Public Private Partnership A remedy to improve Maternal Health indicators in Pakistan

2. NATIONAL CONFERENCE SAVE MOTHER-SAVE FUTURE MDG 5- IMPROVING MATERNAL HEALTH IN PAKISTAN 25-26 Nov 2013 Public Private Partnership A remedy to improve Maternal Health indicators in Pakistan Dr. Mazhar Abbasi M.B.B.S, M.Sc Public Health

3. Health Indicators in Pakistan • 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) • 6th poorest MNCH indicators, globally

4. Key reasons of poor MNCH indicators • 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)

5. Remedy- Public Private Partnership • 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

6. Success Stories (PPP) 1- Battagram Model 2- HSDC (Health Services Delivery Contracting out) Model

7. 1- Battagram Model • 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.

8. Results reflect the efficacy of PPP Comparison of MNCH proxy indicators from year 1 to 4 are self explanatory regarding effectiveness of PPP

9. MNCH services utilization

10. Enhancement in Skilled Birth Attendance

11. Improved Ante Natal Care .

12. Tetanus Immunization

13. Improved EPI

14. Acceptance/utilization of Family Planning Services

15. 2- Health Services contracting Out (HSDC) model (Nawabshah & Larkana)

16. IHSAS( HSDC) Integrated Health System Alliance( Health Services Contracting Out) • 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

17. Promoting Trend of ANC (SBA)

18. ANC Revisit

19. Post Natal Care(Larkana)

20. Family Planning Services(Larkana)

21. Skilled Birth Attendance(SBA)

22. C-Sections(LRK)

23. C-Sections(SBA)

24. Conclusions • 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

25. Recommendations • 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