LAHORE: The Punjab Health Sector Reform – a project of the World Bank – pointed out some of the risks involved in the implementation process including inability of institutional capacity for implementation and sustainability, political influence as well as governance and lack of sector strategies and policies.
According to a recent report, the Punjab government remained unsuccessful in the implementation of $1.1billion Health Sector Reforms project approved in 2013 by the World Bank (WB). About 30% of the work could be completed till date, despite the fact that the project would have to be completed by December 31, 2017.
According to documents available with the Daily Times, only five of the 15 Disbursement Linked Indicators (DLIs) could be achieved to date. The documents showed that substantial and frequent changes in the Health Department management could be one of the reasons to affect overall progress of the programme during the project’s implementation.
“There have also been a series of changes in the strategic direction of the health sector strategy after its approval in 2013,” the documents mentioned. The Punjab Health Sector Reform project is under implementation for the past 18 months since its effectiveness in January 2014. The changes in health management have severely affected the first year of the project implementation.
Regarding the progress on implementation, the project had a very slow start with changes in the senior management of the department and elections. During the last year, the pace of implementation had significantly improved as the department resolved pending issues, which led to the achievements of five out of 15 Disbursement Linked Indicators (DLIs), resulting in 28% of the IDA credit being disbursed.
However, considering the project is already halfway through its implementation, this is still behind the original schedule. There has been also a series of changes in the strategic direction of the Health Sector Strategy after its approval in 2013. The Bank follow-up mission in January 2016 found that a number of recommendations identified and agreed during the MTR are still pending mainly due to contextual changes since MTR, including the bifurcation of DOH and changes in senior management. Hence, the Government of Punjab and the Bank teams have jointly agreed to carry out restructuring of the project by September 2016, the documents further said.
The development objective of the proposed project is to support the implementation of the Punjab Health Sector Strategy by focusing on the improvement of the coverage and utilisation of quality essential health services, particularly in the low performing districts of Punjab. The project will focus on building the capacity and systems to strengthen accountability and stewardship in DoH.
Documents say that the $1.11 billion would spent in four different components including improving health service delivery (Cost $28.34 M), enhancing efficiency and effectiveness of the Health System (Cost $44.00 M), strengthening provincial department of health management’s capacity (Cost $22.26 M) and improving the capacities in technical areas for equitable health services for all (Cost $26.50 M).
