The rapidly growing population in Pakistan, and its horrible consequences have been known & articulated by all the stakeholders including especially the Government and donors, besides the civil society. A quick look at historical evolution to address this issue reveals that at the end of the day, it’s the political will or otherwise which makes a difference.
Modest but impressive beginning
In ’60s, FP (Family Planning was initiated by an NGO, which made a big difference to capture the attention of Government and later within some decades we had a formal Ministry of Population Welfare and a famous program of Village Based FP Workers along with mobile clinics etc. Interestingly this was even before the existing Lady Health Worker Program
Good intentions but bad consequences
The Government appeared to have good intentions in having two ministries i.e. The Ministries of Health, and Population Welfare at Federal level and similarly at the Provincial level. Perhaps the rationale may be to have focus and desired emphasis on population issues. However, this artificial divide resulted in compartmentalized approach by putting all the health related issues to Ministry of Health, except for FP; though some lip-service was still maintained. This issue has further worsened by the devolution in Pakistan and each province is addressing this issue separately; some not paying attention because ‘their’ population is already very low and thus federal distribution of money is also less!!
Playing with Population data
The population have been produced but there had always been issues related to projections and of course fudging of the data at health services delivery levels because of stringent requirements and consequent punitive punishments. Thus, usually, with few exceptions, the news was that all is well and we are slowly progressing in increasing our contraceptive use rates and the consequent indicators. It was untill when PDHS 2007 and later on 2012 revealed that all is not well. I remember that the Ministry of Population Welfare held back the results for more than 6 months. In the meantime several surveys and consultancies (Technical Assistance) work had been conducted to identify the reasons and suggest the solutions. Of course each time we came up with the ‘old wine in a new bottle’.
FP agenda further widened & its consequences
The ICPD agenda and further declarations coined the word for ‘Reproductive Health’ (RH) and then even Sexual and Reproductive Health and we joined the bandwagon as part of political will and international signatory. I have all the fears that it further diluted the FP focus but opened up the doors for new interventions. This followed the advocacy for Adolescent Health, Abortion Rights, Women sexual and Reproductive Health and lot of talks on population bulge, the demographic dividends etc etc.
Failed efforts for integrating Health & Population
There had always been growing realization that population is part of health and why not the two Ministries be at Federal (before devolution) and Provincial levels be merged. There have been lot of efforts by the UN agencies to make it a reality and I know that even there was all the willingness to do it by the head of state, but just because of one of minister it was postponed and in a way cancelled. There are some services provided by both the Departments’ outlets and outreach workers but still each one respectively reports to their parent department. In addition, though some efforts had been made by the other sectors such as education, it has not made a big difference.
Should we keep on using the old wine in a new glass? The way forward
“We cannot solve our problems with the same thinking we used when we created them”, Albert Einstein.
One might be shocked when you start calculating the amount of money put by the Government as well donor agencies and international NGOs to address the issue of FP. Interestingly, most of the NGOs and implementing partners have always showed that they have made a difference in their 1-5 years project. Unfortunately, when money and inputs finishes, all goes to ground zero and no replication, what to talk about scaling up. Perhaps, all the stakeholders and champions have to make some ‘hard’ and ‘bad’ decisions. It appears the existing government and may be the coming government will not have FP in their political agenda, as they have so many other ‘pressing issues’ to tackle. But, the question is, has any bilateral, multilateral and Bank has to courage to make these steps; or should we leave it to civil society or at the last to people themselves. Maybe, let us leave it to Allah, as now we have major populist Islamic dominance who are also not in favour of addressing FP issues.