USAID’s MCH Program Component 5: Health Systems Strengthening QUARTERLY REPORT OCTOBER-DECEMBER 2014 USAID Cooperative Agreement: No. AID-391-A-13-00002 Submitted: January 30, 2015 USAID’s MCH Program Component 5: Health Systems Strengthening Quarterly Report October-December 2014 USAID Cooperative Agreement: No. AID-391-A-13-00002 JSI Research & Training Institute, Inc. HSS Component 44 Farnsworth Street House #6, Street No. 5, F-8/3 Boston, MA 02210 Islamabad, Pakistan 44000 +1 617-482-9485 +92 051-111-000-025 www.jsi.com DISCLAIMER This document is made possible by the generous support of the American people through the United States Agency for International Development (USAID). The contents are the responsibility of JSI Research & Training Institute, Inc. and do not necessarily reflect the views of USAID or the United States Government. Table of Contents Acronyms ........................................................................................................................ 3 I. Executive Summary ..................................................................................................... 4 II. Health Systems Strengthening Component’s Vision of Success ................................. 5 III. Activities and Results ................................................................................................. 7 IR 3.1 Increased Accountability and Transparency of Health System ......................... 7 IR 3.2 Improved Management Capacity at Provincial and District Levels of DOH and PWD .......................................................................................................................... 24 IR 3.3 Strengthened Health System Through Public Private Partnerships ................ 41 IV. Monitoring, Evaluation, and Reporting ..................................................................... 49 V. Project Management ................................................................................................. 52 VI. Issues and Challenges ............................................................................................. 54 VII. Activities Planned for Next Quarter ......................................................................... 55 VIII. Annexes ................................................................................................................. 56 Annex 1:International Travel Status Report ................................................................... 56 Component 5: Health Systems Strengthening Quarterly Report October-December 2014 2 Acronyms BHU Basic Health Unit CMW Community Midwife DAP District Action Plan DHIS District Health Information System DHO District Health Officer DHPC District Health Planning Committee DHPMT District Health & Population Management Team DOH Department of Health DPWO District Population Welfare Officer EPI Expanded Programme on Immunization GOS Government of Sindh HCF Health Care Financing HHF Heartfile Health Financing HSS Health Systems Strengthening IR Intermediate Result JSI JSI Research & Training Institute, Inc. JPMC Jinnah Post-graduate Medical Center LHW Lady Health Worker LSO Local Support Organization LUH Liaquat University Hospital MCH Maternal and Child Health MCHIP Maternal and Child Health Integrated Program M&E Monitoring & Evaluation MIS Management Information System MNCH Maternal, Newborn, and Child Health MSS Marie Stopes Society MTBF Medium Term Budgetary Framework NCD Non-Communicable Disease NICH National Institute of Child Health NICVD National Institute of Cardiovascular Diseases PIMS Pakistan Institute of Medical Sciences PPHI People’s Primary Healthcare Initiative PWD Population Welfare Department RFP Request for Procurement RGH Rawalpindi General Hospital RHC Rural Health Center RMNCH Reproductive, Maternal, Newborn, and Child Health RSPN Rural Support Programmes Network UAT User Acceptance Testing USAID United States Agency for International Development Component 5: Health Systems Strengthening Quarterly Report October-December 2014 3 I. Executive Summary During the quarter, the Health Systems Strengthening (HSS) Component scaled up its support to strengthen M&E of routine immunization in Jacobabad, Kashmore, Thatta, and Tharparkar districts to cover all 151 Union Councils of these four districts. As a result, a total of 22,497 children under the age of two years and 6,445 pregnant women were vaccinated in these Union Councils during the reporting quarter. The project also provided technical support to these low performing districts to develop Union Council micro-plans which will enable them to provide immunization services effectively to children under the age of two years and pregnant women. Keeping in mind the fact that most of the vaccinators lacked transport to cover all the Union Councils, HSS Component provided 550 motorcycles to the Department of Health (DOH) to improve coverage of Expanded Programme of Immunization (EPI) in 11 districts of Sindh. HSS Component successfully supported 23 District Health Departments, including Karachi, to prepare District Action Plans and Medium Term Budgetary Framework (MTBF) estimation for 2015-16 fiscal year of Government of Sindh on prescribed forms of the Finance Department. Prior to this, HSS Component, in close collaboration with the Finance Department, built capacity of all cost centers in the DOH on MTBF and supported them to finalize key performance indicators for service and management components of the DOH. In addition, HSS Component provided technical support to 22 District Health and Population Management Teams (DHPMTs) to hold their quarterly performance review meetings. HSS Component finalized an assessment report on the capacities of the DOH, Population Welfare Department (PWD), and People’s Primary Healthcare Initiative (PPHI) and reviewed them with relevant stakeholders in a workshop held in November. Based on World Health Organization’s six health system building blocks, the assessment will serve as the foundation for the capacity building strategy that HSS Component is developing for the DOH, PWD, and PPHI to improve individual skills and practices and organizational systems and procedures for sustainable delivery of health services in Sindh. The assessment will also inform the work of all partners of USAID’s Maternal and Child Health (MCH) Program. During the reporting quarter, HSS Component finalized a report which tracks health related manifesto commitments of Pakistan’s main political parties before the 2013 general elections. The report, which is the first study of its kind in Pakistan, found that even though manifesto formulation had become more professionalized over the years, it remained centralized and donor-oriented and the manifestos were still not central to electoral success of political parties. Under the Heartfile Health Financing (HHF) program, HSS Component made commitments for 113 underserved patients worth Rs.5,912,799 (approximately $57,968). To date, this figure represents the highest number of patients supported through HHF program in one quarter since the start of the project. Of these 113 patients, 82 were children below the age of 15 and 31 were women. Component 5: Health Systems Strengthening Quarterly Report October-December 2014 4 II. Health Systems Strengthening Component’s Vision of Success By the end of the project, the Government of Sindh’s Department of Health (GOS/DOH) will have the management capacity and systems necessary to move towards universal coverage and address equity issues with a particular focus on the poor and vulnerable. The GOS will have tested and scaled proven public private partnerships (PPPs) and have the capacity to manage and sustain these partnerships and to identify and develop new ones over time. Additionally, the capacity of civil society to effectively engage in policy dialogue will have been built, and there will be a sustained increase in financial risk protection to move towards universal health coverage. Goal The goal of HSS Component is to develop and support innovative, cost effective, integrated, and quality programs and services to strengthen systems around reproductive, maternal, newborn and child health (RMNCH) services for improved outcomes. The primary focus of the program proposed under HSS Component is: 1. Strengthening systems that will foster improved RMNCH service delivery and outcomes, including accountability and transparency; 2. Strengthening management capacity at the provincial and district levels; 3. Developing innovative approaches to catalyze community outreach services and access to health services for marginalized populations (including financing schemes); and 4. Strengthening private sector delivery for the urban and rural poor populations. HSS Component will also engage in the coordination, alignment, and calibration of RMNCH activities undertaken by technical partners of USAID’s MCH Program to ensure there is no duplication of effort and that all critical elements for achieving results reinforce each other and are laid out to achieve synergy and the desired results of USAID’s MCH Program objectives. Health Systems Strengthening Component’s Intermediate Results The results of HSS Component will follow USAID’s Results Framework. Most of the project’s activities will fall under IR 3. IR 3: Strengthened Health System IR 3.1: Increased Accountability and Transparency of Health System IR 3.2: Improved Management Capacity at Provincial and District Levels within the Health Department IR 3.3: Strengthened Public Private Partnerships Component 5: