Dr.Shereen Narejo Program Officer-Health SDSSP, Finance Department August 22, 2005 Improving Social Services Delivery To Achieve MDGs

Introduction State of Social services in Pakistan (Sindh). Government Initiative. Sindh Devolved Social services Program (SDSSP). Way Forward.

Crises in Social Services The Social services outcome are worse than countries of comparable income level. Uneven and inequitable distribution of Health and Education. Poor quality and accessing them is costly. Decreased Demand of Public services.

Cause and Effect: Reasons for poor quality Cause: Weak management and supervision Insufficient Budget. Weak Public demand. Effect: Underused Facilities, Absenteeism, Run down facilities etc. Result : Poor Quality services

Agenda for Change (Devolution) Response to declining level of Public Service Delivery over the years. Giving Powers at Grass root levels to plan and execute. SLGO 2001 provides devolution of Health, Education, Water & Sanitation Sector beside other 09 function. Involvement of people in decision making.

How to Improve Social Services (Road Map) Realigning Provincial Policies to LGs to achieve Results. Building Sector Approach for using all available resources to achieve results. Improved Budget Processes. Using Conditional Grants to Improve performance. Integration of Vertical Programs. Stimulating Demand of Public Services.

SDSSP Initiative ADB funded Program for improving Social Services Delivery in Education, Health and water and sanitation sector to achieve desired results as reflected in PRSP and MDGs. Program is spread over three years started in year

Objectives (i) Strengthen sector and program management and monitoring (ii) Develop Local Governments’ and CBO governance capacity in social services (ii) Support sector work on specific policy reforms to improve sector performance

Scope of the program To create fiscal space with US$ 110 Million by retiring most expensive loans.(Rs.1 bn over three years). To improve Social Service delivery by providing US $ 100 Million as budgetary support to districts and TMAs in Health, Education, Water & Sanitation sectors through PFC. Institutional development of the DGs and PLDs with the Technical Assistance

SDSSP Approach To access SDSSP funds District Governments are required to prepare Annual Sector Plan. Ensure incremental budget raise in health education and water sanitation. Encouraging Participatory approach in sectoral planning. Involvement of CBOs and Civil Society in `sector development. Performance based incentives.

Annual Sector Plan Main Features: a. Current sector analysis b. Total revenues & expenditures c. All other initiatives being taken in the sector d. Total requirement for sector improvement e. Priorities for improving the devolved service

SDSSP Financial Assistance S.No.NAME OF DISTRICTHEALTHEDUCATIONTOTAL HYDERABAD BADIN THATTA DADU SUKKUR KHAIRPUR GHOTKI NAWABSHAH MIRPURKHAS LARKANA THARPARKAR SANGHAR SHIKARPUR JACOBABAD NAUSHEROFEROZE KARACHI 0.00 TOTAL %54%

SDSSP Contribution to Health Sector (To Reduce MMR) Strengthening of Basic Health Services specially MCH services at all levels of District. Providing equipments and Ambulances at DHQ and THQ. Recruitment of staff specially female medical and para medical staff. Introduction of safe motherhood program at Thatta.

SDSSP Contribution to Health Sector (To Reduce IMR) Strengthening immunization services through Vaccines, Cold chain etc. Providing motor cycles and quinchi Richshaw for use of LHWs in Rural areas. Recruitment of staff specially female vaccinators, LHVs. Financing in Awareness campaign.

Achievements DGs prepared Annual sector Plan. Sufficient budget was made available to districts. Successful in developing Synergetic Approach. 40% amount has been utilized by within 06 months. Public Private Partner Ship encouraged.

Challenges Non availability of comprehensive data base. Lack of Technical Capacity at every level of Planning in DGs. Integration of Vertical Programs. Governance. Commitment Continuity

Way Forward Building Capacity through TA funds worth($7.3m). Improving Sectoral Planning Process. Community Participation through initiative of Public Private Partnership, funding through CBOs Placing M&E framework, Participatory Planning. Encouraging dialogue with all stakeholders specially donors.

Thanks