PAKISTAN’S population is growing unhampered at a pace that doubles the size in 20-23 years. With the current rate of acceleration the 200m population could go beyond 400m by 2035-36 — a scary thought if one considers the country’s economic growth trajectory.

Successive governments have missed commitments under the 2012 London Summit on Family Planning (FP), Maternal and Child Health, Universal Access to Reproductive Health, followed by Millennium Development Goals (MDGs) that now stand carried forward under the Sustainable Development Goals 2015-30.

Pakistan was among countries committed to addressing policy and financing issues and socio behavioural norms that prevent women from accessing contraceptive information, services and commodities. Under that scheme, Pakistan is required to raise the contraceptive prevalence rate (CPR) to 55pc by 2020, ensure that all public and private health facilities to offer FP services, double FP funding during the following year, including FP services in the essential service package, strengthen supply chain management, provide training, increase communication, make FP a priority with a focus on lady health workers (LHW), and scale up public-private partnerships through contracting mechanisms.

The 55pc CPR was committed on the basis of provincial targets given devolution of health and population welfare functions under the 18th amendment. Punjab is required to increase the CPR from 41pc to 52pc by 2020, Sindh from 30pc to 45pc, KP from 28.5pc to 42 pc and Balochistan from 20pc to 35pc. So far, only the Sindh government has come up with Costed Implementation Plan (CIP) worth Rs141bn for five year as committed.

Following a broad consultative process across all stakeholders, Dr Talib Lashari, the team leader for CIP funded by the international donors, has prepared the plan now approved by the provincial government with about Rs80bn allocation for five years through annual development programmes.

The plan that also has specific targets for district, tehsil and taluka levels and monitoring mechanism hopes to significantly impact health, demographic and economic activities in Sindh. The proposed interventions expect that an estimated 1,848 maternal and 29,470 child deaths will be averted by the year 2020. Regarding the demographic impact, an estimated 1.77m unintended pregnancies and 193,332 unsafe abortions will be averted, while Rs12.187bn will be saved by implementing the CIP.

The total cost of the CIP during 2015-20 is Rs79.12bn, which includes an infrastructure upgrade and mass media campaign. The Government of Sindh has already allocated Rs998m towards implementing the CIP. It will spend approximately Rs52.238bn during 2015–2020 on FP-related activities through Population Welfare Department (PWD), LHW programme, Maternal, Neonatal and Child Health Programme and hospital services.

Development partners will spend Rs10.287bn over the next three to five years. Thus, the total cost of FP interventions in Sindh during 2015–2020 will be Rs140.647bn. There will still be a financing gap of Rs78.1bn.

In Sindh, there are currently 13m women of reproductive age, and this number is estimated to reach 15m by 2020.

The total fertility rate in Sindh has declined from 5.1 births in 1990–91 to 3.9 births in 2012–13, while the CPR has been stagnant at 29.5pc, with 24pc of women using modern methods of contraception for over a decade. The disparities in the province are visible with 42.7pc CPR in urban areas and 17.4pc in rural areas, while unmet need remains at 21pc.

Sindh’s population is projected to increase to 50m by 2020. There are 1.747m married women of reproductive age (MWRA) who are the current users of contraception. The users of modern methods of contraception are projected to rise to approximately 3m by 2020.

Both the public and private sectors are contributing towards provision of contraceptive services. An estimated 45pc of contraceptives are provided by the public sector. The two major sources within public sector are the Population Welfare Department (PWD) and the Department of Health (DOH). The private sector nongovernmental organizations (NGOs) provide 20.5pc of contraceptives, private pharmacies and chemists provide 25.3pc, private doctors contribute 2.1pc while shops provide 6.5pc of the contraceptives. Thus, the combined share of private sector is estimated to be 54.4pc.

The CIP plans to ensure functional integration to enhance strategic coordination and oversight between the population and health sectors at the provincial, district and sub-district levels and ensure quality of services by enforcing standards and improving providers’ skills.

It also plans to improve supply chain management to the last delivery level and expand services with supply and demand side intervention especially to urban slums, peri-urban and rural areas.

Published in Dawn, Business & Finance weekly, April 25th, 2016