Background

1. STRENGTHENING HEALTH SYSTEM FOR IMPROVING THE QUALITY OF MATERNAL HEALTH CARE- POST DEVOLUTION SCENARIODrSyeda Zahida Sarwar Additional Program Director Technical Health Policy & Strategic Planning unit (PSPU)

2. 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

3. Determinants of Health Peace...shelter....education...food...income ----stable eco-system ----sustainable resources---social justice and equity (Ottawa Charter of Health Promotion-1986)

5. 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

6. Punjab Health Sector Strategy • 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.

7. Broad Policy Objectives “Provision of affordable, accessible and quality health care to the people of Punjab in an equitable manner”

8. Process of PHSS Development • 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

9. 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.

10. Major Barriers to MDGs 4 & 5 • 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

11. Service Delivery Reforms • Development of EPHS & MSDS for PHC and Secondary level • An integrated RMNCH and Nutrition Program- PC-1 approved • Strengthening of referral services by provision of rural ambulances. PC-1 has been prepared and submitted for approval

12. 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

13. Management Reforms • Revisiting and revision of management outsourcing contracts with PRSP with the inclusion of outreach services and also strengthening the evaluation mechanisms • 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 • 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

14. 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 • Establishment of Punjab Health Care Commission to regulate Public & Private health care delivery system • Multi-sectoral Nutrition Initiative • Improved coordination with the Population Welfare Department

15. Human Resource Management • 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

16. Human Resource Managements • 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

17. 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

18. Health Information System • Development of PC-1 for Directorate of Information and Monitoring Evaluation (DIME) at DGHS Office • 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 • E-monitoring scaling up

19. Road is long and tortuous, but ….. ‘Journey of a thousand miles starts with a small step’

20. Thank You