28 – 29 September 2011 Vedic Village Spa Resort Kolkata, India. Dr. Zafar Ahmed General Manager Aga Khan Health Services, Pakistan

28 – 29 September 2011 Vedic Village Spa Resort Kolkata, India. Rural Health Center, Shagram Facility constructed by government No staffing Limited quality Serves population of 48,000 Secondary healthcare facility Remote and isolated

28 – 29 September 2011 Vedic Village Spa Resort Kolkata, India. 1.Total Population of Torkhow Tehsil 32,000 2.Adjacent population of Mulkhow Tehsil 16,000 3.Child Bearing Age Women (CBAs) 8,640 4.< 5 Years Children 7,680 5.< 1 Years Children 1,680 Demographic Data

28 – 29 September 2011 Vedic Village Spa Resort Kolkata, India. Integrated PPP between government and NGO Government provides facility, budget, and some human resources AKHS,P: manages the facility ensures supplies and medicine strengthens human resources (particularly female doctors and nurses) includes community participation District Advisory Committee

28 – 29 September 2011 Vedic Village Spa Resort Kolkata, India. Department of Health Government of Khyber Pakhtunkhwa, Pakistan Aga Khan Health Service, Pakistan District government Local community

28 – 29 September 2011 Vedic Village Spa Resort Kolkata, India. To provide quality health care services for common illnesses to the community To improve availability and access to Basic and Comprehensive emergency obstetric and neonatal care (EmONC) services. To involve local community in the management of the facility To develop plans for the sustainability of the services To share the experience at national and international levels for replication in other part of the world

28 – 29 September 2011 Vedic Village Spa Resort Kolkata, India. Situation analysis Consultation with local community and district government Signing MoU with Department of Health Developing implementation strategies Provision of human and material resources Community involvement Implementation of user fee Sustainability plan Project implementation Progress review with stakeholders

28 – 29 September 2011 Vedic Village Spa Resort Kolkata, India. Standard package of services available at the RHC Increased outpatient and inpatient volume Improved coverage of key maternal and child indicators Antenatal care, TT vaccine, skilled deliveries (normal and C-section), immunization RHC budget available from government Implementation of user fee at RHC Funds available for non-affording patients Referrals strengthened from primary health care and community to RHC Health committees active at facility and district level Strong relationship with Provincial Health Sector Reform Unit

28 – 29 September 2011 Vedic Village Spa Resort Kolkata, India. ChallengesMitigation Plans Human resources (availability & retention) Provision of hardship allowance for recruitment and retention Local politicsActive health committee with diverse membership Lack of community awareness, particularly in Sunni areas Health education sessions and other awareness program at community level Weather-Promoting and encouraging indigenous way of transportation of patient -Presumptive shifting PovertyRemission for poor patients

28 – 29 September 2011 Vedic Village Spa Resort Kolkata, India. Indicators Jan-Aug 2011 OPD ,488 Admission Deliveries Minor surgeries C-Section0665 Ultrasound Lab. Tests ,6644,596 B O (%)27%29%38%36%

28 – 29 September 2011 Vedic Village Spa Resort Kolkata, India. Indicators Jan-Aug 2011 To RHC (PPP) from lower level healthcare From Lady Health Workers (community level) From AKHS,P Facilities From RHC (PPP) to higher level heatlhcare To Booni Medical Center (secondary facility) To District Headquarter Hospital To Provincial Tertiary Hospital1854

28 – 29 September 2011 Vedic Village Spa Resort Kolkata, India. DescriptionJan-Dec 2010Jan-July 2011 Operating incomePKR User Fee 4,580 2,853 Government grant: In cash 1,333 1,859 Government grant: In kind (Staff salaries) 2,033 1,312 Total Income 7,946 6,024 Operating expenditure Medical and Surgical Supplies 2,101 1,374 Support and administrative 1,764 1,248 AKHS,P Staff Cost 4,661 3,490 Government staff cost 2,033 1,312 Total Expenses 10,558 7,423 Funding Gap (Operating + capital) (2,990) (1,439) Sustainability %75%81%

28 – 29 September 2011 Vedic Village Spa Resort Kolkata, India. Pooling resources (public and private) can improve health services Effective involvement of community plays critical role in PPPs and sustaining services Strong linkages with community health providers strengthens referrals Improved community awareness enhances the services utilization Involving communities increases ownership, and therefore utilization, of health services

28 – 29 September 2011 Vedic Village Spa Resort Kolkata, India. KFW team Visit to Shagram

28 – 29 September 2011 Vedic Village Spa Resort Kolkata, India.