ICPD to MDGs- a quest for common grounds : where do we and what needs to be done?
Date of Award
Master of Science in Health Policy & Management (MSc Health Policy & Mgmt)
Community Health Sciences
Background: United Nation has held a series of conferences to understand the demographic transition in different regions of the world, highlighting the social, economical and cultural issues which are contributing in population growth. The fifth conference of that series was held in Cairo in 1994, in which Program of Action was introduced. This was the first time when reproductive health was discussed with the context of social development and reproductive rights. Among 179, many countries adopted the new paradigm shift of reproductive health and broadened their policies by including the reproductive agenda into their national policies. The 1994 ICPD PoA was re-affirmed in 1999 as ICPD+5 and in 2004 as ICPD+10. Meanwhile in 2000, the Millennium Development Goals were introduced, and targets for 2015 were given to the countries to achieve the eight goals. With the inception of MDGs, the donor preference also changed; the funds were diverted to projects which were started to achieve millennium goals. Political influence of some super powers started mounting all over the world. In this scenario, the pace for achieving these targets has been very sluggish in Pakistan, where the maternal mortality and child mortality is one of the highest in the region. The purpose of this study is twofold: to identify the missing links between the ICPD and MDGs in international commitments and national policies; and to find some common grounds to improve RH in Pakistan while working towards MDGs. Methodology: The study is based on two components; a systematic literature review and key informants interviews. The published literature carrying the discussion of ICPD and MDGs from the year 1994-2001 was included, along with the official documents and reports of government of Pakistan and the reports of various international agencies were included in this study. For the key informant's interviews, fourteen interviews were conducted with experts who have some background knowledge about RH, till the time of saturation. Key results: After triangulating the perceptions of key informants and information gathered from literature review, the findings of the study reveals that the ICPD agenda of reproductive health has been declared as the most comprehensive one, which had actually broadened the spectrum of reproductive health. MDGs, however, became tir main focus of the national and international policies around the world. Among all the eight goals there is no explicit goal on RH agenda, therefore, it is considered as the "missing link" from MDGs. Like other countries, government of Pakistan has also shifted focus of its policies and programs towards achieving MDGs. As a result, concepts highlighted in the ICPD dropped eventually. In spite of specific goals on maternal and child mortalities in MDGs and all the investment and policy shift, Pakistan has till one of the highest maternal mortality rates among developing countries. Lack of synchronized efforts, sector wide approaches, inter-sectoral collaboration, unmet need for family planning, unsafe abortions, low literacy rate and dearth of women empowerment are the main reasons. There is a need of political will and involvement of stakeholder for bringing positive change in the policies. The MDGs clearly highlighted the importance of intersectoral collaboration, NGOs role in development and global level cooperation among states, which is lacking in our country. Conclusion: Being a signatory of both of the international agendas (ICPD and MDGs), Pakistan needed to articulate its policies to keep the balance between the two agendas. There are, however, certainly some common grounds which have been experimented by various countries and we can learn lessons from those best practices. An inter-sectoral cooperation and sector wide approaches would be required to achieve such ambitious goals set out in ICPD-PoA while working towards MDGs. There is a need of increasing resource allocation, strengthening primary health care services and EmOC and motivating the human resource employed in health sector by good governance. These endeavors should lead to formulate evidence based national policies, reproductive health services which are affordable, accessible and culturally acceptable and finally a responsive health system.
Abrejo, F. (2007). ICPD to MDGs- a quest for common grounds : where do we and what needs to be done? (Unpublished doctoral thesis). Aga Khan University, Karachi, Pakistan.