Public private partnership in safemotherhood program in Nepal

1. PUBLIC PRIVATE PARTNERSHIP IN
SAFEMOTHERHOOD PROGRAM
Presented by:
Bidhya Basnet
WHD

2. Definition, Introduction, Status,SMNH
Goal

3. Definition: Safemotherhood
• Safemotherhood means creating the
circumstances within which a woman is able
to choose whether she becomes pregnant and
if she does, ensuring that she receives care for
prevention and treatment of pregnancy
complication, that she has access to train birth
assistance, and if she needs it to emergency
obstetric care and care after birth to prevent
death or disability from complications of
pregnancy and childbirth.’

4. Introduction: Safemotherhood
program
• It is the priority one program of Ministry of
Health and Population.
• It comprises of significant portion of the national
health budget in public sector.
• The program was first started in 1997.
• The aim of safemotherhood program is to reduce
maternal and newborn mortalities by addressing
the factor related to morbidities, death,
disabilities associated with pregnancy and
childbirth.

5. Major activities under
safemotherhood program in Nepal
1. Birthprepardness package and MNH activities at community level.
2. Rural ultrasound program
3. Reproductive health morbidity prevention program
• Uterine prolapse
• Cervical cancer screning and prevention training
• Obstetric fistula screening
4. Human resource
5. Emergency referral fund
6. CEONC program
7. Safe abortion services
8. Obstetric first aid orientation
9. Nayano jhola program
10. Aama program
(Source: Annual health report 2070/71)

6. Status of Safemotherhood program
SN INDICATORS 2070/71
1 % of pregnant women who received TT2 40
2 % of pregnant women who received TT2+ 35
3 % of pregnant women attending first ANC among estimated
number ofpregnancies
86
4 % of pregnant women attending at least four ANC visits 59
5 % of pregnant women receiving IFA tablets or syrup during their last
pregnancy
72
6 % of postpartum mothers who received Vitamin A supplements 53
7 % of institutional deliveries 50
8 % of deliveries conducted by a skilled birth attendant 50
9 % of deliveries by caesarian section 6.7
10 % of women who had first post natal care (PNC) visit among
estimated live birth
59
11 Maternal mortality rate 190
12 Neonatal mortality rate 23

7. Status of human resource for health in
Nepal
• Nepal was found to have 0.17 doctors per
1,000/population and 0.50 nurses per
1,000/population. This represents 0.67
doctors and nurses per 1,000/population,
which is significantly less than the WHO
recommendation of 2.3 doctors, nurses and
midwives per 1,000/population.
Source: NHSSP, Human Resource for health
Nepal Country Profile, August 2013

8. • The key indicators for this NSMNH-LTP goal
are:
1. A reduction in the maternal mortality ratio from
539 per 100,000 live births1 to 134 per 100,000 by
2017
2. A reduction in the neonatal mortality ratio from
39 per 1,0002 to 15 per 1,000 by 2017.

10. Public private partnership(PPP) on
health
Definition:
An agreement between the government
(public sector) and non‐government (private
sector-profit or non profit) for the purpose of
delivering health services cost effectively and
equitably.

11. Who may be the partners in health
sector
Non‐state/Private Partners
• Individual practitioners
• Associations of practitioners
• I/NGOs
• Cooperatives
• Community organizations
• Civil society networks
• Private companies/association
• Private hospitals
• Private research institutions
State/Public Partners
• MoHP and its agencies
• Other ministries
• Social insurance
• institutions
• Local government units
• National Research
• Institutes/NHRC
• Public health education
facilities

12. Objective of PPP on health
 To strengthen public sector and implementation of
national health policies.
 To enhance equity, efficiency & effectiveness (a major
focus of reform)
 To reduce both duplication and gaps in health services
 To promote innovation, and equitable access to the
fruits of innovation
 To enhance the role of private sector (or non state
agencies) in delivering health services to achieve
Millennium Development and Health

13. Different PPP Models Used in the
Health Sector of Nepal
1. Service Contracts
2. Management Contract
3. Build, Own, Operate & Transfer (BOOT)
a. Build and Transfer
b. Build, Operate and Transfer
c. Build, Transfer and Operate
4. Joint Venture
5. Leasing
6. Contracting + Pay for Performance (P4P)
7. Contracting via Social Franchising

14. Safe motherhood Neonatal Health
Long term plan and PPP
• One of the output of SMNH
• Purpose: Increased participation of the
private sector, NGOs, community based
organizations and professional/academic
institutions in SMNH related public services to
ensure consumers have equitable access to
affordable services.

15. Role of PPP in safemotherhood
program
• Human resource: development of specefice cadre
• Awareness raising (disease, tratment and
treatment sites)
• Research
• Monitoring and evaluation
• Supply of commodities and technical support
• Capacity building of service provider
• Introducing Initiatives and innovation in
safemotherhood program

16. Development partners contributing to
Safemotherhood program in Nepal
• Multilateral organization- UNFPA, WHO, WHO Nepal
• Bilateral organizations- GIZ,USAID
• International non government organizations- IPAS,
John Snow Research and training institute, Plan
international Nepal,Population services international
(PSI), United mission to Nepal(UMN),World vision
International Nepal(WVIN)
• Non-Governmental organization- Kidasha, Nepal
technical assistance group(NTAG), Nick Simons Institute
(NSI), Sunaulo pariwar nepal

17. Activities and partners in SM program
SN Activities Partners
1 Birthprepardness package and MNH
activities at community level:
•BBP and misoprostol project in 41
district
•Pregnant women groups, health watch
groups, health mother reactivation, child
clubs, women group, husband and
mother in law orientation on danger
signs and complication.
•FCHV training on BCC/IPCC session
•Orientation of traditinal healers
•Community mobilization on equity and
access
•District communication strategy,
mHealth, local FM radio
UNICEF, UNFPA, UMN,
PLAN, H4L, CARE

18. Cont…….
SN Activities Partners
2 Rural ultrasound program: objective of rural
ultrasound program is to timely identify
complications during pregnancy and refer to the
appropriate health facility for complication
management.
MoHP and Nepal health
sector support program
(NHSSP)
One heart one world in
Dhading

19. Cont….
SN Activities Partners
3 Reproductive health
morbidity prevention
program: uterine prolapse,
cervical cancer screening and
prevention training, obstetric
fistula
Cervical cancer screening
program using VIA: three
training sites viz. BPKIHS-
Dharan, BPKMCH-Chitwan,
Kathmandu model hospital
Obstetric fistula operation
has been initiated in Patan
hospital, kathmandu model
hospital, BPKIHS and Bheri
Zonal hospital(technical
support is
provided from JPIEGO
Nepal and financial support
was given by UNFPA.)

20. Cont……
SN Activities Partners
3 Human resource:
•On-site coaching and support
•DGO training
•ASBA training
•OT management training
•SBA training:5850
•Midwifery faculty and training
development
•Obstetric first Aid training at all level
NHSSF, NSI, UNICEF,
UNFPA, GIZ,
MIDSON

21. Cont……
SN Activities Partners
3 Emergency referral fund CARE Nepal, Plan
Nepal, UNICEF,
SUAAHARA
4 CEONC program expansion: 56
district
CEONC service providers recruitmnet
support
CEONC fund use and functionality
monitoring introduced
Nick simon Institute,
UNICEF
5 Safe abortion services Sunaulo pariwar
Nepal, IPAS,
CREPHA,

22. Limitation in PPP
• Unclear government policy on partnership
• Quality assurance and coordination :
• Lack of clear policy and support mechanism on
community initiatives in health service delivery.
• Weak regulatory regimes to monitor private health
sector
• Weak capacity of Government
• Lack of a research and information base on the
dynamics of private sector
• Lack of a policy framework for promoting private
health sector

23. References
• Annual Health report 2070/71
• Proceeding Report,2015 Family health division
• http://www.nhssp.org.np/pulse/Pulse%20Rural%
20USG.pdf
• http://www.nhssp.org.np/about/NHSSP%202%20
Policy%20Document.pdf
• http://www.nhssp.org.np/human_resources/HRH
%20profile%20(QA).pdf
• http://www.nhssp.org.np/human_resources/HRH
%20profile%20(QA).pdf