New Funding Mechanism Strategy for prosthetic and orthotic services by external donor

T​‌‌‌‌‍‌‍‌‍‌‌‌‍‌‍‌‍‍‌​he aim of the paper is recommending an innovation funding mechanism to sponsors (mainly external donors / private sector locally and internationally) the prosthetic and orthodontic services sector in Pakistan. Please find attached document that provides the context. Below are bullet points to help (more suggest) the thinking process to attract donors, how can donors be attracted for a big market, keeping in mind that few people can clinically afford a prosthetic (amputee ) or orthodontic (fore example for polio)device . – there are 197’000’000 people in Pakistan – there are 5 Provinces , Sindh, Punjab, Baluchistan, Khyber Pakhtunkhwa (that includes FATA) and then there is the special statutes of AJ&K as part of the Federal Government. – there are 158 districts in Pakistan and in each such district should have a primary setup of prosthetic and orthodontic devices. – There are only 30 workshops in Pakistan (unofficially) – There are 1 million people that need a prosthetic or orthodontic device (0,5% of a population according to WHO recommendations) – Mobility devices are provided by a prosthetic-orthopedist (P&O): it make sense that education is key of any donor strategy – When people are mobile you give them the means to promote for their own rights – “Why” and “Who” would be willing to support prosthetic and orthodontic services in Pakistan? – What guarantees / assurance would be necessary from the Government to attract “transition funds (donor budgets). ? – How could a combination of Government guarantees/assurance and the involvement of the private sector? – Pakistan is active with the WHO and Gate Initiative? This helps for policies, but still, tangible implementation is missing. – Overall Health insurance is still missing, yes there is the Prime Minister Health Insurance for the very poor, but the administrative pathway is extremely complicated. – Insurance -> unpredictability: related to the private sector / GVT need to recognize P&O workshops – assurance and insurance not be confused. Some additional thinking 1. For any investor do donate or invest in any P&O Centre, there first needs to be a government “assurance” on ​‌‌‌‌‍‌‍‌‍‌‌‌‍‌‍‌‍‍‌​basic sustainability such as HR , running cost and basic materials (don’t confuse with “insurance” ). I think we have this with MPRC . In my view, for any Centre with the right commitment from GVT with assurance on ownership, is a solid basis to request “transition funds” our outside donors that will see their investment with tangible results. Others, such as INDUS go a step further and are confidently investing before GVT commitment; Indus counts on multiple high donors on various health activities and is successful on the combined approach. 2. For example, a center such as MPRC is putting too much “hay on their fork “, yes MPRC is at an efficiency rate of 200%, which of course looks very good, but is not a “selling” point. Again, in my view, the 100% should be equal to GVT support while the additional % should be as “sales model”, “selling” their capacity and motivate Human Resources ( Human Resources are key to sustainability and key do private investors ) and show “private practice” thinking. This is an important point, as it dictates the “revolving fund” and “true” annual budgets. Any center should be responsible for x% of income generating funds that is re-invested in the center/sector. 3. World Banks Asia could be partners on guiding centers or governments-where-there-is-no-insurance on sustainability. 4. Mobility is provided by prosthetist-orthoptist (P&O): it makes sense that education is key of any donor strategy. 5. Additional support to a center is an amalgam of many resources, whether it is private or Prime Minister Heath Insurance, Zaka or anything additional. The latter can only work if there is access to centers and human resources. Centers that are eventually recognized by any insurance and Government. Pakistan needs at least 158 P&O centers (thus in each district hospital) and 5 centers of excellence, provincial referral centers. The latter is where education and services go together. “One-third of all the private investments today in the world is an investment which is done to lessen the market conditions if there is an impact”. Is there any evidence to that and who are those donors / private investors and what drives them to th​‌‌‌‌‍‌‍‌‍‌‌‌‍‌‍‌‍‍‌​is noble cause?




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