Government of Pakistan Finance Department Gender Responsive Budgeting Initiative Gender Budget Statement (Federal) 2006-2007 Education – Health – Population Welfare INTRODUCTION One of the priority tools for Gender Responsive Budgeting (GRB) is a Gender Budget Statement (GBS). A Gender Budget Statement is a summary document published by a Finance Division/Department, but that is actually produced by concerned line ministries, as it is about THEIR spending. Finance only acts as the overall organiser and publisher. The GBS shows what the programs and budgets of these line ministries are doing in respect of promoting gender equality. It can also be seen as an accountability mechanism in which government reports on its work to advance the cause of gender equality. A pilot provincial GBS was developed by the Finance Department, Government of Punjab in 2006, which covered four to six programs each for the sectors of Education, Health and Population Welfare. In 2007, a Federal GBS was planned with inputs from the three concerned Ministries. In this respect, a one-day training workshop was organized by the project on 19th April 2007 to orientate the relevant officials of the three focal ministries on the concept and methods to prepare a GBS. External assistance was subsequently required for government officials in finalizing the GBS. Based on the above process, it was agreed by participants, that a Gender Budget Statement for the Federal Level would be prepared after departments had completed the process of drawing up the budget and allocating resources to different programmes in response to the annual budget call circular. The sub-programmes were chosen on the basis of their relevant importance vis-à-vis gender equality and/or on the basis of sizeable resource allocations. A Note on Selection of Financial Year A Gender Budget Statement exercise is ultimately intended to be a regular annual report published on budget day. Therefore, it is meant to focus on the current year at hand and the coming year. A serious shortcoming of this exercise and subsequent published document, was that data available at the Federal level was sporadic and scattered, since the primary data bank was at the provincial level. The Federal level was simply the provider of funds and not responsible for collecting or maintaining monitoring data. Many projects actually had to calculate and consolidate data for this exercise manually through periodic reports received from their various provincial offices. Therefore, for them this was a tedious task. Data for 2005-2006 was already available to them since it was a year earlier. However, data for 2006-2007 (ending June 2007) was still not available to them at the time of compilation for this GBS (August to November 2007), since it had not yet filtered up to them from their provincial offices. Therefore, a decision was made to compile this Gender Budget Statement for 2005-2006 as the “current” year and 2006-2007 as the “future” year. One of the important aims of this exercise is to encourage better and more timely data collection and reporting. Therefore, for the future, a Gender Budget Statement MUST be developed for the current year at hand, with targets estimated for the next financial year. If information is not yet readily available then one can give what *is* available. If one
does the GBS ‘on time’ (i.e. for tabling on budget day) one cannot have the full year’s performance for the current budget year, as it is not yet finished. In that case, information can be put in for a nine-month period. Or, because of the province-federal gap, for the federal GBS it could be reduced to even a six month period.
Selection of Projects
Projects were selected on the basis of suggestions given by focal persons of all Ministries during a GRBI training workshop in April 2007 on Gender Budget Statements. The outcomes of that workshop were used as a basis for this and relevant projects corresponding to the areas identified by the workshop participants were then suggested by the focal persons met in each Ministry.
Data Collection Methodology Individual project offices within the ministries were contacted to obtain the data required for compiling the Gender Budget Statements. Since this activity is for the Federal level projects, it has been a difficult task to access data, since the actual figures and performance indicators are housed at the provincial level. The Federal Ministries are only the funding agencies for these projects, while the actual implementers are the provinces. Therefore, data coming from provinces is collected monthly rather than yearly, so collating the data is an issue. Primary information on activities and annual budget allocations and some input and output indicators have been gleaned from PC-1s, while in all other cases, inputs and outputs have had to be identified individually and then their targets found for the specific years. Therefore, if GBS is to become standard practice it should contribute to improving the monitoring that should be institutionalized at the federal level, rather than the provincial level. Gender Budget Statement – Education
The following projects were identified for the purpose of compiling a Gender Budget Statement:
• Capacity Building of Teachers training Institutions of MoE and Training of
Elementary School Teachers in FANA, FATA, ICT and AJK
• Presidents Education Sector Reforms – Provision of Missing Facilities
These projects were identified after a series of discussions with the Special Advisor, Education in the Planning and Projects Wing of the MoE. This special Wing of the MoE is responsible for the planning and coordination of all government and donor-funded Education projects, both Federal and Provincial. Since however, education is a provincial subject, there were few projects that were managed and funded at the Federal level. Most other projects were purely managed at the provincial level. Others, such as the two selected, were also fairly newly established and/or had experienced delays in start up.
However, both, especially the ESR – Provision of Missing Facilities project, were extremely relevant to gender concerns. Gender Budget Statement – Health
The following projects were identified for the purpose of compiling a Gender Budget Statement:
• The National Programme for Family Planning and Population Welfare – Lady
• Improvement of Nutrition through PHC/Public Health Awareness
• ADB Health Reproductive Health Project
The Health projects were selected with the assistance and guidance of MTBF consultants deputed in the Ministry of Health, since the focal persons identified by GRBI were no longer part of the Ministry. Most of the projects in the MoH were geared towards both men and women, but the projects selected were specifically targeted towards women. The Lady Health Workers Programme was national in its scope, while the Nutrition/PH Awareness programme, although recently completed, specifically targeted mothers in its strategy1. Both these made very relevant cases for the purposes of compiling a Gender Budget Statement. The ADB Reproductive Health Project was one that had been suggested by participants of the April 2007 Gender Budget Statement training conducted by GRBI. Gender Budget Statement – Population Welfare
The following projects were identified for the purpose of compiling a Gender Budget Statement:
• Communication Strategy (Population Welfare Programme)
• Non-Clinical Training (Population Welfare Programme)
• Clinical Training (Population Welfare Programme) • Population Welfare Services, Islamabad Capital Territory (Population Welfare
These projects were all components of the overall Population Welfare Programme, Approved PC-1 Federal Activity 2003-2008. These specific components were selected with the help of the Director, Financial and Technical, MoPW, who was also the focal person for GRBI and who had also attended Gender Budget Statement workshop. Since all projects in this Ministry are targeted towards either women, couples and/or families, the selection amounted to those components which had been identified by participants of the April 2007 training, i.e awareness-raising, service delivery and capacity building.
1 A GBS is ideally NOT supposed to cover projects that have been completed, rather one that has a budget for the coming year. However, since this was a project that had been pointed out by the Ministry of Health focal persons at the April 2007 workshop, it was included for the purposes of this task. GENDER BUDGET STATEMENT – EDUCATION 1. Programme Presidents Education Sector Reform Programme 2. Sub-Programme Provision of Missing Facilities 3. Gender Issues
The majority of public schools in the country lack physical facilities such as drinking water, electricity, furniture, latrines and in some cases, even buildings. While this is the case for both girls and boys schools, girls suffer more especially due to lack of latrines, as they unlike boys, have nowhere to go. This applies to female school teachers as well. The lack of boundary walls also impact on girls, especially in conservative areas. Therefore, providing such physical facilities is one of the most vital inputs in improving access for girls. 4. Planned Activities
• Construction of additional classrooms
• Provision of clean drinking water and electricity, where available
• Boundary walls for girls schools only • One computer lab for every girls middle school
5. Budgetary Allocations
FY 2005-2006:
6. Inputs Required Inputs FY 2006-20072 Targets Provision of 6 basic FY 2007-2008 facilities in 1200 schools (Quantity) (June 07)
Toilets 1909 where missing facilities are
2 The project actually began implementation in 2006, therefore, in this particular Gender Budget Statement, figures are available for 2006-2007 and onward targets for 2007-2008.
7. Outputs
FY 2006-20073 Targets FY 2007-2008 (Quantity) (June 07)
execution in 13 districts Fast track school
8. Overall Assessment The project plans to cover 16,000 schools all over the country over a 5 year period. Since the project has only begun in 2006 (although allocations had been made in 2005), it is still too early to estimate its impact. However, out of a target of 1200 schools for the first year, approximately 80% have been covered. Specific targets such as computer labs, construction of toilets and classrooms etc. have been met by 100% completion rate.
* all information received from Project Office Islamabad, unless stated otherwise 1.Programme: N/A 2. Sub-Programme: Capacity Building of Teachers Training Institutions of MoE and Training of Elementary School Teachers in ICT, FATA, FANA and AJ&K 3. Gender Issues
Teacher training is a mandatory element for quality education service delivery. There are several existing institutions around the country that are meant for teacher training, both men and women. However, they face an acute shortage of physical facilities, materials and training staff which automatically discourages more women than men, as it provides a hostile and unfavourable environment for omen to work in. If given the appropriate financial and technical staff, these institutions can help create a trained cadre of men and women who will be able to further train school teachers and increase the standard of education service delivery for boys and girls. 4. Planned Activities
• In-service training of teachers and Head-teachers (male and female) of selected
• Scholarships to B.Ed students (male and female) and Diploma in Education
• Support of civil works at NISTE and FCE
5. Budgetary Allocations
FY 2005-2006 FY 2006-2007 (Quantity) (June 06)
4207 teachers and head-teachers (male and female)
700 scholarships to be awarded to men and women (100 B.Ed and 50 Diploma scholarships in each area government; 100+100 in ICT)
8. Overall Assessment
It is too early to assess this project as it has only become operational at the Federal level this year. This was due to a late release of funds, however, the provinces/area governments began implementation a year earlier. The average number of male elementary school teachers in the project areas versus female elementary teachers is 19,273 male teachers to 13,886 female teachers. These are also traditionally conservative areas therefore a greater emphasis can be placed on female teachers and deserving students to equalize this ratio.
* all figures obtained from Project Office Islamabad, unless stated otherwise Gender Budget Statement – Population Welfare
1. Programme
Population Welfare Programme 2. Sub-Programme
Communication Strategy 3. Gender Issue
The first step towards an understanding of any issue, comes from having the knowledge and awareness of the issue itself. Most programmes tend to ignore the fact that communication is a vital tool in being able to successfully impart any level of activity. In the case of population welfare, it is first important that both men and women know the benefits of these activities, before they can actually begin to accept it as a common practice. Women in particular, are virtually ignored when it comes to targeted communication regarding family planning and health services. Indeed, even those who are meant to impart such knowledge i.e family welfare workers or population personnel, are often unaware of the benefits and methods of population welfare practices. Therefore it is vital that communication techniques be incorporated into population welfare activities and be targeted towards both men and women. 4. Planned Activities
• Advertisement and publicity through TV /radio spots, press and print material
• Research and surveys (public opinion polls)
• Conducting awareness-raising seminars and conferences on vital population based
• Foreign study tours for cross-country experience sharing
5. Budgetary Allocations5
Outputs Inputs FY 2005-20069 Targets10 Target Actual FY 2006-2007
religious scholars 8. Overall Assessment The MoPW’s communication activities have been fairly visible through its TV spots and outdoor publicity campaigns. However a near accurate number of the population covered through these media campaigns is difficult to estimate since most of the activities are conducted nationwide and there is no monitoring mechanism available to record the number of viewers, readers etc.
6 Figures taken from approved Federal PC-1 7 Figures taken from approved Federal PC-1 8 Figures taken from Project Office, Islamabad 9 Figures taken from Population Yearbook 2005-2006 10 Figures taken from Population Yearbook 2006-2007
1. Programme
Population Welfare Programme 2. Sub-Programme
Non-Clinical Training 3. Gender Issue
Population welfare activities cannot be successful without proper capacity building and motivation of staff, since it is their responsibility to create levels of awareness to beneficiaries in addition to delivering services. Since women are the primary target beneficiaries of such activities both directly and indirectly, it is only logical that majority of the staff (mobilizers, welfare workers, LHWs etc) are also women. Training and sensitizing female staff towards population welfare practices and services, is therefore an extremely important precursor to implementing population welfare programmes. 4. Planned Activities
• Human resource development of field functionaries (programme and non-
programme) of population welfare programme at the federal and provincial level.
5. Budgetary Allocations11
FY 2005-2006:
6. Inputs
Required Inputs FY 2005-2006 (Number of Persons Target Actual FY 2006-2007 Trained) (June 06) Programme Personnel Pre-Service training Non-programme Personnel Other 7. Outputs
FY 2005-200612 Targets13 Target Actual FY 2006-2007 Population Welfare Training Institute (PWTI), Lahore Programme Personnel Pre-Service Non-Programme Personnel Other
Population Welfare Training Institute (PWTI) Karachi Programme Personnel Pre-Service Non-Programme Personnel Other departments
8. Overall Assessment Non-clinical training component has been focusing on its targeted activities. Particular focus has been on orienting female religious scholars as well as local government representatives. This is a very important target group for such activities, particularly the latter who has a large target audience base among women and can be very influential in spreading an appropriate message to them. Figures show that numbers far exceed the targets set in terms of the number of participants attending the programs, which indicates the level of interest among various target groups of the issue. * All figures obtained from Directorate of Non-Clinical training, Ministry of Population Welfare, Islamabad
12 Gender dis-aggregated data unavailable 13 Gender dis-aggregated data not available
1. Programme Population Welfare Programme 2. Sub-Programme
Clinical Training 3. Gender Issue
In the same way that human resource development is a vital need for trained personnel, technical or in the case of population welfare, clinical training is also just as important. The use and application of various forms of contraceptives and the pros and cons on reproductive health for men and women, both require medically trained personnel. Women in particular, who form the bulk of population welfare staff, therefore need to be skilled enough to manage these services. 4. Planned Activities
• To develop and impart career development courses for programme personnel such
as Assistant Sister Tutors, FTOs, FWCs and Master Trainers.
• To impart HRD programmes for programme and non-programme staff, including
5. Budgetary Allocations14
FY 2005-2006:
6. Inputs15
Required Inputs FY 2005-2006 Targets16 (No. of Persons Trained) Target17 Actual FY 2006-2007 (June 06)
14 Amounts are as per approved PC-1 15 Gender dis-aggregated data not available 16 PC-1 Federal Activity 2003-2008; pp68-69 17 PC-1 Federal Activity 2003-2008; pp68-69 18 Figures taken from Population Yearbook 2005-2006; p14
7. Outputs19
FY 2005-200620 Targets21 Target Actual FY 2006-2007
FWCs, FTOs, ASTs (3,4,5 months) Pre-service training of
Female FWAs (3 weeks) Refresher Training of
Paramedics (1 and 2 weeks) Orientation of Non-
programme personnel on FP/RH (1-2 days) 8. Overall Assessment The clinical training component has achieved most of its targets set for the duration of the 5 year programme. In fact, in most cases, it has overshot its set targets. Since this is a primarily staff-related component, it is not difficult to complete the numbers. Since the emphasis is on female welfare attendants, majority of those targeted are women themselves.
19 Gender dis-aggregated data not available 20 Information Obtained from Population Yearbook 2005-2006; p14 21 Figures obtained from Ministry of Population Welfare, Islamabad
1. Programme
Population Welfare Programme 2. Sub-Programme
Population Welfare Services, ICT 3. Gender Issue
One of the key service delivery tools of population welfare, is the use and practice of contraceptives among men and women. The provision of contraceptives is not simply a matter of providing contraceptive medication. Rather it is also access to services such as counseling, which can help particularly women in better being able to understand the need for and use of contraceptives. Women already have great difficulties in accepting the fact that they have a right to family planning services and that the use of contraceptive is not harmful to them. Men also play a large role in keeping women ignorant of these practices to further their power relationships in society. It is an added burden then that they also do not have appropriately targeted facilities that can provide them with both the advice and the medication that they need. In fact, many reproductive health services also target men which is essential to create overall awareness among the community as a whole. 4. Planned Activities
• Setting up population service centres within the Islamabad Capital Territory
• Provision of reproductive health facilities
• Provision of contraceptives through FWCs, and Mobile Service Units • Increasing the numbers of current contraceptive users through the recruitment of
5. Budgetary Allocations22
FY 2005-2006:
6. Inputs
Required Inputs FY 2005-2006 Targets23 Target Actual FY 2006-2007 (June 06)
Service “A” Centres 22 Amounts are as per approved PC-1 23 This project no longer uses physical targets to monitor progress. It instead has a list of performance indicators that it uses for monitoring performance.
7. Outputs
Outputs Inputs FY 2005-2006 Targets24 Target Actual FY 2006-2007
8. Overall Assessment The project has managed to achieve a sizeable proportion of its targets since inception in 2003. Although its targets have not been very ambitious in terms of size, the area that it is servicing (Islamabad Capital Territory), is primarily urban and educated, hence there has been a greater level of awareness among users of contraception. The highest form of contraception in this area has been of condom use, followed by oral pills. However the percentage use of injectables is the highest in terms of achievement (132% usage), followed by Copper-T (97% achievement rate). GENDER BUDGET STATEMENT – HEALTH
1. Programme
National Programme for Family Planning and Primary Health Care 2. Sub-Programme
Lady Health Workers Programme 2003-2008 3. Gender Issue Providing primary and basic health facilities to women at their doorstep is the first step to ensure access to curative and preventive healthcare to women, especially those in remote and rural areas. Services at the doorstep are also necessary for many women because of the restrictions on their moving beyond their homes. Many such women lose their lives or suffer from chronic health problems, simply because there are no health facilities available nearby. The Lady Health Worker is therefore, the most essential player in allowing poor women and children, access to equitable healthcare without having to travel to far-flung urban centres. 4. Planned Activities
• Selection, training and deployment of 100,000 LHWs throughout the country
5. Budgetary Allocations25
FY 2005-2006:
6. Inputs
Required Inputs FY 2005-200626 Targets27 FY 2006-2007 Target Actual (June 06)
47,473,388 units 47,473,388 units 27,521,905 units
25 Lady Health Workers Programme, Project office, Islamabad 26 Demand of Drugs/Medicines and Non-Drug Items for National Programme for FP and PHC for the Year 2005-06. 27 Cumulative Requirement of Drugs/Medicines and Non-Drug Items for Year 2006-2007 (NP). National Programme for FP and PHC
7. Outputs28
FY 2005-2006 Target Actual FY 2006-200729 Refresher Trainings – Child Health Trainers 15,250 Refresher Trainings – Counseling Cards Trainers 10,800 Basic Training LHWs 4,890 Refresher Training Revised Manual District Master Trainers
8. Overall Assessment The programme is a major contribution in terms of enabling women to pursue employment opportunities, given the ambitious target of employing 100,000 LHWs and 4,000 Supervisors across the country. Through this cadre, approximately 60% of the total population and 80% of the target population (of women and children) is being covered to date.
28 Figures obtained from Project Office, Islamabad 29 Targets unavailable at time of compilation
1. Programme
ADB/GoP Reproductive Health Project 2. Sub-Programme
Reproductive Health Project 3. Gender Issues Women’s reproductive health is one of the most important component of women’s health issues. Several women are unaware of the provisions available for them to support their reproductive activities, including safe motherhood and contraception. Access to and awareness of these services, is the key element in developing a strong base for reproductive health activities for women, as well as improving the numbers of contraceptive prevalence rate, maternal mortality and infant mortality indicators, among others. 4. Planned Activities
• Recruitment and Training of LHWs to support the National Programme for
Primary Health and PHC – LHW component
5. Budgetary Allocations
This programme is a component of the overall ADB/GoP project and primarily supports the National Programme in 3 major areas; payment of stipends and salaries for LHWs, procurement of vehicles and drugs and non-drug items. In accordance with the LHW- MIS there has been an appreciable improvement in targeted indicators along with capacity building for RH in terms of recruitments and procurements under taken through RHP. The following improvements have been recorded:
• Increase in CPR from 11% in 1994 to 38% in 2007
• Increased awareness in RH target groups (women and children)
• Capacity building of doctors, LHWs and LHSs regarding contraceptives use
However the impact and utilization status were considerably influenced (adversely) by the complexity of involvement of six executing agencies in ADB funded RHP including disparities between PC1s and Loan Agreements. * all information received from RPH Project Office, Islamabad
30 The outputs for this project were primarily aimed at recruitment and training, rather than service delivery. This was the responsibility of the larger National Programme for Family Planning and PHC.
1. Programme: N/A 2. Sub- Programme: Improvement of Nutrition through PHC/Public Health Awareness 3. Gender Issues Most women are aware of their own nutritional needs and those of their children but are unable to provide for them due to lack of financial resources or access to proper nutritional sources. As a result, many women and children suffer from malnutrition that leads to many disorders and also creates problems in reproductive health. Therefore, meeting the nutritional requirements of women ad children in particular is extremely important, as is making them aware of what is required, so that mothers are able to meet these needs within their own households to the best of their abilities. 4. Planned Activities31
• provision of child and maternal health care; promotion of breast feeding;
• prevention of night blindness, iron deficiency anemia, as well as iodine deficiency
disease through media awareness and training and distribution of supplements.
5. Budgetary Allocations
6. Inputs
Required FY 2005-06 FY 2006-07 (Quantity) (June 06)
TV Spots 1074 TV Spots 1247 TV Spots 780
CCTV Spots 40235 CCTV Spots 50345 CCTV spots Radio spots 1340 Radio spots 1450 28000 Cinema 214 Cinema 214 Radio Spots
31 Ministry of Health Yearbook, 2005-2006; p6
Procurement of Iron Procurement of Iron Procurement of Procurement of Micronutrients TB Micronutrients TB Patients Patients
Glit"Vit for TB Patients Glit"Vit for TB Patients
7. Outputs Outputs FY FY 2006-07 (Quantity) (June 06)
participants Trained participants Trained
Research Studies on Research Studies on -
knowledge, attitudes knowledge, attitudes and practices
8. Overall Assessment32 This project has just recently been completed and is in the stages of developing a new PC- 1. The project has seen the following as some of its achievements in its duration:
• The National Plan of action on Micronutrient Control has been launched and
• Iron Wheat Flour Fortification - GAIN Project implementation Unit started in
• PC-1 on Nutrition for the 2006 -2010 prepared and submitted to the Ministry of
• The National TB Control Programme, Ministry of Health required micronutrient
supplementation for the TB patients. Purchase of drugs & medicine for the 40,000 T.B patients (combination two micronutrient i.e. Tab Supradyn and Stress Tab 600 (a combination of B-Complex, Zinc, Vitamin C, Folic Acid) that can delay absorption of over dosage and toxic effects of isoniazid, was procured .
* all information received from Project Office Islamabad, unless stated otherwise
Initial Allergy Questionnaire and History No Antihistamines for 1. Please prepare 3 days before your visit! 72 hours prior to 2. Complete this form before your visit and bring it Your Appointment is on: DATE: _____________________ 3. Skin testing is an important part of most Allergy evaluations. For this to be done, antihistamines will TIME: ____________________
51 (2008) Special Issue, 4-10 Texas A&M University, United States of America GUOYAO WU, FULLER W. BAZER, SUJAY DATTA, HAIJUN GAO, GREGORY A. JOHNSON, ARANTZATZU LASSALA, PENG LI, M. CAREY SATTERFIELD and Intrauterine growth retardation in livestock: Implications, mechanisms solutions Nutztier: Implikationen, Mechanismen und Lösungen) Abstract Intrauterine growth retardation (