Dr. Adnan A. KhanDr. Adnan A. Khan

Research and Development Research and Development SolutionsSolutions

USAID Small Grant (2011) to RADS Partners – Punjab and Sindh DOH and PWDs Areas – Family Planning and Immunization in the

context of MNH Purpose - Institutionalize information generation

and use and actions

The Evidence to Policy and Action Grant Initiative

Analysis- existing datasets, LHW, EPI data

(Punjab and Sindh) Research on models of services Working with DoH/PWD to understand their

programmatic data and connect to program improvements

Informed Advocacy to Politicians, communities

Work with donors to address their information needs/efficiency

What is RADS doing

FPAP started in 1953 GoP programs in 1966 Many phases and approaches

FP in Pakistan: The History

Family Planning in Pakistan

Source: PDHS 2006-7 MWRA: 23 million

Modern Methods

Total Users: 5.1 Million

Services for Modern Methods

Total Users: 2.9 Million Total Users: 2.9 Million (12% of (12% of MWRA)MWRA)

Connecting CPR to ServicesCPR

30% of MWRA7.1 Million

UsersModern Methods

22% of MWRA5.1 Million

Users Services

12% of MWRA2.9 Million

Users

Costs of FP in the Public Sector

Per Women served

CYP

MoH 826 671 - BHUs 661 391 - LHWs 887 728MoPW 4,347 1,032

Total for MoH and MoPW

2,414(USD 40)

937(USD 16)In PKR

Regional Costs: PKR 240-400 (USD 4-6)/ CYP

Inferences of Costs

Pakistan public sector costs are 4 fold higher than regional costs (USD 4-5/CYP)

4% of costs in public sector are for commodities

If regional efficiency was to be achieved, public sector FP funding alone can allow >80% CPR

Trends in Services 2006-12

In M

illion

s W

om

en

S

erv

ed

Services by Sectors

Private

1.9 M67%

Public 1 M,33%

2.9 million (12%) of MWRA receive FP services per year

Age when Information Received

JhelumPak

PattanTime Lag(in years)

RH/Puberty 13 120-3

months

Menstruation 14 130-3

monthsMarriage 23 23 2Child bearing 25 31 5-10Birthing options 27 32 5-12

Family Planning

29 40 9-20

Source: Khan et al, Study of Information Processing by Young Women. RAF/ DFID 2012-13

Overall CPR has increased at <1% per annum

12-14% of MWRA receive FP services each year

Government services only account for 33% of all services or around 1 million women.

Nearly half of couples buy FP supplies from stores. Markets serve ~50%. These are poorly understood

Despite investments and programs, the number of users has not increased above secular trends

Young women are a major potential user group that is largely being ignored

What does it all mean

While supply side programming is useful, demand must be created

Spacing messages must be incorporated into common narrative

Address Young women – soon to be married, newly married

Government programs must be held accountable to the investments that go into them. This may mean that unless they produce results, facilities and sections of programs may be closed down

Markets for FP are crucial, better understanding and used

Lessons

Thank You