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

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  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.
Promoting and Ensuring Women’s Right to Health through Vouchers for HealthDistrict Dera Ghazi Khan01-Dec-2011 to 31-Dec-2012MNCH Situation in Pakistan (Maternal Health Indicators)RAHSTA-PPAF: PEWRH-VH Project DGKInequity in Birth PreparednessRAHSTA-PPAF: PEWRH-VH Project DGKSupply 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 DGKDemand 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 DGKThe ProjectRAHSTA-PPAF: PEWRH-VH Project DGKThe 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 DGKProject ObjectivesRAHSTA-PPAF: PEWRH-VH Project DGKTarget Beneficiaries
  • 1,680 Poor and Marginalized (under poverty line) pregnant women in their 2nd and 3rd trimester of pregnancy.
  • RAHSTA-PPAF: PEWRH-VH Project DGKPopulation of the Selected Project AreaRAHSTA-PPAF: PEWRH-VH Project DGKProject Implementation Flow
  • PA Selection
  • Identification of TG
  • Identification of HFs
  • BASELINE SURVEYSuccess Stories Lessons LearntConstitution of VMATrainings & OrientationCapacity Building of StakeholdersSG Meetings and Male Health Sessions and InternshipsSale of HVBsFollow-upService DeliveryComplianceVoucher CollectionReimbursement ReportingRAHSTA-PPAF: PEWRH-VH Project DGKProject Implementation ApproachRAHSTA-PPAF: PEWRH-VH Project DGKSelection 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 DGKKey Activities
  • PEWRH-VH project has been implemented through SIX KEY STEPS:
  • RAHSTA-PPAF: PEWRH-VH Project DGKVoucher 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 DGKMapping/BaselineRAHSTA-PPAF: PEWRH-VH Project DGKOrientation 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 DGKVoucher Management Agency (VMA)RAHSTA-PPAF: PEWRH-VH Project DGKSelected Health FacilitiesRAHSTA-PPAF: PEWRH-VH Project DGKSigning of AgreementsRAHSTA-PPAF: PEWRH-VH Project DGKSale 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 DGKSupport Group MeetingsRAHSTA-PPAF: PEWRH-VH Project DGKTrainings on SG MethodologyRAHSTA-PPAF: PEWRH-VH Project DGKSupport Group (SG)RAHSTA-PPAF: PEWRH-VH Project DGKCapacity Building of StakeholdersRAHSTA-PPAF: PEWRH-VH Project DGKMale Counseling (Health Sessions)RAHSTA-PPAF: PEWRH-VH Project DGKCost of Subsidized Services Offered through VouchersRAHSTA-PPAF: PEWRH-VH Project DGKMonitoring FrameworkRAHSTA-PPAF: PEWRH-VH Project DGKImpact of Health Vouchers on ANC Checkups and TT Shots upto Dec2012RAHSTA-PPAF: PEWRH-VH Project DGKLab Investigations & Ultrasound Checkup upto Oct 2012RAHSTA-PPAF: PEWRH-VH Project DGKStatus of deliveries upto Dec2012RAHSTA-PPAF: PEWRH-VH Project DGKImpact of Health Vouchers on deliveriesRAHSTA-PPAF: PEWRH-VH Project DGKStatus of Vouchers Redeemed Upto Dec2012RAHSTA-PPAF: PEWRH-VH Project DGKOverall Shift of Deliveries from TBA (Home Base) to SBA (Hospital Base)RAHSTA-PPAF: PEWRH-VH Project DGKSuccess 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 DGKLessons 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 DGKSustainability
  • 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.
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