Population programmes in many developing countries have emphasised on family planning services driven largely by numbers and demographic targets. With the advent of the International Conference on Population and Development (ICPD) in 1994, it has been recognised to move beyond a narrow focus on family planning to a more comprehensive concern of reproductive health oriented towards meeting the needs of individuals and families. This advocated shift in population and development strategy, especially in health emphasises that services be offered to women, men and adolescents with a special focus on fulfilling women’s health needs, safeguarding their reproductive rights and involving men as equal partners in meeting the goal of responsible parenthood [United Nations (1995)]. In response to ICPD’s mandate, Pakistan’s population programme has increasingly been focussed on various aspects of reproductive health and is in the process of broadening the scope of services for a transition to reproductive health without losing focus on achieving fertility reduction goal. In this regard, the government has adopted a comprehensive population and development policy incorporating an array of reproductive health services and has integrated population and health departments and their activities in dealing with RH problems. Under the consideration that the revised programme can not simultaneously address all of the RH problems, an integrated National Reproductive Health Services Package has been developed to provide services to eligible women, men and adolescents [Pakistan (1999)]. The major components of RH package include:

Cash transfer programmes are widely considered a ‘magic bullet’ for reducing poverty. Whether they actually have such an incredible impact on poverty reduction is debatable but they surely are gaining credibility as an effective safety net mechanism and consequently an integral part of inclusive growth strategies in many developing countries. As shown by Ali (2007), inclusive growth rests on three basic premises. First, productive employment opportunities should be created to absorb labour force. Second, capability enhancement and skill development should be focused in order to broaden people’s access to economic opportunities. And lastly, a basic level of well-being has to be guaranteed by providing social protection. Safety nets are at the core of the last pillar, provided mainly through cash transfers, which can be both conditional and unconditional.

With the year 2015 fast approaching, Pakistan is not likely to achieve most of the health targets set in the Millennium Development Goals [Pakistan (2010)]. High levels of child and maternal mortality and child malnutrition are among the major health challenges facing the country. Along with this enhanced vulnerability for children and women there is also an economic divide in the society because these health challenges are more profound for the poor segment of the population than for the better off. Another divide is between the rural and urban populations due to concentration of health facilities in urban centres of the country. The high cost of dealing with health issues adversely affects the poor and rural population, lowering their productivity and limiting their lifetime achievements. Without substantially improved health outcomes it is impossible to break out of the cycle of poverty [OECD (2003)].

A woman’s access to health care, in physical, social, and psychological contexts, depends on her health beliefs and her socio-economic and demographic background. As in most developing countries, the health system in Pakistan is a combination of modern and traditional medicine, and the nature of care sought again depends on the individual’s health beliefs and background characteristics. This paper thus not only focuses on whether women seek help or not when sick, but also on the differentials that exist in the health-seeking behaviour among women with different backgrounds. It finds that less than half the women reporting any symptom related to reproductive tract infections seek help, while for some symptoms the proportion seeking help goes down to a mere one-fifth. The decision to seek help depends on a woman’s educational and economic status, the extent to which she is worried about the symptom, duration of experiencing the symptom, and inter-spousal communication about the symptom. Lack of finances to access any health service and considering the symptom as something common not needing attention are the two main reasons for not seeking help. The choice of the healthprovider consulted for a symptom is linked to the perceived cause of the symptom, but allopathic doctors are preferred by the majority of women seeking health care.

With the abolition of Mirdom in 1972, social and economic change picked up in the Northern Areas of Pakistan. Apart from the government, the other significant agent of change has been the Aga Khan Rural Support Programme (AKRSP). For any such programme to be successful it is important that the programme is designed, implemented and managed, keeping in view the local socio-economic conditions, ecology and, most importantly, characteristics of the poor. This paper is based on a study conducted in two villages, Rabat and Chaprote, in the Nagar Sub-division of Gilgit District, in 1990-91.1 It seeks to examine the projects launched by the AKRSP, the relevance of these projects to the local context, and their performance at the micro-level.