the provinces alongwith a delay in budget releases. The provision of reproductive health / family planning service through the health service outlets also requires some re-enforcement. MoPW is providing Contraceptive Commodities to Department of Health, free of cost, for dispensation to the eligible couples. The provision of service has also been directed by the National Commission for Population Welfare (NCPW) in its 1st meeting chaired by the Prime Minister, but still a lot needs to be done in this regard.

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1 . 1

G A S&T R E S OL AGT The present government accord high priority of the Population Welfare Programme. The salient

activities of the programme were quantatively translated into Goals and Targets by the Prime Ministers Secretariat. The progress was required to be submitted on quarterly basis. The Goals & Targets for Population Welfare Programme focused on awareness creation, expansion in services, Human Resource Development, Community Mobilization, Research and Evaluation, Public Private Partnership etc. Ministry of Population Welfare (MoPW) has employed a holistic approach to achieve the envisaged goals through a variety of initiatives including offering wider contraceptive mix, focused promotional campaign , involving opinion leaders and intelligentsia through advocacy initiatives, building partnerships with social sector ministries, private sector & civil society, expansion in service delivery network, human resource development and strengthening of monitoring. MoPW submitted progress on the achievement of Goals & Targets to the Prime Ministers Secretariat on quarterly basis. The level of achievement on Goals & Targets was well beyond 100%. The details of Goals & Targets and achievements are at Annex-II A presentation on Goals & Targets (2005-2006) was made to the Prime Minister of Pakistan on 26 August, 2006 by MoPW. The Prime Minister made the following decisions: S.# 1. 2. 3. 4. 5. 6. 7. 8. Minutes / Decisions Direct MoPW to achieve the Goal of Population Stabilization by reducing Population Growth Rate from 1.86% to 1.3%, Total Fertility Rate from 4.0% to 2.1% and increase Contraceptive Prevalence Rate from existing 36% to 60%. Advise to increase the number of Lady Health Workers of Primary Health Care Programme from 92,000 to 100,000 this year and to 150,000 next year to address Reproductive Health and Family Planning issues. Agree for increasing the outreach of programme through expansion of Reproductive Health Service Centres, Mobile Service Units and Family Welfare Centres with the direction to ensure quality of services through Service Delivery Network. Stress the need to strengthen linkages with Public / Private sector Organizations as well as engaging Ulama and members of civil society for community mobilization for the successful implementation of Population Programme and achievement of planned targets. Observe successful achievement of envisaged Goals & Targets by MoPW during the year 2005-06. And reaffirm full support and commitment of the Government for Population Welfare Programme. Urge mainstreaming of Population Issues and its integration into development planning by the social sector. Ministry of Population Welfare should coordinate with its counterparts in the region in order to ensure best practices. Sales/distribution outlets for contraceptives should be increased by involving institutions such as the armed forces, railways, WAPDA and other public and private sector organizations.
th

The implementation status / necessary follow-up on the decisions was submitted to Prime Minister Secretariat on quarterly basis.

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12 .

C N R C P IV P R O M N E OT AET E E F R AC Overall Performance The data on Population Welfare activities in the country reveals that the Programme has

achieved 9.103 million Couple Years of Protection (CYP) during the period July 2006 to June, 2007 which is 20.6% higher than the last year (Annex-III). The Population Welfare Departments Punjab, Sindh, NWFP, Balochistan and Islamabad have also shown an increase in CYPs by 19.1%, 17.5 %, 26.7 %, 11.1% and 12.3 % respectively. The Social Marketing of Contraceptives (SMC), private sector, has also shown an increase in CYP by 32.6 % where as NGO (FPAP) and PPSOs have shown a decrease of 17.8 % and 5.0 % respectively. The Contraceptive Performance of Program and Non Program service outlets reported a sale of 163.210 million units of Condoms, 8.821 million cycles of Oral Pills, 1.262 million insertions of IUDs, 3.087 million vials of Injectables and 0.188 million cases of Contraceptive Surgery during the period July 2006 to June 2007. Details are given in the following table.

CATEGORY OF SERVICE OUTLE PROVINCE

Contraceptive Delivery Services During the period July 2006 to June 2007, the Nation-wide Programme and Non-Programme Service Outlets reported a sale of 163.210 million Units of Condoms (114.147 million SMC), 8.821 million Cycles of Oral Pills (6.261 million SMC), 1.262 million IUDs (0.273 million SMC) and 3.087 million Injectable (1.279 million SMC) were dispensed. In addition, various Programme and Non-

PUNJAB SINDH
June, 2007.

programme service outlets have performed 187,724 cases of Contraceptive Surgery. The province-wise analysis on Service Delivery indicates that Punjab has achieved 3.725 million CYP, Sindh 1.358 million CYP, NWFP 0.665 million CYP, Balochistan 0.130 million CYP and Federal District Islamabad has achieved 0.067 million CYP whereas SMC has achieved 2.713 million CYP during the period July, 2006The performance of contraceptive delivery services by category indicates that FWCs, RHS-As, RHS-Bs, MSUs, PLDs, RMPs, Male Mobilizer, NGOs and SMC have achieved Couple Years of Protection (CYP)

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2.944 million, 1.573 million, 0.644 million, 0.330 million, 0.128 million, 0.203 million, 0.116 million, 0.375 million and 2.713 million respectively.

CATEGORY OF SERVICE OUTLETS PROVINCE

Method-wise Analysis. The Method wise analysis of the current period 2006-2007, when compared with the last year i.e. July 2005 to June 2006 showed that the Contraceptive Performance has increased for all Methods

FWC Methods RHS-A RHS-B MSUs MALE MOBLIZER

that is Condom, Oral Pills, IUD, Injectable and Contraceptive Surgery by 18.3%, 9.9%, 29.5%,21.7% and 9.8% respectively. Comparison of Performance of Contraceptive Delivery Services during Current Year over Previous two Years

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Achievement of Family Planning and MCH Delivery Services The following table shows that during the period July, 2006-June, 2007, a number of 3.38 million clients availed family Planning Services of various Contraceptive methods. Out of which 0.412 million Pre-natal and 0.243 million Post-natal care services were provided to married women by Family Welfare Centers, apart from these Centers 3.392 million persons were provided treatment for General Ailments.

PROVINCE/ FEDERAL TERRITORY 1 PUNJ AB SINDH NWFP

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R S A C /E A U T N E E R H V L A IO National Research Institute of Fertility Care (NRIFC) The National Research Institute of Fertility Care was established in 1962 as National Research

Institute of Fertility Control and is functioning as one of the technical arm of the Ministry of Population Welfare. It was the prime source for providing technical information on contraceptive technology and advice to the policy makers and programme managers. The scope of NRIFC is to conduct research in the areas of bio-medical, clinical and demographic research. The main focus is on introduction, clinical and effectiveness and side effects of contraceptives methods. New contraceptives are first tested through controlled clinical trials and are then introduced in the programme. Functions: i. Programme. ii. iii. iv. v. vi. vii. viii. Determine suitability of use of contraceptives received from abroad and stored under varying field conditions thorough laboratory tests. Co-ordinate research activities with other national research organizations. Organize research seminars and publish the proceedings to disseminate research findings. Foster Population Welfare Programme research work in other professional and academic institutes through assistance and financial support. Collaborate with international agencies by participating in their research programme. Advise Ministry of Population Welfare on matters related to clinical, biological, bio-medical and related matters. Conduct other research studies as and when required. Research Activities A. Studies Completed i. Comparative Study of Follow up of Tubeligation Cases performed at Reproductive Health Services (RHS) centres and at the FPAP Extension Service Camps. ii. Treatment of Norplant Induced Bleeding. iii. Correlation of Fertility Indices in Normospermics, Oligospermic and Azoospermic Men iv. Comparison pf Experiences of Contraceptives users of IUCD, Pills & Injectables. v. Follow up of Vasectomy Cases in Sindh and Punjab to access the satisfaction level. Conduct clinical trials of new contraceptives which have a potential for use in the Countrys

B. Ongoing Studies i. ii. iii. Return of Fertility following Discontinuation of Hormonal Contraceptives Pre-Introductory Clinical Trial of Implanon Rod-1 (Implant). Impact of Strengthening of Counseling Skills Service Providers and Enhancing Quality of Care

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iv. v. vi. vii. viii. ix. x.

Comparative Clinical Trial of Progesterone only Pills V/s Combined Oral Contraceptive Comparative Clinical Study on Acceptance and continuation rate of copper- T 380 A V/s Multiload 375 (IUD). Post Operative changes in menstrual cycle after Minilaprotomy cases. Comparative Clinical Trial of Mesigyna- Norigest Injection to determine the bleeding pattern and acceptability. Role of Leptin in Male Infertility. Increase Access to Emergency Contraceptive Pills through FWW & Community Women Volunteers. Pre-introductory Clinical Trial on Latest IUD Yuangong-220.

National Institute of Population Studies (NIPS) The National Institute of Population Studies (NIPS) undertook the following studies during the year 2006-07: Activities Completed

Pakistan Demographic Health Survey (PDHS) 2007. Status of Women, Reproductive Health and Family Planning Survey. Population Growth and its implication 2006. Six Research Briefs, Issue-2 (Jan- 2006), Issue-3 (April 06), Special-Issue (Aug

06), Issue-4 (Sep 2006), Issue-5 (Dec 2006), Issue-6 & 7 (May 2007). Report on Proceeding of International Conference (Best practices for scaling up

reproductive Health and Family Planning Programme and reducing material and neonatal mortality Islamabad. Continuation of IUD and injectables in selected districts of Punjab. Demand for children in rural setting. District Population an Development Profile (DPDP). (Fourteen District reports of NFWFP have been published).

Activities in Progress Evaluation of Population Welfare Training Institute (PWTIs). Study on Socio-cultural factors affecting genetic disorder in population of Study on Impact Evaluation of media campaign of population welfare Study on Socio Demographic realities in earthquake hit areas of AJK and

Pakistan. programme. NWFP. Work Shops / Trainings arranged by NIPS

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Training of PDHS Field Research staff (26 days). Two Trainings of DDPWOs and TPWOs (three days each), Research Work Shop on Research modeling and Statistical Modeling March, 16th to 18, Office automation and efficient use of internet (two trainings each of three days)

Methodology and Data Analysis were organized on October and December, 2006. 2007 by Dr. Arshad Mehmood for NIPS research staff. for NIPS Officers and officials were organized by Computer Programme, Mr. Faateh ud din Ahmad 2006.

Three days workshop on Demographic Concepts and their applications organized

at Sukkur on April 19-21, 2007. Seminars arranged at NIPS Seminar on Prehistoric culture of the Indus Region: Population Diversity and Health Status by Prof: Jonathan Make Keoyer, President America Institute of Wisconsin, Madison (USA) April 28, 2007. Understanding the Gendered influence on womens Reproductive Health in Pakistan Moving Beyond Autonomy Paradigm By Dr. Zubia Mumtaz Assistant Professor, University of Saskatchewan, Canada. May 07, 2007. Two seminars on sharing the PDHS findings, 9th May and 18th May, 2007. Workshops on MPS (Master in Population Studies) program were held at the Presentation made on the working of NIPS to the group of NWFP demographers

universities of Faisalabad and Karachi January 9, 2007. visited NIPS. Apart from these studies the Institute organized seven Dissemination Seminars.

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