KARACHI: Highlighting major gaps in the provincial health delivery system, speakers at a programme held on Wednesday urged the government to make health facilities functional by ensuring the presence of adequate medical staff, equipment and medicines at their respective centres.

Health and population welfare departments, they pointed out, should be integrated and basic health units (BHUs) should also offer family planning services.

The round table dialogue between policy makers and community activists on family planning and reproductive health was organised by the Strengthening Participatory Organisation (SPO), a rights-based NGO at a local hotel.

Sharing his experiences while working on a two-year reproductive health project that has recently concluded, Munawar Hussain Jokhio, part of the district health team posted in Gadap, said that the absence of lady doctors at the town’s BHUs was a major obstacle in addressing women’s health issues. The town, already lacking in water, gas and electricity supplies, is also devoid of a functional government hospital.

“Five BHUs located in three union councils, Gadap, Songal and Darsano Channo, were selected for the project. Support teams were formed and trained to go door-to-door and promote messages on reproductive health and family planning,” he explained to the audience.

Most of the people the teams interacted with, Mr Jokhio said, were ignorant of the concept of family planning whereas others that claimed to have heard of it took it as a method to stop childbearing. Some even looked at family planning services as part of a Western agenda.

“We tried to remove these misconceptions and told the communities that family planning is meant to plan a birth, according to one’s needs,” he said.

Regarding the challenges the teams faced during their work, he said that official apathy was very discouraging and efforts undertaken during this project be continued in the future.

The communities in Gadap Town, he said, were still awaiting the reply of the 700 applications that they had submitted to the ombudsman office regarding a shortage of medical staff and equipment at BHUs.

Yasir Memon and Ali Nawaz Lund, part of the project teams that worked in Mitiari and Tando Mohammad Khan respectively, also gave presentations on their field work. The former noted that non-availability of contraceptives was a major problem, hampering efforts to encourage family planning and recommended that there should be a 24-hour operational health facility at taluka level in Sindh to cater to medical emergencies, especially those relating to maternal health.

Mr Lund appreciated the People’s Primary Healthcare Initiative that, he said, had made BHUs functional in Tando Mohammad Khan. Family planning centres were opened under the project funded by the David and Lucile Packard Foundation while government officials, he said, assured the allocation of an amount for family planning services in the next budget. He recommended the provision of ambulance service at BHUs to transport patients with an emergency to hospitals.

Dr Tabinda Sarosh representing Shirkat Gah, an NGO working for social justice, briefed the audience about the history of family planning services in Pakistan and said that though these services were introduced in the mid-1960s, the country’s fertility rate was higher as compared to Bangladesh, Nepal and Sri Lanka and central Asian countries like Tajikistan.

“Family planning is considered as a woman-centric issue, though it is equally important to have men on board especially in our patriarchal society where decision makers are men,” she said, adding that a 2012-2013 Pakistan Demographic Health Survey (PDHS) had shown that one in five married women had an unmet need for family planning.

Dr Sarosh touched upon various aspects of reproductive health that included the subject of abortion which, she said, was being increasingly used by married women in the country as a family planning method. Sexually transmitted diseases like HIV/AIDS, an under-reported disease in Pakistan, she pointed out, was also linked to reproductive health.

On the dynamics of poverty, she said that it had been feminised as studies had shown that women especially adolescent girls were at the lowest level of deprivation. Reproductive health of adolescent girls, she said, was totally missing from the health agenda.

“The PDHS survey shows that 35pc women are married by 18 years of age and that Sindh and Balochistan had the highest number of such cases. Domestic violence is also rampant in our society and violence is not just to beat someone physically; depriving a person from the right to choose is also violence,” she said.

Sindh, she said, was the first province to pass laws on early age marriages and domestic violence but one could not see an implementation of these laws.

Commenting on governance, she said that devolution was good but along with bureaucracy the political system should also be devolved. Devolution, she said, was not properly planned and the division between the health and population welfare department was blocking efforts to encourage family planning.

“The lady health visitors whose primary job was to take care of reproductive health needs have now been engaged only to administer polio drops,” she remarked.

Head of the Indus Resource Centre Sadiqa Salahuddin, regional head of SPO, Karachi, Ellahi Bakhsh and registrar secretariat provincial ombudsman Sindh Masood Ishrat also spoke at the programme.

Published in Dawn, April 23rd, 2015

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