PUBLIC PRIVATE PARTNERSHIP IN SAFEMOTHERHOOD PROGRAM

Presented by:Bidhya Basnet

WHD

Definition, Introduction, Status,SMNH Goal

Definition: Safemotherhood

• Safemotherhood means creating the circumstances within which a woman is able to choose whether she becomes pregnant and if she does, ensuring that she receives care for prevention and treatment of pregnancy complication, that she has access to train birth assistance, and if she needs it to emergency obstetric care and care after birth to prevent death or disability from complications of pregnancy and childbirth.’

Introduction: Safemotherhood program

• It is the priority one program of Ministry of Health and Population.

• It comprises of significant portion of the national health budget in public sector.

• The program was first started in 1997.• The aim of safemotherhood program is to reduce

maternal and newborn mortalities by addressing the factor related to morbidities, death, disabilities associated with pregnancy and childbirth.

Major activities under safemotherhood program in Nepal

1. Birthprepardness package and MNH activities at community level.2. Rural ultrasound program3. Reproductive health morbidity prevention program

• Uterine prolapse• Cervical cancer screning and prevention training• Obstetric fistula screening

4. Human resource5. Emergency referral fund6. CEONC program7. Safe abortion services8. Obstetric first aid orientation9. Nayano jhola program10. Aama program(Source: Annual health report 2070/71)

Status of Safemotherhood programSN INDICATORS 2070/71

1 % of pregnant women who received TT2 40

2 % of pregnant women who received TT2+ 35

3 % of pregnant women attending first ANC among estimated number ofpregnancies

86

4 % of pregnant women attending at least four ANC visits 59

5 % of pregnant women receiving IFA tablets or syrup during their lastpregnancy

72

6 % of postpartum mothers who received Vitamin A supplements 53

7 % of institutional deliveries 50

8 % of deliveries conducted by a skilled birth attendant 50

9 % of deliveries by caesarian section 6.7

10 % of women who had first post natal care (PNC) visit among estimated live birth

59

11 Maternal mortality rate 190

12 Neonatal mortality rate 23

Status of human resource for health in Nepal

• Nepal was found to have 0.17 doctors per 1,000/population and 0.50 nurses per 1,000/population. This represents 0.67 doctors and nurses per 1,000/population, which is significantly less than the WHO recommendation of 2.3 doctors, nurses and midwives per 1,000/population.

Source: NHSSP, Human Resource for health Nepal Country Profile, August 2013

• The key indicators for this NSMNH-LTP goal are: 1. A reduction in the maternal mortality ratio from

539 per 100,000 live births1 to 134 per 100,000 by 2017

2. A reduction in the neonatal mortality ratio from 39 per 1,0002 to 15 per 1,000 by 2017.

Public Private Partnership in health……..

Public private partnership(PPP) on health

Definition: An agreement between the government

(public sector) and non government (private ‐sector-profit or non profit) for the purpose of delivering health services cost effectively and equitably.

Who may be the partners in health sector

Non state/Private Partners‐• Individual practitioners• Associations of practitioners• I/NGOs• Cooperatives• Community organizations• Civil society networks• Private

companies/association• Private hospitals• Private research institutions

State/Public Partners• MoHP and its agencies• Other ministries• Social insurance• institutions• Local government units• National Research• Institutes/NHRC• Public health education

facilities

Objective of PPP on health

To strengthen public sector and implementation of national health policies.

To enhance equity, efficiency & effectiveness (a major focus of reform)

To reduce both duplication and gaps in health services To promote innovation, and equitable access to the fruits

of innovation To enhance the role of private sector (or non state

agencies) in delivering health services to achieve Millennium Development and Health

Different PPP Models Used in the Health Sector of Nepal

1. Service Contracts2. Management Contract3. Build, Own, Operate & Transfer (BOOT)

a. Build and Transferb. Build, Operate and Transferc. Build, Transfer and Operate

4. Joint Venture5. Leasing6. Contracting + Pay for Performance (P4P)7. Contracting via Social Franchising

Safe motherhood Neonatal Health Long term plan and PPP

• One of the output of SMNH• Purpose: Increased participation of the private

sector, NGOs, community based organizations and professional/academic institutions in SMNH related public services to ensure consumers have equitable access to affordable services.

Role of PPP in safemotherhood program

• Human resource: development of specefice cadre• Awareness raising (disease, tratment and treatment

sites)• Research• Monitoring and evaluation• Supply of commodities and technical support• Capacity building of service provider• Introducing Initiatives and innovation in

safemotherhood program

Development partners contributing to Safemotherhood program in Nepal

• Multilateral organization- UNFPA, WHO, WHO Nepal• Bilateral organizations- GIZ,USAID• International non government organizations- IPAS,

John Snow Research and training institute, Plan international Nepal,Population services international (PSI), United mission to Nepal(UMN),World vision International Nepal(WVIN)

• Non-Governmental organization- Kidasha, Nepal technical assistance group(NTAG), Nick Simons Institute (NSI), Sunaulo pariwar nepal

Activities and partners in SM programSN Activities Partners1 Birthprepardness package and MNH

activities at community level: • BBP and misoprostol project in 41

district• Pregnant women groups, health watch

groups, health mother reactivation, child clubs, women group, husband and mother in law orientation on danger signs and complication.

• FCHV training on BCC/IPCC session• Orientation of traditinal healers• Community mobilization on equity and

access• District communication strategy,

mHealth, local FM radio

UNICEF, UNFPA, UMN, PLAN, H4L, CARE

Cont…….SN Activities Partners

2 Rural ultrasound program: objective of rural ultrasound program is to timely identify complications during pregnancy and refer to the appropriate health facility for complication management.

MoHP and Nepal health sector support program (NHSSP)One heart one world in Dhading

Cont….

SN Activities Partners3 Reproductive health

morbidity prevention program: uterine prolapse, cervical cancer screening and prevention training, obstetric fistula

Cervical cancer screening program using VIA: three training sites viz. BPKIHS-Dharan, BPKMCH-Chitwan, Kathmandu model hospitalObstetric fistula operation has been initiated in Patan hospital, kathmandu model hospital, BPKIHS and Bheri Zonal hospital(technical support isprovided from JPIEGO Nepal and financial support was given by UNFPA.)

Cont……SN Activities Partners3 Human resource:

•On-site coaching and support•DGO training•ASBA training•OT management training•SBA training:5850•Midwifery faculty and training development•Obstetric first Aid training at all level

NHSSF, NSI, UNICEF, UNFPA, GIZ, MIDSON

Cont……SN Activities Partners3 Emergency referral fund CARE Nepal, Plan

Nepal, UNICEF, SUAAHARA

4 CEONC program expansion: 56 districtCEONC service providers recruitmnet supportCEONC fund use and functionality monitoring introduced

Nick simon Institute, UNICEF

5 Safe abortion services Sunaulo pariwar Nepal, IPAS, CREPHA,

Limitation in PPP• Unclear government policy on partnership• Quality assurance and coordination :• Lack of clear policy and support mechanism on

community initiatives in health service delivery.• Weak regulatory regimes to monitor private health sector• Weak capacity of Government• Lack of a research and information base on the dynamics

of private sector• Lack of a policy framework for promoting private health

sector

References

• Annual Health report 2070/71• Proceeding Report,2015 Family health division• http

://www.nhssp.org.np/pulse/Pulse%20Rural%20USG.pdf• http://

www.nhssp.org.np/about/NHSSP%202%20Policy%20Document.pdf

• http://www.nhssp.org.np/human_resources/HRH%20profile%20(QA).pdf

• http://www.nhssp.org.np/human_resources/HRH%20profile%20(QA).pdf