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Promoting and Ensuring Women’s Right to Health through Vouchers for Health

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

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  1. Promoting and Ensuring Women’s Right to Health through Vouchers for Health District Dera Ghazi Khan 01-Dec-2011 to 31-Dec-2012

  2. MNCH Situation in Pakistan (Maternal Health Indicators) RAHSTA-PPAF: PEWRH-VH Project DGK

  3. Inequity in Birth Preparedness RAHSTA-PPAF: PEWRH-VH Project DGK

  4. 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

  5. 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

  6. The Project RAHSTA-PPAF: PEWRH-VH Project DGK

  7. 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

  8. Project Objectives RAHSTA-PPAF: PEWRH-VH Project DGK

  9. 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

  10. Population of the Selected Project Area RAHSTA-PPAF: PEWRH-VH Project DGK

  11. 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

  12. Project Implementation Approach RAHSTA-PPAF: PEWRH-VH Project DGK

  13. 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

  14. Key Activities • PEWRH-VH project has been implemented through SIX KEY STEPS: RAHSTA-PPAF: PEWRH-VH Project DGK

  15. 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

  16. Mapping/Baseline RAHSTA-PPAF: PEWRH-VH Project DGK

  17. 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

  18. Voucher Management Agency (VMA) RAHSTA-PPAF: PEWRH-VH Project DGK

  19. Selected Health Facilities RAHSTA-PPAF: PEWRH-VH Project DGK

  20. Signing of Agreements RAHSTA-PPAF: PEWRH-VH Project DGK

  21. 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

  22. Support Group Meetings RAHSTA-PPAF: PEWRH-VH Project DGK

  23. Trainings on SG Methodology RAHSTA-PPAF: PEWRH-VH Project DGK

  24. Support Group (SG) RAHSTA-PPAF: PEWRH-VH Project DGK

  25. Capacity Building of Stakeholders RAHSTA-PPAF: PEWRH-VH Project DGK

  26. Male Counseling (Health Sessions) RAHSTA-PPAF: PEWRH-VH Project DGK

  27. Cost of Subsidized Services Offered through Vouchers RAHSTA-PPAF: PEWRH-VH Project DGK

  28. Monitoring Framework RAHSTA-PPAF: PEWRH-VH Project DGK

  29. Impact of Health Vouchers on ANC Checkups and TT Shots upto Dec2012 RAHSTA-PPAF: PEWRH-VH Project DGK

  30. Lab Investigations & Ultrasound Checkup upto Oct 2012 RAHSTA-PPAF: PEWRH-VH Project DGK

  31. Status of deliveries upto Dec2012 RAHSTA-PPAF: PEWRH-VH Project DGK

  32. Impact of Health Vouchers on deliveries RAHSTA-PPAF: PEWRH-VH Project DGK

  33. Status of Vouchers Redeemed Upto Dec2012 RAHSTA-PPAF: PEWRH-VH Project DGK

  34. Overall Shift of Deliveries from TBA (Home Base) to SBA (Hospital Base) RAHSTA-PPAF: PEWRH-VH Project DGK

  35. 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

  36. 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

  37. 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

  38. THANK YOU! RAHSTA-PPAF: PEWRH-VH Project DGK

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