KARACHI: Despite certain challenges, the European-funded Sindh Union Council and Community Economic Strengthening Support (SUCCESS) programme being carried out in eight districts with government support since 2015 has produced significant results in increasing health insurance coverage to the rural poor, empowering women at the union council level and improving access to public services in villages.

This information was shared at an event titled Policy and Advocacy Dialogue on Health, Local Governance and Women Empowerment held on Wednesday at a local hotel.

Hosted by Rural Support Programmes Network, the dialogue aimed at encouraging public debate and competition for improved outcomes for rural women and families in health, local governance and building empowering systems across political, economic and social structures.

The dialogue comprised three sessions with government ministers and leading experts looking into studies on these three themes to identify recent gains, revisit challenges from previous years and highlight the emerging opportunities in rural development for women created by SUCCESS in Sindh.

The panellists for the session on micro health insurance (MHI) included deputy director of Sehat Sahulat Programme Dr Sonia Riaz, director, health policy and management at Aga Khan University Dr Shehla Zaidi and Saima Zafar representing Jubilee General Insurance.

During the discussion, it was pointed out that the availability of MHI cards given to 192,500 rural households under the programme encouraged communities to access qualified doctors and rely less on quacks.

Those who used cards also reported to have saved their critical assets such as livestock from high cost (both economic and social) of borrowing from landlords and money lenders.

However, challenges still remained in better utilisation of the insurance facility. These included affordability to travel to panel hospitals, seasonal migration, low literacy, superstition and unavailability of CNICs.

Panellists were of the view that sustainability of health insurance schemes couldn’t be achieved through donors alone; both private and public sectors needed to be involved.

In the following session on women’s empowerment, which included chairperson, Sindh Commission on the Status of Women Nuzhat Shirin and associate professor at the Institute of Business Administration Dr Asma Hyder as panellists, it was pointed out that social mobilisation approach had helped women’s mobility and reduced restrictions on girls’ education in Sindh.

“Community governance tiers under SUCCESS, all owned and managed by women, are serving as a bridge between grass-roots communities and line departments responsible for effective public service delivery,” said Durreshawar Mahmood, one of the authors of the study on women’s empowerment.

A number of these departments were already routing their services through these well-structured community institutions, eg CNIC registration, polio vaccination, livestock immunisation, tree plantation and reopening of schools and health centres, she added.

Women Development Minister Shehla Raza chairing the session announced setting up of a group of all female MPAs of Sindh Assembly to oversee human development programmes being implemented in different districts and report on their progress.

“This would bring in ownership of elected representatives in pacing up the results and ensure that innovative ideas are replicated across Sindh,” she said.

Panellists in the session focusing on local governance highlighted challenges pertaining to the sustainability of these governance structures post-SUCCESS funding.

Dr Abid Mehmood from Cardiff University quoted the example of Wales where it took the government 10 years and three million pounds to get their disadvantaged communities involved in policy-level discussion.

Some of the recommendations presented to the government during the detailed analysis of the programme included expansion of partnerships with wider civil society and development organisations and integration of health insurance coverage in all ongoing poverty reduction programmes in Sindh.

The government of Sindh, it was said, should use this opportunity to closely monitor the inputs, outputs and outcomes, and identify ways to sustain SUCCESS activities post-2021, when the programme would end.

Published in Dawn, August 9th, 2019