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Promoting and Ensuring Women’s Right to Health through Vouchers for Health. District Dera Ghazi Khan 01-Dec-2011 to 31-Dec-2012. MNCH Situation in Pakistan (Maternal Health Indicators). Inequity in Birth Preparedness. Supply Side Financing.
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Promoting and Ensuring Women’s Right to Health through Vouchers for Health District Dera Ghazi Khan 01-Dec-2011 to 31-Dec-2012
MNCH Situation in Pakistan (Maternal Health Indicators) RAHSTA-PPAF: PEWRH-VH Project DGK
Inequity in Birth Preparedness RAHSTA-PPAF: PEWRH-VH Project DGK
Supply Side Financing • In Pakistan Health Care (HC) is financed through Supply Side Subsidies (SSS) that is to ensure that the entire Population has the access to “Low Priced” or “Free” Public Health Care; • Supply Side Financing has limitations in terms of efficiency and equity, it can result in inequalities in terms of access and utilization of health services; • The poor benefits less from SSS and results in seeking better quality HC in the private sector. This adds to the financial constraints of the poor. RAHSTA-PPAF: PEWRH-VH Project DGK
Demand Side financing • Given the limitations of Supply Side Financing (SSF) there has been a paradigm shift to Demand Side Financing (DSF). • This approach channels government subsidy for health services directly to consumers allowing them to purchase health services themselves; • PPAF funded project implemented by RAHSTA is one of the few initiatives in Pakistan to introduce DSF through the use of Health Vouchers. RAHSTA-PPAF: PEWRH-VH Project DGK
The Project RAHSTA-PPAF: PEWRH-VH Project DGK
The Project Goal • The Goal of project is to reduce maternal and newborn mortality and morbidity through subsidizing the cost and providing equitable essential health services including RH and FP services to poor and marginalized pregnant women. RAHSTA-PPAF: PEWRH-VH Project DGK
Project Objectives RAHSTA-PPAF: PEWRH-VH Project DGK
Target Beneficiaries • 1,680 Poor and Marginalized (under poverty line) pregnant women in their 2nd and 3rd trimester of pregnancy. RAHSTA-PPAF: PEWRH-VH Project DGK
Population of the Selected Project Area RAHSTA-PPAF: PEWRH-VH Project DGK
Project Implementation Flow • MAPPING • PA Selection • Identification of TG • Identification of HFs BASELINE SURVEY Success Stories Lessons Learnt Constitution of VMA Trainings & Orientation Capacity Building of Stakeholders SG Meetings and Male Health Sessions and Internships Sale of HVBs Follow-up Service Delivery Compliance Voucher Collection Reimbursement Reporting RAHSTA-PPAF: PEWRH-VH Project DGK
Project Implementation Approach RAHSTA-PPAF: PEWRH-VH Project DGK
Selection of Project Area • The Project Area was selected in consultation with District Health Department of DGK. • Project Area comprises 7 Union Councils in Tehsil DGK RAHSTA-PPAF: PEWRH-VH Project DGK
Key Activities • PEWRH-VH project has been implemented through SIX KEY STEPS: RAHSTA-PPAF: PEWRH-VH Project DGK
Voucher Management Agency (VMA) • VMA membership includes Representatives from (RAHSTA, DHD, SWD, PWD, BISP, BAITULMAL and local NGO). • Role of VMA is to: • Participate in Monthly Meetings; • Help in identification of Target Group , project area and HCPs; • Facilitate in mapping and base line survey; • Help in sales of Health Voucher Booklets; • Monitor the Redemption of Vouchers; • Help in ensuring the quality of services provided by SBAs; and • Facilitate in resolving challenges and constraints faced by field staff. RAHSTA-PPAF: PEWRH-VH Project DGK
Mapping/Baseline RAHSTA-PPAF: PEWRH-VH Project DGK
Orientation Meetings • Orientation Meetings were held with: • Newly hired RAHSTA field staff; • Voucher Management Agency (VMA); • District Health Department officials; • LHSs, LHWs and CMWs; and • Health Care Providers RAHSTA-PPAF: PEWRH-VH Project DGK
Voucher Management Agency (VMA) RAHSTA-PPAF: PEWRH-VH Project DGK
Selected Health Facilities RAHSTA-PPAF: PEWRH-VH Project DGK
Signing of Agreements RAHSTA-PPAF: PEWRH-VH Project DGK
Sale of Health Vouchers • Specially Designed Health Voucher Booklets (HBVs) sold to beneficiaries during the period from 9th April to 12th July 2012. • 1,680 HVBs were sold at a cost of Rs. 100 per HVB. RAHSTA-PPAF: PEWRH-VH Project DGK
Support Group Meetings RAHSTA-PPAF: PEWRH-VH Project DGK
Trainings on SG Methodology RAHSTA-PPAF: PEWRH-VH Project DGK
Support Group (SG) RAHSTA-PPAF: PEWRH-VH Project DGK
Capacity Building of Stakeholders RAHSTA-PPAF: PEWRH-VH Project DGK
Male Counseling (Health Sessions) RAHSTA-PPAF: PEWRH-VH Project DGK
Cost of Subsidized Services Offered through Vouchers RAHSTA-PPAF: PEWRH-VH Project DGK
Monitoring Framework RAHSTA-PPAF: PEWRH-VH Project DGK
Impact of Health Vouchers on ANC Checkups and TT Shots upto Dec2012 RAHSTA-PPAF: PEWRH-VH Project DGK
Lab Investigations & Ultrasound Checkup upto Oct 2012 RAHSTA-PPAF: PEWRH-VH Project DGK
Status of deliveries upto Dec2012 RAHSTA-PPAF: PEWRH-VH Project DGK
Impact of Health Vouchers on deliveries RAHSTA-PPAF: PEWRH-VH Project DGK
Status of Vouchers Redeemed Upto Dec2012 RAHSTA-PPAF: PEWRH-VH Project DGK
Overall Shift of Deliveries from TBA (Home Base) to SBA (Hospital Base) RAHSTA-PPAF: PEWRH-VH Project DGK
Success Stories • Following four Success Stories are shared: • Success Story of RABIA from UC Chorhatta • Success Story of LAL MAI from UC ManaAhamadani • Success Story of Amjad from UC Maimoori • Success Story of Khan Muhammad from UC ManaAhamadani RAHSTA-PPAF: PEWRH-VH Project DGK
Lessons Learnt • During the project implementation some of the Lessons Learnt & Problems encountered were: • Quality Assurance for Service Delivery • Delivery at Home by TBA • Misunderstanding on the use of Voucher for C-Section • Impact of Rains and Flood • Impact of Polio Campaign • Lack of Trust on HV Scheme • Cost of Health Vouchers • Project Operational Cost RAHSTA-PPAF: PEWRH-VH Project DGK
Sustainability • To ensure SUSTAINABILITY following efforts are being undertaken: • Constitution of VMA for transparency, monitoring and effective management; • Involvement of DHD, PWD, BISP, BAITULMAL, SWD and Local NGOs; • Initiation of INTERNSHIP Program for on the job – step by step training on the health voucher program; • Regular implementation of SGs and male counseling sessions; • Regular counseling and refresher sessions for awareness for all stakeholders. RAHSTA-PPAF: PEWRH-VH Project DGK
THANK YOU! RAHSTA-PPAF: PEWRH-VH Project DGK