Background

Punjab comprising of more than 95 million populations is more than 50% of Pakistan

Health inequities and inequalities exist within and between the districts

Determinants of HealthPeace...shelter....education...food...income ----stable eco-system ----sustainable resources---social justice and equity

(Ottawa Charter of Health Promotion-1986)

Challenges of devolution Achievement of health related MDGs

○ Leaving many areas unattended Issues of capacity in the province – at least initially - in:

○ Health planning and regulation of policies○ Strategic directions and leadership○ Health information use○ Human resource development & management○ International procurement related matters○ Financial Management○ Governance & Accountability

Punjab Health Sector Strategy

The Punjab Government is committed to the principle of universal health care combining mechanisms for health financing and service provision - and improving the health status of the population

The Strategy would support the Department of Health (DoH) to progress further with a sense of direction, purpose and urgency by prioritizing policy related interventions consistent with availability of financial resources.

It would also help to aligning International Partners’ support to this home grown strategy.

“Provision of affordable, accessible and quality health care to the people of Punjab in an equitable manner”

Broad Policy Objectives

Process of PHSS Development

The PHSS was developed after an exhaustive process of consultation with all stakeholders involving public sector, private sector, independent experts, clinicians, health managers, service providers, clients----- everyone.

The six dimensional situational analysis was done; Service Delivery Governance and Accountability Health Workforce Health Information Systems Essential Medicines/supplies Healthcare Financing

An outcome and results based approach. Ensure adequate provision of preventive care. Realign the role of government as the steward, financier,

purchaser and regulator of health rather than only a provider of health services

Harness private sector capacities and skills to enhance sector performance.

Revisit health financing paradigm by adequate investments in preventive care and by addressing equity issues through social safety nets.

Conceptual underpinnings of the strategy

Major Barriers to MDGs 4 & 5 Availability of Health Care Providers Accessibility of MNCH services in terms of physical,

social and economic access Issues regarding availability of MNCH related

medicines, supplies and equipments Capacity of HCPs Governance and accountability Targeted intervention for the poor and marginalized

to address inequities One size fit for all- (need to have a tailor made

approach to address district specific interventions Women empowerment Evidence based advocacy to raise community

awareness

Service Delivery Reforms

Development of EPHS & MSDS for PHC and Secondary level

An integrated RMNCH and Nutrition Program- PC-1 approved

Strengthening of referral services by provision of rural ambulances. PC-1 has been prepared and submitted for approval

Service Delivery Reforms

Revitalizing the MCH centers located in urban slums to strengthen MNCH services in urban slums

Targeted interventions in hard to reach area/far flung, riverine and tribal areas through involvement of private sector or local NGOs

Management Reforms Revisiting and revision of management

outsourcing contracts with PRSP with the inclusion of outreach services and also strengthening the evaluation mechanisms

Development of contracting in Model with EDOs and MSs of the districts.

Development of key performance indicators for district level health managers to strengthen the accountability system

Design of a revamped DoH with full-fledged Procurement, Financial Management, Human Resource Management and Policy and Strategic Planning Units as integral part of DoH

Management Reforms strengthening the role of Punjab Health

Foundation underway for the development of private sector

In pursuance of LGO 2013 and take devolution further to districts establishment of “District Health Authorities” under process

Establishment of Punjab Health Care Commission to regulate Public & Private health care delivery system

Multi-sectoral Nutrition Initiative

Improved coordination with the Population Welfare Department

Human Resource Management Lack of trained staff resulting in

Underutilization of primary health care services Uneven deployment in urban and rural areas Absenteeism and dual practice issues Weak HR development & retention mechanisms Concerns about service structures – strikes by

Young doctorsNursesParamedical staff

Human Resource Managements Flexible Performance contracts for

specialist services at DHQ and THQ Hospitals

Finalization of proposal of rotational visits of PG students in consultation with CPSP Task Shifting by short term training to

WMOs, MOs and Lab technicians on C/section, anesthesia and blood

transfusion Reforming Punjab Medical Faculty and raising

standards of paramedics training. Improving conditions of nursing and

paramedical schools to enhance the quality of training

Health Financing Development and approval of Social

Health Insurance and Voucher Schemes models

Plan for increasing overall health expenditure, particularly non-salary component at district level

Health Information Systemo Development of PC-1 for Directorate of Information and Monitoring Evaluation (DIME) at DGHS Office

o Development of M&E dashboard to assess the district specific progress Establishment of Knowledge management Unit for Knowledge acquisition, organization and sharing, Program reviews, Policy research, Data mining and Coordination at PSPU

o E-monitoring scaling up

Road is long and tortuous, but ….. ‘Journey of a thousand miles starts with a small step’