Looking Forward & Looking Beyond: Millennium Development Goals After Improving Health Indicators in Pakistan Post 18th Amendment

Transcription

1 Small Group Meetings Looking Forward & Looking Beyond: Millennium Development Goals After Improving Health Indicators in Pakistan Post 18th Amendment February 14 & 15,

2 Table of Contents Executuive Summary... Error! Bookmark not defined. Session 1: Status of Reproductive Health in Pakistan After Devolution... 4 Session 2: Women and Reproductive Health: Entrepreneurship & Leadership... 7 Session 3: Integrating Demand Side Financing in Health Systems of Pakistan Session 4: Exploring Linkages Between Population, Health & Climate Change Annexure 1: Agenda Annexure 2: Profile of Speakers Annexure 3: Participants List

3 Executive Summary 'Our World' Women Leadership in Reproductive Health & Development is a 3 year ( ) project of LEAD Pakistan in collaboration with the David & Lucile Packard Foundation that aims to sensitize a cross-sectoral network of leaders and motivate them to raise the profile of Reproductive Health (RH) in social development sector through public policy engagement and innovative range of communication strategies. The conference Looking Forward & Looking Beyond: Millennium Development Goals After Improving Health Indicators in Pakistan Post 18th Amendment held on 14 th and 15 th February, Lahore was divided into 4 sessions or small group meetings on Status of Reproductive Health in Pakistan After Devolution: Issues and Challenges, Women and Reproductive Health: Entrepreneurship, Innovation & Leadership, Integrating Demand Side Financing in Mainstream Health Systems of Pakistan and Exploring Linkages Between Population, Health & Climate Change. The purpose of these meetings were to understand the under laying issues and challenges and engage in policy discourse. This event was attended by multi sectoral experts, development practioners, academics and government representatives. 3

4 Small Group Meeting 1 : Status of Reproductive Health in Pakistan After Devolution: Issues and Challenges The opening remarks were given by Dr. Yasmeen Qazi, Senior Country Advisor Population Program-The David and Lucile Packard Foundation. She explained the historical perspective of 1994 International Conference on Population and Development (ICPD), held in Cairo. This was a turning point in international discussions on population as the earlier world conferences on population had focused on controlling population growth in developing countries, mainly through family planning but the Cairo conference enlarged the scope of policy discussions. Governments agreed that population policies should address social development beyond family planning, especially the advancement of women, and that family planning should be provided as part of a broader package of reproductive health care. Underlying this new emphasis was a belief that enhancing individual health and rights would ultimately lower fertility and slow population growth. The programme of action and benchmarks added at the ICPD went on to form the eight Millennium Development Goals. Taking into account the reproductive health indicators of the country she said Our focus from family planning is slipping. Unmet need is not understood, adolescents sexual and reproductive health (SRH) rights are ignored and there seems to be no clear framework for bringing SRH issues of youth in mainstream public health policy. Results can only be achieved through when institutions and departments can work together which brings to attention organizational capabilities and resources. This was followed by a presentation by Dr. Ali Mir, Director Programs - Population Council on Reproductive Health Scenario of Pakistan: Where We Are and What Should We Be Doing. He mentioned some of the problems such as inadequate services in supply, inequitable allocation of resources and different standards of service delivery in urban rural context. He shared Pakistan s score card on health: 4

5 Among married women of reproductive age (MWRA) approximately 1 out of 3 of births are spaced <2 years apart Women average 4 births during their reproductive life (the second highest fertility rate in South Asia after Afghanistan) Low contraceptive use (only 30% of married couples use contraception) The fourth highest under-five child deaths (after India, Nigeria and Congo) Serious malnutrition with 38% of children under five (9 million) underweight. Poor access to water and sanitation. Diarrhea is the main killer of children. World s third highest burden of deaths due to neonatal tetanus 250, ,000 new cases of TB every year. HIV prevalence high rates in populations most-at-risk especially injecting drug users and male sex workers His recommendations on improving the health system were to: Focus on service for the poor and rural 67 percent population Develop a functional referral system Strengthen role of LHWs Upgrade skills of existing staff through trainings and add responsibilities Improve staff motivation through incentives and facilities Use Performance based audit and improved monitoring and accountability Increase Female staff recruitment and retention by providing lucrative facilities Provide proactive family planning/birth spacing services- develop synergies The next speaker was Farasat Iqbal, Program Director-Punjab Health Sector Reforms. He talked about the challenges brought by the 18 th amendment. Problems of coordination among Federal Ministries and between provinces and Federal government. Management of transition runs into serious problems Issues of coordination with international partners Serious issues with Interprovincial disease surveillance Data collection and consolidation for key health indicators Capacity constraints at bureaucratic and technocratic level Lack of Political consensus between central and provincial governments The participants discussed several key points: Policy should focus on SRHR, Gender Based violence leading to HIV. There should be more attention given to youth sexual and reproductive health based on the rights based approach. The youth policy also needs to address adolescent sexual and reproductive health. Early child marriage also needs to be addressed. The role of men should not be ignored as they are the main decision makers. They need to be involved in the communication and participation process. Unless we involve them their ideas will not change. Family planning and contraception programs need to be revived, as Pakistan has the second highest fertility rate. The biggest risk factor is birth spacing-1 of 3 births spaced is less than 2 years, in Pakistan. 5

6 Devolution provides an opportunity to address these issues. Provinces are new to policymaking, but consultants/ organizations are available to facilitate the provinces in this transition. New roles for provinces include, policy making, training, contraceptive procurement, storage and distribution, financial disbursement, IEC (information, education communication). Malnutrition, Asphyxia, infections (tetanus), prematurity are some of the reasons for child mortality but they can disappear with very simple interventions e.g. we can reduce asphyxia by training LHW and TBA on resuscitation etc. The training curriculum of LHWs and TBAs need to be revised and it should include postpartum and post natal care. The recommendations were: Prioritize population so as to increase politician s focus. Refining of federal govt/planning commission role after devolution Capacity building required of provincial/district managers to ensure services are provided. Family Planning requires multidepartment approach, involving both the health and the population welfare department. Establish loose coordination mechanism between federal and provincial health ministries ensuring disease surveillance, data collection etc. (Short term) Develop systems to ensure coordination (Medium term) Restructure provincial health dept, since they are not designed to address new challenges. They are designed for administrative mode and need to focus on policy formulation. Introduce Demand side financing for targeted population, involving private sector insurance sector as well. Shift resources from tertiary care to primary care. Also the approach towards health care should shift from input based to output based. 6

7 Small Group Meeting 2: Women and Reproductive Health: Entrepreneurship, Innovation & Leadership-Exploring Issues of Women Entrepreneurship in context of Labour Laws, Gender and Reproductive Health in Pakistan Women Empowerment is the most vital tool for development of society. Despite many international agreements affirming their human rights, women are still much more likely than men to be poor and illiterate. They usually have less access than men to medical care, property ownership, credit, training and employment. They are far less likely than men to be politically active and far more likely to be victims of domestic violence. In the past decades, there has been much investment in health and education of women and girls in developing countries but there has been a slow growth in economic opportunity for women. In Pakistan the state of female entrepreneurship and empowerment is dismal. Even with increasing population of women, their participation in the nation's life is much less than their population. Culture, traditional mindset, gender inequity and inequality, lack of autonomy for decision making, economic disparity are some of the barriers preventing women empowerment and economic growth. In July 2012, LEAD Pakistan arranged stakeholder dialogue on the topic of Pakistani Labor laws in corporate and social sectors of Pakistan and Implementation of Gender Protection Laws in the Corporate & Social Sector of Pakistan. The recommendations of this dialogue were compiled into a discussion paper Labor Laws, Gender and Reproductive Health: An Analysis of Pakistan. This paper discusses the present status of women s social and economic empowerment in Pakistan and a review of labour laws in the country which cover women workers and to what extent reproductive health rights are represented in these laws. In order to share the findings of this research amongst different stakeholders and to discuss policy challenges for promotion of women empowerment the session of Women and Reproductive Health: Entrepreneurship, Innovation & Leadership was organized on 14 th February 2013 in the conference Looking Forward & Looking Beyond: Millennium Development Goals After Improving Health Indicators in Pakistan Post 18th Amendment. The session started with the presentation of Sarah Javeed who explained Pakistan has more than 70 laws related to labour issues. The Constitution of 1973, in its Principles of Policy section, declares that steps shall be taken to ensure full participation of women in all spheres of national life (Article 34). Furthermore, Article 37 (e) of the Constitution says, The State shall make provisions for securing just and humane conditions of work ensuring that children and women are not employed in vocations unsuited to their age or sex and for maternity benefits for women in employment. In addition to there are specific Articles that support women s role in the country s economic development and condemns any form of discrimination and exploitation. 7

8 The recent Women s Protection Law (2011) and the Sexual Harassment Bill (2012) has been a positive development but there are serious concerns of implementation, compliance and accountability. The existing labour laws need to be reviewed and repealed to address specific needs of women workers. This should not only apply to just maternity leaves but a more holistic view of the women s reproductive needs as a recognized and integral part of all labour laws considering women have equal rights according to the Country s Constitution. She explained the labour trends of Pakistan: Roughly six out of ten employed people in Pakistan (61.6 percent) and in these indicators were considered to be vulnerable, meaning at risk of lacking decent work. The large share of female vulnerability (78.3 percent) needs special attention. Pakistan has seen very low labour productivity over the last decade. In addition the relatively low growth in labour productivity has not gone hand in hand with the increasing labour force and employment growth. Most new labour market entrants are taking on low-productivity, poorly remunerated work. Despite recent gains in terms of employment and unemployment, the reviewed labour market indicators highlight the gender gap. Women continue to be underutilized in the economy and labour market as reflected in their overall participation, as well as in the distributions in terms of economic sector and status groups. In line with the trend since , the proportion of women in the status group of wage and salaried workers decreased in the recent survey years. Less than a quarter of all women are now in a salaried position, as compared to a third at the beginning of the decade. She mentioned the specific law and by-laws for various terms of employment pertaining to employment e.g. contract of employment whereby establishing a relationship between the employer and employee through a contract of employment. The Ordinance applies to all industrial and commercial establishments throughout the country employing 20 or more workers and provides for security of employment. In case of informal or casual workers like domestic workers, farm workers or daily wagers, labour contracts are undocumented and can be enforced through the courts on the basis of oral evidence or past practices. Services of a permanent worker cannot be terminated unless other than misconduct without one month s notice or wages in lieu thereof has been furnished by the employer or by the worker if he or she chooses to leave his or her service. The law also covers working time and rest time (Factories Act 1934), minimum age of the worker (Article 11(3)), paid leave provision (Factories Act 1934), maternity leave and maternity protection (Article 37). 8

9 The next speaker was Tara Uzra Dawood CEO, Dawood Capital Management Ltd. & Founder, LADIESFUND who spoke on the policy challenges in promoting women entrepreneurship in Pakistan. Commenting on the key challenges she said Pakistani women's participation in the formal labour force is still among the lowest in the. According to the Pakistan Labour Laws, women have a right to maternity leave but in most cases it is considered a favour by the employers rather than a right of the mother. Women of reproductive ages are discriminated against by employers who fear that they will not be able to deliver as much as required. This was followed by a discussion amongst the participants moderated by Irfan Mufti. Deputy Director, South Asia Partnership Pakistan. The participants agreed that there is a serious dearth of information on labor laws and reproductive rights. There is a need for sensitization employers and employees so that both parties understand their legal obligations and rights. Gender sensitization is needed for all the people so that they know about legal protection. Kokab Parveen, Former President -Central and North Women Chamber of Commerce brought attention to the issues of women workers in the informal labour force. She said that there have been several cases where the employers put inhumane conditions, such as no marriage or no pregnancy during employment, on women upon hiring. This issue takes added significance when noting the high composition of labour force being of informal sector. There was debate on the participation of women in unions and more so for home based workers. There are over 20 million women workers in Pakistan are engaged in home based work. The working hours of these women range from 12 to 16 whereas their daily income is Rs. 10 to Rs. 50 only. Although women working from their homes make a significant contribution to the national economy, their work is undervalued. These home-based workers lack access to formal sources of credit, so it is not uncommon for them to become indebted to their contractors in times of need such as sickness, accidents, childbirth, marriages or deaths. Often, this accumulated debt is difficult to pay off. It is a vicious cycle of dependency and exploitation. In March 2013, the Cabinet of the Punjab Provincial Government in Pakistan adopted a Home-Based Workers Policy, based on the 2012 Punjab Home-Based Workers Act, which recognizes home-based workers as workers and extends social protection to them. Punjab is the first province in Pakistan to pass a law and policy for home-based workers. The Punjab Home-Based Workers Act and Policy include the major elements of the Draft National Policy for Home-Based Workers in Pakistan but the participants agreed that there are numerous issues of implementation. 9

10 There was strong emphasis on implementation of laws. Harassment at work place, although addressed by a recently passed bill, remains extremely underreported. The overall perception amongst women is that such inconveniences have to be borne and not taken to court. Dr. Saleem Bashir Associate Professor Kinnaird College for Women The Federal Ombudsmen Institutional Reforms Act was lauded by which ombudsmen can take swift legal action. The victims of sexual harassment can also seek redress of their complaints from the Ombudsman for Women, if they are not satisfied with the internal proceedings of the concerned organisation. Summing up the recommendations were: The existing labor laws need to be reviewed and repealed to address specific needs of women workers. This should not only apply to just maternity leaves but a more holistic view of the women s reproductive needs as a recognized and integral part of all labor laws considering women have equal rights according to the Country s Constitution; Gender sensitization across board is essential to break the patriarchal mindset starting from inclusion of RH and gender issues in the school curriculums; There is a definite need to factor in the informal sector which constitutes majority of the labour force of the country including women in the legal framework; The Government needs to regulate and monitor the private sector which at present is out of the country legal loop; Cultural and social context needs to be kept in mind while formulating policies and laws, which can even vary regionally; 10

11 Small Group Meeting 3: Integrating Demand Side Financing in Mainstream Health Systems of Pakistan Evidence suggests that poor women in developing countries often do not have adequate access to maternal health services. Both supplyside constraints and demand-side barriers are responsible for the low use of these services. It is known that poorer households face numerous financial and non-financial barriers that prevent their access to services, even where services are nominally free. Increasingly, policy makers in many low-income countries are considering the use of Demand Side Financing (DSF) systems, as an alternate mechanism to accelerate progress towards the achievement of MDG 5 the reduction of maternal mortality. Demand Side Financing includes a range of mechanisms that provide direct subsidies to the poor for access to specified health services. The purpose of DSF mechanisms is intended to increase the overall use of specific services, to increase equitable access to care by vulnerable groups and to help improve the quality of services provided. DSF techniques include the use of insurance (CBHI), health equity funds, voucher schemes, conditional cash transfers (CCT) and other mechanisms. In Pakistan, a number of demand side financing and social safety nets have been implemented such as Benazir Income Support Program (BISP), National Rural Support Program s microfinance program for the poor in rural communities, Punjab Health Sector Reform Program (PHSRP) subsidized reproductive healthcare through distribution of health cards, government schemes like the Chief Minister s Health Initiative for Attainment and Realization of MDGs (CHARMS) and the Thardeep Rural Development Program (TRDP) in Sindh that provides social safety nets in the form of health insurance schemes with collaboration from Adamjee Insurance. NGOs like Marie Stopes Society (MSS), Greenstar Social Marketing and Health and Nutrition Development Society (HANDS) have also undertaken similar initiatives but these initiatives have been pilot projects. In September 2012, LEAD Pakistan arranged a stakeholder dialogue where participants deliberated upon the feasibility and impact of demand side financing in Pakistan. The recommendations of that dialogue were further explored in a discussion paper titled The Role of Demand Side Financing and Social Safety Nets in Reproductive Health by Dr. Adnan Khan, Director-Research and Development Solutions, Islamabad. The paper gave an overall picture on the different options for financing healthcare in Pakistan, 11

12 highlighting the key challenges and barriers and most importantly the effectiveness of these tools as means of behaviour change. In order to further explore how demand side financing can be integrated in main stream health systems of Pakistan, a small group meeting was held on 15 th February 2013 in the conference Looking Forward & Looking Beyond: Millennium Development Goals After Improving Health Indicators in Pakistan Post 18th Amendment. Dr. Adnan Khan was the first presenter who spoke on the different perspectives of demand side financing and social safety nets. The purpose of demand side financing is to help the poor access healthcare, create need for preventive services, induce behavioural change in communities to improve certain desired behaviors and stimulate supply through demand creation. In Pakistan healthcare costs constitute a higher proportion of the income of the poorest households than it does for the more privileged class. While healthcare costs have increased, the ability of the public sector to provide healthcare (to protect the poor from healthcare expenditure) has shrunk. 26% of total healthcare expenses are borne by public sector, 60% of the health expenditures are out of pocket expenditure and 6% is covered by health insurance. He mentioned successful stories of China, Cambodia and Bangladesh emphasizing the importance of social enterprise models that provide sustainability, self reliance, need less investment but requires training of service providers and sustained motivation. Dr. Nameem-ud-din, CEO-Contech International was the key note speaker. Demand side financing is tool for behaviour change. It may help the poor but depends on incentives being offered to them and the buying power of the people. Determining the criteria of target beneficiaries, sustainability, transparency, operational management, price stability and lack of suppliers are some of the challenges that need to be solved before DSF can be scaled up. Inequality is endemic, more so in healthcare, especially access to healthcare. DSF provides an effective solution but there is no one solution-we need to have a combination of solutions. He mentioned that the distribution of health voucher schemes is a part of the Punjab Health Strategy. In Punjab, Sehat Sahulat Card is one such initiative. It started 4 years ago in Punjab in 3 union councils to improve the quality of MNCH and increase 12

13 access to health care. The model was simple- the financing body was the government and implemented through private sector and service providers. The beneficiaries were selected through poverty scoring. The lessons learnt were that this scheme bought a positive change especially amongst women. Through this scheme family planning became a part of a comprehensive service being provided to beneficiaries such as birth spacing. This is an ideal model for public private partnership. Innovative ideas such as use of technology or telehealth can be incorporated. A large number of service providers are needed e.g. providing transport to patients. It is the responsibility of the government to provide funds but in this model, private organizations can participate as implementing and monitoring partners. He also spoke on the subject of health insurance that insurance companies offer high rates so they need to be regulated. This is an opportunity for private organizations, banks, and corporations to work together. This was followed by a discussion amongst the participants moderated by Dr. Ain-ul- Momina, Assistant Professor Institute of Public Health, Lahore. The participants identified the key issues of demand side financing such as partnerships between public and private sector, sustainability, role of stakeholders such as government, private sector and corporations engaged in corporate social responsibility, mechanism/system of transparency and mechanism and system of financing. Mr. Aman Ullah Khan, Project Director- Chief Minister Initiative for Primary Health Care, PRSP said that any government funded demand side plans needs to have substantial financial backing to support at least for the duration of project life. Apart from BISP, there are is no evidence of a government supported large scale running demand side financing program. The participants agreed that lessons learnt from past models, schemes and design should be collated to find out what were the hits and misses. On the issue of sustainability the discussants said that there are two aspects to be considered financial and behavioural. Vouchers and other similar schemes must not only be used to promote healthcare seeking but rather be used to foster behavior change and must therefore be introduced for a sufficient duration that is required for such a behavioral change and then wean off without creating any dependency. The recommendations of this meeting will be compiled in an occasional paper that will pave the way for a more focused policy discussion with policy makers, government representatives and civil society. 13

14 Small Group Meeting 4: Exploring Linkages between Populations, Health & Climate Change Mr. Rafay Alam during his presentation shared some of the key findings of his research. The crux of his findings was that Pakistan s development paradigm had mainly focused on poverty alleviation. In the coming decades, as Pakistan would become highly urbanized, the development paradigm would have to be changed and more focus would have to be placed on urban-healthdevelopment nexus. Mr. Muzaffar Ahmad in his presentation highlighted the issue of poor reflection of population and health issues in development policies of the country especially the climate change policy of He explained different relevant concepts and explained as how our lifestyle changes had brought about climate crisis. He shared his practical experience in the federal government service and said that most of our health workforce including the officers had been least motivated and remained engaged on their petty professional growth issues without showing any commitment to bring improvement in the health sector. The issues had become more complicated after devolution. During the discussion session, Dr. Javed Akram commented that all the important problems have been highlighted during the workshop but little has been discussed about the solutions. He said that we our opinions should be based upon facts and not upon emotions. He fetched the attention of the audience towards the rise of noncommunicable diseases such as heart strokes, diabetes and hyper blood pressure and deplored that little focus that was being placed on them as we had not been able even to tackle the communicable diseases. He added that political will was lacking. For example, in the case of Dengue, the political will did marvels but that was not sustained under normal conditions. The technical people, we could influence policy makers with facts. For example, BRT in Lahore had been completed in less than one year at the cost of billion but the surgical department in his hospital had not been completed in 5 years which cost only one billion rupees and would benefit more than 400 people a day. So it was the matter of political prioritization. A comment was raised from the audience that the politicians were easy scapegoats to blame for the entrenched corruption in the system. However, the bureaucracy and 14

15 other government officials were mainly responsible for the decay and malfunctioning of the system. Dr. Javed Akram responded that the politicians were blamed because they appointed the bureaucracy. It was their incompetence at least that they did not appoint right people for the right job. Mr. Rafay Alam quoted two examples and said that in one case, a new IT based intervention was implemented within a week by Lahore Waste Management Company with the help of Punjab Information Technology Board for waste collection in Lahore on the occasion of Eid last year. On the other hand, smart metering could not be introduced by WASA for so many years because of the system inertia in that institution. He also quoted the example of Dengue control drive which was very successful owing to the political commitment, provision of finances, inter-departmental coordination and accountability of the concerned departments. On this, Mr.Sajjad Hyder said that the two examples with different responses might have been due to the fact that LWMC was a new institution and more active like motorway police whereas older institutions like WASA had entrenched corruption and inertia in their systems and operations. Dr. Amena Hassan argued that non-communicable and zoonotic diseases. Similarly, there was a need to talk at micro level as well in terms of disease control and climate effects of disease patterns on our communities. The mental health and effects of poor water and sanitation and air quality should also be researched and discussed. Mr. Muzaffar Ahmad stepped in to give his viewpoint that donors were very much willing to fund good schemes especially in the aftermath of disasters but due to corruption and lack of discipline at all levels including the community level, the misuse of aid pushed the donors away. He said that the social behavior needed to be improved and documentation needed to be done at an integrated level in the aftermath of three major disasters in Pakistan in the course of 7 years. Mr. Hyder Zaidi gave his remarks that there was a need to start creative thinking in our institutions and organizational processes. The aim should be impact generation and outcomes through integrated approaches within departments themselves. Dr. Seema Mohsin Khan seconded him and said that vertical programs in health sector had done havoc and stopped the departmental learning process. The fragmented approach yielded little impact. Mr. Ali Hasnain from WWF said that the misconception about climate change should be corrected. It was said that climate change action was some sort of Western agenda but the facts might be otherwise as most of the Western countries might benefit from rising temperatures in terms of increased mobility and food production. We must have recognized that the Western countries were helping the developing countries for adaptation both with resources and expertise. A comment came from one of the audience that system should have been there not depending on personalities. Mr. Mubashar Ahmad voiced that our policies change with the change in personalities and political system. For example, mandatory environmental assessment was introduced for all the projects in the public sector, then came the gender assessment and so on but none of them could sustain beyond the government which introduced them. On a comment from the audience that people used to go for costly mobiles but not for washroom or healthy sanitation which was a necessity, by Mr. Rafay Alam said that perhaps the transaction cost involved and ease of purchase in the case of mobile 15

16 phones are the reasons for people s anomalistic behavior. For sanitation they expected that the relief agencies or the government should finance or provide subsidy. Dr. Amena took over again and said that long term subsidy was not the right choice. She said women and child rights should be mainstreamed in all policy matters including health and climate change. For disaster management, stress factors should also be focused and addressed by the relief workers and their parent agencies. Mr. Hyder Zaidi said that NGOs should not go for infrastructure development projects per se. Decentralization should go down to cities and union council s level. The public private partnership model could easily be adopted in health sector by seeking in association with corporate philanthropists and entrepreneurs. He also contended that any law for the sake of accountability, quality assurance or certification should first be implemented in the government sector. Only then private businesses could be pressurized for compliance. When the journalistic ethics for poor media coverage of health and climate change was discussed, Mr. Ali Tauqeer Sheikh differed with the general opinion and said that the commercial interests could not be challenged in the choice and coverage of a news story. The electronic journalists were toddlers like many other professions in the country and they would learn with the passage of time. However, the civil society should keep on sensitizing them on pertinent issues with effective advocacy and media campaigns. The real problem in his opinion was that there was a culture of secrecy and transparency was lacking in all walks of our social life including our institutions. When the media infringed upon that self imposed privacy notions of individuals and organizations, there was as a general furor over it. Referring to Dr. Adnan s opinion in one of the previous sessions that increased regulation did not always result in better service delivery and in many cases restricted the delivery of services to the needy, Mr. Sheikh said that somehow the regulations had to be introduced to streamline and improve the quality of services though it made the service more expensive. 16

17 Annexure 1: Agenda Looking Forward & Looking Beyond: Millennium Development Goals After Improving Health Indicators in Pakistan Post 18th Amendment 14 & 15 February 2013 Pearl Continental, Lahore Day One: Thursday, 14 February 2013 Agenda 9:30 Registration & Networking 9:45 Welcome Remarks: Hasan Akhtar Rizvi, Chief Operating Officer - LEAD Pakistan 9:50 Opening Note: Dr. Yasmeen Qazi, Senior Country Advisor Population Program-The David and Lucile Packard Foundation 10:00 Inaugural Address: Shahnaz Wazir Ali, Chairperson Higher Education Commission Session 1: Status of Reproductive Health in Pakistan After Devolution: Issues and Challenges 10:15 Introduction 10:25 Presentation on Reproductive Health Scenario of Pakistan: Where We Are and What Should We Be Doing: Dr. Ali Mir, Director Programs - Population Council 10:45 Q & A 11:05 Guest Speaker: Mr. Farasat Iqbal, Program Director-Punjab Health Sector Reforms 11:25 Open Discussion on Impact on Reproductive Health (RH) Programs in Pakistan Post 18 th Amendment (Moderated by Ms. Nabila Malick, Director Advocacy- Rahnuma,FPAP) 12:40 Summing Up of Key Discussion Points 1:00 Lunch 2:00 Session 2: Women and Reproductive Health: Entrepreneurship, Innovation & Leadership Introduction 2:10 Presentation on Labor Laws, Gender and Reproductive Health: Sarah Javeed, Researcher 2:30 Q & A 2:50 Guest speaker: Ms. Tara Uzra Dawood, President, Dawood Global Foundation & Founder LADIESFUND 3:10 Open Discussion on Labor Laws, Gender and Reproductive Health in Pakistan (Moderated by Irfan Mufti, Deputy Director - South Asia Partnership Pakistan) 4:30 Summing Up of Key Discussion Points 17

18 5:00 Tea Day Two : Friday, 15 February 2013 Agenda 9:30 Registration & Networking 9:40 Welcome Note: Ali Tauqeer Sheikh, CEO-LEAD Pakistan 9:50 Session 3: Integrating Demand Side Financing in Mainstream Health Systems of Pakistan Presentation on Role of Demand Side Financing in Achieving Health Related Millennium Development Goals: Dr. Adnan Khan, Director-Research and Development Solutions 10:10 Q & A 10:40 Guest speaker: Dr. Nameem-ud-din,CEO-Contech International 11:00 Open Discussion on Integrating Demand Side Financing in Mainstream Health Systems (Moderated by Dr. Ain-ul-Momina, Assistant Professor- Institute of Public Health Lahore) 12:35 Summing Up of Key Discussion Points 1:00 Lunch 2:30 Session 4:Exploring Linkages Between Population, Health & Climate Change Introduction 2:40 Presentation on Climate Change and Population Health: Policy & Research Issue for Pakistan after Devolution: Rafay Alam, Lawyer/Activist 3:00 Q & A 3:25 Guest speaker: Mr. Muzaffer Mehmood Qureshi, Resident Director - Greenstar Social Marketing 3:45 Open Discussion on Linkages of Population & Health with Climate Change in Pakistan after Devolution (Moderated by Ali Hasnain Sayed, Manager Policy - Freshwater at World Wide Fund for Nature) 4:40 Summing Up of Key Discussion Points 5:00 Concluding Remarks: Dr. Yasmeen Qazi, Senior Country Advisor Population Program-The David and Lucile Packard Foundation 5:15 Vote of Thanks: Ali Tauqeer Sheikh, CEO - LEAD Pakistan 5:30 Tea * The conference will take place at Pearl Continental, Lahore. 18

19 Annexure 2: Profile of Speakers Dr. Yasmeen Qazi, Senior Country Advisor, Population Program-The David And Lucile Packard Foundation Dr. Yasmeen Qazi is renowned reproductive health expert and the senior country advisor at the David & Lucile Packard Foundation. The David & Lucile Packard Foundation is working in countries with high fertility rates to enhance and protect women s reproductive health and reproductive rights, especially for marginalized and disadvantaged girls, women, and communities. In Pakistan their focus in on family planning and reproductive health programs that address both the supply and demand side issues. They are also engaged in efforts to address services, supplies and information, along with initiatives to overcome social, cultural, economic and political barriers. Dr. Ali Mohammad Mir, Director Programs - Population Council Dr. Ali Mohammad Mir is Director Programs at the Population Council. He served as Chief of Party for the FALAH project of Population Council from Under his leadership, the FALAH project was successful in influencing the paradigm shift with the new concepts of birth spacing for health. Through his technical and strategic leadership, the project successfully developed communications and training strategies to introduce birth spacing concepts to link them with reductions in maternal and child mortality. He has a Master s Degree in Public Health (MPH) from Leeds University, UK and a Degree in Medicine (MBBS) from Rawalpindi Medical College. He has attended specialized management training from Harvard University, USA and has also attended leadership courses from the Public Health Institute, Santa Cruz and Johns Hopkins University, USA. Muhammad Farasat Iqbal, Program Director-Punjab Health Sector Reforms Farasat Iqbal is a civil servant from Pakistan Administrative Service (PAS) with 17 years of experience in public administration, public sector management and program management with interest in procurement and health sector reforms. He has a Post Graduate Diploma in Public Finance and Management from IBA, Karachi ( ) and Masters Public Administration from Harvard Kennedy School, USA ( ). He successfully completed a course in health sector financing from the World Bank Institute (WBI) in 2010.Attended international workshops on Result Based Financing in Health Sector in Dhaka, Bangladesh (October, 2011) and Health Sector Management Reforms in Bangkok (July, 2012). He was awarded Innovation Hero Award by the Chief Minister, Punjab for conceiving, designing and rolling out an ICT based program of electronic monitoring Monitoring the Monitors in district health management in 18 districts in collaboration with the International Growth Center Research Team of London School of Economics, based at LUMS and World Bank s Pro-active Governance Program. 19

20 Sarah Javed, Researcher Sarah Javeed is a development consultant with over 15 years of experience. She has worked in PIEDAR, IUCN, Population Council, National Institute of Population Studies and Pakistan Institute of Development Economics. She has been a consultant for PIEDAR, Swiss Development Cooperation, Society for the Protection of Rights of Children (SPARC), Action Aid, Plan International and LEAD Pakistan. She has a Masters degree in Anthropology from Quaid-i-Azam University, Islamabad, Pakistan. Her areas of interest are population, demography and health. Tara Uzra Dawood, President-Dawood Global Foundation & Founder LADIESFUND Tara Uzra Dawood is an entrepreneur, money manager and freelance journalist. She is the CEO of Daewoo Capital Management Ltd. (DCM), a leading asset management company which she established with Asian Development Bank in 2003.With the success of DCM, she was able to launch LADIESFUND -a pro bono investment advisory wing of DCM, working exclusively with women clients and entrepreneurs to help women in need of financial guidance. She is also the Editor-in-Chief of LADIESFUND Magazine, Pakistan's first magazine for women professionals and entrepreneurs. She is recognized as a world speaker on issues regarding women's investment, entrepreneurship and money management. Dr. Adnan A. Khan, Director Research & Development Solutions Dr. Adnan A. Khan is a Public Health Researcher with experience with Family Planning, HIV and Hepatitis transmission and prevention and Health Systems.In his work with the Health Ministry in Pakistan, he applied epidemiological and other analysis methodologies to develop evidence base to inform planning and evaluation of HIV and Family Planning programs and helped run its Health Policy Unit. He has also worked closely with the WHO, the UNICEF and the UNAIDS to provide consultancy services in the Middle East and Asia. He is a member of the Advisory Board of the Asian AIDS Data Hub, a core member of the UN Reference Group on HIV and Drug Use and a member of the Technical Review Panel (TRP) of the Global Fund for the Fight Against AIDS, Tuberculosis and Malaria (GFATM). He is also an Adjunct Assistant Professor for Preventive Medicine at the Vanderbilt University. Dr. Naeem uddin Mian, CEO Contech International & Health Specialist Dr. Mian is an International Consultant and has vast experience in the field of public health planning and management. He has visited and studied a number of health systems including those of Philippines, Thailand, Indonesia and United Kingdom. As Executive Director Special Projects, he headed foreign assisted projects of the Department of Health, Government of Punjab. As In-charge of the Health Sector 20

21 Reform Unit (HSRU) of the Department of Health, developed Long Term Vision (10 years plan) for health and supervised operations research studies. He has evaluated preventive programs and prepared project proposals for multi-million dollar investments in health sector. He has represented Pakistan at international health forums, actively contributing to health policy formulation and health sector reforms both at national and provincial levels. Ahmad Rafay Alam, Lawyer/Environmental Activist & Chairman Lahore Electric Supply Company (LESCO) Ahmad Rafay Alam is a lawyer and environmental activist. He has a decade's experience in civil and corporate litigation throughout Pakistan and is currently the Chairman of the Board of Directors of the Lahore Electric Supply Company. Although he continues his private practice, his current focus is to improve the efficiency of Pakistan's largest electricity distribution company. He also teaches a course on environmental law and regulation and property law at the Law & Policy Department of the Lahore University of Management Sciences (LUMS). At LUMS, he is also the coordinator of the Environment and Natural Resource Cluster of the Development Policy Research Center (DPRC), which is about to begin a Canadian $500,000 three-year project in partnership with WFF-Pakistan to study the effects of climate change on food security in 10 districts of Pakistan. He is also the coordinator of the LUMS Water Program, which was established in 2009 to act as a platform for Track-II diplomacy on water issues between India and Pakistan. Muzaffar Mehmood Qureshi, Resident Director- Green Star Social Marketing He was the former Federal Secretary of Population. He has more than 15 years of experience with interest in governance, health systems and policy making. He has participated in many international forums and training sessions. 21

22 Annexure 2 : Participants of Status of Reproductive Health in Pakistan After Devolution: Issues and Challenges Sr Individual's Name Designation Organizational Affiliation 1 Dr. Yasmeen Qazi Senior Country Advisor The David & Lucile Pacakard Foundation 2 Sarah Javeed Oxford Policy Researcher Management 3 Dr. Ali Mir Director Population Council Dr. Naeem Majeed JSCD Program Manager / Former Advisor - National Program FP and PHC Punjab 5 Dr. Zainab Dawood SPHERE Consultant 6 Muhammad Javed SPO Coordinator 7 Officer Networking & Amnah Amjad SEDC - LUMS Linkages 8 Dr. Saleem Bashir Kinnaird College for Women Associate Professor 9 Arshed Rafiq Communication Specialsit Urban Unit 10 Farasat Iqbal Punjab Health Sector Reforms Programme (PHSRP) Programe Director Nabila Malick Rahnuma FPAP Director Dr. Jamil Chaudhary UNFPA Provincial Coordinator Bunyad Samiya Fayyaz Foundation Coordinator Phoenix Foundation & Dr. Noor - uz Zaman Rafiq Research Development CEO Najeeb Aslam SDC Manager Admin Zulfiqar Ahmed HANDS Manager Chief Research & Development Dr. Sarwat Mirza HANDS Executive Syed Wasim Iqbal Suniya Taimour Saleem & Alam Associates Conservation Speaclist Sadia Nawaz SPO Field Researcher Imran Saleem SPO Consultant Zeeshan Ayub SPO Field Researcher Javed Pasha HomeNet Pakistan Senior Program Officer Nida Welfare Fozia Chugtai Society President Nida Welfare Ambreen Iqbal Society Joint Sect Aurat Zubair Yousaf Foundation Program Officer Dr. Hafiz M Iqbal Punjab Professor 22

23 University Dr. Sabiha Khurshid Serat Mehdi Sajjad Haider Skill Development Council Indus Foundation National Coordinator GFATM CEO Exe Director Small Group Meeting 2 : Labor Laws, Gender and RH Sr Individual's Name Designation Organizational Affiliation 1 Javed Pasha HomeNet Pakistan Senior Program Officer 2 Sarah Javeed Researcher Oxford Policy Management 3 Amnah Amjad SEDC - LUMS 4 Officer Networking & Linkages 5 6 Dr. Noor - uz Zaman Rafiq Shaista Khalid Phoenix Foundation & Research Development Community Support Concern CEO CEO Kinnaird College for Women Associate Professor 7 Dr. Saleem Bashir 8 Muhammad Javed SPO Coordinator Mirza Abdul Qadir Mayo Hospital Road, Lahore, Punjab, Pakistan Department of Telemedicine Mayo Hospital Lahore, Punjab, Pakistan 9 Dr. Salik Nawaz Punjab University Assistant Professor 23

24 10 11 Mrs. Kokab Parveen Central and North Women Chamber of Commerce Former President 12 Rukhsana Khan Central and North Women Chamber of Commerce Executive Member Nida Welfare Fozia Chugtai Society 13 Dr. Adnan Khan Research and Development Solutions President Director 14 Irfan Mufti 15 Arshed Rafiq 16 Farrukh Nisar ul Haque South Asia Partnership Pakistan (SAP-PK) Urban Unit All Pakistan Women Association Director Communication Specialsit Vice Chairman 17 Mrs. Ruhi Sayid All Pakistan Women Association Chairperson 18 Prof. Naseer A. Chaudhary Pakistan Family Welfare Organization Dr. Sarwat Mirza HANDS Director Chief Research & Development Executive 21 Syed Wasim Iqbal 22 Zulfiqar Ahmed HANDS Manager Ismet Leghari Akhuwat Researcher 24

25 23 24 Nida Akhtar Nida Welfare Society Finance Sect Syeda Anum Fatima Agahe Officer 25 Ms. Tara Uzra Dawood Dawood Global Foundation President 26 Dr. Yasmeen Qazi Senior Country Advisor The David & Lucile Pacakard Foundation Small Group Meeting 3 : Demand Side Financing Sr Individual's Name Designation Organizational Affiliation 1 Dr. Yasmeen Qazi The David & Lucile Pacakard Foundation 2 Senior Country Advisor Dr. Naeem ud Din Mian Contech Internationa Health Consultants 3 Dr. Adnan Khan Research and Development Solutions CEO Director 25

26 4 5 Dr. Ainul Momina Institute of Public Healh, Lahore Assistant Professor 6 7 Muhammad Javed SPO Coordinator Amnah Amjad Dr. Azeem Mir 8 Prof. Naseer A. Chaudhary 9 SEDC - LUMS Rahnuma - FPAP Pakistan Family Welfare Organization Officer Networking & Linkages Director Director Zulfiqar Ahmed HANDS Manager Dr. Sarwat Mirza HANDS Chief Research & Development Executive Dr. Zainab Dawood SPHERE Consultant 12 Dr. Naeem Majeed JSCD Program Manager / Former Advisor - National Program FP and PHC Punjab 13 Aman Ullah Khan Chief Minister Initiative for Primary Health Care, PRSP Project Director 14 AIDS Awareness Society (AAS) 15 Nazia Paul Project Coordinator 16 Naveen Sohail Khan SEDC - LUMS Communications Officer Shantul Ramsha Kinnard College Student 26

27 Dr. Noor - uz Zaman Rafiq Phoenix Foundation & Research Development CEO Suniya Taimour Mirza Abdul Qadir Saleem & Alam Associates Mayo Hospital Road, Lahore, Punjab, Pakistan Conservation Specalist Department of Telemedicine Mayo Hospital Lahore, Punjab, Pakistan 20 Sarah Assad Consultant 21 Fozia Chugtai Nida Welfare Society President 22 Syed Usman Nida Welfare Society Member 23 Saeed Qadir Sheikh Anjum-ne- Himayate- Islam Public Relations Officer 24 Qasier Salman Population Welfare Dept Director General 25 Muhammad Saeed Khan Bahadur Memorial Society, Lahore Chief Organizer 27

28 Small Group Meeting 4: Population Health and Climate Change Sr Individual's Name Designation Organizational Affiliation 1 Mr. Muzaffar Qurashi Resident Director Green Star Marketing 2 Rafay Alam Chairman LESCO 3 Ali Hasnain WWF Manager 4 5 Muhammad Saeed Khan Bahadur Memorial Society, Lahore Chief Organizer 6 Haider President Nida Welfare Fozia Chugtai Society 7 Shabrar Khan Aurat Foundation - Lahore ( USAID Gender Project) President Project Monitoring Officer - USAID Gender 8 Prof. Javed Akram Allama Medical Complex Advisor Medical Education 9 Engineer Khurram Baig Pakistan Council for Research in Water Resources (PCRWR) Assistant Director 28