Monitoring Helps Services to Reach the Poor

Kamal Biswas UPHCP II, HLSP ( presenter)

M Kabir, UPHCP II, HLSP

A.B. Siddique, UPHCP II, PMU

Sharmin Mizan, UPHCPII,PMU

Urban Primary Health Care ProjectUPHCP in Bangladesh

• Ministry of Local Govt. launched UPHCP I in 1998 in collaboration with ADB

• Second Urban Primary Health Care Project started in 2005 with ADB, DFID, UNFPA

• UPHCP II ends on Dec 2011

• Area: 11 City/townships

• Population: 10 m approximately

Core policy

• Public Private Partnership for service delivery

• Reimbursable finance mechanism

• User fees

• 30% of each service free to poor

• ESP plus services (CS operation, eye care)

• Sustainability fund

• Contracted out Management Services

Mother and new born

Management

• Executing agency – Local Govt. Division of MoLGRD&C: Project Management Unit (PMU)

• Local supervision: Project Implementation Unit of City Corporation/ municipality health department

• Service Delivery : Partner NGOs/ Health departments

• Monitoring Firm: PPME (HLSP)

Objective of the study

• Assess the situation of coverage of institutional delivery for the poor over a period of 2005 to 2009.

• Define policy inputs helping the poverty related target.

Methods

• Data of the institutional deliveries in 24 maternal hospitals were taken from Health Management Information System (HMIS).

• Descriptive analyses were undertaken to see the changes over the time.

• HMIS data quality is assured through regular monitoring with a systematic approach.

Findings

Trend of delivery coverage for poor in UPHCP Hospital in Dhaka

05

1015202530354045

2005 2006 2007 2008 2009

Year

perc

ent o

f poo

r del

iver

ed in

CR

HCC

DCC PA 1

DCC PA 2

DCC PA 3

DCC PA 4

DCC PA 5

DCC PA 6

DCC PA 7

DCC PA 8

DCC PA 9

DCC PA 10

Percent of poor for UPHCP Hospital delivery in Dhaka

PAs 2005 2006 2007 2008 2009

DCC PA 1 0.9 1.3 4.7 13.6 20.1

DCC PA 2 0 0.3 0 12.5 26.8

DCC PA 3 0 0 0.4 21.6 39.7

DCC PA 4 0 0 0 20.2 23.5

DCC PA 5 0 0 1.9 15.4 34.4

DCC PA 6 0 0 0.7 18.8 25.1

DCC PA 7 20 15.2 28.5 39.6 34.2

DCC PA 8 0 1.7 6.4 20.6 24.8

DCC PA 9 0 0 4.6 22.1 29

DCC PA 10 0 0 3.5 11.6 29.9

Average 2.09 1.85 5.07 19.6 28.75

Findings

Trend of delivery coverage for poor in other CC & DMs

0

5

10

15

20

25

30

35

40

45

2005 2006 2007 2008 2009

Year

per

cen

t

CCCPA1

CCCPA2

CCCPA3

RCCPA1

RCCPA2

KCCPA1

KCCPA2

SCCPA1

BCCPA1

BogM PA 1

ComM PA1

MaM PA1

SavM PA1

SriM PA1

Avearge

Percent of delivery for poor in UPHCP Hospitals in 14 Other cities, municipalities

PAs 2005 2006 2007 2008 2009

CCCPA1 0 0 0 13.7 26.3

CCCPA2 3.1 2.7 5.7 18.5 21

CCCPA3 0 0 4.3 6.6 23.5

RCCPA1 0 0 17.3 13.9 27.4

RCCPA2 0 0 0 15.3 25.6

KCCPA1 0 0 3 17 38.5

KCCPA2 0 0 10.8 20.5 31.5

SCCPA1 0 0 1.3 23.8 23.8

BCCPA1 0 0 2.6 18.5 28.7

BogM PA 1 0 0 11.1 27.3 38

ComM PA1 0 0 5.2 42.3 31.8

MaM PA1 0 0 3.9 12 20.8

SavM PA1 0 0 19.5 21.6 20.8

SriM PA1 0 0 0 28.5 33.5

Average 0.22 0.19 6.05 19.64 27.94

Learning

• Pro-poor policy should be supplemented by strategies such as the entitlement card.

• Pro-poor policy frame may not work alone. Regular monitoring with specific pro-poor indicators drives providers to reach maternal services to the poor.

• Professional monitoring helps to improve performance and reach the poor.

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