Strengthening Health Activities for the Rural Poor

PROJECT COMPONENTS

The project was composed of four components:

• Component 1. Sustaining and strengthening the Basic Package of Health Services (BPHS): This component was to support the implementation of the BPHS through Performance-based Partnership Agreements (PPA) between the MOPH and NGOs. It was also to support the MOPH’s efforts to deliver the BPHS through contracting in management services (the MOPH strengthening mechanism) in a number of provinces. The component intended to support further expansion of health facilities, particularly sub-centers, to improve access for the 60% of people living over an hour away from a health facility; training of additional community mid-wives (CMW); and training of female community nurses (CNs).

• Component 2. Strengthening the delivery of the Essential Package of Hospital Services: This component was to finance an evaluation of the impact and lessons learnt from different approaches adopted for the EPHS implementation during 2005-2008. The component intended to support the policy dialogue to develop a systematic and coherent package of hospital policies to ensure efficient use of resources and provision of priority services, especially for the poor. Through a third party assessment (Component 3), SHARP aimed to contribute to monitoring hospital performance in the country. Possible options to support hospitals included contracting NGOs or strengthening the MOPH delivery mechanism, based on a specific EPHS expansion plan and on availability of resources.

• Component 3. Strengthening MOPH stewardship functions: This component was to strengthen both the central MOPH and the Provincial Health Offices (PHOs), while maintaining coordination and promoting decentralization. At the central level, this component intended to finance contractual staff in critical areas of the MOPH as well as a limited number of line manager positions. At the provincial level, the PHOs would be strengthened through computerization and reactivation of provincial health coordination meetings. SHARP was to contribute to the organization of semi-annual national health coordination workshops and to upgrading of the MOPH website, as a communication platform between the center and the periphery. The component also envisaged capacity building of staff at central and provincial levels through training activities as well as relevant national and international conferences. Renovation of Grant and Contracts Management Unit (GCMU) office was also planned. This component intended to further support monitoring and evaluation of the BPHS and EPHS through contracting of a third party evaluator to conduct health facility surveys and household surveys.

• Component 4. Piloting Innovations: This component intended to pilot supply-side interventions as part of a global experiment in results-based financing (RBF). One pilot targeted the providers of the BPHS by paying for performance against achievement of agreed indicators related to MDGs 4 and 5. Another RBF pilot supported testing of performance based payments in the hospital sector. An impact evaluation was conducted to assess and document the effects of the pilots. To ensure credibility and independence, a qualified research organization was contracted to objectively verify results, gauge annual performance, conduct annual facility surveys, and carry out full household surveys.

PROJECT RESULTS

• 19.5% of women 15-49 years currently using a family planning method;
• 90.1% TB treatment success rate: 90.1%;
• 53% of newborns who were breastfed within one hour after birth;
• 46.7% DTP3 coverage among children 12-23;
• 47.4% of births attended by skilled attendants;
• 54% of all pregnant women receiving at least one antenatal care visit;
• 1.6 consultations per person per year;
• 54% Score on the Balance Scorecard examining quality of care in Basic Health Centers, Comprehensive Health Centers and District Hospitals;
• 74% of the lowest income quintile using BPHS services when sick in the last month;
• 73.4 Hospital Balanced Scorecard measuring quality of care, equity, service delivery, and management processes;
• Semiannual  supervision of BPHS and EPHS facilities carried out by MOPH officials based on BSC;
• Successful completion of impact evaluations that test results-based financing (RBF) approaches in 2012 by Johns Hopkins University