Repoductive health programmes of Pakistan: stand alone or integrated
Date of Award
Master of Science in Health Policy & Management (MSc Health Policy & Mgmt)
Community Health Sciences
Background Pakistan is one of the fast growing countries in the world in general and particularly in the region regarding population and reproductive health problems become rampant. Besides a heavy disease burden, the health planners are faced with a dual challenge of coming up with ways of utilizing the available pool of meager resources. Currently Pakistan is having multiple vertical reproductive health programmes in public or private sector and are in one way or the other, targeting a single outcome: to improve the reproductive health of Pakistani population at large. Considering the fact that the health systems in Pakistan is severely constrained in financial terms, it becomes important that one looks deeper into the reasons of having more than one vertically run programmes fulfilling the same purpose and to look deeper into their effects. Methodology This was a case study based on descriptive qualitative approach and was conducted in Islamabad. Respondents for in-depth interviews were selected through a purposive sampling technique. In addition a document review was done in order to triangulate the findings. The study attempts to explore the perceptions of different stakeholders in the health sector of Pakistan including representatives/decision makers both from public, private sector as well as the donor community regarding the reasons, advantages, disadvantages and possibilities for integration of vertical programmes currently working for the improvement of reproductive health in Pakistan. Results After triangulating the perceptions of key informants and information collected from document review, we found that in the Pakistani context there is no need of having multiple vertical programmes for reproductive health but keeping in view the context of the country government is unable to negotiate with the donors regarding priorities other than family planning, HIV/AIDS, maternal and child health. Our study showed that the public health professionals have an important role in the initiation of these vertical programmes. The results also indicate that the disadvantages of vertical programmes are more than the advantages and the donor's wish is much prominent in the launching of vertical programmes for reproductive health in Pakistan. The lack of management capacity and owner ship by the provincial governments also came forward as reasons for this verticality. Exploring the possibility of integration of these vertical programmes we found that it is only possible at the district or service delivery level in Pakistan and the role of government and policy makers will be of key importance in this regard. Recommendations & Conclusion Improvement in the policy making process, evaluation and capacity building of public health professionals should be ensured. There is a need for the development of basic services package for reproductive health services and government must give a timeframe and make a strategic plan for the integration of various reproductive health initiatives both under Health and Population Welfare ministries. In addition, at the ministerial and policy level, there should be an explicit commitment to and support for integration of reproductive health programmes at the district level. A clearer understanding of variety of multiple vertical RH programmes was gained through this study. Having discussed the advantages and disadvantages and the possibilities for integration of these vertical programmes at different levels, we came across some fruitful recommendations. We believe that these suggestions will of great help to the policy and decision makers to reorient their strategies to invest in reproductive health in future and to negotiate with the donors for the same. Most importantly the study will benefit the programme-implementers for fostering collaboration and working with more coordination towards the same goal of improving RH indicators in the country.
Alizai, A. A. (2009). Repoductive health programmes of Pakistan: stand alone or integrated (Unpublished doctoral thesis). Aga Khan University, Karachi, Pakistan.