Pakistan struggles to live up to its commitments to realize Millenium Development Goals four and five relating to maternal health and child mortality. The Pakistani government therefore seeks to improve the situation by cooperating with international partners to better the quality of its health delivery systems and to make these accessible to ordinary people. Norway is the chosen cooperating partner for improving conditions in ten districts in rural Sindh. The districts were chosen on the basis of poor quality of health services and their unsatisfactory health related social indicators.
Three UN agencies; UNFPA, UNICEF and WHO will implement the project in collaboration with the Ministry of Health and a range of other national partners. These partners and Norway have drawn up an overall project plan. This plan will now be supplemented with agreements between the technical UN agencies on how to split responsibilities for program implementation. These are to be assigned between the individual UN agencies and between governmental and private actors. There are many options for how to do this, and there are several opinions on which ways will prove the most efficient, - and varied views are of course to be expected in a large program that seeks to explore new ways! All plans and technical meetings should be completed, and project implementation is expected to start, in the second quarter of 2009.
Norway has signed an agreement for the project is with the One UN in Pakistan as part of the One UN Joint Program. This is the largest bilateral agreement so far for the new One UN Program, both time- and budget wise. The UN hails the NPPI as a constructive contribution to UN reform and inter-agency collaboration at the national and provincial levels.
The NPPI project is unusual as it seeks to promote a public – private partnership for health care delivery. The project will upgrade and improve the quality and the accessibility of the government health delivery systems. It will also work with the private sector health delivery services and improve the quality and make these available to poor people through voucher schemes. Delivery vouchers will be particularly valuable for complicated deliveries, as post partum complications are a grave concern. Voucher schemes have been tried with good results in other countries. They will presumably work well in Pakistan; too, even if there will be practical and adminisrative challenges to be met along the way.
Two major pre-project studies have started. Arjumand and Associates are collecting baseline data on households, health services and non-state service providers. Their study is approaching completion, and the results will be presented end March or early April. The Aga Khan University is doing a second pre-project study to consider what health interventions are likely to be efficient and cost efficient. Their findings and recommendations will be ready for presentation mid March. Both researchers have collected huge amounts of data and accumulated very valuable knowledge; the challenge will be to translate all this good information into an effective base for action on the ground.