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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