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3 Years Since Devolution Stock Taking: Implications for MNCH

3 Years Since Devolution Stock Taking: Implications for MNCH. Dr Talib Lashari National Conference MDGs: Improving Maternal Health in Pakistan Margalla Hotel, Islamabad November 25-26, 2013. Overview. Introduction Devolution: Cabinet Div, CCI, Federal Legislative List

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3 Years Since Devolution Stock Taking: Implications for MNCH

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  1. 3 Years Since DevolutionStock Taking: Implications for MNCH Dr Talib Lashari National Conference MDGs: Improving Maternal Health in Pakistan Margalla Hotel, Islamabad November 25-26, 2013

  2. Overview • Introduction • Devolution: Cabinet Div, CCI, Federal Legislative List • Implementing Devolution Reforms • Vertical Programs – status • MDGs targets • MNCH: Inequities • Challenges • Conclusion • Recommendations

  3. Introduction • Constitution (Eighteenth Amendment) Act 2010: paradigm shift • Momentous change: health services placed closer to communities. • Implementation has been challenging -preparedness at relevant levels • Clarity regarding the roles and responsibilities :federal and provincial tier.

  4. Introduction • Cabinet Division notification of June 29, 2011: eight different Divisions assigned residual functions • Planning Commission/P&D assigned the prime role of “national planning & coordination in the field of health” • Recently, Ministry of National Health Services, Regulation and Coordination (NHSRC) established

  5. Cabinet Division Notifications

  6. Decisions of Council of Common Interest • Council of Common Interest (CCI) held April 28, 2011 considered a summary submitted by the Finance Division. The CCI decided that the Federal Government shall provide funding for the vertical programs in Health • The vertical programs in Health will receive funding at the level of 2010-11 budgeted level • CCI also decided: The financing for development program of Population Welfare beyond June 2011 would depend upon the approval of ECNEC for this program. Later on the PC 1 of the Population program was approved.

  7. Federal Legislative List

  8. Implementing Devolution Reforms Tactical vs. Strategic Issues Planning Commission: Resolution of outstanding tactical issues being faced by provinces July 2011-June 2012: resolving tactical issues Concerns of Donor Pre devolution mechanisms need to be translated at provincial level Equality in donor support Concerns of Provinces releases of funds Level of funding Future of vertical programs donor grants Lack of flexibility in utilization Resource gap drug regulation Procurement • Devolution issues were also being discussed at i.e. IPC; High Powered Committee of the Cabinet; Devolution Cell at the Cabinet Division etc

  9. Devolution ReformsInter Provincial Meetings • Inter-provincial meeting January, 2012: • Current status and financing modalities for vertical health programs . • Provincial PC 1s at the fixed ceiling for PSDP FY 2010-11 as per decision of CCI • March, April, 2012 the matters related to Project Management Units (PMUs) with regard to Global Fund and GAVI discussed. • Mechanism of CCM • 3 PMUs shall function with a revised structure till currency of available GF grant • February 24, 2012 on PC1s; sustainability of programs; liabilities; release of funds and PMUs: • pending releases • DFID component for MNCH • level of funding same with >salaries of LHWs • Tactical issues resolved/Strategic • Policy coordination • Implementation of above mentioned decisions require a coordination mechanism at federal and provincial level

  10. Status of Vertical Programs

  11. MGDs 4&5 Economic Survey s; PHDS 1990;2007; 2012-13;MDGs Report 2010; PSLM 2004-05

  12. MNCH: Inequities PDHS 2012-13 Fertility Rate

  13. MNCH: Inequities PDHS 2012-13

  14. MNCH: InequitiesPDHS 2012-13

  15. MNCH: Inequities PDHS 2012-13

  16. Challenges • Policy, Planning; Governance • Post devolution strategic issues • Coordinated policy framework based on provincial policies • Oversight, stewardship, evaluation • Donor coordination • Flow of information and surveillance • International commitments • Programmatic • Resource gap: federal, provincial, donor funding • Need assessment by donor/NGOs based on PC 1 • MNCH program: weak public private partnership; linkages with PWD, LHWs; communication strategy • Releases, coordination

  17. Conclusion • Devolution has positive implications for MNCH; strategic & governance issues need to be addressed: which may affect gains • Federal roles to be streamlined: Ministry of National Health Services, Regulation & Coordination (NHSRC) • Federal, provincial, donor, INGOs/NGOs coordination for financing, procurement is weak • Inequities hampering the achievement of MDGs

  18. Recommendations • Policy, Planning & Governance • NHSRC may focus on broader policy coordination, TA, facilitation, stewardship, inter provincial & donor coordination, international commitments (should not engage itself in project approach) • Coordinated Health Policy Framework • Health Systems Strengthening Unit • Donor Coordination Strategy • Flow of information, IHR, vaccine procurement • Programmatic • Federal, provincial & donor/INGOs, NGOs funding – gaps to fill in • Integration of programs • Targeted voucher schemes, alternative financing & poverty reduction initiatives (BISP) to address inequities in short to medium term

  19. Thank you

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