Top Five Factors for Family Planning Success in Sindh
By: Dr. Azra Fazal Pechuho, Dr. Talib Lashari, and Shahnaz Wazir Ali
We are proud to be among the first places to develop a costed implementation plan (CIP) to help ensure we achieve our provincial FP2020 commitments. While having a CIP does not guarantee success, it helps us stay on track and move forward in the right direction. In Sindh, we have been able to capitalize on contextual and political factors that have allowed family planning to take hold in the province. Based on our experiences in Sindh, we present the top five factors that have helped us achieve effective leadership commitment and sustained ownership to family planning. In sum, ownership and leadership are key.
#1. Committed political leadership. This is critical when advocating for family planning. In Sindh, the Minister of Health and Population Welfare is central to the family planning effort, leading the FP2020 and CIP efforts for the province. Previously, ministries for health and population welfare worked in silos in terms of family planning, but now these have been integrated functionally in terms of one minister for both ministries, which means that the provincial efforts to advance family planning are led by a minister committed to family planning. As another illustration of committed political leadership, the Chief Minister of Sindh has established a Task Force on Population Growth that brings together ministers, technocrats, and high-level government officials to focus on population, family planning, and achieving the FP2020 commitments. We all need to work to ensure that political leaders are committed to family planning and find ways to support it.
#2. Strong technical leadership. This is also critical to implementing the vision of the political leader. While decision makers make commitments, technical leaders are responsible for translating those commitments into results. In Sindh Province, we are very fortunate to have both political and technical support: the minister leads on the policy planning front, and the technical advisor CIP provides support to her on the technical front and leads the execution. In addition, the coordinator of Public Health Programs in Sindh provides a unique role of bridging the political and technical leadership. Together, these three individuals work together, understand each other’s roles and strengths, and work to advance the common goals. In addition, as explained below, implementing and development partners regularly meet with the provincial leadership to ensure the CIP is effectively and efficiently executed.
#3. Strong collaboration between the public and private sectors. Through the process of developing the CIP, not only did the provincial Departments of Health and Population Welfare work together to provide leadership, but nongovernmental organizations (NGO) and civil society organizations (CSO) worked together to identify best practices, sharing ideas in a collaborative way. Sindh health/population-sector leadership advances stewardship, creating an environment in which the public and NGO and CSO sectors work well together, providing complementary functions in all aspects of family planning and CIP execution. This collaboration extends to the Sindh FP2020 Working Group, which is a province-wide platform where public- and private-sector stakeholders meet quarterly to discuss progress on executing the CIP. Subgroups of the working group focus on 13 different aspects of the CIP and provide a structure for bringing together knowledge and best practices to advance the CIP’s execution.
#4. Institutional mechanisms foster success. Three mechanisms help guide CIP execution and coordination of progress on FP2020 commitments: the CIP PIU, the FP2020 Working Group, and the Country Engagement Working Group. Sindh’s CIP includes both the creation of a management unit for CIP execution and a process for bringing stakeholders together to advance progress. The Sindh government gives the CIP PIU a small amount of funding to carry out its management functions. One of the functions of the PIU is to convene the quarterly meetings of the FP2020 Working Group, which tracks CIP progress and engages key players, including the public sector, NGOs, donors, and the private sector. The third mechanism is the Country Engagement Working Group, which facilitates coordination among the provinces, the national level, and the global FP2020 initiative. Having defined mechanisms places responsibility for CIP execution on a public sector entity, while recognizing the role that stakeholders have in achieving FP2020 commitments. Lately, CIP PIU has been declared a Technical Support Unit (TSU) to assist the Chief Minister’s Task Force on Population Growth in Sindh. The task force has been created in response to the Supreme Court of Pakistan suo moto on the alarming level of population growth and subsequent decision by the Council of Common Interest (CCI), a Prime Minister led constitutional body looking after matters between federation and provinces.
#5. Tolerant religious-cultural norms facilitates discussion and use of family planning. Historically, Sindh has been a place of religious tolerance grounded in mysticism. Religious leaders in Sindh have not impeded discussion or use of family planning. This contextual factor helps ensure that religious leadership does not hinder any following-through on family planning commitments.
In isolation, each of these factors has helped local ownership of family planning. When taken together, and in the given context, these factors have created an environment in which Sindh has made important advances related to the policy environment, resource mobilization, and reaching underserved populations. A few of our high points have been:
· Implementing task sharing policies that increase the role of female community workers (known as Lady Health Workers) in providing injectable contraception and Population Welfare Workers at grassroots level called Family Welfare Workers to inserting implants.
· Allocating resources and successful procurement of contraceptives. In addition, provision of contraceptives to NGOs free of cost.
· Reviving two district level structures that focus on family planning (District Health and Population Management Teams and District Family Planning Technical Committees) and prioritizing family planning in the district health agenda.
· Engaging young people in family planning programs and rolling out Life Skills Based Education that includes self-protection, personal hygiene, nutrition, human rights, disease prevention, and gender equality.
· Emphasising post pregnancy family planning (PPFP) and post abortion care family planning.
· Engaging private sector hospitals and clinics by signing memorandums of understanding and declaring those as Reproductive Health Services B Centers (RHS B) parallel to RHS A centres in the public sector.
Sindh’s strong political commitments, its partnerships, and its institutional mechanisms create an environment for reforms and achievements in family planning. While we still face challenges in our family planning program, we are proud of how local ownership and committed leadership have been instrumental in in achieving our successes.
Dr. Azra Fazal Pechuho is the Minister of Health and Population Welfare, Sindh Province, Pakistan.
Dr. Talib Lashari is the Technical Advisor/Head of CIP Plan Implementation Unit (PIU), Population Welfare Department, Government of Sindh, Sindh Province, Pakistan.
Ms. Shahnaz Wazir Ali is the Coordinator of Public Health Programs, Sindh Province, Pakistan
This blog was written with contributions from Jay Gribble.
