Health Systems Strengthening Quarterly Report October–December, 2016

The Minister of State for Health, Ms. Saira Afzal Tarar, formally endorsed and launched the strategic framework for the containment of antimicrobial resistance in Pakistan. This framework was a result of the technical and financial support provided through USAID's MCH program in Pakistan. The Ministry of National Health Services, Regulation & Coordination (MONHSR&C) became the first Pakistani ministry in history to receive ISO 9001:2015-certification. Ms. Afzal Tarar publicly recognized the technical and financial support provided by USAID's MCH program, which contributed to this achievement. Additionally, the rigorous advocacy of the HSS Component's team on behalf of the departments of health (DOH) Sindh led to the online release of funds amounting to PKR 165 million to implement annual operational plan activities during the last two quarters of 2016-17. To facilitate the fast-track operationalization of the Sindh health care commission (SHC), the HSS Component's team facilitated a tour for the board of commissioners and other DOH Sindh senior officials to study the dynamics of the Punjab health care commission. DOH Sindh officials were also supported to submit a revised budget to the finance department Sindh to establish SHC as a corporate body and to elect a commission chair to accelerate activities. The HSS Component provided technical assistance to DOH Sindh to set up a technical unit at the health secretariat to facilitate efficiency, transparency, and accountability in deploying human resource (HR) and tracking service delivery progress. The design for this unit was prepared and given to DOH Sindh for review and approval, and the building process began. As of today, the measurement for space allocation is complete. The HSS Component received a second consignment of one million chlorhexidine (CHX) tubes from Nepal. The local drug regulatory authority of Pakistan issued a "no objection" certificate to import the medicine after completing the physical inspection of the product and conducting an analysis of each batch to ensure quality assurance. After the completion of all formalities, the MONHSR&C issued approval for CHX distribution to pilot districts of AJK, Balochistan, KPK, and Punjab. Technical assistance was also provided to district health and population committees of 23 districts of Sindh to update district analytical profiles and prepare district action plans (DAPs) for the next three years (2018-21), as well as preparation of annual operational plans for the next financial year (2017-18). With the HSS Component team's assistance, training sessions to strengthen the monitoring and supervision system were conducted in Hyderabad at the office of the directorate general health services Sindh. A total of 138 district focal persons and 12 provincial representatives were trained by their respective provincial technical teams on the use of online monitoring and supervisory checklists. In addition, the HSS Component's team has been supporting DOH Sindh to refurbish monitoring and evaluation (M&E) cells to improve the coordination with the DOH, vertical programs, and with other stakeholders (PPHI, PWD, IHS, and Indus hospital) for the use of data for better evidence-based decision-making. During the reporting quarter, the refurbishment was completed in eight districts: Badin, Khairpur, Larkana, Mirpur Khas, Shaheed Benazirabad, Tharparkar, and Umerkot. During the previous quarter, it was completed in five districts (Jamshoro, Mitiari, Sanghar, Tando Allahyar, and Thatta), for a total of 13 refurbished districts. Work in the remaining districts is ongoing. The HSS Component provided technical assistance to assess the quality of the district health information system (DHIS) using the Performance Review of Information System Management (PRISM) framework. The objective of this assessment was to find out whether DHIS had been implemented and monitored in all districts of Sindh so that high-quality information can be used to make informed health decisions. It concluded that the number of health facilities reporting monthly DHIS performance reports increased from 83 percent in August 2013 to more than 99 percent in 2016. More than 78 percent of the managers, medics, and paramedics were trained in 2016 in the use of DHIS, compared to 56 percent in 2013. The HSS Component's team also provided technical and financial assistance to upgrade the provincial health development center (PHDC) to the level of a health services academy. In this context, the team prepared and presented the draft Planning Commission Form-1 to the director general (DG) health services Sindh. The HSS Component partner, Heartfile Health Financing (HHF), paid for 101 people's critical medical care, totaling PKR 9,213,190 (US $ 87,081), which they otherwise could not have afforded. Since project inception, 1