Comprehensive List of International Commitments of Pakistan in Health
The WHO defines health as ‘‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’’.1 Global health phenomenon calls for improving health for all people in all nations by eliminating avoidable disease, disability, and death. Agreements are made to address different burdens of diseases and issues in health on hand. The impact of different institutions, both domestic and international, on state policy depends crucially on the conditions under which states comply to these commitments and in some cases fulfill their
prior agreements
.


The purpose of the list of the International commitments made by Pakistan since year 2000 is to:
 

  • Improve alignment between global investments and country’s implementation processes
  • for monitoring of progress and performance.
  • To enhance efficiency and streamline investments in various health projects.
  • Improve the quality of results-based monitoring
     

The list was generated after a retrospective review of secondary data and information generated primarily by Pakistan government, multilateral agencies and United Nations organizations. The commitments were then classified as per different domains in perspective of multiple dimensions of health.


WHO is the leading technical partner of the Pakistan government on health issues. The other main development partners in the Health Sector are the Asian Development Bank (ADB), Canadian International Development Agency (CIDA), Government of China, Department For nternational Development-UK (DFID), Economic Cooperation Organization (ECO), European Union (EU), German International Cooperation (GIZ), International Development Agency (IDA), Islamic Development Bank (IDB), International Monetary Fund (IMF), Government of Italy, Japan International Cooperation Agency (JICA), KfW, Governments of Norway, Italy and Spain, Government of Saudi Arabia, South Asian Association for Regional Cooperation (SAARC), Swedish International Development Agency (SIDA), The World Bank (WB), United States Agency for International Development (USAID), and UN agencies and funds such as FAO, IOM, UNDP, UNESCO, UNFPA, UNHCR, UNICEF and WFP. Global Health Institutions such as GAVI and GFATM are also supporting Pakistan.


Generally speaking, public sector investment in the health sector is quite low, with the overwhelming share of health costs continuing to be through the out-of-pocket expenditure by the majority of the people with low average per capita income. Urgent donor support is a clear prerequisite for meeting International commitments, necessitating a substantial up scaling of investment along with result based and end user oriented interventions.


Following are the lists generated to get an overview of Pakistan’s International commitments in Health and their status as of August 2015:
1. Classification of Commitments
2. Loans and fundings.


1. Pakistan’s Multilateral and Bilateral Commitments in Health – Classification

Commitment Objectives/ goals Status
Global Issues
MDGs ? Reducing infant (under-5) mortality
? Reducing maternal mortality;
? Combating HIV/AIDS,
tuberculosis, malaria and other
significant communicable diseases.
The MDGs will not be achieved by
2015. Over the years, Pakistan has
made considerable progress in
reducing its Under-5 mortality and
maternal mortality rates
? The 2005
Bangkok
Charter for
Health
Promotion in a
Globalized
World
Charter identifies major challenges,
actions and commitments needed to
address the determinants of health in a
globalized world by engaging the many
actors and stakeholders critical to
achieving health for all.
? Progress has been made
globally by putting health
central to development e.g
through MDGs..
? Post 2015
Agenda
To collect the lessons learned, to
understand what worked well and
continue on it. And to understand what
did not work and why, so as not to
repeat it. In August 2014 17 sustainable
development goals (SDGs) with
169 associated targets were proposed,
which are supported by the three pillars
of sustainability.
? Prime Minister’s National
Health Insurance Scheme for
poor in the country funded by
federal and provincial
governments jointly taken as a
major step towards universal
health coverage.

? Pakistan is developing a
comprehensive health
information portal and analysis
unit to assist evidence based
decision making.

? National ten point action plan
on MNCH and nutrition
launched the directives of PM of
Pakistan to ensure syngerisation
and improvement in MNCH
targets
? International
Health
Global health security and capacity
building in detecting, assessing and
? GoP has asked for second
extension (to June 2016) to meet


 

regulations -
2005
reporting public health events IHR obligations.
? National Institute of Health has
been designated as the National
Focal Point for IHR and some
of the key activities include
epidemiologists trained,
diseases surveillance and
response units, monitoring,
detection and response to
disease outbreaks
? 2010 Adelaide
Statement on
Health in All
Policies
Emphasizes better health-centered
policy at all levels and across all
departments of government
Paris
Declaration
Set out principles for making aid more
effective. These principles include
ownership, alignment, harmonization,
mutual accountability and managing for
results.
? Pakistan has relatively low
dependence on aid but large
performance and financial gaps
in meeting MDGs. Aid
constitutes approximately 2% of
GDP and 5-6% of government
expenditures.

? World Bank’s CAS FY06-09 is
being aligned closely with the
government’s priorities set in
the PRSP.
Committee on
Elimination of
Racial
Discrimination
? In March 1997 Pakistan
submitted a five years compiled
single report which indicated
that the said party addressed the
recommendations of the
committee, though no
declaration was made for the
article 14 of the convention
Convention on
Child Rights
A human rights treaty which sets out
the civil, political, economic, social,
health and cultural rights of children
signed by 194 countries. Compliance is
monitored by the UN Committee on the
Rights of the Child.
? National Plan of Action
? Code of Ethics for Media on
reporting of issues on children.

? Ordinance for prevention of
control of Human Trafficking

? Protection of Breastfeeding and
Child nutrition Ordinance

? Juvenile Justice System
Ordinance

? Compulsory Primary Education
Act 1995


 

Convention on
the Rights of
Persons with
Disabilities -
2008
? Directorate General of Special
Education, social welfare, Child
Welfare and development is
main focal institution on
disability matters.

? National policy on disability
exists -2002
Convention on
the Elimination
of all Forms of
Discrimination
Against Women
(CEDAW)
The Convention adopted in 1979 by the
UN General Assembly, defines what
constitutes discrimination against
women and sets up an agenda for
national action to end such
discrimination. Commitments made:

? to incorporate the principle of
equality of men and women in their
legal system, abolish all
discriminatory laws and adopt
appropriate ones prohibiting
discrimination against women;

? to establish tribunals and other
public institutions to ensure the
effective protection of women
against discrimination;

? to ensure elimination of all acts of
discrimination against women by
persons, organizations or
enterprises.
? Pakistan ratified CEDAW in
1996, with a declaration making
the compliance subject to its
Constitution and a reservation
under article 29 para 1.

? Pakistan has not adopted any
legal framework for translating
the CEDAW provisions to its
domestic laws.

? The National Commission on
the Status of Women (NCSW)
was established in 2000.

? So far Pakistan has submitted
four reports. In the last report
(2013) it was noted that

? Pakistan has enacted and
revised numerous laws
and legal provisions
aimed at eliminating
discrimination against
women

? Land to the Landless
model allows land titles
to be granted to women
Mother & Child
FP2020 Commitments made at the London
Family Planning Summit in 2012 to
support the right of women and girls to
decide freely and for themselves,
whether, when and how many children
they choose to have. Commitments
specific to Pakistan:

? Universal access to
reproductive health and raising
CPR to 55% in 2020.

? All public and private health
facilities to offer birth spacing
? Re- focusing of Lady Health
Workers programs priority on
the family planning aspect.

? Provinces included
contraception in their Essential
Health Services Package
(EHSP) in 2013.

? The Sukh Initiative launched in
March 2014 will bring family
planning services to one million
low-income inhabitants of
Karachi.


 

services.
? Amount spent on family
planning to be increased to
nearly US $200M in 2012/13
and further in years
? In Khyber Pakhtunkhwa
province, 110 new Family
Welfare Centers are bringing
reproductive health care to rural
villages

? Pakistan is the new Logistics
Modeling Information System
(LMIS),
Food, Drugs & Substance use
? Framework
Convention on
Tobacco
Control -2003
Regulatory strategy to address
addictive substances
? Pakistan recently became the
third country in the world to
have 85% pictorial warnings on
Tobacco packs from June 2015.

? There has been incorporation of
tobacco control messages in the
curriculum and health programs.

? Various Tobacco control laws
are being enforced.
? Rome
Declaration
It pledges political will and common
and national commitment to achieve
food security for all and to an ongoing
effort to eradicate hunger in all
countries with an immediate view to
reducing the number of undernourished
people to half their present level no
later than 2015.
? Government of Pakistan’s
commitment to nutrition is in
line with National Vision 2025
and provincial multi-sectoral
nutrition guidance notes.

? In 2013 in a national
consultative workshop was held
and bottle neck analysis and
action plan were developed.

? Ministry of National health is
working jointly with UN-WFP,
UNICEF and Micronutrient
Initiative for addressing
micronutrient deficiencies in
Pakistan through Wheat Flour
fortification
Agreements Between group of countries
? ECO Promoting economic, technical and
cultural cooperation among the
Member States
? The meeting of Health Ministers
of Economic Cooperation
Organisation was held on the
sidelines of the World Health
Assembly on 19
th May 2015. It
was decided to develop "ECO
Plan of Action on Health
Cooperation" for post 2015
strengthening health


 

cooperation in the ECO Region
in post-2015 era in line with the
emerging global agenda on
health.
? G5 G 5 is a good forum for member
countries to share their experiences, set
up multi sectoral mechanism for
universal health coverage to address
different elements of health system
blocks and look at options how G 5
countries can support each others in
various areas pertaining to health.
? A two years plan for
coordination on communicable
diseases was agreed upon by all
members in a technical side
meeting during 68
Th World
Health Assembly in May 2015.

? Each member state agreed to
allocate an amount for G 5
activities in their next JPRM
cycle of budgeting.
? South Asian
Association for
Regional
Cooperation
(SAARC)
SAARC organization was established
by the governments of Bangladesh,
Bhutan, India, Maldives, Nepal,
Pakistan and Sri Lanka in 1985.
? The 18th SAARC Summit was
held in November 2014.

? The SAARC Regional Strategy
on HIV/AIDS has been
developed.

? The SAARC Goodwill
Ambassadors Program active
since 2009 with the aim of
bringing the issue of HIV and
AIDS to the political and public
forefront.

? Technical Committee on Health
and Population Activities,
reviews the progress of agenda
implementation of the health
ministers’ meetings.

? Resolutions adopted ; Dhaka
Declaration – A Better Health
Profile for South Asia(2005).
Male Resolution on Regional
Health Issues (2012).
? Resolution on
Anti Microbial
Resistance
(AMR) 2014
67th World Health Assembly held in
May 2014 adopted a resolution through
which member states committed to
enhanced cooperation to combat AMR.
? During 68Th World Health
Assembly in 2015 participants
of AMR side meeting signed a
document to affirm their
commitment to working
together as part of the global
alliance of champions for AMR.

? Pakistan has developed a draft
Plan of Action on AMR with
objectives to improve awareness


 

Name of Project                            Loan ID Signing Date Closing Date
Asian Development Bank
1 Health Care Development 1200-PAK 23-03-1993 31-03-2004
2 Women Health Project 1671-PAK(SF) 21-01-2000 31-12-2006
3 Women’s Health Project-OC 1671-PAK-OC 21-01-2000 30-06-2007
4 Reproductive Health Project 1900-PAK(SF) 20-03-2003 30-06-2008
5 Reproductive Health Project OC 1900-PAK-OC 20-03-2003 18-08-2009
Germany
7 Northern Area Health 200465039 02-02-2007 31-03-2015
IDA
8 Family Health 2240-PAK 08-07-1991 28-02-2001
9 Second Family Health 2464-PAK 16-04-1993 30-12-2000
10 Northern Health Program 2883-PAK 18-07-1996 31-12-2001
11 Partnership Polio Eradication 3761(1)-PAK 29-10-2004 30-06-2006
12 HIV/AIDS Prevention Project 3776-PAK 09-10-2003 31-12-2011
13 II Part.Ship Polio Eradication 4145-1-PAK 07-06-2007 30-06-2008
14 Second Partnership For Polio 4145-PAK 17-02-2006 30-06-2008
15 3rd Partnership For Polio Eradication 4616-PAK 03-07-2009 30-06-2014
16 3rd Polio Eradication – Add
Financing
4927-PAK 02-06-2011 30-06-2014
17 3rd Partnership For Polio Eradication 5169-PAK 24-10-2012 30-06-2015
18 Punjab Health Sector Reform
Project
5258-PAK 02-12-2013 31-12-2017
IDB
19 Support Polio Eradication Program PAK-0142 18-02-2013 31-12-2015
Japan
20 Polio Eradication Project

2. Health related Funding and Loans
Health Related Project Loans

Foreign assistance has played a critical role in developing the health sector of Pakistan, with the country historically receiving large volumes in aid. In 2007, Pakistan received more 7 than US$ 2.2 billion in Official Development Assistance (ODA), ranking the country as the sixth largest recipient of official aid in the world.



Health Related Foreign Funding

Health and Nutrition
Funding Source Funding Agency Committed
(USD)
Disbursed
(USD)
Expended
(USD)
Australia AusAID (Australian Agency for International
Development); Australia
39425691 40918059 40740303
Belgium Belgium 9047 9047 9042
Brazil Brazil 50000 50000 37500
Canada Canada; CIDA (Canadian International Development
Agency)
15115220 11110694 1388221
China China 5000000
Denmark Denmark 1278015 1226809 595980
EU (European Union) EU (European Union); ECHO (European Commission's
Humanitarian Aid Office)
8795549 7218455 3348052
Finland Finland 5311935 5311934 311812
France AFD (Agence Francaise de Developpement) 1350621 1223391 0
Germany Germany; GIZ (Gesellschaft for International
Zusammenarbeit); KfW (Kreditanstalt f?r Wiederaufbau)
160046329 53724316 51608016
Hungary Hungary 2465 2465 2449
IDB (Islamic Development Bank) IDB (Islamic Development Bank) 200000 115513 115513
International Private Donors Rotary International; GAVI Alliance (Global Alliance for
Vaccines and Immunization); United Nations
Foundation; International Private Donors; Micronutrient
Initiative; Bill & Melinda Gates Foundation
43679283 44323592 28780128
Italy Italy 3021691 1463099 1417786
Japan Japan; JICA (Japan International Cooperation Agency) 93522785 20023956 17954386
Netherlands Netherlands 619107 512466 512328
Norway Norway 6364709 5398711 2619075
Oman Oman 2500000
OPEC Fund (Organization of Petroleum Exporting
Countries Fund)
OPEC Fund (Organization of the Petroleum Exporting
Countries Fund)
73887 73887 73473
Saudi Arabia Saudi Arabia 2489681 2489681 1842665
Spain Spain 118903 118903 118861


 

Sweden Sweden 1605422 1605422 727152
Switzerland Switzerland 138745 138745 44339
UAE (United Arab Emirates) UAE (United Arab Emirates) 1909906 1909906 622681
UK DFID (UK Department for International Development);
UK (United Kingdom)
167591595 61858432 61115819
UN (United Nations) UNOCHA (United Nations Office for the Coordination of
Humanitarian Affairs); UN (United Nations); UNAIDS
(Joint United Nations Programme on HIV/AIDS); UNFPA
(United Nations Fund for Population Activities); UNICEF
(United Nations Children's Fund); UNODC (United
Nations Office on Drugs and Crime); WHO (World Health
Organization)
26225508 23995922 21097253
UN Globally Mobilized Non-Core Assistance UNICEF National Committees; Thematic Funds of
UNICEF; CERF (Centeral Emergency Response Fund);
Australian Committee for UNICEF; Belgian Committee
for UNICEF; Canadian UNICEF Committee; Norwegian
Committee for UNICEF; Spanish Committee for UNICEF;
United Kingdom Committee for UNICEF; United States
Fund for UNICEF; MDTF (Multi Donor Trust Fund) -
UNDP; UN-EFW (Extended Funding Window); MDGF
(Millennium Development Goals Fund)
38787972 39427210 28951798
USA USA; USAID (United States Agency for International
Development); USA OFDA (Office of U.S. Foreign
Disaster Assistance); USA CDC (Centers for Disease
Control & Prevention); BPRM (Bureau for Population,
Refugees and Migration) USA
259690485 165189475 120809691
WB (World Bank) IDA (International Development Association); Trust
Fund/World Bank; MDTF (Multi Donor Trust Fund) - WB
184835065 31600005


References
1. WHO. Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference,
New York, 19-22 June 1946, and entered into force on 7 April 1948.
2. Country Cooperation Strategy for WHO and Pakistan- 2011–2017Document WHO-EM/PME/001/E/04.13
3. Compliance with International Commitments: Politics Within a Framework of Law; Robert O. Keohane; Vol. 86 (APRIL 1-4,
1992), pp. 176-180