Dr. Zafar Ahmed
General Manager
Aga Khan Health Services, Pakistan
28 – 29 September 2011
Vedic Village Spa Resort
Kolkata, India.
Rural Health Center,
Shagram
• Facility constructed by
government
• No staffing
• Limited quality
• Serves population of
48,000
• Secondary healthcare
facility
• Remote and isolated
28 – 29 September 2011
Vedic Village Spa Resort
Kolkata, India.
Demographic Data
1.
2.
3.
4.
5.
Total Population of Torkhow Tehsil
Adjacent population of Mulkhow Tehsil
Child Bearing Age Women (CBAs)
< 5 Years Children
< 1 Years Children
32,000
16,000
8,640
7,680
28 – 29 September 2011
1,680
Vedic Village Spa Resort
Kolkata, India.
•
•
Integrated PPP between government and NGO
•
Government provides facility, budget, and some human
resources
•
AKHS,P:
•
•
•
manages the facility
•
includes community participation
ensures supplies and medicine
strengthens human resources (particularly female doctors
and nurses)
District Advisory Committee
28 – 29 September 2011
Vedic Village Spa Resort
Kolkata, India.
•
Department of Health
Government of Khyber
Pakhtunkhwa, Pakistan
•
Aga Khan Health Service,
Pakistan
•
•
District government
Local community
28 – 29 September 2011
Vedic Village Spa Resort
Kolkata, India.
•
To provide quality health care services for common
illnesses to the community
•
To improve availability and access to Basic and
Comprehensive emergency obstetric and neonatal care
(EmONC) services.
•
To involve local community in the management of the
facility
•
•
To develop plans for the sustainability of the services
To share the experience at national and international
levels for replication in other part of the world
28 – 29 September 2011
Vedic Village Spa Resort
Kolkata, India.
•
•
•
•
Situation analysis
Consultation with local community and district government
Signing MoU with Department of Health
Developing implementation strategies
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•
•
•
•
•
Provision of human and material resources
Community involvement
Implementation of user fee
Sustainability plan
Project implementation
Progress review with stakeholders
28 – 29 September 2011
Vedic Village Spa Resort
Kolkata, India.
•
•
•
Standard package of services available at the RHC
Increased outpatient and inpatient volume
Improved coverage of key maternal and child indicators
•
Antenatal care, TT vaccine, skilled deliveries (normal and C-section),
immunization
•
•
•
•
RHC budget available from government
•
•
Health committees active at facility and district level
Implementation of user fee at RHC
Funds available for non-affording patients
Referrals strengthened from primary health care and community
to RHC
Strong relationship with Provincial Health Sector Reform Unit
28 – 29 September 2011
Vedic Village Spa Resort
Kolkata, India.
Challenges
Mitigation Plans
Human resources
(availability & retention)
Provision of hardship allowance for recruitment
and retention
Local politics
Active health committee with diverse membership
Lack of community
awareness, particularly
in Sunni areas
Health education sessions and other awareness
program at community level
Weather
-Promoting and encouraging indigenous way of
transportation of patient
-Presumptive shifting
Poverty
Remission for poor patients
28 – 29 September 2011
Vedic Village Spa Resort
Kolkata, India.
Indicators
2008
2009
2010
Jan-Aug
2011
OPD
2468
4657
5196
3,488
Admission
404
618
761
521
Deliveries
142
165
193
171
Minor surgeries
34
65
120
92
C-Section
0
6
6
5
Ultrasound
362
503
830
627
Lab. Tests
2107
4867
5,664
4,596
B O (%)
27%
29%
38%
36%
28 – 29 September 2011
Vedic Village Spa Resort
Kolkata, India.
Indicators
2008
2009
2010
Jan-Aug
2011
87
115
1732
778
45
24
31
45
37
34
21
15
8
23
5
14
4
To RHC (PPP) from lower level healthcare
From Lady Health Workers
(community level)
From AKHS,P Facilities
From RHC (PPP) to higher level heatlhcare
To Booni Medical Center (secondary
41
facility)
To District Headquarter Hospital
7
To Provincial Tertiary Hospital
1
28 – 29 September 2011
Vedic Village Spa Resort
Kolkata, India.
Description
Operating income
User Fee
Government grant: In cash
Government grant: In kind (Staff
salaries)
Total Income
Operating expenditure
Medical and Surgical Supplies
Support and administrative
AKHS,P Staff Cost
Government staff cost
Total Expenses
Funding Gap (Operating + capital)
Sustainability %
Jan-Dec 2010 Jan-July 2011
PKR
PKR
4,580
2,853
1,333
1,859
2,033
7,946
1,312
6,024
2,101
1,764
4,661
2,033
10,558
(2,990)
75%
1,374
1,248
3,490
1,312
7,423
(1,439)
81%
28 – 29 September 2011
Vedic Village Spa Resort
Kolkata, India.
•
Pooling resources (public and private) can improve health
services
•
Effective involvement of community plays critical role in
PPPs and sustaining services
•
Strong linkages with community health providers
strengthens referrals
•
Improved community awareness enhances the services
utilization
•
Involving communities increases ownership, and therefore
utilization, of health services
28 – 29 September 2011
Vedic Village Spa Resort
Kolkata, India.
KFW team Visit to Shagram
28 – 29 September 2011
Vedic Village Spa Resort
Kolkata, India.
28 – 29 September 2011
Vedic Village Spa Resort
Kolkata, India.