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2ND URBAN PRIMARY HEALTH CARE PROJECT Local Govt. Division, Ministry of LGRD&C

BANGLADESH

Dr. Md. Sarwar Bari

26-28 March 2012 Colombo, Sri Lanka

Deputy Secretary & Deputy Project Director 2nd Urban Primary Health care Project Local Govt. Division, Ministry of LGRD&C 1 Bangladesh

BACKGROUND

Urban Primary Health Care Project is a unique, innovative and remarkable project in Bangladesh for delivering affordable Quality PHC and RH care to urban poor , particularly women and Children The 2nd Urban Health Care Project is a continuation of successful first phase of the project which started in 1998 and ended in June 2005 This project is a pioneer in implementation of public private partnership (PPP) model and pro-poor targeting in primary health care & maternal health sector of Bangladesh Executing Agency: Local Government Division Implementing Agencies: City Corporations and Municipalities Service providers: Partner NGOs Project Period: 7 years (July 2005-June 2012) (with 6 months no-cost extension)
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Goal of the Project

The goal of the project is to improve the health status of the urban population, especially the poor, women and children through improved access to and utilization of efficient, effective and sustainable primary health care (PHC) services.

The Specific Objective of 2nd Urban Primary Health Care Project is to improve

Access to and use of urban PHC services in the project area, with a particular focus on extending provision to the poorest The quality of urban PHC services in the project area The cost-effectiveness, efficiency, and institutional and financial sustainability of PHC to meet the needs of the urban poor

OUTCOME & OUTPUT

Outcome: Improved access to and use of efficient, effective and sustainable good quality primary health care (PHC) services for the urban poor in project areas, with a particular focus on women and girls. Outputs: 1. Provision of PHC through Partnership Agreements & Behavior Change Communication and Marketing (BCCM ) 2. Urban Primary Health Care Infrastructure & Environmental Health 3. Building Capacity & Policy Support for Urban Primary Health Care 4. Project implementation and operationally relevant research
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Pro-Poor Targeting and PPP Approach

At least 30% of each service will be provided free to the poor, identified through participatory poverty assessments and household listings.

The poor are provided free services, including free medicines. For the nonpoor, sliding user fees is charged and drugs are made available at 1020% lower than market price.
Poor households were identified based on the social and economic indicators. These households were given entitlement health cards giving them free access to health services under the Project. The survey of the poor households will be updated annually by the partner NGO. Project has a unique implementation strategy, a PPP approach, using NGOs 6 and private sector for service delivery through partnership agreements.

GENDER ACTION PLAN

Activities, Indicators and Targets
Activity: Identify poor through poverty assessments and household listings and ensure services to them. Indicators: Project beneficiaries increased from 30% to 60% (70% women & children) from project baseline to end. 30% of each service provided to poor women and men

TO IMPROVE ACCESSIBILITY AND AFFORDABILITY OF PHC SERVICES TO POOR WOMEN AND CHILDREN (OUTPUT 1)

Achievement
Yearly contact (patient flow in health care facility in the project area) increased 361% in 2010-11 from 2005-06 (Number of red card holder household was 236,492 in 2007 and 352,088 in 2011)
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GENDER ACTION PLAN

Activities, Indicators and Targets
Activity: Provide 30% of each service free of cost to the poor women, men and children. Indicators: At least 30% of each service provided to urban poor of which women and children will constitute at least 75%.

(OUTPUT 1)

Achievement
Pro-poor targeting was 40% in 2010-11, 30% in 2005-11 (Women 78%, Children 21%) ( number of poor patient 42.3 M, 16.2 M card holder) 948% counseling increased in 2011 from baseline (2005). End line survey is8 required for

Activity: Counseling of parents and adult members of households on safe delivery Indicators: More than 10% reduction in morbidity and mortality among women and children from project baseline to the end.

GENDER ACTION PLAN

Activities, Indicators and Targets
Activity: Access to basic curative services. Indicators: Proportion of women and girls accessing basic curative services is at least 60%.

(OUTPUT 1)

Achievement
Among the service recipients accessing basic curative services, the proportion of women and girls is around 80% 275% increase in safe deliveries in hospitals or health care clinics in 201011 compared to 2005-06 baseline 9

Activity: Counseling and motivation to husbands and household adult members to ensure safe deliveries for women Indicators: Increased delivery at health care institutions from project baseline to the end is more than 20%.

GENDER ACTION PLAN

Activities, Indicators and Targets
Activity: Counseling and motivation to husbands and adult family members for postnatal care. Indicators: More than 40% of the PNC service recipients received services and the under-five mortality rate decreased towards the target level of 60%.

(OUTPUT 1)

Achievement
891% counseling increased in 2011 from baseline (2005). 166,496 service contact of PNC increased in 2011 from 21,813 service contact in 2005, which is 8 times more.
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GENDER ACTION PLAN

Activities, Indicators and Targets

(OUTPUT 1)

Achievement

Activity: Conducting awareness session, door to 2,280 session (11,983 door counseling, ensure condom supplies. participant) Indicators: At least 6,000 awareness sessions conducted/PA/ conducted yearly by each PA on promotion of year Assessment survey condom use by male partner; Condom user is required for rate by male partner during sex with noncondom use regular partners increased by 10%-15% every rate. year
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GENDER ACTION PLAN

Activities, Indicators and Targets
Activity: Conduct training for staff on gender based violence. Indicators: 100% of PHCCs & CRHCCs has at least 2 trained staff on gender based violence;

(OUTPUT 1)

Achievement
175 concerned staffs of PMU, PIU, CC, MC, PHCC & CRHCCs in 7 batches received training on VAW by MS&T Firm; 55 female Ward Counselors from 24 PAs received training by BCCP Firm.
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GENDER ACTION PLAN

Activities, Indicators and Targets
Activity: Promote women and baby friendly health care infrastructure facilities (breast feeding
corner, separate toilet etc for both service provider and recipient)

(OUTPUT 2)

Achievement
Within the client flow around 78% to 80% are female and 20% to 22% are male

Indicators: More than 75% women and children and 25% men received services due to improved infrastructure from project baseline to the end. Activity: Promote women & User friendly Community Toilets. Indicators: At least 50% of the toilet blocks are reserved for the use of women.

50% of each toilet blocks are reserved for women 13

GENDER ACTION PLAN

Activities, Indicators and Targets
Activity: Recruitment and Management Indicators: Women constitutes 30% of the management position and 50% of health service providers.

(OUTPUT 3)

Achievement
30% (managerial) More than 70% (service providers)

Activity: Training Indicators: Women represent 50% of in-country training courses; Women represent 30% of out-country training courses.

60% (in-country) 20% (out-country)

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GENDER ACTION PLAN

Activities, Indicators and Targets

(OUTPUT 3)

Achievement

WPHCC formed Activity: Institutional Arrangement and headed by Ward Management for GAP Councilor and coIndicators: 100% GAP activities implemented; At Chaired by female least 30% women members in all WPHCC; ward councilor. 3 women member Women chairs at least 30% of WPHCC; All the from slum dweller user forum have at least 50% women members and poor group including poor and non-poor. are included. User Forum formed with both poor and non-poor maintaining 15 gender equity.

GENDER ACTION PLAN

Activities, Indicators and Targets
Activity: Promote gender inclusive M&E, research. Indicators: All project related tools, formats, documents are maintained with sex disaggregated manner.

(OUTPUT 4)

Achievement
MIS report from the partner NGOs include gender disaggregated data. The Quarterly Performance Report of the project shows the gender distribution of beneficiaries. 16

ACHIEVEMENTS
Improving Womens Employment & Leadership in Health Sector The project provides employment opportunity to a large number of female medical technocrats and other professionals covering a target population of 8 million Women have attained leadership positions through partnership agreement Improving Accessible and Affordable Health Care Services The project has constructed its own health infrastructure facilities (CRHCC- 09 no. and PHCC- 116 no.) within the close proximity of the poor Poor households particularly women saved time and money having access to health care services close to their homes 30% of essential PHC services provided free of charge Significant effort in BCCM in poor urban communities

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ACHIEVEMENTS
Improving the Capacity of City Corporations/municipalities and their partners to strengthen the capacity of local governments to plan, provide, finance, monitor and manage urban PHC services
Strengthen the women and baby friendly urban PHC infrastructure through construction of 125 no. health care facilities near slums Considerable number of training programs conducted on specific topics in urban PHC for service providers, cc/municipalities and PMU staffs Gender equity in in-country training programs; study tours and out-of country training and fellowships provided in PHC management, health financing and health management information systems (MIS) Gender inclusive MIS has been developed in the project and sex disaggregated data are available
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IMPACT

Present data (2005 vs. 2011) show impact on poverty reduction by improving the health condition of the poor urban women and children by More than 90% Immunization coverage 76% Knowledge on PHC and family planning Reduction in common diseases More than 60% Prenatal and around 33% post-natal checkups etc (project MIS data shows total number of ANC increased 6 times and PNC increased 8 times since 2005)
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CHALLANGES & SOLUTIONS

Ward Primary Health Care Coordination Committee members are not well informed on their roles, responsibilities and obligation Suggestion: Hold meetings/workshops to clarify the project aspects among all stakeholders including women and BCC to be strengthened Majority of the contraceptive users are women Suggestion: Organize partner counseling and male contraception to be

encouraged

Most of the NGO staff is not adequately gender sensitized Suggestion: Organize gender sensitization training with series of refresher courses Suggestion: Include gender and development issues in all training courses

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CHALLANGES & SOLUTIONS

Difficulties in timely availability of logistics and equipment that hampers the service delivery to women, children Suggestion: Ensure timely supply of logistic and equipment Lack of adequate gender and child friendly infrastructure with sufficient space both for service providers and service users Suggestion: Construct more gender and child friendly infrastructure addressing the needs of both service providers and service users Shortage of female staff at management level Suggestion: Recruit and deploy female staff at management level
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