1. Recommendations for Improving Reproductive Health in Punjab
Review of the Punjab Health Sector Strategy

2. Punjab Health Sector Strategy (PHSS) 2012 – 2020 Approved in February 2013
Strategic Direction
Achieve universal coverage of health services
Focus on Primary Healthcare
Improve Quality of care
Mainstreaming private sector health services
Redefining the Government’s role to one of facilitator
Strengthening of institutional collaborations

3. Comprehensive Reproductive Health care includes(1)
Counseling, information, education, communication and clinical services in family planning;
Safe motherhood, including antenatal care, safe delivery care (skilled assistance for delivery with suitable referral for women with obstetric complications) and postnatal care, breastfeeding and infant and women’s health care;
Gynaecological care, including prevention of abortion, treatment of complications of abortion, and safe termination of pregnancy as allowed by law;
Prevention and treatment of sexually transmitted diseases (including HIV/AIDS), including condom distribution, universal precautions against transmission of bloodborne infections, voluntary testing and counselling
Prevention and management of sexual violence;
Active discouragement of harmful traditional practices such as female genital mutilation; and reproductive health programmes for specific groups such as adolescents, including information, education, communication and services.
1- Reproductive Health Indicators - Reproductive Health and Research Guidelines for their generation, interpretation and analysis for global monitoring - World Health Organization 2006

4. Reproductive Health Strategies identified in the PHSS 2012-2020

5. Focus and strengthen MNCH, family planning and nutrition services at all levels as part of Essential Package of Health Services (EPHS).
Integrate all MNCH, family planning and nutrition activities at community and primary health facility level as part of Essential Package of Health Services (EPHS).
Create referral backup for community-level health workers, like CMWs to cater maternal complications
Strengthen routine immunization services for full immunization of all children and women
Provide family planning services through uninterrupted supply of family planning commodities to all the primary and secondary level health facilities and outreach workers
Upgrade a minimum of one third of the BHUs to BHU-plus model for delivery of services on 24/7 basis in 20 low performing districts
Ensure full package of 24/7 Basic EmONC services at all RHCs and develop RHCs as hub of primary health care system; with services, management and supervision support fanning out to the adjoining BHUs

6. Focus and strengthen MNCH, family planning and nutrition services at all levels as part of Essential Package of Health Services (EPHS).
Upgrade RHCs to RHC-plus model for provision of 24/7 Comprehensive EmONC services in each of 20 low performing districts of Punjab
Upgrade and strengthen all THQ and DHQ hospitals to provide full package of 24/7 Comprehensive EmONC services, including neonatal intensive care units with qualified staff
Upgrade, strengthen and realign all tertiary care level hospitals to cater MNCH related management and referral
Institute mass and interpersonal communication focusing key issues of MNCH, family planning and nutrition
Conduct training of staff at all levels on Integrated Management of Newborn and Childhood Illnesses (IMNCI) with a functional follow-up after training mechanism

7. Strengthening of Nutritional services for mothers and children as part of EPHS
Integrate nutritional services in pregnancy care both at health facilities and through outreach workers and provide management of severe acute malnutrition in targeted health facilities.
Ensure availability of nutrition supplements and build capacity of healthcare providers, both public and private, on nutritional assessment and management of malnutrition
Protect all pregnancies through provision of micronutrient supplements including iron, calcium, zinc, vitamins and folic acid

8. Integration of preventive healthcare (vertical) programmes
Ensure functional and managerial integration of vertical programmes under EPHS at primary level and for the interim period regroup programmes having common objectives.
Optimize healthcare service delivery arrangements through adopting integrated models, like SRH-HIV and family planning service for reproductive health

9. Areas for Improvement
The budgetary allocations present no prioritization for correcting reproductive health situation
Budgetary allocation focuses on structural actions such as building infrastructure.
Demand generation i.e. stimulating health seeking behaviour, is ignored.
Phasing of interventions is not described.
Contents (and their prioritization) of Essential Package of Health Services (EPHS) are not defined.
Annual targets and operational plans to achieve targets are missing.
LHW Programme - one of the largest vertical programs focusing on MNCH and family planning has not been discussed in the strategy
Capacity building initiatives for community outreach workers such as the LHWs or the CMWs are not well defined

10. Areas for Improvement Missing Reproductive Health issues:
Safe abortions
Youth Reproductive health
Reproductive Health education
Rights based approach

11. Recommendations
An integrated approach to Reproductive Health through Interdepartmental coordination and planning including departments of Population Welfare, Education, Women Development, Planning & Development, Human Rights, Social Welfare and Law.
Scaling Up, to poor districts, of :
Health cards by Punjab Health Sector Reform Program(PHSRP)
Chief Minister’s Health Initiative for Attainment and Realization of MDGs (CHARMS)
Protect and advance women’s reproductive health rights by strengthening the legal frameworks in Punjab
Health education to raise awareness about sexual and reproductive health & rights in the province.

12. Recommendations Focus on adolescent and youth reproductive health
Include safe abortions and post abortion care in health strategy.
Gender based Violence be made part of health strategy, including identification, management and referral of GBV cases.
Prioritization and strengthen reproductive health and family planning services including counselling and referrals by LHW and MNCH Programmes.
Contracting out government services, in case of low utilization and closing down of underperforming public facilities
Income pro-rated payments (i.e. no fees or subsidized payments from the poor based on their income and more complete payments from more affluent users of health services) for services at public sector facilities and allow facilities to retain the user fees they collect.

13. Recommendations
Create performance standards and performance related incentives for both facility and outreach workers to provide reproductive health services.
Partnering with private sector and donors to improve supply and uptake of reproductive health services in rural and remote areas
Strengthen information management and logistics systems to minimize stock outs for family planning and reproductive health commodities.
The strategies must be followed by SMART (Specific, Measurable, Attainable, Relevant, Time-bound) action plans.

14. Immediate Actions Recommended
Formation of Inter-departmental Coordination Mechanism for Reproductive Health.
Acknowledge and address Youth as a specific demographic group in Health policy and strategy.
Gender based Violence be made part of health strategy, including identification, management and referral of GBV cases.
Health education to raise awareness about sexual and reproductive health & rights in the province.

15. Thank you