A Plan to Rally Around
Co-Authored by: Kamyla Marvi
In December 2015, Sindh province in southeastern Pakistan launched its Costed Implementation Plan (CIP) on Family Planning. The CIP aims to contribute to a national goal of 55% CPR by taking Sindh from a contraception prevalence rate (CPR) of 30% to 45% by 2020. Sindh is one of the focal geographies of PAI’s QUEST project, which seeks to assess systematic determinants that affect quality and fulfillment of reproductive health and rights and identify policy levers for improving the quality of family planning (FP).
Sindh’s accomplishment comes amidst a global wave of CIP development, as countries throughout Africa and Asia strive to set their FP priorities and operationalize ambitious goals through concrete, costed roadmaps. With more countries undergoing decentralization, we are also seeing an increase in this type of costed FP strategy at subnational levels in countries like Kenya, Nigeria, and Uganda.
The Sindh CIP, with a budget of 51.2 billion Pakistani rupees, or nearly half a billion US dollars, is critical to the delivery of quality family planning services in Sindh. The CIP was developed jointly by the Population Welfare Department (PWD) and Department of Health (DoH). The CIP was established to realize the commitments made by Pakistan at the FP2020 Summit, and Sindh provincial departments have demonstrated strong ownership of the plan and the province’s family planning programs more generally.
In 2010, as per the 18th Amendment to the constitution of Pakistan, the federal cabinet devolved several functions to its four provinces. Among these, health, education, and population welfare were also devolved, resulting in increased authority at the provincial level. Provinces thereby went about developing their own policies and programs to meet their expanded role and learning how to adapt to their new responsibilities. For Sindh, this transition has included setting a five-year path for family planning programs. As Dr. Azra Pechuho, the chair of Sindh’s Oversight and Coordination Cell for Public Health Programs (the body responsible for oversight of the implementation of the CIP) says in the opening remarks, “Sindh is the first province in Pakistan that took the bold initiative to formulate its CIP document. The government of Sindh has already dedicated funds for the procurement of contraceptives over the next five years.”
The Sindh CIP identifies broad priorities and presents six strategic areas to meet the goals of increasing CPR in the Sindh province: functional integration; quality of care; supply chain management; expansion of services; knowledge and meeting demand; and governance, monitoring, and evaluation. While the strategic area of ‘quality of care’ lays out plans for ensuring the quality of services by enforcing standards, improving providers’ skills and ensuring client satisfaction, the remaining strategic areas are also critical to ensure that the health system delivers on quality services.
In a recent conversation, Dr. Tauseef Ahmed of Pathfinder International, who played an instrumental role in supporting and developing the CIP, emphasized the importance of quality within the CIP framework because “that’s where unmet need is directly addressed and Sindh has a very high unmet need.” The inclusion of quality as a core pillar of the CIP, as well as the recent Sindh Population Policy, marks a shift from historic FP strategies targeting increasing access towards a more holistic approach that factors in the choice of methods, counseling, and other factors that shape a woman’s experience receiving FP services. Ultimately, a program cannot be successful unless clients receive high-quality services.
Despite the challenges associated with devolution, the Sindh provincial government has shown great political will and local ownership of increasing access to quality family planning services, as evidenced by the CIP. The Sindh CIP provides an opportunity for the Sindh government to mobilize resources towards its vision and to build its own capacity. The CIP also establishes a framework for coordinated FP efforts, opening the door for civil society to support the government by contributing to a larger vision through solutions tailored to local problems and by promoting innovation and new ideas. While the development of the CIP is an important step, sustained advocacy and multi-sectoral collaboration is important to ensuring that the CIP is effectively implemented and key priorities, such as quality of care, are fully addressed.