Transcript Devolution in Health Sector Challenges and WAY FORWARD

Background
Punjab comprising of more than 95 million
populations is more than 50% of Pakistan
 Health inequities and inequalities exist within and
between the districts
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Determinants of Health
Peace...shelter....education...food...in
come ----stable eco-system ---sustainable resources---social justice
and equity
(Ottawa Charter of Health Promotion-1986)
Challenges of devolution
Achievement of health related MDGs
○ Leaving many areas unattended
 Issues of capacity in the province – at least initially - in:
○ Health planning and regulation of policies
○ Strategic directions and leadership
○ Health information use
○ Human resource development & management
○ International procurement related matters
○ Financial Management
○ Governance & Accountability
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Punjab Health Sector Strategy
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The Punjab Government is committed to the principle of
universal health care combining mechanisms for health
financing and service provision - and improving the health
status of the population
The Strategy would support the Department of Health
(DoH) to progress further with a sense of direction,
purpose and urgency by prioritizing policy related
interventions consistent with availability of financial
resources.
It would also help to aligning International Partners’
support to this home grown strategy.
Broad Policy Objectives
“Provision of affordable, accessible and
quality health care to the people of
Punjab in an equitable manner”
Process of PHSS Development
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The PHSS was developed after an exhaustive process of
consultation with all stakeholders involving public sector,
private sector, independent experts, clinicians, health
managers, service providers, clients----- everyone.
The six dimensional situational analysis was done;
 Service Delivery
 Governance and Accountability
 Health Workforce
 Health Information Systems
 Essential Medicines/supplies
 Healthcare Financing
Conceptual underpinnings of the strategy
 An outcome and results based approach.
 Ensure adequate provision of preventive care.
 Realign the role of government as the steward, financier,
purchaser and regulator of health rather than only a
provider of health services
 Harness private sector capacities and skills to enhance
sector performance.
 Revisit health financing paradigm by adequate
investments in preventive care and by addressing equity
issues through social safety nets.
Major Barriers to MDGs 4 & 5
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Availability of Health Care Providers
Accessibility of MNCH services in terms of physical,
social and economic access
Issues regarding availability of MNCH related
medicines, supplies and equipments
Capacity of HCPs
Governance and accountability
Targeted intervention for the poor and marginalized to
address inequities
One size fit for all- (need to have a tailor made
approach to address district specific interventions
Women empowerment
Evidence based advocacy to raise community
awareness
Service Delivery Reforms
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Development of EPHS & MSDS for
PHC and Secondary level
 An integrated RMNCH and Nutrition
Program- PC-1 approved
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Strengthening of referral services by
provision of rural ambulances. PC-1 has
been prepared and submitted for
approval
Service Delivery Reforms
 Revitalizing
the MCH centers located in
urban slums to strengthen MNCH
services in urban slums
 Targeted interventions in hard to reach
area/far flung, riverine and tribal areas
through involvement of private sector or
local
NGOs
Management Reforms
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Revisiting
and revision of management
outsourcing contracts with PRSP with the
inclusion of outreach services and also
strengthening the evaluation mechanisms
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Development of contracting in Model with EDOs
and MSs of the districts.
 Development of key performance indicators for
district level health managers to strengthen the
accountability
system
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Design of a revamped DoH with full-fledged
Procurement, Financial Management, Human
Resource Management and Policy and Strategic
Planning Units as integral part of DoH
Management Reforms
strengthening the role of Punjab Health
Foundation underway for the development of
private sector
 In pursuance of LGO 2013 and take devolution further
to districts establishment of “District Health
Authorities”
under
process
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Establishment of Punjab Health Care Commission to
regulate Public & Private health care delivery system
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Multi-sectoral
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Improved coordination with the Population Welfare
Department
Nutrition
Initiative
Human Resource Management
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Lack of trained staff resulting in
 Underutilization of primary health care services
Uneven deployment in urban and rural areas
Absenteeism and dual practice issues
Weak HR development & retention mechanisms
Concerns about service structures – strikes by
 Young doctors
 Nurses
 Paramedical staff
Human Resource Managements
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Flexible
Performance
contracts
for
specialist services at DHQ and THQ
Hospitals
 Finalization of proposal of rotational visits
of PG students in consultation with CPSP
 Task Shifting by short term training to
WMOs, MOs and Lab technicians on
C/section,
anesthesia
and
blood
transfusion
 Reforming Punjab Medical Faculty and raising
standards of paramedics training.
 Improving
conditions
of
nursing
and
paramedical
schools to enhance the
quality of training
Health Financing
 Development
and approval of Social
Health Insurance and Voucher
Schemes models
 Plan for increasing overall health
expenditure, particularly non-salary
component at district level
Health Information System
Development of PC-1 for Directorate of
Information and Monitoring Evaluation
(DIME) at DGHS Office
o Development of M&E dashboard to assess
the
district
specific
progress
Establishment of Knowledge management
Unit
for Knowledge acquisition,
organization and sharing, Program reviews,
Policy research, Data mining and
Coordination at PSPU
o E-monitoring scaling up
o
Road is long and tortuous,
but ….. ‘Journey of a
thousand miles starts with
a small step’