RAWALPINDI, Dec 18: The Punjab government has developed a health sector reform framework to accelerate attainment of two millennium development goals (MDGs) relating to health of women and infants.

While the province is likely to achieve most MDGs by the targeted date of 2015, it is seriously lagging behind on two important goals — MDG4, which includes reducing the infant mortality rate; and MDG5, which is reducing the maternal mortality rate.

The province is unlikely to reach these two MDGs without significant and concerted additional efforts and wide-ranging reforms in the health service delivery and improvements in health care financing. Failure on this front would have serious implications, given the size of the province and its contribution to Pakistans economy, says an official report.

Punjab has the highest under-five mortality rate and an infant mortality rate that surpasses other countries in the region, although it compares favourably on maternal mortality in relation to other countries in South Asia.

The Punjab government has recently increased budget allocations to social sectors, and, recognising the challenges, the government has demonstrated a strong commitment in recent years to broad-based inclusive growth.

It embarked on social sector reforms with its own resources as well as support from the international community as MDG attainment has been given prominence in Punjabs medium-term development agenda.

The government sought support from the Asian Development Bank (ADB) to bolster its efforts to increase the quality of and access to key social services, especially by improving management of service delivery and public resources. The government has been undertaking education sector reforms for the last several years with the World Bank’s programme support, and has seen education millennium development goal indicators improve. On the other hand, the health MDGs have shown very little improvement.

The ADB is providing $100 million to help the Punjab government improve health care services to meet the two MDGs for reducing maternal and infant mortality rates.

At a broader level, the provincial government has initiated service delivery reforms as part of the ADB-supported Public Resource Management Programme and the Punjab Devolved Social Services Programme. The former aims at improving the operational efficiency of the provincial government and thereby creating fiscal space for social service delivery, while the latter aims at strengthening district systems and developing necessary service delivery standards for devolved social services, including health, education, water supply and sanitation.

In line with ADB’s ‘Strategy 2020’, the Punjab Millennium Development Goals Programme (PMDGP) focuses on governance of health service delivery and management of public resources.

The report says the programme marks a major priority shift by the Punjab health department from quantity to quality of health care, from fragmented to consolidated health service, and from tertiary to primary and secondary health care.

The impact of the PMDGP is the attainment of MDGs relating to the reduction of the infant mortality rate and maternal mortality ratio in Punjab.

PMDGP will help the government ensure implementation of certain minimum service delivery standards (MSDS) for primary and secondary health services, through incorporation of the MSDS in provincial and district health sector plans, and by increasing the quality and quantity of human resources in the health sector.

The programme will also help the government improve daily management of health service delivery by reducing delays in the procurement of essential drugs, institutionalising the contracting of health services to non-government organisations, and improving the existing performance monitoring and evaluation systems.

Full implementation of the MSDS is projected to cost the government Rs34 billion over 2008-2011. The first phase of MSDS implementation, with focus on maternal, neonatal and child health, will cost about Rs7 billion apart from expenditure for capacity-building and enhancement of information systems, says the report.

The proposed programme will reduce the health care burden and the risks of falling seriously ill through timely health interventions, by making quality care available and affordable at public facilities through a targeted programme, and through the development of an equitable health financing system.

The programme will increase and improve the efficiency of the public stream of health care financing while supporting development of alternative health care financing systems that may pool different financial resources.

According to the report, the future of local government system under the present political setup may be at risk. While a drastic reversal of the devolved setup is unlikely, changes in the current attribution of power and authority across levels of government may occur.

However, the health sector is likely to remain devolved given the ground level implementation requirements.

Regardless, the flexibility built into the cluster approach is suitable for changing the implementation arrangements.