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Greenstar Social MarketingPakistanAndrea Godon – Senior Project Manager KfW

Entwicklungsbank

August 25/26 2013, Bonn

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Country Health Portrait: Pakistan

› Population 180 million

› People living in poverty: ~30%

› Fertility rate: 3.3 (India 2.6, Bangladesh

2.2)

› Contraceptive prevalence: 33% (India 47%,

Bangladesh 52%)

› Unmet need: 25%

› Maternal Mortality Rate (per 100,000 live

births): 260 (India: 200, Bangladesh: 240)

in Balochistan: 785

› Infant Mortality Rate (per 1,000): 59 (India:

47, Bangladesh: 37)

General indicators

› Public Health Expenditure/BIP: 0.4% (India

& Bangladesh 0.9%)

› Private Health Expenditure/BIP: 1.8%

(India 4.1%, Bangladesh 2.2%)

98% Out-of-pocket payments

› 80% of population consults private health

care facilities

Health financing

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Services Data

Franchisee(Private practitioner)

Access

Equity

Quality

Centerof

Excellence

› Standards

› Training & CMEs

› Supportive Supervision

› Supplies and Marketing

Greenstar Social Marketing, Pakistan

Franchisor (Greenstar)

Social Franchising

› Founded in 1991 as a local NGO and subsidiary of PSI (Population Services International)

› Mission: improving the quality of life among low-income people throughout Pakistan by increasing

access to and use of health products, services, and information through social franchising and

social marketing

History and mission

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› Strengthening and expanding the social franchise network

› Training of Greenstar providers at all levels

› Supply and distribution of the products of reproductive health

› Development and monitoring of BCC

› Design and implementation of a voucher scheme

German Financial Cooperation Projects with GreenstarObjectives & Components

Reproductive Health,

Phase I(2008-2011)

Rural Family Planning,

Phase II(2012-2014)

› Training government and private

sector medical providers on MCH

› Training Traditional Birth Attendants

› Strengthening the health system by

refurbishing Lady Health Workers’

Health Houses and Government

MCH Centres

› Establishing a Toll Free Helpline

Mother & Child Health Program FATA (2010 – 2014)

Improved quality, access, availability, affordability and utilization of quality RH and MCH

EUR 6 Mio EUR 750,000

Khyber Pakhtunkhwa Khyber Pakhtunkhwa, Azad

Jammu & Kashmir, Gilgit-

Baltistan, Northern Punjab

FATA (Federally Administered Tribal

Areas)

Region

Components

Costs

Objectives

EUR 12 Mio

› Flood Relief Measures › Extension to rural areas

› Establishment of MCH

clinic at Afghan Refugee

Camp in Islamabad

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Salient Results

Mother & Child Health Program

(2010 – 2013)

› Moving to new and difficult

geographic areas

› Enhanced liaison with other

partners

Completed end of 2011 Ongoing Ongoing

Reproductive Health, Phase

I(2008-2011)

Rural Family Planning, Phase II(2012-2014)

Reproductive Health

› 1.5 million CYP achieved

› >600,000 beneficiaries

› >700 private medical advisors

trained

Voucher Scheme

› 4000 vouchers sold, 3800

redeemed

Flood Relief Activities

› Free distribution of bed-nets,

clean delivery kits, domestic

water cleaning sachets/tablets,

nutritional products

› 1 million CYP achieved

› >50,000 beneficiaries

› 496 private medical advisors

trained

› 1 Afghan refugee clinic and 26

rural clinics established

8 Mobile Service Units functioning › 220 medical providers trained on

MCH

› 368 TBAs oriented on safe

birthing techniques

› 100 health houses re-furbished

› 20 MCH centers upgraded

› 1 toll free help line functional

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Challenges

Challenges

Socio-Cultural ChallengesFranchise System

Political Challenges

Social taboos

Cooperation with the ministries

No capacities for directing,

monitoring or evaluation

› Providers‘ compliance

with quality standards

› Price control

mechanisms

› Management of a

rapidly growing

network

› Commodity security Institutional Challenges

Strong dependence on

donor support

Cost coverage rate of

only 25%

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Lessons Learnt/Conclusion

› Opportunities to expand as private sector continues growing

›Social franchising well-suiting approach to expand and improve reproductive health services

› Social franchising provides a mechanism for expanding access to high quality reproductive health services

1. Behaviour Change Communication is a key component for success

3. building strong and lasting bonds with the public sector is of

high priority

2. Cost efficiency

Sustainability

Access for low-income groups

6. Further evaluation of the program’s impact on access and equity needed

4. very rapid scale-up of providers creates difficulties in monitoring the

outlets and managing incoming

information

5. Monitoring quality is of paramount importance

Bank aus Verantwortung

Thank you for your attention!

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Inhalt

1 Country Health Portrait

2 Portrait of the NGO Greenstar

3 Greenstars Work

4 KfW: FC in the Pakistani Health Sector?

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Greenstar Social Marketing (Guarantee) Limited

› Founded in 1991 as a local NGO and subsidiary of PSI (Population Services International)

› Mission: improving the quality of life among low-income people throughout Pakistan by

increasing access to and use of health products, services, and information

History and mission

› In: 96 Pakistani districts

› Aim: distribution of its more than 20 health care

and family planning products

› With: 65 physicians, 7,000 clinics and other health

facilities, 42 medical detailers and 75,000 retail

outlets

also: community-based distribtion

› Contribution: Standards, Trainings&CMEs,

Supportive Supervision, Supplies and Marketing

Social Franchising

› In: 107 Pakistani districts

› Aim: promoting its health care and family planning

products

› With: 24,000 drug stores and pharmacies, 33

medical detailers, 51,000 retail outlets

Social Marketing