LAHORE
Punjab has lost Rs 2.381 billion Health Results Innovation Trust Fund (HRITF) grant, following a lamentable performance in implementing Rs 12.751 billion Punjab Health Sector Reform that resulted in restructuring the program in April 2017, documents available with Pakistan Today revealed.
HRITF was to be used with a programmatic approach in supporting the implementation of Punjab government strategic sectoral plans. The project was also supported by Rs 2.381 billion from HRITF with an in-built impact evaluation to implement the results-based financing (RBF) and health care financing (HCF) pilots.
The program was approved in March 2013 and restructured in order to ensure that it may help achieve the required objectives in Punjab health sector. The restructuring lead to change, including addition of a new component to strengthen the Punjab government’s response to addressing a persisting high burden of stunting and malnutrition and addressing the slow reduction of the fertility rate
The restructuring also escorted 7 disbursement-linked indicators which, the documents say, no longer remained relevant due to changes in policy directions and 3 links have been changed to strengthen related activities.
The poor performance steer change in implementation arrangements by expanding the number of implementing agencies to three besides changing financial management and procurement arrangements to allow for the three entities; disbursement into three designated accounts components.
Change of (eligible) expenditure category for nutrition interventions to Interim Financial Reports(IFR) based payments; reallocation among the eligible expenditure categories; and revision of the results framework.
Documents mention that 5 components have been hanged back now; $ 31.58 Improving Health Service Delivery, $ 10.80 Enhancing Efficiency and effectiveness of the Health System, $ 10.80 Strengthening Provincial Department of Health management capacity, $ 9 Improving the Capacities in Technical Areas for Equitable Health Services for All and $ 37.82 Strengthening Nutrition Interventions.
The management reforms have been lagging; including contracting/ outsourcing, restructuring of the Directorate General Health Services (DGHS), fiduciary, and monitoring and evaluation (M&E). These reforms have mostly been discarded by the departments of health as IT-based systems for monitoring and division of the health department into two entities has been undertaken.
There were some areas which were found lagging like refresher training for nutrition, nutrition guidelines, LHWs evaluation etc. which were still pending as of January 2016, mainly as a result of significant changes in the reform context in the health sector in Punjab and with respect to the institutional arrangements in the DOH.
The conditions on which this restructuring has been undertaken are: i) continue with intervention areas which are showing good progress; ii) enhance efforts on areas which are a high priority, and iii) drop activities which due to policy changes are no longer relevant to the reform agenda. To ensure effective monitoring of the project, mechanisms between the Bank and Punjab government agreed are: i) revamping of the Project Steering Committee to enable better coordination between the two bifurcated Departments, and ii) the alignment with and utilisation of the Roadmap.
