Greenstar Social Marketing Pakistan Andrea Godon – Senior Project Manager KfW Entwicklungsbank August 25/26 2013, Bonn

Country Health Portrait: Pakistan General indicators Health financing 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) 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

Greenstar Social Marketing, Pakistan History and mission 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 Services Data Social Franchising Equity Quality Center of Excellence Access Standards Training & CMEs Supportive Supervision Supplies and Marketing Franchisee (Private practitioner) Franchisor (Greenstar)

German Financial Cooperation Projects with Greenstar Objectives & Components Reproductive Health, Phase I (2008-2011) Rural Family Planning, Phase II (2012-2014) Mother & Child Health Program FATA (2010 – 2014) Region Khyber Pakhtunkhwa Khyber Pakhtunkhwa, Azad Jammu & Kashmir, Gilgit- Baltistan, Northern Punjab FATA (Federally Administered Tribal Areas) Objectives Improved quality, access, availability, affordability and utilization of quality RH and MCH Costs EUR 6 Mio EUR 12 Mio EUR 750,000 Components 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 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 Sollen Phase I und II in einen Kasten? Flood Relief Measures Extension to rural areas Establishment of MCH clinic at Afghan Refugee Camp in Islamabad

Salient Results Reproductive Health, Phase I (2008-2011) Rural Family Planning, Phase II (2012-2014) Mother & Child Health Program (2010 – 2013) Completed end of 2011 Ongoing Ongoing 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 Sollen Phase I und II in einen Kasten? Moving to new and difficult geographic areas Enhanced liaison with other partners

Challenges Challenges Franchise System Socio-Cultural Challenges Providers‘ compliance with quality standards Price control mechanisms Management of a rapidly growing network Commodity security Social taboos Challenges Institutional Challenges Strong dependence on donor support  Cost coverage rate of only 25% Cooperation with the ministries  No capacities for directing, monitoring or evaluation Political Challenges

Lessons Learnt/Conclusion 1. Behaviour Change Communication is a key component for success 2. Cost efficiency Sustainability Access for low-income groups 3. building strong and lasting bonds with the public sector is of high priority 4. very rapid scale-up of providers creates difficulties in monitoring the outlets and managing incoming information 5. Monitoring quality is of paramount importance 6. Further evaluation of the program’s impact on access and equity needed 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

Thank you for your attention!

Inhalt 1 Country Health Portrait 2 Portrait of the NGO Greenstar 3 Greenstars Work 4 KfW: FC in the Pakistani Health Sector?

Greenstar Social Marketing (Guarantee) Limited History and mission 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 Social Franchising Social Marketing 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 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 Können wir irgendwoher greenstars Logo bekommen?