Population Welfare Department (PWD) in Balochistan, therefore, remains without a minister and a secretary since the formation of the provincial cabinet. Reason? Neither any minister nor any secretary seems to be interested in leading the department and many are perhaps of the view that this should be shelved for good as it is reducing the numerical strength of the province and making things worse for it at the National Finance Commission (NFC) and National Assembly which are institutions formulated on majoritarian footings for the distribution of resources and representative slots. Advocacy on war-footings is required to change that perception and to infuse this realization that the Population Welfare Department is making an intervention that aims at saving precious lives of the mothers, reducing morbidity among them and giving our coming generation a healthy future.
In this regard, data matters to assess that how many women have access to family planning services; what are the budgetary allocations thereof, and what are the gaps that need to be filled. Digital Adaptation Kits (DAKs), which are essentially a part of the World Health Organiztion’s (WHO) smart guidelines for family planning have been implemented in seven countries. These guidelines, of course, have been designed generally as per WHO protocols which are adopted in each country in the local context to improve the status of reproductive health services through the acquisition of data on family planning. WHO has chosen Pakistan to be the first country in the region to implement these smart guidelines to empower departments that provide FP services, through accurate data that can be capitalized on in the policy formulation.
Recently, an orientation session on DAKs was organised by WHO in collaboration with the Ministry of National Health Services, Regulation and Coordination at Islamabad where the WHO team, along with introducing the basics of DAKs in a two-day session, also made a thorough assessment of the systems already existing in the country on data acquisition. It was learnt that each province was collecting data on contraception in its own way and for each its data is reflected on a different forum. In Balochistan, Contraceptive Logistic Management System (cLMIS), developed by USAID, is used which only collects data from the district managers. However, the facilities which provide data to the districts first compile their data on papers whereas Sindh has introduced a somewhat advanced system, called that Electronic Client Registration (ECR), which is an extension of the cLMIS, enabling the service providers through a user friendly application on their smart phones to update real-time data of the FP clients.
Similarly, KP, Punjab and AJK were also advanced in their systems of data collection, but one of the participants beautifully explained the status of FP data in the country, saying that our data do not talk to each other and each province’s data is collected and reflected in silos. Even when it comes to the provinces, the departments which are responsible for data collection and sharing do not work in unanimity. For example, in Balochistan Health Department and Population Welfare use different systems for the same purpose and hence their data is reflected in silos, obscuring the accuracy on Contraceptive Prevalence Rate (CPR).
Yet another thing which astounded the participants during the session was to come home to the fact that contraceptive stock was out for the past eight years with the Health Department in Balochistan. Population Welfare Department, which is the soul custodian of the FP services; procurement of the contraceptives, and in this capacity should bear responsibility of equipping facilities of Health Department with contraceptives, had only, until recently, Rs. 30 million budget during these years which was not sufficient for its own service outlets, and therefore; it could not cater to the demands of the service outlets of the Health Department. The latter have extensive outreach but lack the essential resource. The budget for the contraceptive procurement has recently been increased from Rs. 30 to 120 million but the procurement is yet to take place. It was also learnt during this orientation session that in Pakistan not more than four to five methods for contraception are offered but there exist, across the globe, as many as 25 methods which need to be explored for their efficacy to make procurements in the future.
WHO and other donor agencies should not only remain limited to the data collection role. Their support is needed in all the varied fields of reproductive health ecosystems to make meaningful headways. They should rather make interventions in all the areas where commodity security, demand generation for contraception through proactive advocacy, and access of FP services to all eligible couples is ensured. Above all, an extensive orientation is required of the policy makers and executors on FP interventions and their importance for the lives of mothers and infants in Balochistan. As long as the administrative, logistics, supply chain, capacity, behaviourial and budgetary issues remain intact, mothers and children would continue to die premature deaths.

The writer is a former member of the staff at BE