Transcript Document

Public Private Partnership
A remedy to improve Maternal Health
indicators in Pakistan
Dr. Mazhar Abbasi
M.B.B.S, M.Sc Public Health
NATIONAL CONFERENCE
SAVE MOTHER-SAVE FUTURE
MDG 5- IMPROVING MATERNAL HEALTH IN PAKISTAN
25-26 Nov 2013
Health Indicators in Pakistan
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Health indicators poorest even in South Asia
“Off track” from MDGs
MMR- 276/100,000 live births (PDHS 07, MIS 2009)
Under 5 Mortality 94/1000 live births (PDHS 07, MIS
2009)
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6th poorest MNCH indicators, globally
Key reasons of poor MNCH
indicators
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Inability of Health System to be responsive to
people’s need
Lack of stewardship role at policy levels
Poor availability, accessibility, quality &
utilization of MNCH services
Weak Emergency Obstetric Newborn & Child
Care (EmONC) services particularly in rural
areas ( Basic& Comprehensive)
Remedy- Public Private
Partnership
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Outsourcing Public Sector Health Services to
credible /competent private partners
For defined period of time
Against set bench marks
Globally/regionally successful strategy
Multiple Health Care Financing Models
Some models recently being piloted in Pakistan
Significant improvement in MNCH services
delivery recorded affecting proxy indicators
Success Stories (PPP)
1- Battagram Model
2- HSDC (Health Services Delivery
Contracting out) Model
1- Battagram Model
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In 2007, Save the Children with support of World Bank
entered into a Public Private Partnership with
department of health , government of N.W.F.P (now
KPK), for managing PHC services in district Battagram.
As per MoU between Save The Children and
Department of Health, NWFP government, salary and
non salary budget of all PCH facilities in the district
(MCH centers, Government dispensaries, BHUs and
RHCs) was transferred to former
Along with management control of the facilities for period
of four years i.e. 2007 to 2011.
Results reflect the efficacy of PPP
Comparison of MNCH proxy indicators
from year 1 to 4 are self explanatory
regarding effectiveness of PPP
MNCH services utilization
Average monthly OPD
40000
33550
35000
30000
28274
25000
20568
20000
Average monthly OPD
15000
10000
7029
5000
0
2007
2008
2009
2010
Enhancement in Skilled Birth Attendance
Deliveries assisted by Skill Birth Attendant
500
433
450
400
363
350
300
250
Deliveries assisted by SBA
189
200
150
100
50
32
0
2007
2008
2009
2010
Improved Ante Natal Care
.
Registered for ANC
1400
1223
1200
1192
1000
838
800
Registered for ANC
600
451
400
200
0
2007
2008
2009
2010
Tetanus Immunization
TT immunization completed
600
521
537
500
414
400
300
TT2 immunization completed
200
137
100
0
2007
2008
2009
2010
Improved EPI
Fully Immunized children
1800
1692
1600
1400
1200
1000
922
Children fully immunized
793
800
600
400
200
128
0
2007
2008
2009
2010
Acceptance/utilization of Family Planning Services
Family Planning users
600
535
500
446
400
306
300
FP users
200
100
56
0
2007
2008
2009
2010
2- Health Services
contracting Out (HSDC)
model (Nawabshah &
Larkana)
IHSAS( HSDC)
Integrated Health System Alliance( Health Services Contracting Out)
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Health Care Financing Model, Contracting Out ,
Sindh
Under Norwegian Pakistan partnership Initiative
(NPPI)
MNCH services in 2 districts, Shaheed Benazeer
Abad & Larkano contracted out
Integrated Health Services(IHS) lead consortium is
the contractor
Total 3 years project, past half way now
Tangible improvement in MNCH services (24/7), and
almost all proxy indicators
Promoting Trend of ANC
(SBA)
5000
4500
4000
3500
3000
2500
2000
1500
1000
500
0
ANC Revisit
3000
2500
2000
1500
1000
500
0
Post Natal Care
(Larkana)
500
450
400
350
300
250
200
150
100
50
0
Family Planning Services
(Larkana)
600
500
400
300
200
100
0
Skilled Birth Attendance
(SBA)
600
500
400
300
200
100
0
C-Sections
(LRK)
70
60
50
40
30
20
10
0
C-Sections
(SBA)
90
80
70
60
50
40
30
20
10
0
Conclusions
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PPP yields results more efficiently
Human Resources deficiency met with
Absenteeism countered
Medicines, supplies available smoothly
Resources are allowed to be reappropriated
Delays in processes addressed, through innovative
approaches
Result based management
Structured M&E system in place
Performance Based Incentives introduced
Targets tracked to achieve given milestones
MNCH indicators improved in shorter period of time
Recommendations
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Provincial Governments need to include PPP
in their long term strategic plans for Health
Sector
NGOs lead advocacy with provincial
governments (DoH) for PPP
Capacity Building of Provincial Health
Departments on managing PPP
Replication of Battagram model in KPK &
HSDC in whole Sindh