Supervision System a Key Link to Productivity and Quality I will be presenting the GS experience of supportive supervision which is a key link to improve provider productivity GREENSTAR SOCIAL MARKETING PAKISTAN Dr Aleya Ali

CONTENT Country Demographics Greenstar Network Product & Services Objectives Support supervision Results Lesson Learnt The content of the presentation listed as

Pakistan: Country Demographics 188 million to 300 million by 2020 Growth rate 2 % and Total Fertility Rate 3.8 Contraceptive Prevalence Rate: 35% (26% modern methods) Large Unmet Need 20% Stagnating CPR Government goal is to double CPR by 2020 Women want to adopt FP but face socio cultural hurdles Pakistan is a country of 188 million people which will increase to 300 million by year 2020 with a current growth rate of 2%. TFR declined by 0.3 from 4.1 in 2006-07 to 3.8 in 2012-13. This means that now on average a Pakistani woman will now give birth to 3.8 children during her entire reproductive period. Inspire of slight decrease in TFR in last 6 years, still TFR in Pakistan is much higher than TFRs in other countries of the region which according to UN estimates range from the lowest 1.59 in Iran to the highest 2.59 in Nepal. CPR is 35 % & Current use of modern FP methods as shown in Preliminary report of PDHS 20012-13 is 26.1% PDHS : 2012-13

GREENSTAR NETWORK - Social Marketing Covering 107(134districts) districts of Pakistan through Social marketing 135 Sub distributors 400 Sales force 54,000 FMCG: retail outlets carrying condoms 21,000 Pharmacies and Medical stores GS has a network of commercial distribution setup & clinical SF outlets . The commercial outlets coverage is 79% of the districts for product availability through retail & medical stores

GS NETWORK – Social Franchising Covering 96 (134 districts) districts of Pakistan through Social franchise 7200 GS Trained providers 56 Trainers (Doctors) 90 Medical detailers 400 Community mobilizers Clinical social franchise covers 7 0 % of the districts with the over 7000 network providers

PRODUCTS & SERVICES CONDOMS PILLS INJECTABLES IUCDs IMPLANTS VSC WATER PURIFICATION TB DOTS

Objective To improve access, productivity and quality of long term contraception Greenstar selected 1874 out of 7200 provider network for a two year project Greenstar has a large network of providers and there is varying level of productivity in terms of clientele and quality of care service . To improve access to long term contraceptive methods and there by increasing the productivity and quality provider network , Greenstar selected 1874 franchisees out of its 7000 plus network, for a two year improvement project (Apr’11-Apr’13).

Supportive Supervision These providers were given maximum support Technical Support Supervision (1 medical trainer responsible for 45 providers) Community mobilization Product detailing & promotion 200 providers were trained in post placental IUCD. These providers were given maximum support monthly quality visit & quarterly assessment by a group of medical doctors. The provider vs technical assistance ratio is 45 providers per technical support. The providers were visited monthly & quality assessments were done each quarter Demand generation by community mobalizers for a six month period promotion & product detailing by medical detailers. To further enhance the productivity some selected providers with maternity homes were also trained in Post placental IUD technique

RESULTS The way we want to measure is to see the provider productivity data before and at the end of the project . The forthcoming slide will be showing the IUCD insertion & PPIUCD

Provider Productivity AT the start the provider monthly insertion average was under 3 which more then double to above 6 per month

Provider Productivity In Post placental insertion there was 6 provider trained at the begning with a an average monthly insertion of less then when to 212 providers with an average insertion of above 3 per month

Quality of care The over all score of the QOC was 63 % which improve to 74 % and some quality indicators who were already better but there was a marginal increase

LESSONS LEARNT In clinical work provider need ongoing support & encouragement. Product availability for continuity of services SF key contribution is in strengthening private care provision Women FP methods uptake is highly dependent on clinical SF services Greater efforts are required to motivate private sector to proactively provide FP services Provider needs ongoing support & encouragement to maintain there clinical quality like infection prevention, record maintenance etc. Although not shown in the result but the consistency of product availability improves service delivery Govt is not doing enough for the Quality of C are service of the private sector & regulation are weak so NGOs key contribution is strengthening private sector service provision a FP services provision culturally a sensitive issue & cannot be advertised & it is also a low profit margin services for the providers & the for private sector the business contribution is 5-10% so it is vital to have greater efforts by the provider for the fp services adoption

QUESTIONS?