by MONEM FAROOQI
Punjab government was sluggish in the implementation of USD 1.1165 billion Health Sector Reform Project approved in 2013 by World Bank (WB), as only 27 percent of project components could be carried out till date.
The World Bank’s project, to be closed down after 13 months now, documents available with the Pakistan Today explicate that only five out of fifteen Disbursement Linked Indicators (DLIs) could be achieved till yet.
Project Development Objective Indicators (PDOIs) clearly illustrate that Punjab government remained persistently apathetic, right after coming into power in 2013 and did not touch anything which might lead to increase percentage of users-satisfaction level with government health care services.
The government event did not move on to increase in percentage of the budget allocated for preventive programmes out of total provincial government health budget, the WB documents added.
The documents clearly give its words regarding high risks involved in implementing the project including unpardonable political influence and governance, lack of sector strategies and policies, inability of institutional capacity for Implementation and sustainability.
Besides, the documents specify, substantial and frequent changes in the Department of Health (DOH) management had also severely affected the overall progress of the program during the project implementation. “There has been also a series of changes in the strategic direction of the Health Sector Strategy after its approval in 2013,” the documents mentioned.
The program could only move only 27 percent since 2013, comprising four components stirring side by side in improvement of Health Service Delivery by utilizing USD 28.34 million, enhancing efficiency and effectiveness of the Health System USD 44.00 million, strengthening provincial Department of Health management capacity costing USD 22.26 million and fourth component will cost USD 26.5 million for improving the capacities in technical areas for Equitable Health Services for all.
The documents said about implementation progress, ‘the project had a very slow start with changes in the senior management of the department”. However, last year, the documents stated the pace of implementation had improved a little as DOH resolved pending issues, which led to the achievements of five out of fifteen Disbursement Linked Indicators (DLIs), resulting in 27 percent of the IDA credit being disbursed.
However, the documents referred “considering the project is already start moving through its implementation, this is still far behind the original schedule.”
Highlighting the Banks apprehensions up, they documents mentioned, “There has been also a series of changes in the strategic direction of the health sector strategy after its approval in 2013. The bank’s follow-up mission in January 2016 found that a number of recommendations identified and agreed during the MTR were still pending mainly due to contextual changes since MTR, including the bifurcation of DOH and changes in senior management.
Project Development Objective Indicators illustrated that Punjab government stayed conscious significantly in touching anything which might led to an increase in percentage of users-satisfaction level with government health care services.
However, only upward movement witnessed in contraceptive prevalence rate, which got at its peak in achieving 100 percent target for provision of products and services to family planning clients.
Number of RHCs providing 24/7 basic EmONC services had been increased significantly on monthly average basis. In addition, proportion of children with SAM registered for treatment at stabilization centres in target districts, percentage of pregnant women registered with LHWs receiving IFA tablets during the last pregnancy, DUs reached by the program who reported using a new syringe at their last injection, monthly average number of OPD visits in BHUs and RHCs and percentage of districts with their respective BHUs providing all essential drugs were also increased.
Highly placed Health Department sources told Pakistan Today that development objective of the proposed project was to support the implementation of the Punjab Health Sector Strategy, by focusing on the improvement of the coverage and utilization of quality essential health services, particularly in the low performing districts of Punjab.
The project will focus on building the capacity and systems to strengthen accountability and stewardship in DoH.
Sources said that the bank’s follow-up mission in January 2016 found that a number of recommendations identified and agreed during the MTR were still pending mainly, however consequently, the Punjab government is going to the bank to carry out restructuring of the project, however, it’s Level 2 was approved on Jan 17th January 2014