USAID’s MCH Program Component 5: Health Systems Strengthening Quarterly Report April-June 2014 Cooperative Agreement No. AID-391-A-13-00002 This Report has been submitted to the United States Agency for International Development for consideration and approval. It was submitted by JSI Research & Training Institute, Inc. and prepared by JSI Research & Training Institute, Inc. in collaboration with Contech, Rural Support Programmes Network, and Heartfile. USAID’s MCH Program Component 5: Health Systems Strengthening Quarterly Report April-June 2014 Cooperative Agreement No. AID-391-A-13-00002 Disclaimer: “This study/report 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.” Component 5: Health Systems Strengthening Quarterly Report April-June 2014 2 Table of Contents Acronyms ........................................................................................................................ 4 I. Executive Summary ..................................................................................................... 5 II. Health Systems Strengthening Component’s Vision of Success ................................. 5 Health Systems Strengthening Component’s Intermediate Results ................................ 6 III. Activities and Results ................................................................................................. 8 IR 3.1 Increased Accountability and Transparency of Health System ......................... 8 IR 3.2 Improved Management Capacity at Provincial and District levels within the Health Department ..................................................................................................... 22 IR 3.3 Strengthened Public Private Partnerships ....................................................... 25 IV. Coordination ............................................................................................................ 31 V. Monitoring, Evaluation, and Reporting ...................................................................... 31 VI. Project Management ................................................................................................ 36 VII. Issues and Challenges ............................................................................................ 37 VIII. Activities Planned for Next Quarter ........................................................................ 38 IX. Annexes ................................................................................................................... 40 Component 5: Health Systems Strengthening Quarterly Report April-June 2014 3 Acronyms BHU Basic Health Unit DAP District Action Plan DHIS District Health Information System DHN District Health Network DHO District Health Officer DHPMT District Health & Population Management Team DOH Department of Health EPI Expanded Programme on Immunization GOS Government of Sindh HCF Health Care Financing HHF Heartfile Health Financing HSRU Health Sector Reforms Unit IR Intermediate Result JSI JSI Research & Training Institute, Inc. 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 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 RMNCH Reproductive, Maternal, Newborn, and Child Health RSPN Rural Support Programmes Network UCHC Union Council Health Committee USAID United States Agency for International Development VHC Village Health Committee Component 5: Health Systems Strengthening Quarterly Report April-June 2014 4 I. Executive Summary During the April-June 2014 quarter, Government of Sindh’s Department of Health (DOH) created an M&E Cell to improve monitoring, supervision, and accountability within the DOH. Established with technical support from the Health Systems Strengthening Component, the formation of M&E Cell is a crucial step in the direction of integrating District Health Information System (DHIS) and Management Information Systems (MIS) of vertical programs as well as monitoring and improving the performance of District Health & Population Management Teams (DHPMTs). The Health Systems Strengthening Component and DELIVER are jointly providing support for renovation and office equipment for the M&E Cell which will be formally inaugurated in the next quarter. All 22 DHPMTs held their quarterly review meetings with technical support from the Health Systems Strengthening Component. This intervention is proving extremely helpful in monitoring key performance indicators, using information and generating evidence for decision-making as well as improving coordination among district level stakeholders. During the April-June quarter, the Health Systems Strengthening Component supported District Health Departments in linking activity costs of District Action Plans (DAPs) with district budgets and preparation of budgets on Medium Term Budgetary Framework, enabling districts to develop realistic budgets to implement DAPs. The Health Systems Strengthening Component continued to support Village Health Committees (VHCs). Out of the 1,021 VHCs formed so far, 1,016 VHCs held meetings during April-June quarter. Since October 2013, when VHCs started to meet, 302 VHCs have held three quarterly meetings, 431 have held two quarterly meetings, and 283 have met once. 67% of VHC members who participated in these meetings were women. Under Heartfile Health Financing (HHF) scheme, the Health Systems Strengthening Component supported 80 patients for medical treatment. Of these patients, 37 were women and 43 children (24 boys and 19 girls). The total number of patients supported by the project to date is 184. One more hospital was enrolled in the scheme during the quarter, bringing the total number of enrolled hospitals to six. The Health Systems Strengthening Component provided technical support to develop “Rules and Regulations” and “Human Resource Strategy” for Jacobabad Institute of Medical Sciences (JIMS); both were approved by the Board of Governors of JIMS so that the hospital can provide state of the art services by adopting the best management practices from private sector hospitals as well as improve the quality of care by attracting skilled human resources. In June, 50 applicants from DOH and Population Welfare Department (PWD) appeared for testing and interviews to enroll in a Masters of Science in Public Health program at the Health Services Academy. This is part of the long-term management capacity building options that the Health Systems Strengthening Component is providing to health managers in Sindh. Thirty successful candidates will start this program in August. Component 5: Health Systems Strengthening Quarterly Report April-June 2014 5 II. Health Systems Strengthening Component’s Vision of Success At 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 the Health Systems Strengthening 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 Health Systems Strengthening Component will also engage in the coordination, alignment, and calibration of RMNCH activities undertaken by technical partners of USAID’s Maternal and Child Health (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 Health Systems Strengthening 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 Overall Approach and Strategic Principles JSI and its sub-partners RSPN, Contech International, and Heartfile implement the Health Systems Strengthening Component to improve the capacity of the Government of Pakistan (GOP), and particularly the GOS, to develop and implement innovative, cost-effective, integrated, and quality programs and services to strengthen systems around RMNCH services. Throughout