USAID’s MCH Program Component 5: Health Systems Strengthening Quarterly Report January-March 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 January-March 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 January-March 2014 2 Contents Acronyms 4 I. Executive Summary 5 II. Health Systems Strengthening Component’s Vision of Success 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 21 Health Department IR 3.3 Strengthened Public Private Partnerships 25 IV. Coordination 29 V. Monitoring, Evaluation, and Reporting 30 VI. Issues and Challenges 35 VII. Activities Planned for Next Quarter 35 VIII. Annexes Annex 1: District-wise Details of Private Health Facilities 36 Annex 2: District-wise Details of Quarterly Meetings and Formation of VHCs 37 Annex 3: MTBF Planning Committee Notification 38 Component 5: Health Systems Strengthening Quarterly Report January-March 2014 3 Acronyms CMWs Community Midwives DAP District Action Plan DHIS District Health Information System DHN District Health Network DHO District Health Officer DHPC District Health Planning Committee 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 HSS Health Systems Strengthening HSRU Health Sector Reforms Unit IR Intermediate Result JSI JSI Research & Training Institute, Inc. LHV Lady Health Visitor LHW Lady Health Worker MCH Maternal and Child Health MCHIP Maternal and Child Health Integrated Program M&E Monitoring and Evaluation MIS Management Information System MNCH Maternal, Newborn and Child Health MSS Marie Stopes Society MTBF Medium Term Budgetary Framework PHDC Provincial Health Development Center RMNCH Reproductive, Maternal, Newborn and Child Health RSP Rural Support Program RSPN Rural Support Programmes Network UCHCs Union Council Health Committees USAID United States Agency for International Development VHCs Village Health Committees Component 5: Health Systems Strengthening Quarterly Report January-March 2014 4 I. Executive Summary During the January-March 2014 quarter, the Government of Sindh’s District Health Departments completed drafts of all 22 District Action Plans (DAPS), which are three- year rolling operational plans for the implementation of the Sindh Health Sector Strategy with accompanying goals and strategies to enable each District Health office to meet the health needs of their populations. This enormous accomplishment was made possible with the guidance, support, and leadership of the Health Systems Strengthening Component and is the culmination of eight months of preparation and technical assistance, which include the development of District Profiles and capacity building training. In addition, the Health Systems Strengthening Component provided technical support to District Health & Population Management Teams (DHPMTs) to establish a routine quarterly performance review process, and during this quarter, 21 districts successfully organized and executed these performance review meetings.1 The Health Systems Strengthening Component continued its support for Village Health Committees (VHCs), and during the January-March quarter, 536 VHCs held meetings. Overall, since October 2013, 738 VHCs have met at least once, and 276 VHCs have held two quarterly meetings. 65% of VHC members who participated in these meetings were women. As part of its role to advocate on issues related to accountability and transparency in Pakistan’s mixed health system, the Health Systems Strengthening Component issued a Request for Procurement (RFP) for the production of a documentary on Choked Pipes, a 2010 publication which focuses on Pakistan’s health systems issues and offers reforms. Under Heartfile Health Financing (HHF), the Health Systems Strengthening Component supported 56 patients for medical treatment during the January-March quarter. Of these 56 patients, 39 were female and 17 were male children. The total number of patients supported to date is 104. HHF enrolled three additional hospitals in the scheme to support increased scale up. The Health Systems Strengthening Component entered into negotiations with the Health Services Academy, Islamabad, to explore long-term capacity building options for Government of Sindh Department of Health (GOS/DOH) staff. During this quarter, the Health Services Academy agreed to initiate a new batch for 30 mid-level managers from Sindh for Masters of Science in Public Health. At the special request of USAID, the Health Systems Strengthening Component began providing technical assistance to Jacobabad Institute of Medical Sciences (JIMS) to: 1) draft key job descriptions; 2) develop a business plan; and 3) design a human resources strategy and management plan. 1 DHPMT Tharparkar did not meet during the reporting quarter because the health authorities were dealing a famine emergency (see page 8 of the report for more details). Component 5: Health Systems Strengthening Quarterly Report January-March 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 primary focus of the program proposed under the Health Systems Strengthening 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. The Health Systems Strengthening 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 Maternal and Child Health (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 Component 5: Health Systems Strengthening Quarterly Report January-March 2014 6 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 the project, the Health Systems Strengthening Component will strictly adhere to and promote the following strategic principles: Using a customized approach to capacity building that will be fit to each specific entity. This is reflective of the project’s overall commitment to flexibility and adaptability in implementation; Strengthening strategic partnerships and coordination to effectively manage an integrated health system; Promoting a culture and practice of results-oriented approach; Strengthening local expertise and focusing on local innovation to promote sustainability and ownership; Focusing on demand and supply side financing schemes to strengthen the health system; Promoting community actions for