After the passage of the 18th Amendment, provinces have to take population control more seriously
According to census, Pakistan’s population is about 210 million. After the 18th Amendment in the Constitution, the subject of population control falls in the provincial domain.
Population welfare departments have not been able to create an impact because of various social and logistical reasons, such a lack of staff and lack of the political will.
The biggest issue is human resource. According to Punjab government, the population welfare department has an adequate stock of contraceptives but there is a shortage of lady health visitors and mobilisers.
Given the limited number of workers, the department cannot cover the targeted population, which is about 16 percent of the total population in a district. The number of mobilisers, outreach workers, and family welfare assistants is less than 100 per district. There is a shortage of staff for going door-to-door. In many districts, a lady health visitor (LHV) divides her time among two to three units.
Contraceptive prevalence rate has gone down in the province from 45 percent last year to 38 percent this year. The number of workers has not increased with the increasing population.
Progarmmes initiated by the population welfare departments engage clergy, non-government organisations, and people from sports and showbiz industry. But this can be no substitute for departmental staff that reaches out to the people at their doorstep.
In Punjab, district population offices report to the Directorate General of Population Welfare. Tehsil offices, service delivery outlets, namely family health clinics, men advisory centers, mobile service units, family welfare centers, and the training centres located in the family health clinics and men advisory centres are under the administrative control of the district offices.
In Khyber Pakhtunkhwa, the government has announced plans to recruit more than 1,000 clerics a few months ago and set up more than 1,000 centres for reproductive health.
Dr Attiya Inayatullah, a former federal minister for population, is optimistic about overcoming challenges. "After the devolution, provinces have taken responsibility of family planning and population control programmes. We have to remember that this programme has been run by the federal government in the past. It was not going to be easy for the provinces to take its ownership."
In the past few years, provinces have carefully looked into this programme and have prepared for its thorough implementation. "That’s why seeing the needs of the departments, the Punjab and Sindh provinces have doubled the budget in fiscal year 2019-20," she says.
The new money would be spent on logistics, increasing staff, training and, buildings. "We are hoping that provinces will complete their reviews and will focus on making the programme more efficient."
Also read:Advantage or albatross?
Provinces have also engaged with Health Departments for helping in population control by setting up family planning desks in local health facilities.
Efforts are also being made to hold LHVs to their job description. "Primarily, they were meant to help the mother in basic health issues and population control. Later, they were also tasked with other activities, such as helping in polio vaccination, etc. Now, the provinces are making it mandatory that these LHVs spend 25 percent of their time on family planning and population control assignments."
The United Kingdom, through its Department for International Development (DFID), is also helping Pakistan to deal with the population welfare problems as part of its global efforts to control population growth rates. Through its Delivering Accelerated Family Planning Programme, DFID is making family planning information and services accessible to those in need in Pakistan. By March 2022, the UK, , aims to achieve 550,000 modern contraception users with help from relevant departments.