Islamabad, June 3, 2013 - The World Bank approved on Friday a package of assistance worth $100 million to support the implementation of the Punjab Health Sector Reform Project, which will focus on enhancing the number of people who access quality essential health services, particularly in the low performing districts of Punjab, Pakistan.
“Punjab holds the key to Pakistan’s progress towards attaining the MDGs as it constitutes 60% of Pakistan’s population”, said Rachid Benmessaoud, World Bank Country Director for Pakistan. “This program will help the government of Punjab implement its Health Sector Strategy for the province by building the capacity and systems to strengthen accountability and stewardship in the Department of Health.”
Despite recent gains, the health sector performance in Punjab remains inadequate due to multiple external and internal health system factors. Punjab's overall health outcomes are comparable to the national average or slightly better than other provinces, but the pace of change remains slow and uneven with significant disparities among regions, rural and urban areas, and by economic status. The average duration of exclusive breastfeeding is only 0.9 months in Punjab, as compared to the national average of 3.2 months. Immunization coverage also remains low: only one in three children aged 12-23 months are fully immunized (34.6%).
The government of Punjab is keen to make progress on human development to build a productive workforce with its large and increasing share of youth. In health it has developed a holistic, results-focused Punjab Health Sector Strategy 2012-2020, involving governance and accountability reforms and strengthening health systems to improve sector management performance and health outcomes in the province.
“Punjab has gradually improved maternal and child outcomes and the key to further improvement is addressing the huge burden of malnutrition among women and children which have not improved in the past two decades. Stunting occurs among 39% children under five,” said Dr. Inaam ul Haq, task team leader of the project. “The project will aim to improve the capacity of health service providers to deliver nutrition interventions at the facility and community level.”
The project comprises of four components: 1) Improving Health Service Delivery; 2) Enhancing Efficiency and Effectiveness of the Health System; 3) Strengthening Provincial Department of Health Management Capacity; and 4) Improving the Capacities in Technical Areas for Equitable Health Services. The first three components take a results-based approach using Disbursement Linked Indicators (DLIs), while the fourth component will finance inputs for piloting and Technical Assistance (TA).
The project results would specifically measure improvements in three health service indicators: fully immunized children 12-23 months of age; use of skilled birth attendants; and use of modern birth-spacing methods, in low performing districts of Punjab. In addition to these indicators, a full set of intermediate outcome indicators will be used to track improvements in service delivery, performance, governance and accountability. Funding for the three DLI-based components will be disbursed upon achievement of key intermediate results related to implementation performance targets or milestones for institutional change under these components.
The credit is financed from the International Development Association (IDA), and will be on standard IDA blend terms, with a maturity of 25 years, including a grace period of 5 years.