Aftab Ahmed Awan, Pakistan
Afghanistan is a country ravaged by decades of war,
internal conflict and strife. It is only in the last few years that a
democratically elected government has been able to bring some semblance of
stability in the different part of the country, though the situation still
remains highly volatile. The country is
getting a lot of support from international community for the rebuilding of the
infrastructure and systems which have been almost wiped out by continuous war
like situation.
Though Afghanistan is going through a phase of
rebuilding and restructuring, yet she still faces huge challenges in providing
essential services to its citizens. These difficulties are caused by factors
such as geographical remoteness, civil instability, the over-centralization of
government, a lack of infrastructure such as transportation systems, and a lack
of government resources, among others[1].
All the above mentioned problems have severely
hampered the development process which almost stood still form many years in
the past and started afresh only recently. The effects are manifest in the
population statistics which are a real cause of concern for the development
planners in Afghanistan. Using estimates derived from a number of recent
surveys, the UN estimates the current Total Fertility Rate (TFR) at 6.6
children per woman and the U.S. Census Bureau estimates 5.7. Not only do these
TFRs, as high as they are, represent quite a decline from the past, but the onset
of decline has been quite recent. The real question now is: what about
the country's demographic future? The UN has quantified the effect of
such high TFRs in its constant-fertility projection. If the TFR remains at
6.6, by 2050 the country's population would reach 111 million and be
growing at 3.6 percent per year, a rate that would double a population in 19
years[2].
Keeping in view the scarce resources and not so good
economic condition, the Afghan government needs to strengthen the family
planning and population planning programs in the country in order to check the
alarming trends in population increase. However this a challenge as there are
many obstacles in way of population planning programs because of typical
socio-cultural and traditional tribal set up in Afghanistan. These challenges
can only be overcome by bringing together all stakeholders on single platform.
Afghanistan can learn a lot from the other Muslims
countries of Asia like Iran, Indonesia and Malaysia who have highly successful
FP programs and have succeeded in overcoming the challenges caused by
traditional and conservative interpretation of religion. In all these countries
governments initiated dialogues with
religious scholars and convince them to look for reinterpretation of religion
in the light of the changing requirements of modern times. Regular interaction
of Afghan religious scholars with religious scholars of the above mentioned
countries can be a right step in this direction. This interaction can be very
helpful Afghan religious scholars and would help in overcoming the resistance
which is mostly caused by narrow and traditional interpretation.
NGOs are also an important stakeholder and can play
a very important role increasing effectiveness and efficiency of the family
planning programs in the country due to their unique advantages. In all South
Asian countries and similarly in neighboring countries of Pakistan, Bangladesh,
Nepal and India, NGOs have emerged as alternate providers of public services,
particularly within poor and rural communities.
Many lessons can be learnt from the neighboring
country of Pakistan, which has successfully involved NGOs in the family
programs to enhance the reach, quality and effectiveness of the service
delivery. Pakistan is also similar to Afghanistan in many respects as both
countries share similar socio-cultural background, traditions and the recent
history of conflict. Though Pakistan has an area slightly bigger that
Afghanistan and contains a population nearly six times the size Afghan population
yet the challenges faced by both the countries are very similar. Many
Pakistanis do not have access to government services, due different factors
including geographical remoteness, lack of resources, lack of capacity in
public sector and an ongoing conflict situation in northern areas of Pakistan.
So the role of NGOs has increased manifold which have stepped up to fill the
gap. NGOs have emerged as alternate providers of public services, particularly
within poor, rural and hard to reach communities. The role of NGOs in provision
of family planning services is even more prominent as NGOs have been involved
in the family planning program since the beginning.
In Pakistan the early programs on family planning
were started in late 1950s and early 60s. Provision of family planning services
was started through setting up of FPAP which today in one of the largest
organizations working in the sector of family planning[3].
NGOs have played a pioneering role in establishing family planning in all
countries of South Asia and in setting the reproductive health agenda. NGOs
have provided important clinical services, including contraceptive surgery.
Apart from service delivery, there has been a considerable role for NGOs and
CBOs in advocacy, BCC and community mobilization, where they have advantages. They
have also been used as agents of information and advocacy to support the
national program. Some other roles of
NGOs also include: ensuring quality of services being delivered, community
mobilization, social Marketing and facilitators of Family planning education,
training and linkages development.
NGOs and civil society organizations have many
advantages over the public and private sector which can contribute in enhancing
effectiveness, efficiency and reach of the FP program. The foremost advantage
which the NGOs and CSOs enjoy is their capacity to work at the grassroots level
at very low costs. Since most of the NGOs have strong community linkages and
presence, therefore they find it much easier to work at the community level and
to overcome barriers and resistance which is often faced by public or private
sector. Moreover, they often operate without a lot of overheads which keeps
their cost very low which is a very important factor in resource constraint
situations.
The slightly informal structure of NGOs gives them a
flexibility which the public sector often lacks and which is of utmost
importance in socially and culturally sensitive programs. They can adopt and
review their program according to the changing ground realities. They do not
have to go through the bureaucratic channels to review and redesign their
program to meet the needs of community. This reduces the time required for
taking necessary decisions and for taking prompt actions when required. Since
most of the NGOs have to report back to donors and government and go through
the rigorous audits conducted by donors and governments, they have to maintain
high levels of transparency and accountability which is another argument for
employing NGOs in FP programs. Of course, there have been studies and
researches which prove that NGOs have proved more effective in implementing FP
program because of higher quality of services, high rates of success, better
outcomes, presence of more female workers and their capacity to scale up when
pilots have proved successful[4].
However this does not mean that there are no
disadvantages or challenges while working with NGO. There are several
challenges which should be considered before going ahead with the decision. It
is a common issue that most CSOs and NGOs have limited resources and
sustainability problems, and do not have the capacity to locally raise funds
for themselves. There exists a certain amount of distrust for NGOs among
stakeholders due to the religious and cultural norms and they are often seen as
working on foreign agenda which leads to unfavorable working environment for
NGOs. NGO have also been criticized for their heavy reliance upon donors and
sustainability issues of the projects. NGOs have also suffered in recent times
because of the shifting trends of donor funding and lack of focus on FP. In the
last decade or so the funding for FP program has declined considerably which
has adversely affected the effectiveness or FP program and has resulted in
stagnant indicators like unmet need and CPR.
Despite the above mentioned disadvantages and
drawbacks, NGO remain the most important stakeholders in FP and population
planning programs. No FP program can succeed without active and meaningful
participation and support of NGOs in Afghanistan or for that matter anywhere else.
This fact has been proven time and again through many studies. Learning from
the experience of Paksitan with similar challenges and factors can be very
helpful for the success of FP program in Afghanistan. This can be done through
exchange visits, brining technical expertise from region or through involving
NGOs from other countries of the region for capacity building of NGOs and civil
society organizations in Afghanistan.
[1] (Evaluating NGO Service Delivery in South Asia: Lessons for
Afghanistan: Laura Antuono, Chris Meeks Melissa Kay Miller, Jean Rene Watchou,
Robert M. La Follette School of Public Affairs University of Wisconsin-Madison,
2006)
[4] Evaluating NGO Service Delivery in South Asia: Lessons for
Afghanistan; Laura Antuono, Chris Meeks, Melissa Kay Miller, Jean Rene Watchou,
Prepared for Workshop in Public Affairs, International Issues Public Affairs,
2006
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