EC/UNFPA Reproductive Health Initiative (RHI)

Pakistan

Background

The International Conference on Population and Development (ICPD) held in Cairo in 1994 set out an ambitious agenda for support to population, sexual and reproductive health and rights issues. The European Commission (EC) endorsed the ICPD Programme of Action (PoA) and recognized its goals as priorities for its development assistance.

In this context, conscious of the challenge to significantly improve the reproductive health status of large number of population across the Asian continent, the EC and UNFPA initiated discussions in mid-1996 on collaboration in designing a special Programme that would bring together the diversity of expertise and resources offered by civil society organizations. On 30 January 1997, the two Organizations signed a Financing Agreement (F.A.), that allowed the official launching of a four-year programme entitled EC/UNFPA Reproductive Health Initiative for Asia (RHI). The goal of this initiative is to create sustainable alternatives to current systems, that will contribute effectively to improving the reproductive health status of women, men and youth.

A total of 30 million Euro was committed to support the RHI Programmes 25 million Euro by the EC and 5 million Euro by UNFPA and 2.5 million Euro by the participating NGOs. The execution modality of the RHI was also defined: UNFPA assumes the responsibility for the overall management and implementation of the F.A.; NGOs are responsible for project execution and implementation, and the EC plays a monitoring role, both at central and country level.

The RHI was initially planned for a period of 4 years; one year for project preparation and 3 years for implementation. On 20 November 2000, the F.A. was amended to extend the duration of the RHI by two years, up to December 2002, with an additional funding of 4.9 million Euro.

Faced with the challenge of addressing a population growth rate of 2.2% in Pakistan, a country with the 7^th largest population in the world, community-based reproductive health (RH) services in under-served rural areas and among under-served groups were selected as the RHI country focus. Through this approach and the involvement of grass root NGOs, efforts are made to spread the awareness on RH to larger segments of the general population, complementing government intervention. Four national NGOs, in partnership with three major international NGOs, implement activities under the Initiative, some working through as many as 91 Community Based Organizations (CBOs). In addition, a number of smaller local NGOs are associated with the RHI the programme through training and capacity building activities, organized by the Capacity Building Project. The overall co-ordination and monitoring function is executed by UNFPA. The Mid Term Review showed that good results had been achieved by the 4 projects of the RHI in Pakistan.

• UNFPA Coordination Unit

The Coordination Unit acts the hub of the RHI in Pakistan:

1. The Unit provides linkages, monitoring and coordination for the entire RHI in Pakistan. It promotes synergy, and harmonizes the programs to incorporate the national and regional dimension. It also serves as the link to the EC, MU and TU.

2. The coordination unit disseminates all RHI information to the NGOs, it compiles and distributes the quarterly and annual consolidated reports.

During 2000, UNFPA provided every-day support in organizational and administrative matters. A Mid Term Review (MTR) was carried out in each country, and the reports were made available to the EC evaluation team. Members of the RHI team participated in the MTR meetings and undertook monitoring visits to all seven countries.

Profiles of the Projects

• Partnership with NGOs for RH Promotion and Services (RAS/98/P07)

Implementing Agency - Family Planning Association of Pakistan (FPAP)Executing Agency - World Population Foundation (WPF)

The project aims to provide quality RH/FP services and information to the under-served and marginalised communities in Pakistan through collaboration with 91 local NGOs. 200 Paramedics, 117 LHVs/FWWs from organizations have been trained in RH, while 500 volunteers and outreach workers have been trained in community mobilization for RH. Local NGOs have been equipped with support packages, including contraceptives and IEC materials for outreach activities. Collaborating partners have started thinking in the mid-course how to develop the programme on a sustainable model approach.

A major success of the project has been the incorporation of a collaborating mechanism with the local NGOs into a legal relationship, training the partner NGOs on the various aspects of RH, regularizing their financial performance and instilling a feeling of ownership of the programme.

Implementing Agency - Marie Stopes Society (MSS) Executing Agency - Marie Stopes International

In the year 2000 a total RH services provided by the Dera Ghazi Khan clinic amounted to 15,362, with a total of 8,459 clients served. The project is currently delivering more than 1,000 services per month to men and women of DG Khan.

Besides providing services for women, the center also conducted campaigns for males regarding vasectomy and other RH issues. A total of 258 vasectomies have been performed to date; an unexpected outcome in and area traditionally thought to be very conservative. The center is now organizing male counselling and vasectomies once a week.

The contraceptive prevalence rate (CPR) in the community changed from 22.54% at project start to 40% in less than 1.5 years. A comprehensive strategy was used to provide services in the outreach areas and for this purpose more than 60 camps were arranged in the radius of 24km to 170km from the centre.

The DG khan project has proved to be model project within the MSS programme across Pakistan: the MSS centre and outreach teams have received visits from other project teams for training and demonstration of the high standards of the service it provides.

Implementing Agency - Pakistan Association of Voluntary Health and Nutrition (PAVHNA)Executing Agency - Population Concern

The project, implemented by PAVHNA, is providing a comprehensive RH Programme to a population of 400,000 in Karachi and Larkana in interior Sind. The model of service delivery used is CBD, supported by two fully equipped contraceptive surgical centers. PAVHNA acts as the co-ordination organization for four participating CBOs, implementing the project at grass root level.

All field project staff are women, as they have been found to be the most culturally appropriate providers of RH services in the project areas; however, the project increasingly involves adolescent males and men.

The full range of RH services is provided by the project: Information and counseling on RH, a wide choice of contraceptive methods, parent education on child care, child immunization, information on ARH (Adolescent Reproductive Health) issues, infertility management, treatment of STDs and screening for HIV.

Door to door information and outreach services have been delivered to a population of 411,757 in both areas. The two surgical centres have collectively provided services to 4,068 clients. The RH package has been extended to include breast screening and emergency contraception. The contraceptive prevalence rate has increased to 29.10% from an original baseline of 13.25%.

• Capacity Building NGO (RS/98/P29)

Implementing Agency - World Population Foundation (Pakistan) (WPF)Executing Agency -World Population Foundation (Holland)

The project attempts to synergise the efforts of eleven local NGOs interested in including RH in their work. The main target groups of the project are adults and adolescents. As a direct result of the consultative process the RHI encourages, WPF decided through their consultative needs assessment process with their partner NGOs that the targets of their awareness raising should not only be mothers, but also include husbands and mother-in-laws, who traditionally hold decision making power at home.

In order to strengthen the management capacity of NGOs on RH projects, the project partners have participated in training on project cycle management and monitoring and evaluation.

WPF has developed 2 working groups:

1. Reproductive Health Alliance (RHA)

2. Adolescent Health Awareness Network (AHAN)

Research from these 2 working groups has been utilized to:

1. Develop pictorial IEC material in the 4 local languages with conscious consideration given to the regional differences in Pakistan.

2. The Adolescents Reproductive Health manuals have been developed which provide clarification on RH facts for adolescents, parents & service providers.

The Regional Dimension

The RHI in Pakistan is linked to the other seven RHI countries (Bangladesh Cambodia India, Lao PDR, Nepal, Sri Lanka, Viet Nam) by three Regional Dimension Projects:

• Monitoring and Evaluation (RAS/98/P27)

Implementing Agency - Netherlands Demographic Institute (NIDI)Executing Agency - London School of Health and Tropical Medicine (LSHTM)

The Monitoring and Evaluation Project with the assistance of the In Country Researcher collects and compiles data from all the RHI projects in each of the RHI seven countries. This data will contribute to providing feedback on the overall RHI performance and RHI impact.

• Information and Communication Network (COMNET) (RAS/98/P28)

Implementing Agency - German Foundation for World Population (DSW)

This regional project provides linkages through information flow and communication within the RHI. COMNET promotes the exchange of ideas and lessons learnt.

• The Gender Equity and Rights Project (RAS/98/P26)

Implementing Agency - Italian Association for Women’s Development

A training manual has been developed which will apply a common gender strategy for all RHI local NGOs in Pakistan. The generic manual was developed by the Women’s Health Project of the University of Witwatersrand. It will be adapted for Pakistan by Shirkat Gah Women's Resource Centre. Shirkat Gah will then hold training courses for RHI NGOs and government officials.

For more details on the regional dimension projects, please see

www.asia-initiative.org
www.unfpa.org/regions/apd/ecinitiative.htm