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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
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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