Improving Access to Family Planning Services through the Private Sector in Pakistan A Stakeholder Analysis

Abstract

Pakistan’s population has crossed 208 million and is growing at a high rate of 2.4% (1998–2017). The contraceptive prevalence rate (CPR) regressed from 35% to 34% between 2013 and 2018, despite unmet need for family planning (FP) among 17.3% of married women of reproductive age (MWRA) (PDHS 2017–18). According to recent studies, key barriers to uptake of FP include difficulties in reaching public health facilities as well as poor care quality at these facilities, particularly, discouraging attitudes of providers, frequent stock-outs of contraceptives, and inadequate counseling. Private health facilities are often perceived by users to offer better quality of care and are far more physically accessible as they are more numerous than public facilities. However, they are less affordable and a substantial proportion do not offer FP services. There is growing realization among Pakistani policymakers, as in the wider international community, that the capacity of the private sector must also be utilized systematically through formal public–private partnerships (PPPs) to attain FP and other development goals. This analysis of private sector stakeholders was carried out by the Population Council with support from the United Nations Population Fund (UNFPA) to assess their current role in FP service provision, the challenges they face in providing FP services, and their viewpoints about PPP to improve access to FP services, and to identify the broad avenues and modalities for cooperation and implementation of PPPs in FP. The funding for the study was provided by DFID UK. The study included secondary data analysis and a qualitative study of private sector and user perspectives, complemented by literature reviews concerning global experiences of PPPs for FP and models for increasing private participation in FP service provision in Pakistan. The private sector stakeholders who participated in the qualitative study included 156 service providers, 29 pharmacists, 26 wholesalers and distributors, 3 importers, 1 manufacturer, 6 non-governmental organizations (NGOs) and 2 social marketing organizations (SMOs). In-depth interviews (IDIs) were conducted with these stakeholders. In addition, perspectives of consumers were also covered through 47 focus group discussions (FGDs). The FGDs and IDIs were conducted in six districts across four provinces, including Bahawalpur and Faisalabad in Punjab; Thatta and Sukkur in Sindh; Lasbela in Balochistan; and Mansehra in Khyber Pakhtunkhwa (KP).