1. Dr. Adnan A. Khan Research and Development Solutions

2.   USAID Small Grant (2011) to RADS  Partners – Punjab and Sindh DOH and PWDs  Areas – Family Planning and Immunization in the context of MNH  Purpose - Institutionalize information generation and use and actions The Evidence to Policy and Action Grant Initiative

3.   Analysis- existing datasets, LHW, EPI data (Punjab and Sindh)  Research on models of services  Working with DoH/PWD to understand their programmatic data and connect to program improvements  Informed Advocacy to Politicians, communities  Work with donors to address their information needs/efficiency What is RADS doing

4.   FPAP started in 1953  GoP programs in 1966  Many phases and approaches FP in Pakistan: The History

5.  Family Planning in Pakistan Source: PDHS 2006-7 MWRA: 23 million

6.  Modern Methods Total Users: 5.1 Million

7.  Services for Modern Methods Total Users: 2.9 Million (12% of MWRA)

8.  Connecting CPR to Services CPR 30% of MWRA 7.1 Million Users Modern Methods 22% of MWRA 5.1 Million Users Services 12% of MWRA 2.9 Million Users

9.  Costs of FP in the Public Sector Per Women served CYP MoH 826671 - BHUs 661391 - LHWs 887728 MoPW 4,3471,032 Total for MoH and MoPW 2,414 (USD 40) 937 (USD 16) In PKR Regional Costs: PKR 240-400 (USD 4-6)/ CYP

10.  Inferences of Costs  Pakistan public sector costs are 4 fold higher than regional costs (USD 4-5/CYP)  4% of costs in public sector are for commodities  If regional efficiency was to be achieved, public sector FP funding alone can allow >80% CPR

11.  Trends in Services 2006-12 In Millions Women Served

12.  Services by Sectors Private 1.9 M 67% Public 1 M, 33% 2.9 million (12%) of MWRA receive FP services per year

13. Age when Information Received JhelumPak Pattan Time Lag (in years) RH/Puberty 13120-3 months Menstruation 14130-3 months Marriage 23 2 Child bearing 25315-10 Birthing options 27325-12 Family Planning 29409-20 Source: Khan et al, Study of Information Processing by Young Women. RAF/ DFID 2012-13

14.   Overall CPR has increased at <1% per annum  12-14% of MWRA receive FP services each year  Government services only account for 33% of all services or around 1 million women.  Nearly half of couples buy FP supplies from stores. Markets serve ~50%. These are poorly understood  Despite investments and programs, the number of users has not increased above secular trends  Young women are a major potential user group that is largely being ignored What does it all mean

15.   While supply side programming is useful, demand must be created  Spacing messages must be incorporated into common narrative  Address Young women – soon to be married, newly married  Government programs must be held accountable to the investments that go into them. This may mean that unless they produce results, facilities and sections of programs may be closed down  Markets for FP are crucial, better understanding and used Lessons

16.  Thank You