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Gender Budget Statement (2008-09)
Education, Health, Population Welfare
Government of the Punjab

Planning and Development Department
Strengthening Poverty Reduction Strategy Monitoring - Punjab
Title: Gender Budget Statement (2008-09). Education, Health, Population Welfare
Copyright © 2011 by United Nations System in Pakistan

All rights reserved
The views expressed in the report are those of the author and do not necessarily reflect those of
the United Nations Development Program.
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to knowledge, experience and resources to help people build a better life.
Published in 2011
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Table of
Contents
Foreword i
Abbreviations & Acronyms iii
Executive Summary iv
Background 1
Health - Gender Budget Statement 3

National Maternal Newborn & Child Health (MNCH) Programme 5
Punjab Integrated Primary Health Care Model Programme (PIPHCM) 6
National Programme for Primary Health Care and Family Planning (Lady 10
Health Workers Programme) 14
Reproductive Health Project 17
Punjab Safe Motherhood Initiative Project 20
Education - Gender Budget Statement 23

Provision of Edible Oil to Government’s Primary Girls School 25
Provision of Rs. 200 stipends to Girls 26
Provision of free textbooks to all school children in all districts across Punjab 28
Provision of missing infrastructure 30
33
Population Welfare - Gender Budget Statement 35

Reproductive Health Services (RHS) 37
Mobile Service Units (MSU) 40
Male Mobilizers (MB) 42
Information, Education and Communication (IEC) 44
Family Welfare Centers (FWC) 47
FOREWORD
Though women make half of our population they have suffered from negligence of state and
societal institutions in the past alike in almost every country of the world. Discriminatory power
structure, limited access to social services such as education, health, family planning, etc, have
resulted in their socioeconomic marginalisation. However with the embracing of democratic
values, as well as the realisation of economic advantages, need was felt for affirmative action
in favour of women to mainstream them politically and economically; and also to make them
equal par tners in, and equal beneficiar y of socioeconomic development.
Government of the Punjab initiated several multidimensional reforms as part of its Poverty
Reduction Strategy (PRSP) as well as Gender Reforms Action Plan (GRAP) to end the discrimination
and marginalisation. A number of studies and reports have documented most of these reforms.
One critical determinant of attention being attached to these initiatives is financial allocations
to gender related issues.
Gender Responsive Budgeting (GRB) is an important component of gender reforms framework

intended to promote resource allocation and expenditure policies with a gender perspective.
It entails reprioritization of resources within a given sector while taking into account different
needs and priorities of men and women on the basis of analysis of the differential impacts of
public expenditure on them. This has been piloted by the Finance Department, Government
of the Punjab for a few sectors under the Gender Responsive Budgeting Initiative. Gender
Budget Statement (GBS) is an accountability tool which a government uses to inform
parliamentarians and members of civil society about its initiatives for advancing gender equality.
It is linked directly to the budget because it depicts the extent to which any government is
willing to back its intentions with actual resource commitments.
Preparation of Gender Budget Statement in Education, Health & Population Welfare is has
become a regular feature in Punjab. This report is third in the series and it is expected that it
shall help to improve the status of women in policy spheres.
This report would not have been possible without cooperation of Finance, Education, Health
and Population Welfare department, of Punjab and continued support and cooperation of the
United Nations Development Program (UNDP) support through the Strengthening Poverty
Reduction Strategy Monitoring Project. Finally, credit is also due to Mr. Shoeb Iqbal Syed who
conducted research and documented it in a much improved and easily comprehensible manner.
Hamed Yaqoob Sheikh

Dated: 24th December 2009 Chief Economist
Planning & Development Department
Government of the Punjab
Gender Budget Statement i

Abbreviations
&Acronyms
ADB Asian Development Bank MO Medical Officer

BHU Basic Health Unit NGO Non-Government Organization
CMW Community Midwife Ob/Gyn Obstetrics Gynecology
CPR Contraceptive Prevalence Rate P&D Planning and Development Department
CYP Couple Year Protection PC-1 Planning Commission – Performa 1
DCO District Coordinating Officer PDHS Pakistan Demographic Household Survey
DHQ District Headquarter Hospital PHC Primary Health Care
DOH Department of Health PIHS Pakistan Integrated Household Survey
EmONC Emergency Obstetric and Newborn Care PSDP Public Sector Development Program
FLCF First Level Care Facility PSLM Pakistan Social and Living Standards
FP Family Planning Measurement Survey
FWC Family Welfare Center RHC Rural Health Center
IMNCI Integrated Management of Newborn & RHP Reproductive Health Project
Childhood Illness RHS Reproductive Health Service
IMPAC Integrated Management of Pregnancy TBAs Traditional Birth Attendants
and Child Birth THQH Tehsil Headquarter Hospital
IMR Infant Mortality Rate UC Union Council
LHS Lady Health Supervisor UNFPA United Nation’s Population Fund
LHV Lady Health Visitor UNICEF United Nation’s Child Fund
LHW Lady Health Worker WB World Bank
MMR Maternal Mortality Ratio WHO World Health Organization
MNCH Maternal, Newborn and Child Health WMO Women Medical Officer
Gender Budget Statement iii

Executive
Summary
A Gender Budget Statement is a gender-specific accountability document
showing performance of various programmes and initiatives in respect of gender
equity. The basic objective of this document is to review the public budgetary
allocations in three pilot sectors including Education, Health and Population
Welfare Department “through a gender lens”. Punjab is striving hard to accomplish
the MDGs milestones in health, education and population welfare sectors.
However, in order for desired results, availability of gender disaggregated data
is a major constraint on evidence based planning and effective resource allocation
in Punjab.
In health sector, Government assigns highest priority to primary and preventive

healthcare with major focus on reducing maternal mortality rate (MMR) and
infant mortality rate (IMR) and strengthening primary healthcare with focus on
rural and urban slums. In order to strengthen healthcare services, Government
has committed Rs. 9000 million under ADP 2008-09 representing more than 38
percent increase over previous year allocation of Rs. 6500 million. During 2007-
08 about 22 percent (Rs. 1433.023 million) of the total health sector allocation
exclusively targeted female. Interestingly during FY 2008-09, about 11.46 percent
(Rs. 1031.09 million) of the total health sector allocation exclusively targets
female population. However, hardly any allocation specifically targets the male
population during the 2007-08 and 2008-09.
Following health sector interventions have been selected to explore gender

dimensions of the health sector ADP 2008-09 in Punjab.
• National Maternal Newborn & Child Health (MNCH) Programme (Punjab

Component)
• Punjab Integrated Primary Health Care Model Programme (PIPHCM)
• National Programme for Primary Health Care and Family Planning
• Reproductive Health Project Punjab
• Punjab Safe Motherhood Initiative Project
Education indicators in Punjab are generally better than for Pakistan as a whole,
but the province is still riddled with disparities in education across regions and
by gender. The Punjab Education Sector Reform Programme (PESRP) is perhaps
the most ambitious initiative in education sector ever taken in Punjab, with
possibly significant long-term effects. In general, the prominence accorded to
education in Punjab in recent years is likely to have positive effects, if the
government adheres to its efforts. Government has allocated Rs. 30,129 million
under the ADP (2008-09) which represents about 40 percent increase over last
year’s (ADP/2007-08) allocation of Rs. 21,480 million.
Gender Budget Statement v

In 2007-08, about Rs. 325.5 million exclusively targeted females which represents about 3.85 percent of the total
allocation for school education1. Male school education received about Rs. 178.731 million which represents about
2.1 percent of the total allocation. Similarly, in sub-sector of higher education, only 10.88 percent (Rs. 1080.991
million) were meant exclusively for females.
Male higher education received about Rs.621.563 million which is about 6.26 percent of the total allocation. Likewise
during 2008-09, about Rs. 2075.474 million exclusively targets the females which represents about 16.88 percent
of the total allocation for school education. Male school education receives only 11.78 percent (Rs. 1937.332 million)
of the total allocated funds for school education. Similarly in the higher education sub-sector, only 13.39 percent
(Rs. 1218.071 million) have exclusively been allocated for the females. Male higher education receives about Rs.
884.849 million (9.7 percent) only.
Some major interventions have been examined individually through gender lens.
• Promotion of Primary Education for Girls in Rural Areas (World Food Program)
• Provision of free textbooks to all school children in all Districts across Punjab
• Provision of stipends to girls in class 6 to class 10 in 15 districts of Punjab where
overall literacy rate is below 40 percent
• Provision of missing infrastructures to schools in Punjab
In Population Welfare Sector, availability of sex disaggregated data remains a challenging task. Therefore, it is
hard to assess input and output indicators for informed decision making and desired results. Lack of disaggregated
data on utilization of allocated funds is another constraint. Despite financial crisis, government managed to allocate
Rs. 1400 million for the current financial year 2008-09. Although the current budget exceeds the last year’s allocation
yet there is glaring reduction in budgetary allocation for main initiatives under the Population Welfare Programme
such as Reproductive Health Services, Male Mobilizers, MSU, Information, Education and Communication, and
Family Welfare Centers. Following programmes have been included in the Gender Budget Statement.
• Reproductive health services centers

• Mobile service units
• Male Mobilizers
• Information, education and communication
• Family welfare centers
Overall assessment of the three sectors clearly shows government’s resolve to address the gender needs. Various
gender specific interventions have accrued considerable gains; however, much is needed to be done for exploiting
the full potential of gender in Pakistan.
1
The discussion is confined to only Annual Development Programme 2007-08 /2008-09. Therefore, the gender specific estimates are based on ADP allocations only.
Gender Budget Statement vi

Background
A gender budget is not a separate budget for women; instead it is an ‘approach which
can be used to highlight the gap between policy statements and the resources
2
committed to their implementation’ . Gender budget indeed, ensures that public
money is utilized equitably between genders. While linking government policy
commitments with budgetary allocations; gender budgets objectively appraise
government's commitments to address needs of women and men and girls and boys.
Similarly, gender budget analysis helps improve the effectiveness, efficiency,
accountability and transparency of government policies.
A gender budget statement is a gender-specific accountability document showing

performance of various programmes and initiatives in respect of gender equity. The
gender budget statement examines the public polices and spending through gender
lens and helps answer the following main policy puzzles3.
• Whether or not the main public policies and spending ensure gender mainstreaming?
• Which interventions can make a big difference for gender equality?
Government of Pakistan is committed to mainstreaming gender and equity objectives

in the planning and budgeting processes. Strong policy commitments enshrined in
various national policy documents4 very clearly demonstrate government’s firm resolve
and consistent efforts to address gender concerns. Gender Responsive Budgeting
Initiative (GRBI) is one such effort to address the needs of both female and male on
equitable basis. Pakistan’s commitment towards gender specific equity is further
strengthened by its adherence to international agreements.5
The basic objective of this document is to review the public budgetary allocations
in three pilot sectors including Education, Health and Population Welfare “through a
gender lens”. The document will assess whether the budget allocations in respect of
Education, Health and Population Welfare sectors in Punjab province are in line with
different priorities and needs of girls/women and boys/men. Overall assessment of
individual interventions also includes some recommendations for better results.
2
Women Gender Budget: http://www.wbg.org.UK
3
Budlender, D. (2007) ‘Gender-Responsive Call Circulars and Gender Budget Statements’ Guidance sheet series - No. 1 January 2007
4
Pakistan Poverty Reduction Strategy Paper (PRSP), Medium Term Budgetary Framework (MTBF), Medium Term Development Framework (MTDF), Gender Reform
Action Programme (GRAP), National policy for development and empowerment of women
5
The Beijing Platform for Action, The Convention on Elimination of all kinds of discrimination against women (CEDAW) and Millennium
Gender Budget Statement 1

Scope of gender budget statement includes major interventions in departments of
health, education and population welfare in the province of Punjab either funded by
the federal or the provincial government.
6
Methodology includes intensive review of government policy and strategy documents
for the purpose of assessing the extent to which the public policy/strategies address
gender issues. The documents reviewed include both sector-specific as well as general
policy papers. A brief review of gender-specific policy papers was also undertaken in
the context of three pilot sectors. This was based on a review of: (i) government policy
documents; and (ii) official statistical sources. Several meetings / interviews were also
held with the provincial project staff and officials of the relevant departments.
7
Following Ronda Sharp’s “three-way categorization of expenditure”, an attempt has
been made to find some reasonable estimates of budgetary allocations directly or
indirectly targeting female/male in the pilot sectors. The estimates are based on a very
simple categorization of allocations / interventions intended exclusively for female or
male. Medium Term Development Framework (MTDF) / Annual Development
Programme (ADP) and White Papers on the budget for financial years 2007-08 and
2008-09 have been a very useful source of information for this exercise. As a final point,
these estimates may have some gaps, yet these provide enough evidence and
understanding on our resource allocation policies in terms of gender priorities and
resource allocation.
6 Government policy documents mainly included National and Provincial Policy Documents for education, health and population welfare; programmes /project specific
documents, Budgets and White Papers of 2007-08 and 2008-09, Medium Term Development Framework (MTDF), medium term budgetary framework (MTBF), provincial
and federal PRSPs etc. Official statistical sources included the Pakistan Social and Living Standards Measurement Survey (2004/05 & 2006-07); Pakistan Demographic
and Health Survey 2006-07, the Multiple Indicators Cluster Survey (MICS) (200-4-05), Education, Health, Population Welfare, Finance and Planning and Development
Departments, Government of the Punjab.
7 Ronda Sharp (1998) divides the public expenditure into three categories for gender sensitive analysis of public budgets. The categories include (1) expenditures specifically
targeting female, (2) expenditure for both the genders and (3) general budget.

-HEALTHSECTOR-
GENDER
BUDGET
STATEMENT
8
Summary of Provincial Expenditure (Rs. in million)
Description Budget Estimates / Revised Estimates / Budget Estimates /

Allocation 2007-08 Allocation 2007-08 Allocation 2008-09
Current Revenue
Expenditure 7,194.878 9,004.478 11,024.703
Annual
Development
Programme 6,500.00 7,316.00 9,000.00
Total 13,694.878 16,320.478 20,024.703
8
White Paper on Budget 2008-09 / Annual Budget Statement 2008-09.

-Introduction- Reform measures unleashed during last few years led to improved health indicators
and resource availability in the health sector. The primary health care is better financed
than ever before but under utilization remains a significant challenge. The preventive
healthcare programmes have gained significance in the sector but their integration
in the mainstream health delivery system continues to be an ongoing challenge. The
decentralization initiative still needs to be tuned to local needs and strengthen capacity
to cope with the onerous challenge of devolved service delivery.
Health sector envisions a health delivery system that is effective, efficient and responsive
to the health needs of low socio-economic groups especially women in the reproductive
age group. Although health sector has no stated strategy to engender health sector
interventions; it is fully committed to introduce women focused initiatives to eliminate
gender disparities in the health sector and achieve health related MDGs. To accomplish
this milestone, various interventions have been initiated including Punjab Integrated
Primary Health Care Model Programme (PIPHCM), Reproductive Health Project Punjab
and Punjab Safe Motherhood Initiative Project. However, availability of gender
disaggregated data is a major constraint for evidence based planning and resource
allocation in health sector in Punjab. Government assigns highest priority to primary
and preventive healthcare with major focus on reducing maternal mortality rate
(MMR), reducing infant mortality rate (IMR) and strengthening primary healthcare
with focus on rural and urban slums. In order to strengthen healthcare services,
Government has committed Rs. 9000 million under ADP 2008-09 representing more
9
than 38 percent increase over previous year allocation of Rs. 6500 million . Health
sector allocation accounts for about 7.6 percent of the total allocation for social sectors
during 2008-09 as against 7 percent during 2007-08.
In health sector, finding out an accurate figure of government spending intended

exclusively for female remains a challenging task. Indeed, it is hard to segregate
interventions that exclusively focus females since spending in health sector invariably
benefits both genders. Spending on a hospital (either teaching, District Headquarter
or Tehsil Headquarter) definitely benefits both male and female however, not everybody
particularly women has access to these facilities. Our cultural and religious barriers
still don’t allow our women to avail these healthcare facilities. In order to accomplish
health related Millennium Development Goals (MDGs), government has to strengthen
preventive and primary healthcare services. Government needs to take affirmative
action and spend more on women and child health.
9
White Paper on Budget 2008-09/2007-08 MTDF (2008-11)

An effort has been made to segregate those allocations that exclusively focus on female, male or child healthcare.
It has also been tried to identify those interventions that indirectly target female particularly in the reproductive,
10
family planning and neonatal healthcare . This is based on a very simple categorization of health sector allocations.
However, the analysis does offer a broad understanding of the health sector allocations.
During 2007-08, out of Rs. 6,500 million only Rs. 1433.023 million were allocated exclusively for women which
11
represents about 22 percent of the total allocation . About Rs. 463.812 million was specifically allocated to child
healthcare which is about 7.14 percent of the total allocation during the same period. Rough estimates further
show that about 70.82 percent (Rs. 4603.165 million) of the total allocation though not directed specifically towards
females or males; indirectly benefited the female along with the male population. However, there is hardly any
noteworthy allocation meant exclusively for the male population.
During 2008-09, out of Rs. 9000 million, about Rs. 1031.09 million was allocated exclusively for female which is
about 11.46 percent of the total allocation for health sector. About 84.6 percent (Rs. 7614.104 million) of the total
health sector allocation has been allocated to interventions that though not directed specifically to any gender;
would also benefit the women along with men during the current financial year. However, following the past trend,
male specific allocations again remain a rare commodity.
Given the significance of MDGs, government needs to further enhance the allocations to reproductive health,
family planning, neonatal health care, child health and other areas where women benefit directly and the impact
is immediate and greater. While this will help Pakistan attain the health related MDGs, it will also build a healthy
and prosperous Punjab.
Following health sector interventions have been selected to explore gender dimension of the healthcare industry
in Punjab.
• National Maternal Newborn & Child Health (MNCH) Programme (Punjab

Component)
• Punjab Integrated Primary Health Care Model Programme (PIPHCM)
• National Programme for Primary Health Care and Family Planning
• Reproductive Health Project Punjab
• Punjab Safe Motherhood Initiative Project
Very little information is available on sex specific input and output performance indicators to assess the gender
aspect of the interventions. Projects that are women specific definitely had good amount of information on women
specific project interventions. Projects focusing both genders seldom have information on male and female specific
measures inputs and outputs. This makes analysis hard and less objective. Individual appraisal of each project has
been presented briefly in the following pages. Specific weaknesses and strengths have also been discussed very
briefly.
10 Allocations meant for BHU, RHC, DHQs, THQs or tertiary hospitals / teaching hospitals etc.
11 The discussion is confined to only Annual Development Programme 2007-08 /2008-09. Therefore, the gender specific estimates are based on ADP allocations only.

1. Name of the Programme: Preventive Healthcare
2. Name of the Intervention: National Maternal Newborn & Child Health (MNCH) Programme (Punjab
Component)
3. Gender Challenge:
Maternal Mortality Rate (MMR) is believed to be the most sensitive indicator of women’s status in a society and of
the quality and accessibility of maternal health services available to women. Indeed, a maternal death is not merely
a result of treatment failure; rather it is the final outcome of a complex interplay between a myriad of social, cultural
and economic factors. Pakistan’s maternal and child health indicators remain extremely poor. The maternal mortality
12
rate (MMR) is 276 per 100,000 live births, infant mortality rate (IMR) is 77 per 1000 live births; and newborn morality
rate is 55 per 1000 live births (Reference). Prevalence of nutritional disorders and infectious diseases and access
to health care facilities are among the worst, even in South Asia.
4. Planned Activities:
In order to achieve MDG 4 and 5, Pakistan has to urgently reverse the current maternal and neonatal mortality rates.
MNCH Programme aims to improve maternal, newborn and child health of the population, particularly among
poor, marginalized and disadvantaged segments. The overarching program goal is to improve accessibility of quality
MNCH services through development and implementation of an integrated and sustainable MNCH services at all
levels of the health care delivery system. The programme is working in all 35 districts and mainly includes the
following activities.
• Introduction of new cadre of community based skilled birth attendants
• Strengthening of community midwifery training institutions and stress on trainings
• Construction of CMWs’ school
• Training of doctors and paramedics in IMNCI & EmONCs
• Provision of additional ambulance to RHCs
• Provision of equipments to all the health facilities for strengthening basic and
comprehensive EmONCs services
• Establishment of district MCH Cells
13
5. Budgetary allocation :
FY 2007-08: Rs. 1341.461 million
FY 2008-09: Rs. 2454.234 million
12 PLSM Survey (2006-07)

13 Data provided by the Programme Office

6. Inputs:
Input indicators FY 2007-08 FY 2008-09

Targets Actual Targets
14
Setting up of the Staffing / office equipment Staffing Completed : Procurement of touring
PMU /transportation Vehicles procured vehicle for monitoring and
16 computers for PMU training purpose
Procurement of furniture Furniture for 27 CMW Provision of vehicles for

Strengthening CMW for 27 CMW training training schools procured field training and
Training Schools Schools and delivered Programme activities
monitoring of and
teaching aids
Strengthening District Procurement of IT 61 computers for district Provision of furniture and

Health System equipments MCH Cells procured office equipment to District
MNCH offices
Books / studying material for Books / studying material Books / studying material Relevant book to be
CMWs to be procured for student purchased and delivered procured for student
CMWs to CMW students CMWs
Strengthening of IMNCI Provide audio / video Four Televisions and four Provision of equipments
services equipment DVDs procured for 12 days for IMNCI course in
workshop of District Rawalpindi and Faisalabad
Clinical Case Management
course on IMNCI in Lahore
and Multan
Strengthening of EmONC EmONC Manuals Printing 500 EmONC Manuals 100 percent coverage for
Printed for 12 days all health providers
workshop on District
Master Trainers in EmONC
Setting of District MNCH Complete Staffing Public Health Specialists Provision of vehicles for
Cells (34) monitoring Programme
Social Organizer (34) activities
Account Assistant (34)
Awareness and advocacy Utilize Rs. 4 million utilized Utilize

Rs. 4 million Rs. 5 million
14 Provincial Programme Coordinator (1), Additional Directors (2), Finance Officer (1), Communication Officer (2), Account Officers (2), and supporting staff

7. Outputs:
Output indicators FY 2007-08 FY 2008-09

Strengthening of District Appoint 293 doctors and 86 doctors and 159 207 doctors and 159 LHWs
Health MNCH facilities 293 LHVs at RHC LHWs recruited recruited
Training and workshops 8 Workshops 8 Workshops IMNCI (17)

IMNCI (4) IMNCI (4) EmONC (17)
EmONC (4) EmONC (4) 2 years diploma course in
anesthesiology
TOT for CMWs’ tutor (Rs. 2
million)
Training / recruitment of 1000 1000 1000

Community Midwives (CMWs)
Awareness and advocacy 5 print media ads 5 print media ads 10 Newspaper Ads
5000 calendars 5000 calendars 5000 Calendars
3 workshops 3 workshops 5 workshops
Jang Forum 2 2 Jang Forum 3 Jang Forum
8. Overall Assessment:
National Maternal, Newborn & Child Health (MNCH) Programme is an ambitious intervention in the health sector.
Programme’s main milestones to be achieved by 2011 include the following.
• Reduce the Under Five Mortality Rate from 94 to less than 65 per 1000 live births
• Reduce the Newborn Mortality Rate from 54 to less than 40 per 1000 live births
• Reduce the Infant Mortality Rate from 78 to less than 55 per 1000 live births
• Reduce Maternal Mortality ratio from 300 to 200 per 100,000 live births
• Increase the proportion of deliveries attended by SKB from 38% to 90%
• Increase the CPR from 36 % to 51%
These are highly ambitious targets and need gigantic efforts and resources to be realized. In fact, budgetary
allocation for 2008-09 has increased by about 93 percent over the previous year budget of 2007-08. This shows
the resolve of the government and the significance of the intervention.
The programme has achieved all its input and output targets except for the staffing of doctors and LHVs at RHCs.
District MNCH Cells have also been established successfully.

The programme has introduced a new cadre of Community Midwives (CMWs) that will take place of the traditional
birth attendants. Under this programme more than 6000 CMWs will be recruited and trained during the project
period. In fact, 27 CMW Training Schools have been strengthened to provide training to the newly created cadre
of CMWs. The Programme has recruited the targeted number (1000) of CMWs. Aided by the LHWs; CMWs surely
can achieve the milestones of a healthy and prosperous society through enhanced healthcare for maternal, new
born and child healthcare. Unlike some other projects, MNCH Programme also has a strong focuses on RHC and
BHU. Huge amount has been allocated to implement this initiative which calls for a well trained human resource
for successful implementation of the Programme’s mandate.

1. Name of the Programme: Primary Healthcare
2. Name of the intervention: Punjab Integrated Primary Health Care Model Programme (PIPHCM)
15
Surveys report that only 53 percent of Pakistani women receive antenatal care . Approximately 80 percent of
deliveries occur without the help of any trained attendant. In Punjab, more than 60 percent of births are attended
16
by unskilled birth attendants . Moreover, inadequate nutrition affects health of women and children alike. The
prevalence of anemia is significantly high among pregnant women and this coupled with low caloric intake results
in 25 percent of births being low weight babies17. Moreover, learning ability of our primary school students is
constrained by many impediments such as visual and hearing impairment, dental, skin and personal hygiene
challenges. A WHO studies reports national prevalence of blindness of 1 percent. Another estimate reveals that
nearly 11.6 million people in Pakistan are either blind or visually impaired in 2002. Studies report that about 80
percent of diseases in Pakistan are preventable in nature; however, major focus of the country’s healthcare system
rests on curative side mainly at the secondary and tertiary level healthcare facilities.
The overall Programme objective is to ensure all preventive as well as basic curative health services for each and
every individual in the Programme target areas. This will be achieved through converting each BHU and its catchment
area into a “Mini PHC UNIT” with the responsibility to cater to basic health needs of all community members residing
18
within the catchment area of a BHU. The Programme is to be implemented in 919 BHUs located in 12 districts of
Punjab by the respective district health department and facilitation from National Commission for Human
Development, Pakistan.
• Integration of facility based and outreach health intervention under the leadership of health
officer (formerly medical officer) and all staff working in the catchment area of a BHU; performs
under the general directions of health officer
• Setting of realistic targets for each staff member to achieve in specified time period
• Development of human resource through training of all concerned in various program components
• Ensuring 100 percent coverage of LHWs through determination of all concerned uncovered areas
and recruitment LHWs under PIPHCM following national LHW Programme criteria and guidelines
• Establishment of precise community health needs through conducting a house to house baseline
heath census after training health officers, LHS and LHW
• Registration of community members with their relevant BHU
• Conduct systems analysis of each BHU to identify gaps in demand and supply
• Establishment of effective referral system
• Mobilize and organize local communities to play an effective role in health care delivery system
15 PLSM Survey 2006-07

16 PIPHCM Project Document /PRMP (2006)
17 IPHCM Project Document (2007-2010)
18 Attock, Jhelum, Gujarat, M.B. Din, Sheikhupura, Jhang, Sargodha, Sialkot, Khanewal, Muzaffargarh,Bahawalpur, Gujranwala

5. Budgetary allocation:
FY 2007-08: Rs. 500 million
6. Inputs:

Total cost for the Programme 500 307.67 565
Operationalization of Programme’s Establishment of PMU, Establishment of PMU, 12 Strengthening of

Administrative Arms 12 districts PMUs, and districts PMUs, and Programme’s
provincial coordination provincial coordination administrative arms
unit unit continues
Baseline health census in one third 290 BHUs Against target of 570,412 290 BHUs
BHUs households in nine
districts, data from
539,018 data have been
collected
Formation of BHU health councils in 290 BHUs 83 percent of 290 councils 290 BHUs
one third BHUs have functional health
councils
Computerization of baseline data in 290 BHUs Computers are available 290 BHUs
one third of BHUs in one district only,
however,
Computer assistants are
available in four districts
only
Establishment of benchmarks in one 290 BHUs Not started 290 BHUs

third of BHUs
Redefining of BHU catchment areas of 290 BHUs So far no achievement 290 BHUs
one third BHUs
Establishment of referral system Establishment of Referral system Establishment of referral

referral system in 579 established in 579 BHUs system in 340 BHUs
BHUs
Registration of Primary School Registration of Primary Primary School Students Registration of Primary
Students School Students with of all schools have been School Students with
579 BHUs registered with 579 BHUs 340 BHUs

7. Outputs:

Strengthening PMUs Training of PMUs 4 Senior Programme Strengthening of PMUs continues
Managers,12 District
Programme Managers, 73
District Programme
Supervisors
12 Data Managers
trained,535 Health officers
De-worming of Primary School De-worming of Primary 443,464 Primary School De-worming of Primary School
Students School Students in 290 BHUs Students de-wormed in Students in remaining 340 BHUs
579 BHUs
Screening of primary school Screening of Primary School 598,413 Primary School Primary School Students of
students Students of 579 BHUs Students screened remaining 340 BHUs
Training of primary school Training of primary school 34,690 Primary School Training of Primary School Teachers
teachers teachers in 579 BHU Teachers in 579 BHU in remaining 340 BHU
Generate data analysis reports Analysis reports of 290 BHUs Not started Analysis reports of BHUs
Redefining of BHUs catchments Redefine BHUs catchments Still to be done Redefine BHUs catchments in one
in one third BHUs in 290 BHUs third BHUs
Punjab Integrated Primary Health Care Model Programme (PIPHCM) is a much needed and potential intervention
by the government of the Punjab. Its effective and successful implementation will definitely improve the health
status of people in the programme districts. Key interventions and milestones to be accomplished under this
programme are as follows:
• Bring IMR to 64 percent per 1000 live births by the year 2011
• Bring under five mortality rate to 83 percent by the year 2011
• Bring fully immunized children (12-23 months ) to at least 80 percent by the year 2011
• Bring under five children (who are under weight) to at least 25% by the year 2011
• Bring maternal mortality rate to 280 per 100,000 live births by the year 2011
• Improving the percentage of births attended by SBA to 70 percent by 2011
• Improving contraceptive prevalence to 40 percent by the year 2011
• Increase women employment by 200 percent increase at the local rural level in 12 districts

Although the set targets seem little too ambitious but are not impossible to be accomplished. However, these need
highly motivated and capable human resource supported by adequate technical and financial resources. Capacity
development and benchmarks and standards setting are among the most significant initiatives under this Programme.
For these objectives to be realized, effective and dynamic information back up needs to be developed. Although
project performs well on the capacity development part, yet little is observed on database / MIS development side.
Various significant and much needed school health interventions are being carried out under PIPHCM. The project
has performed very well on these interventions.
A concern that needs to be addressed urgently relates to National Commission for Human Development itself. The
project needs to be protected from the negative impact of the current challenges surrounding NCHD.

1. Name of the Programme: National Programme for Primary Health Care and Family Planning
2. Name of the Intervention: The Lady Health Workers Programme
The current health status of the nation is characterized by a high population growth rate, high incidence of low
birth-weight babies and maternal mortality. An important reason for high maternal mortality is unskilled birth
attendants such as family members and traditional birth attendants. Therefore, skilled and trained birth attendants
remain a key to reverse the high incidence of maternal and infant mortality in Pakistan.
The Programme is dispensing primary healthcare and family planning in all 35 districts.
• Recruitment of additional lady health workers (LHWs)

• Training of new LHWs and build the capacity of existing LHWs and lady health supervisors (LHS)
• Ensuring greater coverage households by LHWs for addressing and providing referral for reproductive
health services
5. Budgetary Allocation:
FY 2007-08: Rs. 1.913 billion

FY 2008-09: Rs. 2.3 billion
6. Inputs
Vehicles for Lady Health 813 813 330
Workers (LHW)
Provision of training Rs. 16 million Rs. 16 millions Rs.19 million

materials and other items
including information
education and
communication material
provided by the federal
component of the
Programme based on
provincial needs
Stocks of 12 different Rs. 555 million Rs. 569 million Rs. 623 million
medicines , LHW kits,
weighing machines, scissors,
bandages and etc. provided
by the federal component of
the program based on the
forecasted provincial needs
Cost of contraceptive 218 million 233 million 255 million

Supplies
Recruitment of LHW 52381 46582 57381
Recruitment of lady health 2096 1644 2096

supervisors (LHS)
Training of LHSs and LHWs 52381 LHWs 2096 LHSs 46823 LHWs 1644 LHSs 57381 LHWs 2096 LHSs
Computerization of HR 100 percent 90 percent 100 percent

database
7. Outputs:

(LHW covering areas)
Contraceptive Prevalence Rate 30 percent 42 percent 44 percent
Infant Mortality Rate (IMR) 78 per 1000 live 44 per 1000 live births 42 per 1000 live births
births
Maternal Mortality Rate (MMR) 276 per 100,000 live 141 per 100,000 live births 138 per 100,000 live
births births
EPI Coverage 47 percent 47 percent 47 percent
Antenatal Care 28 percent four 76 percent four antenatal care 78 percent four antenatal
antenatal care visits visits care visits
Number of pregnant women visited To increase LHW 340,722 To increase LHW

by LHWs population coverage population coverage
55 to 70 percent 60 to 80 percent
Number of pregnant women 100 percent 80 percent 100 percent

registered by LHW in their catchment
areas
Generation of computerized payroll Ten Programme 12 Programme districts 23 Programme districts

districts

8. Overall Assessment
‘National Programme for Primary Health Care and Family Planning’ mainly aimed to provide basic healthcare services
to women on their doorsteps and bridge the gap between the community and institutionalized services. More
specifically, the Programme needs to improve contraceptive prevalence rate (CPR), immunization of children, and
antenatal care. The Lady Health Worker is the lynch pin for all activities of the National Programme. The Programme
now covers almost all districts of Pakistan.
The Lady Health Workers’ Programme has proved to be a successful intervention. Above list of performance indicators
confirms an increasingly steady performance of the Programme. Enhanced annual allocations (19 percent increase)
show increased demand for the Programme services. This is further supported by the increased allocations for
medicines/ LHW kits etc (12 percent increase) and for contraceptive (17 percent increase). However, the Programme
lags behind set targets on registration of pregnant women. This is a very important indicator to measure the
performance of the LHWs as registering all pregnant women in the catchment area remains central to this intervention
to be a complete success.
Preparation of LHW-MIS for each district has proved to be a very important tool for evidence supported planning
and policy making for development in the health sector. So far 12 districts have been computerized. Remaining
23 programme districts will be computerized next year. The MIS will include information on all relevant indicators
such as number of immunized children, CPR, activities of LHWs etc.
The programme derives its strength mainly from its linkages with the community. Because the LHWs are from the
communities where they work, and because they are women, they are able to have close interaction with the
women in the community, and through them reach children as well. This relationship is built on mutual trust and
respect for each other. Success of this programme actually signifies the usefulness of community based interventions
in the social sectors.
The National Programme for FP & PHC has played a significant role in women empowerment by creating job
opportunities to rural women by deploying more than 96,000 LHWs and 2096 supervisors in the field. Programme
is having a significant impact on a range of health outcomes. This is a result that is rarely found in community health
19
programmes of this size .
19
WHO (2004), ‘Pakistan’s experience in Lady Health Workers (LHWs) Programme’: Islamabad, Pakistan.

1. Name of the Programme: Primary Health Care
2. Name of the Intervention: Reproductive Health Project Punjab
The negative sex ratio is an indicator of gender disparities in health. Women’s health situation needs to be seen
20
together with their reproductive health role. A high maternal mortality rate (276/100,000) , as well as female
mortality ratio of 1 to 4 year olds (which is 66 % higher for girls than boys) is indicative of the social factors that
militate against women in the country. Twelve percent of Pakistan’s burden of disease is due to reproductive health
problems and 6% to nutritional deficiencies. Women’s disproportionate poverty, low social status and reproductive
role expose them to high health risks, resulting in needless suffering, many preventable deaths and disabilities.
This unfortunate situation can no longer be ignored.
The project is working in ten districts across Punjab. The tasks planned under this intervention are as follows:
• Improving quality and range of RH services through Integration of family planning and mother
and child healthcare into district health care systems such as district headquarter hospitals
• Training of doctors at Rural Health Centers and Basic Health Units in family planning, infant
healthcare and obstetric complications management
• Training of midwives for better healthcare
21
5. Budgetary Allocation :
FY 2007-08: Rs. 98.72 million

FY 2008-09: Rs. 20.46 million
6. Inputs

Targets Actual Targets 22
Cost of 18 months
training for midwives 15,720,000 14,419,275 No specific targets
Infant care and family Six months training of 2 women Could not be No specific
planning training of medical officers and 2 other achieved due targets
doctors(masters trainers at medical officers in gynecology largely to non
the provincial level) and anesthesia respectively in availability of
23
the nearest teaching hospital funds from ADB
from each project district
20
Pakistan Demographic and Health Survey 2006-07
21
Project office / MTDF /Planning and Development Department government of the Punjab
22
It was decided to close down the project in June 2008; however, in order to accomplish unachieved targets, Project’s life has been extended up to June 2009. Therefore,
targets for the financial year 2008-09 have not been specified.
23
Funds stopped in June 2007

24 25
TBA training 2000 per district 22,670,000 2,875,945 No specific targets
Cost of Disposable Safe 3,360,000 3,326,499 No specific targets

Delivery Kits (sterilized)
Civil work of 10 DHQ hospitals 9,747,215 9,747,215 No specific targets
7. Outputs:

Targets Actual Targets26
Civil Works / improvement of 10 DHQ Complete up gradation of 10 Complete up gradation of No specific targets
hospitals to provide labour rooms, DHQ 10 DHQ
gynecology rooms etc. Provincial Project Office
Purchase of ambulances for 10 DHQ Availability of 10 ambulances 10 ambulances purchased No specific targets
hospitals to THQs and delivered
Provision of electro-medical Anesthesia apparatus with Anesthesia apparatus No specific targets

equipment to DHQ hospitals ventricular, plain with ventricular, plain
photographer, TV, DVD, (one photographer, TV, DVD,
set) safe delivery kits (one set) safe delivery kits
disposable, disposable disposable, disposable
syringes 5cc to be provided syringes 5cc provided
27
18 months training for midwives 331 303 No specific targets
28
TBA training 2000 per district 20,000 2222 No specific targets
Disposable Safe Delivery Kits (sterilized) 108,000 105,000 distributed to the No specific targets
target district to be used
at First level care facility
24
In 10 project districts
25 Due to lack of funds
26 It was decided to close down the project in June 2008; however, in order to accomplish unachieved targets, Project’s life has been extended up to June 2009. Therefore,
targets for the financial year 2008-09 have not been specified.
27 28 Midwives left on one or the other account.
28 In 10 project districts

Given the close relationship between the reproductive healthcare and human development, the project held great
significant. The project was initiated in 2004 over six years’ duration. However, it was decided to close the project
in June 2008 well before the set deadlines. However, in order to complete the unfinished assignments, the project
has been extended for another year and a small amount has been allocated in FY 2008-09. This unexpected closure
badly impacted the performance of the project. Many interventions had to be left unachieved or done in haste.
This indeed, reversed the earlier gains of the project. Performance indicators clearly show that most targets remain
unaccomplished. Training component is the badly hit component of the project. About 20,000 Traditional Birth
Attendant were to be trained under this project; however, due to shortage of funds only 2222 TBAs could be trained
as trained birth attendants. Even the 18 months’ training course for the midwives was completed with the transfer
of funds from Maternal Newborn Child Health (MNCH) Programme. The target of six months training of 2 women
medical officers and 2 other medical officers in gynecology and anesthesia respectively in the nearest teaching
hospital from each project district also remained unaccomplished due to unavailability of funds.
However, project shows some good achievements on procurement of ambulances and medical equipments. About
105,000 Disposable Safe Delivery Kits (sterilized) were procured and distributed to the first level care facility in the
target districts. Similar interventions need to be initiated for better reproductive healthcare and family planning
services.

1. Name of the Programme: Preventive Health Care Programme
2. Name of the Intervention: Punjab Safe Motherhood Initiative Project
Maternal mortality is a sensitive indicator of gender inequity. It indicates the status of women, their access to
healthcare facilities, and economic impoverishment. Every 20 minutes a Pakistani woman dies of pregnancy related
complication29. Pregnancy related problems and complications can be avoided with better healthcare education
and early detection of high risk pregnancies. In Pakistan, lack of access to emergency obstetric care remains largely
responsible for the high maternal mortality rate. Unfortunately about 95 percent rural and 60 percent urban women
use non trained birth attendants. The situation is further exacerbated due to high illiteracy among women.
Keeping these constraints and challenges in view, the government of the Punjab with the help of UNICEF adopted
an innovative approach to link the vertical programmes to create a referral system between the tertiary care hospitals
and Basic Health Units in district Sheikhupura. This is a pilot project of the government of Punjab, in collaboration
with the Lady Wellington Hospital, King Edward University and United Nations Children’s Fund (UNICEF) working
in Sheikhupura district. The project mainly looks after the following tasks.
• Provision of 24 hours antenatal and emergency obstetric acre services at the doorsteps through
linkages between basic heat units, rural health centers district and Tehsils headquarter hospitals
• Undertaking monthly rotation of postgraduate trainee doctors in government facilities in rural
areas to provide round the clock emergency obstetric cover
• Mobilization of community through village and mohala level meetings
• Awareness raising through use of media and interpersonal communications
30
FY 2007-08: Rs. 14.982 Million

FY 2008-09: Rs. 11.399 Million
6. Input
Arrange appointment and Appoint 10 female doctors at Appointed 10 female Appoint 10 female doctors at THQ
residence of 10 female doctors THQ and DHQ hospitals on doctors at THQ and and DHQ hospitals on monthly
at Tehsil and district monthly rotation DHQ hospitals on rotation
headquarter hospitals on monthly rotation
monthly rotation basis
29
Pakistan needs to do a lot more to prevent child deaths / http://www.paiman.org.pk/newsdetail.php?NEwsI_d=237
30
Data provided by Project Office

7. Outputs:

Availability of female doctors at the DHQ Rotation of 120 doctors 120 doctors rotated Rotation of 120 doctors
&THQ hospitals Sheikhupura
Outdoor attendance in THQ Hospital Daily outdoor with 8,000 Daily outdoor conducted Daily outdoor with 13,000
Muridke patients to benefit and 12,881 patients patients to benefit
benefited
Indoor Admission in THQ Hospital, Indoor admissions of 800 1110 patients admitted in Indoor admissions of 1200
Muridke patients indoor patients
Deliveries in THQ Hospital, Muridke 400 deliveries attended at the 570 deliveries were Deliveries of 600 patients in the
hospital attended at the hospital hospital
C-Section in THQ Hospital, Muridke C sections of 85 patients at the 118 patients provided the C sections of 125 patients at
hospital facility of C sections the hospital
Outdoor attendance in DHQ Hospital, Daily outdoor with 21,900 Daily outdoor conducted Daily outdoor with 23,500
Sheikhupura patients to benefit and 23,176 patients patients to benefit
benefited
C-Section in DHQ Hospital, Sheikhupura C sections of 500 patients at the 750 patients provided the C sections of 780 patients at
hospital facility of C sections the hospital
Antenatal visits to RHC/BHU 240 visits to provide antenatal 240 visits with 24,353 240 visits to provide antenatal
care female beneficiaries care
Awareness raising seminars Arrange 8 seminars with 800 Arranged 8 seminars with Arrange 8 seminars with 800
participants 800 participants participants
Community awareness raising meetings 168 meetings with 5040 168 meetings 168 meetings with 5040
participants with 12341 Participants participants
Program on FM 100 24 programmes 24 programmes conducted 24 programmes
Survey of Project progress Third party survey of the project Survey of the project Disseminate the results of third
progress to be conducted progress conducted by party survey
independent assessors

Any intervention targeting maternal health cannot be evaluated in isolation. Numerous factors go into improving
the health of mothers. Therefore, performance of safe motherhood project cannot be determined very objectively.
However, available evidence strongly points to a very heartening impact on target population. Input and output
tables present a detailed account of various performance indicators of the project.
Outdoor female attendance at the THQ Hospital Muridke recorded about 38 percent increase followed by 27 percent
increase in indoor admission of female patients over the set target. Similar improvement is evident at DHQ hospital
Sheikhupura. While striking improvement in all the performance indicators confirms usefulness of the project, it
also shows community confidence in the public sector health system. Increase in the number of patients coming
for antenatal care at the project Rural Health Centers / Basic health Units highlights an encouraging response from
the rural community.
Greater number of deliveries, outdoor visits and indoor admissions all point to quality healthcare and an effective
awareness raising campaign. This notion is confirmed from the number of participants who attended the awareness
raising events. Following the success of the project in Sheikhupura, government has replicated the safe motherhood
project in tow more districts of Chakwal and Nankana Sahib.
Despite this successful performance, the allocation for the next year has witnessed a decrease by Rs. 3.6 million (24
percent decrease). Now when the project has indeed, found ground among the community, decreased funding
may weaken the quality and delivery of service in the target areas. Other challenges concern sustainability of project
interventions. Once the project completes its life, what mechanisms are put in place for mainstreaming the project
interventions into general healthcare facilities? Indeed, strong and sustainable linkages with the mainstream
healthcare system would add to project sustainability and longevity.

E
-DUCATIONSECTOR-
GENDER BUDGET
STATEMENT
31
Summary of Provincial Expenditure (Rs. in million )
Description Budget Estimates / Revised Estimates / Budget Estimates /
Allocation Allocation Allocation
2007-08 2007-08 2008-09
Current Revenue 23,745.718 16,218.551 25,272.437
Expenditure
Annual Development 21,480.450 18,078.289 30,129.00

Programme
Total 45,226.168 34,296.840 55,401.437
Summary of Provincial Education ADP (Rs. in million)

Sub-Sector Allocation Allocation Percentage
2007- 08 2008 - 09 Increase
School Education 8488.00 16454.00 93.9%
Higher Education 9936.00 9100.00 -8.42%
Special Education 954.45 1825.00 91.2%
Literacy & NFBE 1200.00 1250.00 4.2%
Sports 902.00 1500.00 66.3%
Total 21480.45 30129.00 40.3%
31
White Paper on Budget 2008-09 / Annual Budget Statement 2008-09.

-Introduction-
Education sector envisions an enlightened and prospering Punjab through provision
of equitable opportunity for quality education. To accomplish the Millennium
Development Goals by 2015, government is committed to ensure universal primary
education, completion of full primary schooling by all children, gender equality and
women empowerment. Government is further resolved to reduce gender and regional
disparities in the education sector. In order to achieve these milestones, Government
has allocated Rs. 30,129 million under the ADP (2008-09) which represents about 40
32
percent increase over last year’s (ADP/2007-08) allocation of Rs. 21,480 million .
Education sector allocation accounts for about 25.3 percent of the total allocation for
the social sectors in 2008-09 as compared to 23.1 percent during FY 2007- 08. It is
challenging to reach an accurate figure of government’s spending meant exclusively
for female in the education sector. However, an effort has been made to identify those
33
allocations that focus only female in the education sector.
In 2007-08, out of a total allocation of Rs. 8,488 million for school education, about Rs.
325.5 million exclusively targeted female which represents about 3.85 percent of the
total allocation for school education . Male school education received about Rs. 178.731
million which represents about 2.1 percent of the total allocation. Rough estimates
further show that about Rs. 7983.774 million (94.1 percent) didn’t target any specific
gender. However, indirectly these had benefited both genders. Similarly, out of a total
allocation of Rs. 9936.00 million for sub-sector of higher education, only 10.88 percent
(Rs. 1080.991 million) were meant exclusively for female. Male higher education received
about Rs.621.563 million which is about 6.26 percent of the total allocation. However,
major chunk of ADP (Rs. 8233.45 million / 82.9 percent) didn’t target any specific gender.
Correspondingly during 2008-09, school education sub-sector allocation increased to

Rs. 16454 million. About Rs. 2075.474 million exclusively targets the female which
represents about 16.88 percent of the total allocation for school education. Male school
education receives only 11.78 percent (Rs. 1937.332 million) of the total allocated funds
for school education. However, about Rs. 12297.293 million (about 74.74 percent) of
the total allocation doesn’t specifically target any gender. Similarly in the higher
education sub-sector, out of a total allocation of Rs. 9100 million, only 13.39 percent
(Rs. 1218.071 million) have exclusively been allocated for the females. Male higher
education receives about Rs. 884.849 million (9.7 percent) only. About Rs. 6999.08
million (76.9 percent) doesn’t target any specific gender. This amount would however,
benefit both the genders.
32
MTDF (2008-11) / White Paper on Budget 2008-09
33
The discussion is confined to only Annual Development Programme 2007-08 /2008-09. Therefore, the gender specific estimates are based on ADP allocations only.

The meager allocation for the female / male education calls for an urgent and objective review of our resource
allocation policies. Indeed, female specific allocations need to be enhanced in order to effectively address the gender
needs and subsequently exploit gender potential in favour of national development and MDGs’ accomplishment.
Education indicators in Punjab are generally better than for Pakistan as a whole, but the province is still riddled with
disparities in education across region and by gender. The PESRP is perhaps the most ambitious initiative in education
ever taken in Punjab, with possibly significant long-term effects. In general, the prominence accorded to education
in Punjab in recent years is likely to have positive effects, if the government adheres to its efforts.
Some major interventions have been examined individually through gender lens.
• Promotion of Primary Education for Girls in Rural Areas (World Food Program)
• Provision of free textbooks to all school children in all Districts across Punjab
• Provision of stipends to girls in class 6 to class 10 in 15 districts of Punjab where overall literacy
rate is below 40 percent
• Provision of missing infrastructures to schools in Punjab
With the assistance of the World Food Programme, Punjab government is providing edible oil to all girl students
and teachers in primary schools of the seven project districts. Under Punjab Education Sectors Reform Programme
(PESRF); free textbooks are being provided to all students from katchi level to Class X in government schools in all
35 districts. To address the gender imbalance in middle/secondary school education, a stipend programme for girl
students in 15 low-literacy districts has been introduced. Punjab government is also providing missing facilities to
about 62090 functional schools under an arrangement with National Logistic Corporation (NLC) in 35 districts in
Punjab. The gender aspect of these initiatives has been discussed individually in the following pages.

1. Name of Programme: Promotion of Primary Education for Girls in Rural Areas (World Food Program)
2004-09
2. Name of Intervention: Provision of Edible Oil to girls’ primary schools
Education plays a key role in reducing poverty. Empirical research suggests an inverse relationship between poverty,
education level and literacy. Educated people have higher earnings and consequently, have a lesser chance to slip
into poverty. However, ever growing household expenses force poor parents to compromise on education of their
children specifically girls thus perpetuating poverty and destitution.
In order to increase enrollment, achieve gender balance and enhance literacy in Punjab, World Food Programme
is supporting the Punjab Government through supplying the edible oil to girl students and teachers of 700 primary
schools in seven districts of Punjab. The seven districts include Rajanpur, D.G. Khan, Muzaffargarh, Layyah, Bhakkar,
Mianwali and Khushab. Main criteria for distribution of oil include the following activities.
• All girl students and teachers in primary schools of the project districts are entitled to receive 3.7
kg edible oil each month during the academic year (33.3 kg per annum).
• Each student has to attend the school for a minimum of 20 days and the teacher has to be present
in the school for at least 22 days for nine months of the year to qualify for provision of oil.
5. Budgetary allocation : 34
FY 2007-08: Rs. 27.330
FY 2008-09: Rs. 45.180
6. Inputs: Required Inputs FY 2007-08 FY 2008-09

Edible Oil provided by WFP to Girls’ 3777 3392 4,126
School (Oil in MT)
Operation Cost (Rs. in millions) 27.33 21.812 45.180
34
Data provided by Project Office

7. Output:
Number of Girls Schools where oil

is being distributed in each District FY 2007-08 FY 2008-09
D.G. Khan 120 120 120
Rajanpur 130 130 130
Muzaffargarh 100 100 100
Layyah 100 100 100
Bhakkar 100 100 100
Mianwali 100 100 100
Khushab 50 50 50
Total Number of Schools 700 700 700
Total Number of Beneficiaries Given Oil (oil 113,412 104,167 123912
provided three times in a year)
Number of Teachers given Oil in Schools 1566 1350 1566
8. Overall Assessment :
Current (FY 2008-09) budget exceeds the previous year’s budget by about 65 percent. This shows Programme’s
momentum and government’s resolve to improve the educational status of the people of Punjab. The project seeks
to improve enrollment, gender balance, and retention and literacy rates at the primary education level. The project
also envisages complementing the national efforts to achieve the MDG of Universal Primary Education. However,
it is hard to detach the impact of this intervention alone as at one time many things are working to improve the
literacy level in the province such as interventions under Punjab Education Sector Reforms Programme.
Number of teacher beneficiaries keeps on changing on account of transfers and other reason. This make harder for
the project to achieve the set targets. Therefore, project missed on the teachers’ target. Programme also failed to
meet the set target of the beneficiaries of girl students.
Oil distribution mechanism needs to be revisited. As per the available information, headmistress is solely responsible
for the distribution of oil to girls and submission of monthly reports. In order to ensure greater transparency,
accountability and integrity (ATI), the distribution of oil should ideally be carried out under the supervision of school
councils that include members of the community as well.
Although the Programme, to some extent misses on some of the targets, nevertheless, existing evidence suggests
that enrollment has continuously increased from 64,412 in 2002-03 to 104,167 in 2007-08. This represents a 62
percent increase. In fact, female enrollment at primary level increased from 47 percent in 2001-02 to 66 percent
35
in 2006-07 . Despite this evidence, it is still hard to attribute this improvement only to this intervention. However,
number of beneficiaries is increasing every year which points to the positive impact of this intervention. Therefore,
project intervention (provision of edible oil) needs to be replicated in other districts as well.
35
PLSM (2006-07) & White paper (2008-09)
1. Name of the Programme: Punjab Education Sector Reforms Programme
2. Name of the Intervention: Provision of free textbooks to all school children in all Districts across
Punjab
Poverty is both a consequence and a cause of inadequate education. Capacity and opportunities to earn higher
income remain weak due to low education levels in terms of quantity and quality. Alternatively low income levels
and poverty also constrain households/individuals to invest in education of girls. As a result gap widens between
enrollment of boys and girls and achievement of MDGs - universal primary education empowerment of women
and gender parity becomes harder to accomplish.
In order to motivate poor households to send their children especially girls to school, Government of the Punjab
is distributing free textbooks to all school gong children. While this intervention created a fiscal space for the poor
parents, and improved enrollment, it enhanced the quality of education on account of timely provision of quality
textbooks. Main activities of the interventions are as follows.
• Purchase of books through Punjab Textbook board

• Distribution of textbooks through national logistic corporation (NLC) of Pakistan
36
FY 2007-08: Rs. 1000 Million

FY 2008-09: Rs. 1000 Million
6. Inputs:
Required Inputs FY 2007-08 FY 2008-09
Targets
24 million Actual
29.2 million Targets
29.5 million
37
Number of books purchased textbook
and distributed to districts jackets
Rs. 72. 5 million Rs. 88.2 million 107.7 million
38
Cost of books
37
White Paper (2007-08)
38
Due to current steep rise in production cost

7. Outputs:
Student beneficiaries FY 2007-08 FY 2008-09

Number of girl students who 5.1 million 5.1 million 5.6 million
received books
Number of boy students who 6.2 million 6.2 million 6.7 million
received books
39
Total 11.3 million 11.3 million 12.3 million
Despite recent fall down of capital market, the budgetary allocation remains unchanged for FY 2008-09. Available
literature shows that overall primary net enrollment increased from 45 percent in 2001-02 to 70 percent in 2006-
07. Net enrollment rate for female also improved from 43 percent to 66 percent during the same period. From last
few years; various initiatives have been launched in Punjab. Hence increasing enrollment rate cannot be the result
of one single intervention. Indeed, relating the current enhanced enrollment rate only to free textbooks provision
seems unfair. Therefore, we need to look somewhere else to find the impact of this specific intervention.
Quite interestingly during 2007-08, 29.2 million books were distributed among the target group, which is 5.2 million
beyond the target of Rs. 24 million. Given the current price hike, cost of books purchased has also increased
dramatically. In this scenario, provision of free textbooks remains a significant achievement of the government.
There is only 0.3 million increase in the number of books to be procured in FY 2008-09, however, there is an increase
of about Rs. 20 million in the procurement cost of the books.
Above given input and output performance indicators point to the positive impact of this intervention. Number
of books actually passed the target value and similarly number of beneficiary students has also increased. Indeed,
steady increase in number of beneficiaries and books, lend evidence in support of the effectiveness and positive
outcome of the intervention.
39 @10 percent expected increase in enrollment

1. Name of the Programme: Punjab Education Sector Reforms Programme
2. Name of the Intervention: Provision of stipends to girls in class 6 to class 10 in 15 districts of Punjab
where overall literacy rate is below 40 percent
With considerable gaps across genders, the overall adult literacy is estimated at 55 percent in Pakistan. Indeed,
40
PLSM Survey reports a 25 percent points differential between male (67 percent) and female (42) literacy rates .
Recognizing a close nexus between poverty and illiteracy eliminating gender and access gaps and ensuring retention
of students particularly girl students remains a formidable challenge for the Government. Poor parents are unable
to support their daughters’ education beyond primary level. Poor households need to be supported to further
education of their daughters. Indeed, effective development of females’ potential calls for affirmative action for
improved survival rate of female students.
Under the Punjab Education Sector Reforms Programme, Punjab Government has offered an incentive package to
address the educational and financial needs of the poor students particularly the girls. Initially, stipends of Rs. 200
per month (Rs. 600 quarterly) to the girl students of class VI-VIII, was distributed in 15 low literacy districts (> 40%
literacy rate). The Districts with low literacy rate were selected consciously keeping in view the low women
participation rate in these districts to bridge up the gap between male and female participation in socio-economic
development of the country. Main features of the intervention include the following.
• Provide Rs. 200 stipends each month to girl students in 15 districts across Punjab to those
girls whose attendance is 80 percent or above for the previous quarter (3 months).
• Provision of stipend through postal services at a cost of Rs. 15 per reimbursement
5. Budgetary Allocation:

6. Inputs:
Number of schools in each district FY 2007-08 FY 2008-09
where stipends were distributed Targets Actual Targets
Bahawalnagar 273 273 273
Bahawalpur 188 188 188
Bhakkar 89 89 89
DG Khan 85 85 85
Jhang 192 192 192
Kasur 172 172 172
Khanewal 210 210 210
Layyah 162 162 162
40
PLSM Survey (2006-07)

Lodhran 100 100 100
Okara 188 188 188
Pakpatan 88 88 88
Rahimyar Khan 217 217 217
Rajanpur 43 43 43
Vehari 209 209 209
Total number of school where stipends 2341 2341 2341
distributed
Total allocated stipend amount 900 900 900
7. Outputs:

Bahawalnagar 35070 30585 36824
Bahawalpur 31312 23112 32878
Bhakkar 15392 13407 16162
D.G. Khan 22271 22033 23385
Jhang 35117 31754 36873
Kasur 34147 30474 35854
Khanewal 38270 36758 40184
Layyah 20764 15447 21802
Lodhran 12343 10222 12960
Okara 34443 31922 36165
Pakpatan 16798 15272 17638
Rahimyar Khan 43294 36077 45459
Rajanpur 9950 9669 10448
Vehari 32714 31731 34350
41
Total number of girls student who 406234 360137 426546
received stipends distributed
41
Actual enrollment numbers cannot be obtained until March / April as the Education Census is finalized in March / April each year. Therefore, projected enrollment numbers
are taken keeping in view the previous trend.

The overall budget for 2008-09 remains the same. A mere glance at the increased enrollment points towards positive
impact of this intervention however; isolating the outcome of this intervention remains a challenging task. The
42
male enrollment at middle level has increased from 47 in 2001-02 to 66 percent in 2006-07 . Similarly female
enrollment increased from 39 to 62 during the same period. Overall enrollment has also increased to 62 percent
at the middle level. Steady increase in the enrollment of students and beneficiaries as well support the notion that
provision of stipends has led to positive results. This makes the intervention quite significant for poverty reduction
and improved literacy. Input performance indicators have fully been achieved however beneficiary target couldn’t
be achieved; stipend qualifying criteria might have worked behind this descent.
42
PLSP (2006-07)

1. Name of Programme: Punjab Education Sector Reforms Programme
2. Name of Intervention: Provision of missing infrastructures to schools in Punjab
The education service delivery in Punjab is faced with a multitude of challenges; from severe shortage of qualified
and trained teachers to lack of infrastructure and facilities. Poor facilities in schools negatively impact the enrollment
and retention rate in Punjab. The impact comes out very strongly in case of female schools. Non availability of basic
facilities such as washroom, safe drinking water or school boundary wall essentially doesn’t let the parents send
their daughters to schools. Punjab Education Sector Reforms Programme (PERSP) annual progress report for 2004/05
documents that 16 percent of Punjab’s primary school had no provision of water, 38 percent had no boundary
walls, 65 percent had no electricity and only 59 percent had latrines. Also, provision of missing facilities at the
schools will help achieve the MDG of universal primary education through increased enrollment and survival rate.
Unlike previous years, the government has adopted a ‘whole school’ approach. Under this approach a school is
refurbished and provided with full facilities instead of piecemeal provision of basic facilities. The main features of
the interventions are listed below.
• Provide missing facilities to about 62090 functional schools under an arrangement with
National Logistic Corporation (NLC) in 35 districts in Punjab
• Release of funds is based on a formula which gives 40 percent weight to performance
of the district in education sector and 60 percent weight to needs of the district.
43
FY 2007-08: Rs. 4000 million

FY 2008-09: Rs. 2500 million
6. Inputs:
Required Costs FY 2007-08 FY 2008-09
Cost of schemes providing missing facilities Not specified 1,921,960,080 Not specified
to girls schools
Cost of schemes providing missing facilities Not specified 3,416,817,920 Not specified
to boys schools
Total cost of schemes providing missing Not specified 5,338,778,000 Not specified
facilities
Total Units / schools to be overhauled 4038 1367 schools Not specified
overhauled and
handed over back to
education department
2421 schools under
work
43 MTDF 2007-08 & 2008-09

44 There are no specific annual targets. NLC has to provide all the missing facilities to the selected schools. At one point of time range of activities are taking place right from
administrative approval, technical sanction and contracting out to handing over the completed schools back to the education department. Hence it is hard to obtained
data / information specific to a particular year or period of time.

7. Outputs:
No of schools being provided

missing facilities FY 2007-08 FY 2008-09
Total boys schools to be provided with missing Not specified 2194 Not specified
facilities
Total girls schools to be provided with missing Not specified 1590 Not specified
facilities
Total number of schools Not specified 3784 Not specified
Last FY 2007-08, initially Rs. 2500 million were allocated for this intervention. Later the allocation was enhanced
46
to Rs. 4000 million . As per available information, Rs. 4000 million have been transferred to the Districts Account
IV, however, little has been spent from this block allocation due to certain administrative obstacles. Current work
is being undertaken with the help of previous non-lapsable funds.
Lack of facilities in our schools comes out to be a very crucial barrier towards achieving Universal Primary Education
MDG. Parents don’t want to send their daughters to schools where basic facilities such as washroom, boundary
walls and electricity don’t exist at all. Punjab government under PERSP committed itself to provide the missing
facilities to the about 62090 schools in Punjab. Although the female and male enrollment has increased over the
years, the impact cannot be attributed to provision of missing facilities only. Punjab Education Department and
PESRP have under taken number of initiatives to improve the enrollment and achieve the MDG. In the presence
various initiatives, any improvement in literacy or enrollment level may not be directly related to provision of missing
facilities. However, we can very safely conclude that provision of missing facilities remains one of the contributing
factors for improved enrollment levels in Punjab.
Government has engaged the National Logistics Corporation (NLC) for complete construction / renovation of
schools once for all. A short analysis, done by the PESRP shows the slow pace of work being implemented by NLC.
This could be partly due to the administrative issues as well. NLC has started work on the identified schools; however,
in most cases their targets remain unspecified. Indeed, there are no time bound targets and hence measuring the
efficiency and performance of the intervention becomes hard. As per available information, there are no annual
targets. NLC is bound to complete the assignment within the contract period. Therefore, better time bound and
performance based targets need to be put in place to effectively monitor the pace and quality of work being done
by NLC.
45
Ibid.
46
Rs. 1500 million allocation for Colleges was also added to the Schools Education

- S
E
C
O
T
RWA
R
E
F
E
LONIP
O
TP
A
U
L -
GENDER
BUDGET
STATEMENT
47
Budgetary Allocation for FY 2007-08: Rs. 1355 million
Budgetary Allocation for FY 2008-09: Rs. 1400 million
47
Allocation obtained from the office DG Population Welfare, Punjab / Programme Documents. The allocation also includes the allocation for administrative expenditures.

-Introduction-
The Population Welfare Programme recognizes the strong linkages between population
and poverty, and status of women and sustainable development. Therefore, the
Programme has number of gender specific interventions including reproductive health
services, family planning, information / communication, and maternal and child
healthcare services. Although the Programme has a strong focus on women, it duly
caters to the needs of males as well. Ministry of Population Welfare remains responsible
for policymaking, planning, contraceptive procurement and distribution, human
resource management and monitoring and evaluation of the Programme. The Welfare
Population Programme is operating under PCI (2003-08) that has been extended for
the year 2008-09. The current PCI will be replaced with the new PCI (2009-14) once
it is finalized.
The Programme’s total allocation for FY 2008-09 exceeded last year’s allocations by
Rs. 45 million. The Programme gets its funding from the federal government. In fact,
the demand based allocations within the province are available on the actual advice
from the federal government. The payments are made quarterly which actually is a
drag on Programme’s efficiency and performance.
Availability of sex disaggregated data remains a challenging task in Population Welfare

Department. In fact, Population Welfare Department is engaged in activities that focus
both male and female. The Programme doesn’t provide information on gender
disaggregated allocation and utilization of different methods of contraception. Lack
of data on allocation and utilization of funds is another constraint on performance
evaluation and future planning in the sector. Therefore, performance indicators are
seldom revised or rationalized. The Programme repeats its targets every year as
specified in PC I (2003-08) with little consideration for reduction or increase in budgetary
allocation. This is very much clear from the fact that although last year’s budget
exceeds the current year’s budget, the targets remained unchanged. It is rare and
hard to find any inter vention that specifically targets the youth.
Although the current budget exceeds the last year’s budget yet there is glaring
reduction in budgetary allocation for Reproductive Health Services (RHS), Male
Mobilizers, Mobile Service Units (MSU), Information, Education and Communication
(IEC), and Family Welfare Centers (FWC). Preparation of new PCI is in the pipeline with
highly ambitious funding of more than Rs. 20 billion. This would be a very welcome
allocation of resources for interventions that specifically target the gender concerns.
However, the department also needs to strengthen its administrative capacity to
ensure effective and proper utilization of available resources.

1. Name of Programme: Population Welfare Programme
2. Name of Intervention: Reproductive Health Services (RHS)
Pakistan has one of the lowest records in female health and education and lags behind most developing countries
in the reproductive health risk index. Its fertility rate of 4.1 and population growth rate of 1.9 is considerably higher
than other Asian countries including Bangladesh, India and Sri Lanka. Almost one half of women are anemic
throughout their pregnancies. Maternal mortality is estimated at 276 per 100,000 live births and Infant Mortality
48
Rate (IMR) at 77 per 1000 live births . Women’s disproportionate poverty, low social status and reproductive role
expose them to high health risks, resulting in needless suffering, many preventable deaths and disabilities. This
unfortunate situation can no longer be ignored.
• Provide Service according to the reproductive health packages

• Provide trainings to medical staff (doctors and paramedics) and non-technical personnel
through RHS ‘A’ Centers.
• Meet unmet RH needs through construction of more RHS ‘A’ Centers.
• Establish vasectomy units in selected RHS ‘A’ Centers.
• Offer RH services through trained private practitioners (RHS ‘B’ Centers).
49
FY 2007-08: Rs. 314.463 million

FY 2008-09: Rs. 173.424 million
6. Inputs:

Targets Actual Targets50
Number of ‘A’ RHA 130 118 12

Number of new ‘A’ RHA 22 10 12
Number of vasectomy units 3 0 3
51
Number of Women Medical Officers 129 64 65
Number of RHS ‘B’ centers provided
with institutional reimbursement 56 54 2
costs Rs. 700 each
48 PLSM Survey (2006-07)

49 Provided by DG Population Welfare Department, Government of the Punjab
50 Since the current PCI has lived out its life and the new PC I is still in the pipeline, there are no specific targets. The department is in the process of revising its targets. The
current targets will be replaced with the revised targets once the new PCI is in place.
51 Unavailability of doctors

7. Outputs:

Number of contraceptives surgeries male / 100,100 71,750 100,100

female (through RHS ‘A’ Centers)
Number of condoms distributed (through 1,679,400 596,956 1,679,400

RHS ‘A’ Centers)
Number of IUD/oral pills/injection given to 16,000 31,942 16,000

female (through RHS ‘A’ Centers)
Number of training beneficiaries at ‘A’ RHS 200 199 Programme Doctors 200 Programme Doctors
Centers Programme Doctors 70 Non-Programme 250 Non-Programme
250 Non-Programme Doctors Doctors
Doctors
Number of users of ‘A’ RHS Center 150,211 120,073 150,211
Number of contraceptive surgeries at RHS ‘B’ 20,900 36,147 20,900

centers
Number of condoms distributed at RHS ‘B’ 805,300 4,868 805,300

Centers
Number of IUD/oral pills/injection given to 69,000 945 7,400

female (through RHS ‘B’ Centers)
Number of users of ‘B’ RHS Center (male / 44,919 3,019 69,000

female )
Allocation for the financial year 2008-09 shows a decrease of nearly 45 percent over the previous year’s allocation.
Given the significance of Reproductive Health Services (RHS), this phenomenal decrease will be a fatal blow to the
efforts of the State to reverse the fertility rate, increase CYP and enhance contraception use for economic and social
prosperity.
RHS Centers are hospital based service delivery units. They offer full range of family planning and RH services
including contraceptive surgery for both female and male, mother and child health (MCH) care, prevention and
management of RTIs / STDs and HIV/AIDS, counseling and referral services and also education for early detection
of breast and uterus cancer. These services if delivered and utilized properly can effectively contribute to population
stabilization through reduced fertility. Available data show that while Punjab performed better than Sind with an
increase of 12.5 percent in couple years of protection (CYP), it trailed behind NWFP led the race 13 percent increase
in CYP over the previous year.

RHS Centers are categorized as ‘A’ Centers which locate at the public hospitals and B Centers which locate at the
private hospitals of NGOs etc. Catering to the growing needs for family planning and reproductive health services
remains a daunting challenge for Pakistan public health sector. This emphasizes the need to tap into the potential
of private sector that caters to more than 70 percent of the health needs of the people. However, data show that
‘B’ RHS Centers though greater in number remained underutilized during 2007-08.
Indeed, against given targets; RHS B Centers could undertake 12.77 percent of the IUD and multi-load case, 0.60
percent contraception through condoms and 3.23 percent through oral pills. Interestingly RHS B Centers performed
greatly and even better than the RHS ‘A’ Centers under contraceptive surgeries. This could be due to better financial
reward / incentive / charges for contraceptive surgery. Population Welfare Department needs to innovate to ensure
effective participation of private sector in provision of FP and RHS. Non-state service providers need to partner with
resource constrained public sector for better health care services.
Social Marketing of contraceptive also performed poorly with 9.9 percent decrease in CYP over the previous year
showing the ineffectiveness of communication services. Experience of public private sector partnerships also
exhibited a decline of about 15.5 percent in CYP over the last year. Their performance remained significantly modest
against targeted contraception.
There are measured differences in fertility rates among rural versus urban dwellers. Data show that about 78 percent
of the poor of Pakistan live in the rural areas. However; most RHS Centers exist at the DHQ and teaching hospitals
and only a few are located at the THQ level. While this limits the accessibility of rural poor to modern contraception
methods; it adds to the sufferings of poor rural women. Perhaps relocation of RHS Centers at Rural Health Centers
will effectively help realize the unmet needs of rural population for FP and RH care.

2. Name of Intervention: Mobile Service Units
A large share of Pakistani women continue to have an unmet need for family planning; that is, they want to either
wait for their next child or not have any more children but are not using a method of contraception due largely
to the unavailability of family planning services. Unmet need (above 35 percent) is highest among the poor, those
living in rural areas, and women with no education. This emphasizes an urgent need for enhanced accessibility and
availability of comprehensive reproductive health and family planning services at the doorsteps of households.
• Provision of RH services at doorsteps through RHS ‘A’ Women Medical Officers (WMO)
and Family Welfare Counselors (FWC)
• Provision of specially designed vehicles for MSUs
• Advocacy and sensitization material to increase community awareness of reproductive
health services
52
FY 2007-08: Rs. 124.05 million

FY 2008-09: Rs. 68.628 million
6. Inputs:
53
Number of mobile service units 117 117 0
54
Number of MSU Camps 16,848 11836 16,848
Number of purpose built vehicles 117 117 0
7. Outputs:
Number of MSUs beneficiaries 198,907 96,146 198,907
Number of condoms 6,278,900 874,090 6,278,900

distributed at MSUs
Number of IUD 64,400 69,214 64,400
Oral Pills etc. 237,100 65,613 237,100
53
Current PCI has been extended for one year (2009). New PCI (2009-2014) is still in the pipeline. In the current year only left over targets are being pursued.
54 12 MSU camps at each MSU per annum

Given the population growth trend in Pakistan nearly 45 percent decrease in budgetary allocation for the current
financial year (2008-09) sounds too alarming. Mobile Service Units (MSUs) offer FP and RH care at the household
doorsteps mostly to the rural and poor women. Any decrease in the budgetary allocation to this component will
negatively impact the measures targeting reduction in fertility and stabilization of population.
Below target and small number of users of MSUs shows underutilization of 117 MSUs. Although MSUs successfully
accomplished milestone under IUD contraception method, yet targets for use of condoms, and oral pills remained
unachieved. MSUs also missed CYP targets with only 78 percent achievement rate. While this points to ambitious
nature of targets; it shows failure of communication and advocacy efforts of the Programme. The poor and other
hard-to reach groups (especially those living in remote areas) are vulnerable and underserved populations with
regard to family planning and reproductive health information and services. Many of these hard-to-reach populations
55
exhibit higher total fertility rates compared to the national averages. There is a need to focus on reaching these
populations using culturally and linguistically- appropriate messages, and appropriate media channels . Strategic
deployment of MSUs aided by effective communication strategy can yield desired results of social and economic
sustainability.
55
National Institute of Population Studies NIPS (2000)

2. Name of Intervention: Male Mobilizers
For too long, women have been excluded from political, community, and family decision-making in Pakistan. In
our society; male domination has been perpetuated through customs, traditions, and sometimes by false interpretation
of ‘religious’ teachings. Indeed, gender is one of the organizing principles of Pakistani society. Embedded in local
traditions and culture patriarchal values predetermine the social value of gender. Lack of skills, limited opportunities
in the job market, and social and cultural restrictions limit women’s chances to compete for resources in the public
arena. This situation has led to the social and economic dependency of women that becomes the basis for male
power over women in all social relationships. Men are considered agent of change. Hence unless men are convinced
and become involved; family planning efforts cannot yield desired results. Indeed, better and sustainable family
planning solutions need equal participation from male family members. Therefore, male family members need to
be sensitized on modern family planning practices. This will not only stabilize population mix but would also allow
women play an effective and productive role in family and economic decision making for the household.
• Hiring of male Mobilizers

• Planning a range of community services to be undertaken by male mobilizes such as
chalking and visiting community members
• Provision of contraceptives to male mobilizes
56
FY 2007-08: Rs. 142.983 million

FY 2008-09: Rs. 107.399 million
6. Inputs:

Number of male Mobilizers
57
trained and paid 3300 2148 1152
56
Provided by DG Population Welfare Department, Government of the Punjab
57 Recruitment stopped till finalization of third party evaluation

7. Outputs:
Number of condoms distributed 1,810,000 12,641,621 1,810,000
by the male Mobilizers
Number of oral pills distributed 68,300 461,904 68,300

by the male Mobilizers
Beneficiaries 23,354 162,397 23,354
Indeed, involvement of males is central to effective family planning and reproductive health care for responsible
parenthood and reduction in fertility. Male Mobilizers play a very significant role in mobilizing and outreaching
particularly the male segment of our society. Its effectiveness is very much evident from its CYP achievement rate
of 701.74 percent. Performance of male Mobilizers has been outstanding on all accounts. In fact, male Mobilizers
accomplished achievement rate of about 698 percent and 676 percent for contraception through condoms and
oral pills respectively. Male Mobilizers provided services to about 162,397 users. This represents a seven times
increase over the targeted number of 23,345 users.
With bulk of the decision making power with the male family members, male Mobilizers are a very apt intervention
for affording family planning and reproductive health care. Any decrease in budgetary allocation to this intervention
would prove fatal for the attainment of the goal of reduced population growth rate and better delivery of economic
and social services. A reduction of about Rs. 35 million for FY 2008-09 needs revision and subsequent enhancement.
Recruitment of male Mobilizers is constrained due to delay in finalization of third party valuation. Addition of 1152
to the existing pool of male Mobilizers would complement government’s efforts for ensuring greater access and
outreach of family planning and reproductive services to maximum number of people.

2. Name of Intervention: Information, Education and Communication (IEC)
Appropriate and effective communication is central to the success of population stabilization in Pakistan. Lack of
awareness and knowledge about reproductive health practices and services negatively impact women’s health. Little
awareness about the benefits of small family size and modern contraceptives are other major constraints on family
planning and reproductive healthcare in Pakistan for the attainment of a balance between population & resources
in line with the national population policy and development goals.
Population welfare department is pursuing a comprehensive plan of action to serve as a roadmap for increasing
knowledge, improving attitudes, and changing behaviors with regard to family planning and reproductive health.
Main activities include the following.
• Radio programmes for raising awareness of RHS

• Television programmes / advertisements on RH
• Dissemination of material on RH
• Interpersonal communication
58
FY 2007-08: Rs. 24.295 million
FY 2008-09: Rs. 3.00 million
6. Inputs:

Number of film shows 2040 1333 2040
Baby shows to inculcate sense of 150 290 150

responsible motherhood
Seminars, workshops, group meetings 500 1,215 500

with Hakeem, homeopaths, RMPs
(101), ulema /khateeb (386), nazims/
councilors and local key persons (!68)
Family Welfare Center Committees 18000 10223 18000

Meetings
Establishment of Punjab population 1 1 0

information center
58
59
Targets for 2008-09 are repeated or not specified as the new PCI is still in the pipeline. As the new PCI is finalized, the targets will be revised accordingly.

Free medical camps 100 41 100
Sukhi Ghar Mehfils 1300 1000 1300
Establishment of district 35 34 1
population information centers
Visibility enhancement measures 31 hoarding at 31 district / 31 hoarding at 31 district Not specified

(advertisement on buses and railway station of Punjab /326 Boards
billboards
TV commercials 12 episodes play 300 12 episodes play 254 12 episodes play

commercials Commercials 300 commercials
Radio programmes 94 program 61 Programmes 94 program

470 Commercials 470 Commercials
Press releases 20 112 20
7. Outputs:

Film show beneficiaries 200,000 264,580 200,000
Participants at the seminars 25,000 Male: 12,390

Female: 4039 25,000
Number of participants in family welfare 90,000 66916

center committees meetings F=35506
M=31410 90,000
Participants of training and awareness 10,000 Male Ulema: 9,180

raising events Female Ulema: 2,090 10,000
Participants of celebration of special days, 295,000 Male: 216,244

other activities (mehfal –e- melad Female: 116,546 295,000
speeches etc.) Baby shows to inculcate
sense of responsible motherhood Fairs/
exhibitions / variety shows, Walks

Achieving universal access to reproductive health requires efforts to improve motivation and communication,
support new family size norms and provide women with information on the advantages of child-spacing and
improve the availability of quality services. Such measures should be promoted within the religious, social and
cultural norms of the country and taking into account those population groups that are at particular risk, including
60
adolescent girls and those living in remote rural and tribal areas . With about 88 percent decrease in budgetary
allocation for 2008-09 over the previous budget is not going to achieve this goal.
Most of the input and output targets have been achieved. However, targets of radio programmes and number of
participants at the seminars couldn’t be achieved. Moreover, against a target of 18000, only 10223 family welfare
meetings could be conducted showing only 43 percent achievement rate.
Output performance indicators clearly show the gender gap in participants of the awareness raising events. Under
output indicator ‘training and awareness raising’; against 2090 female participants, there are 9180 male participants.
Similarly against 116,546 female participants, there are 216,244 male participants who took part in various special
days’ celebrations. This shows that IEC efforts need to be further intensified to enhance women’s involvement in
events to raise awareness on family planning and reproductive health issues.
60
MDGR (2006)

1. Name of the Programme: Population Welfare Programme
2. Name of the Intervention: Family Welfare Centers
Needless to say responsible parenthood remains central to national development. Population stabilization is the
key to the attainment of goals and objectives of poverty reduction and economic prosperity. Unabated growth of
population has reversed the gains of development in Pakistan. Therefore, the context for providing family planning
in Pakistan is challenging. Pakistan has been among the vanguard countries in Asia in starting family planning
programmes more than five decades ago; however, fertility has declined more slowly in Pakistan than in most other
Asian countries. Despite over 95 percent level of awareness of family planning, results from the 2006-07 Demographic
and Health Survey (DHS) report that only 22 percent of married women use a modern contraceptive method and
another 8 percent use less effective traditional methods.
• Provide reproductive and family planning services

• Provide referral for contraceptives complications and / or surgeries
• Establish special Intra – Uterine Device (IUD) Camps in catchment areas
61
FY 2007-08: Rs. 802. 779 million

FY 2008-09: Rs. 785.462 million
6. Inputs:

Number of Family Welfare 1,500 1500 Targets not specified
Centers
510 510 Targets not specified
Number of new Family
Welfare Centers 1413 1042 371
Number of Family Welfare

Workers / Counselors 18000 10223 18000
Family Welfare Center

Committees Meetings
61

7. Outputs:

Number of condoms distributed at 21,832,800 17,194,836 21,832,800

the family welfare centers
Number of IUD 213,700 510,345 213,700
Number of FWC Users 672,931 845,911 672,931
Number of participants in family 90,000 66916

welfare centers committees F=35506 90,000
meetings M=31410
Number of Oral Pills distributed 824,500 793,819 824,500

Couple Years of Protection (CYP) 1132013 2061092 1132013
Current financial year (2008-09) experiences a decrease of Rs. 17 million over the previous financial year’s allocation.
The programme shows huge success both in terms of input and output indicators’ performance.
In fact, FWCs registered 239 percent achievement rate under IUD contraceptive method. Similarly against condom
and oral pills distribution targets, FWCs recorded 79 and 96 percent achievement rate. Success and effectiveness
of FWCs is further evident from the increase in number of users of FWCs. At 125 percent rate of achievement, the
number of users crossed the target of 672,931 to 845,911. Its CYP achievement rate of 182 percent is also outstanding.
However, FWCs fell short of target of FWCs Committees meetings by 7777 meetings and recorded only 43 percent
achievement rate.FWC Committee has very interesting composition. Committee consists of the following members;
lady councilor, girls’ school teacher, satisfied clients, TBA, religious leaders, LHS, NGO/CBOs Representative and in-
charge FWC (Secretary). Main functions of the Committee include facilitation of day to day functions of the centre,
promote RH programme, selection of under-served areas, and dissemination of IEC material etc. if we look at the
composition and functions of the Committee, we can understand the significance of FWC Committee. Failing on
this account should be taken very seriously.
FWCs are working with 371 less (26 percent) family welfare workers / councilor. Family Welfare Workers / Councilor
play an important role in awareness raising and advocacy campaign of the FWCs. Therefore, for effective and desired
results, FWCs needs to be fully staffed.

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Gender Budget Statement (2008-09)

Education, Health, Population Welfare

Government of the Punjab

Copyright © 2011 by United Nations System in Pakistan

Designed & Printed by Identity Design House

Room No. 417, Planning & Development Department,

Abbreviations & Acronyms iii

Health - Gender Budget Statement 3

Education - Gender Budget Statement 23

Population Welfare - Gender Budget Statement 35

Gender Responsive Budgeting (GRB) is an important component of gender reforms framework

Hamed Yaqoob Sheikh

Gender Budget Statement i

ADB Asian Development Bank MO Medical Officer

Gender Budget Statement iii

In health sector, Government assigns highest priority to primary and preventive

Following health sector interventions have been selected to explore gender

• National Maternal Newborn & Child Health (MNCH) Programme (Punjab

Gender Budget Statement v

• Reproductive health services centers

Gender Budget Statement vi

A gender budget statement is a gender-specific accountability document showing

Government of Pakistan is committed to mainstreaming gender and equity objectives

Gender Budget Statement 1

Gender Budget Statement 2

Description Budget Estimates / Revised Estimates / Budget Estimates /

Total 13,694.878 16,320.478 20,024.703

Gender Budget Statement 3

In health sector, finding out an accurate figure of government spending intended

Gender Budget Statement 4

• National Maternal Newborn & Child Health (MNCH) Programme (Punjab

Gender Budget Statement 5

12 PLSM Survey (2006-07)

Gender Budget Statement 6

Input indicators FY 2007-08 FY 2008-09

Procurement of furniture Furniture for 27 CMW Provision of vehicles for

Strengthening District Procurement of IT 61 computers for district Provision of furniture and

Awareness and advocacy Utilize Rs. 4 million utilized Utilize

Gender Budget Statement 7

Output indicators FY 2007-08 FY 2008-09

Training and workshops 8 Workshops 8 Workshops IMNCI (17)

Training / recruitment of 1000 1000 1000

Gender Budget Statement 8

Gender Budget Statement 9

15 PLSM Survey 2006-07

Gender Budget Statement 10

Input indicators FY 2007-08 FY 2008-09

Operationalization of Programme’s Establishment of PMU, Establishment of PMU, 12 Strengthening of

Establishment of benchmarks in one 290 BHUs Not started 290 BHUs

Establishment of referral system Establishment of Referral system Establishment of referral

Gender Budget Statement 11

Output indicators FY 2007-08 FY 2008-09

Gender Budget Statement 12

Gender Budget Statement 13

2. Name of the Intervention: The Lady Health Workers Programme

• Recruitment of additional lady health workers (LHWs)

FY 2007-08: Rs. 1.913 billion

Provision of training Rs. 16 million Rs. 16 millions Rs.19 million

Cost of contraceptive 218 million 233 million 255 million

Recruitment of LHW 52381 46582 57381

Recruitment of lady health 2096 1644 2096

Computerization of HR 100 percent 90 percent 100 percent