Center for Health Market Innovations (CHMI)

Programs

Initiative on Primary Healthcare (IPH)

last updated Nov 5, 2011

Overview

Implementing organization: 
Punjab Rural Support Organization (PRSP), Lahore
Implementation Partner(s): 
Twelve (12) District Governments in Punjab
Legal Status: 
Public-private partnership
Year Launched: 
2003
Stage: 
Existing/expansion stage
Income Level of Target Population: 
All income levels

Funding

Primary Source of Funding: 
Government
Additional Source(s) of Funding: 
Donor

Scale

Personnel Employed: 
10-49
Number of Clients Served: 
131,998,284 OPD Beneficiaries, 5,107,471 immunizations, 1,598,388 children treated, 9,123,918 females provided medical assistance and 190,888 monitoring visits between 2003 and 2010
Number of Facilities Operated/Networked: 
844 Basic Health Units, 182 Medical Dispensaries
Other Measures of Scale: 
• 4,233,951 patient health sessions; • Coverage by 598 medical officers enhanced through clustering in different health facilities
Summary: 

The programme is designed to ensure smooth and effective management of primary health care facilities (Basic Health Units or BHUs) for efficient delivery of all associated services. The program clusters BHUs in order to ensure the presence of doctors and paramedics and a transparent system of procurement of medicines and equipment. It also puts in place a system of effective monitoring and supervision through facilitation visits whereby target communities are connected with BHUs through support groups. Key components of the program include improved service delivery from BHUs, female health programs, community and school health sessions, availability of preventive as well as promotive health care facilities at the local level.

Key program components: 

Key program components include:

  • Innovative management. The program organizes all basic health units in a district into clusters of two or three to ensure that the distance within a cluster is manageable (no more than 15–20 kilometers). The doctor is the administrative head of a cluster (rather than a single basic health unit) allowing for a higher salary (12,000–30,000 rupees per month), incentivizing the doctor to reside at the focal basic health unit, which is chosen based on residential facilities for the doctor and availability of electricity and water. A project management unit is established in the district and led by a project director and support staff.
  • Customized services. The preventive and curative health services that basic health units are already designated to provide address local health needs, specifically targeting poor women and children. With the introduction of female doctors into the service and additional clinical facilities, the quality and scope of the services have been revitalized.
  • Monitoring system. A monitoring system independent of the district health office is the essence of the initiative. The district support unit is responsible for monitoring, supervision, and data collection. Each health facility is visited at least once a month by the district support manager and executive monitoring.
  • Community mobilization and education. Mobilizing and educating the community is an integral component of the initiative. Support groups for all basic health units have been organized with 20–25 people that meet monthly. These groups have played a commendable role in organizing preventive and promotive activities, solving local issues concerning the BHUs, and providing routine maintenance. Community and BHU-based health education sessions are regularly organized, and healthcare providers visit schools to impart health education to children.

The program was originally launched in district Rahim Yar khan during 2003 and was later extended to districts of Chakwal, Vehari, Lahore, Faisalabad, Sahiwal, Qasur, Mianwali, Toba Tek Singh, Hafizabad, Lodhran and Pak Pattan. In all these cases, MOUs were signed between the Punjab Rural Support Organization (PRSP) and the relevant district governments. These MOUs were meant to protect the terms of employment of BHU staff, ensure uninterrupted implementation of provincial and federal vertical programs, and safeguard transparency, discipline and adherence to appropriate service delivery standards. The initiative has proved to be a success but is now under active review within provincial government for a final decision on its future.

Program history: 

Recognizing the urgent need to strengthen the primary health system in rural areas, the government of Punjab launched a pilot project in the district of Rahim Yar Khan to restructure primary healthcare services by transferring the management of 104 basic health units to the Punjab Rural Support Program (PRSP), a local nongovernmental organization. The initiative’s goal was to drastically reorganize the system by employing innovative management techniques and performance-based incentives, while leaving basic health unit budgets the same. The program introduced several innovations, including recruiting personnel (managers and doctors) at market salaries, enhancing administrative supervision, improving the drug supply, and actively involving the community through support groups. After the encouraging results in Rahim Yar Khan, the project has been replicated in 80 additional districts (out of 120).

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