Pakistan, Province of Punjab, Systems-Oriented Health Investment Program (SOHIP): January 2006–December 2010
Sector: Health and Population
Region: South Asia
Funded by:
Canadian International Development Agency (CIDA)
Total Value: C$12 million (Canadian contribution: Agriteam component: C$7 million; multilateral grants/contribution component C$5 million)
Partners and Counterparts:
In Pakistan, the project’s main counterparts are the Department of Health, provincial Government of Punjab, and the Departments of Health in the District Governments of Pakpattan Mianwali.
Purpose
To support the implementation of decentralized health services—with particular attention to women’s health—through systems strengthening within a health promotion framework.
Challenge
The Government of Pakistan implemented a devolution program in 2001, under which local governments at the district level became much more autonomous. Responsibility for planning and delivery of health services was transferred to district governments. The new system was intended to bring decision-making closer to the beneficiaries of public services and ensure citizens’ involvement in planning and implementation of those services.
However, studies undertaken several years after the beginning of devolution showed that many of its potential benefits had yet to be realized, particularly in terms of increased local accountability and improved management. At the district level, there is still only limited capacity for evidence-based planning; inadequate use of data from the health management information system; a lack of attention to health education and the monitoring and supervision of health promotion activities; and a continued emphasis of curative services over preventive care, to the detriment of the latter.
Approach
SOHIP is designed to take a systems approach: strengthening the structures behind service delivery by improving attention to health promotion at the district level as well as strengthening the management domain of public services. Capacity development activities are complemented by efforts to ensure systems and policies become more supportive of new ways of working, so people can apply improved capacity in a sustainable way. There are a number of significant government and donor-financed health reform efforts happening in parallel in Punjab province, and SOHIP takes a very collaborative approach with respect to these efforts.
Project Description
The planned outcome result for SOHIP is strengthened management and accountability systems for the effective delivery of gender-sensitive, pro-poor health services integrating prevention and health promotion.
SOHIP operates at three levels:
- At the district level through intensive activities in our two demonstration districts
- At the inter-district level to promote exchange of information, ideas and innovations between districts
- At the provincial level to provide systems and structures that can better support improved health management at the district level
SOHIP is working to:
- integrate health promotion into pre-service and in-service training programs for various cadres of paramedical staff
- strengthen supportive supervision of outreach service providers
- strengthen the operation of health management information systems at the district level improve systems for strategic and operational planning and monitoring in district health departments
Note: Design phase: January 2005–August 2006; implementation phase September 2006–June 2010
Results
- The development of a tool for assessing the health promotion orientation of training programs for medical and paramedical personnel.
- The formation of a Health Promoters Network, comprising individuals with responsibility for health promotion and health education at the district level and in training institutions, and providing training to that network on different strategies for health promotion.
- The training of 35 dispenser trainers from across Punjab in learner-centred interactive teaching methodologies, health promotion, and gender equality. These trainers were then able to offer exam preparation courses to 251 dispenser students prior to annual qualification exams. The refresher training contributed to an improvement of the dispenser examination pass rate from 10% in 2006 to 17% in 2007.
- The development of training materials and resources on health promotion including video case studies.
- The provision of orientation sessions on gender-sensitive health promotion to approximately 250 health care providers, supervisors and managers.
- The creation of a cross-sectoral, high-level District Health Management Team in one of our demonstration districts.
- The training of approximately 300 people from 13 districts on evidence-based planning and improving the functioning of district health management information systems.
- The provision of infrastructure support for District Health Information Systems (DHIS) in Mianwali and Pakpattan and the training of over 750 medical and paramedical staff in the operation of the revised DHIS.
- The performance of a gender audit of the Departments of Health and Population Welfare at the provincial and district levels, and the provision of gender sensitization training to health department staff.
- The provision of infrastructure support to improve the training environment in two District Health Development Centres and six paramedical schools.
- The inception of a program for training on community mobilization for health promotion that is engaging and creating linkages between health department staff and NGOs in our demonstration districts.
Canadian Project Manager
Morag Humble
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