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Article Article January 11th, 2016
Health • Technology

The politics of performance in Punjab

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The Punjab government uses real-time data to transform services for the better

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Its Special Monitoring Unit drives reforms and uses technology to track progress

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A key priority is for the reforms to be truly embedded into the system

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All government leaders strive for improvements in public services. Systems differ, approaches fluctuate and funding streams vary, but theirs is a shared goal of achieving better services for their citizens. It's how they get re-elected - and how they make a difference.

Take Shehbaz Sharif, for example. The chief minister of Punjab has a lot on his plate. As the leader of the most populated province in Pakistan he does not lack for issues to address. But while challenges still abound, his is a track record likely to prompt envious looks from his peers. After all, any government leader would be proud of getting over one million more children into school and reforming health service delivery for over 100 million people. Sharif, though, is just getting started.

Data to delivery

At the heart of the Punjab government's approach is the recognition that data - especially real-time data - offers a huge opportunity to transform services for the better. In 2014, the chief minister created the Special Monitoring Unit (SMU) as a delivery unit residing in his office. Among other priorities, SMU's key role has been to drive reforms in education, health, clean drinking water and sanitation. It also collaborates with the Punjab Information Technology Board to design and build state of the art technology to collect data and track progress in each of the reforms.

With 52,000 schools, 350,000 teachers and 11 million students, Punjab has one of the biggest public education systems in the world. The government has increased annual spending on education to $2.7 billion, in addition to support provided by donor organisations such as DFID, but extra money - while important - only represented one piece of the puzzle. Sharif wanted to ensure that the money spent was achieving the necessary public impact.

“Education is the right of every citizen across the globe,” he points out, “but in Pakistan there is unfortunately a wide gulf in terms of education for children of average Pakistanis and education to the children of the privileged class. The privileged have all the options to send their children to the best schools in Pakistan or internationally, but millions of children in Pakistan do not have even basic standards of education - facilities have been missing for decades, teachers are not properly trained and not properly inducted. Put together, this meant it was a big challenge for me in 2008 when I was elected for the second time as chief minister.”

And so in 2011, with the support of Sir Michael Barber, his government launched an Education Reform Road Map, focusing on specific areas with the potential to transform education standards and unlock potential for millions of children, including those most marginalised and from the poorest backgrounds. Improving student participation and enrolment were key priorities from day one and, since 2011, primary enrolment has increased from 84.8% to 90.4%, translating into an additional one million students attending school each day. Educating girls remains a strong focus and there has been an increase in the gender parity index from 0.85 to 0.91.

Monthly data for core indicators is collected through the government's Programme Management & Implementation Unit, and the data speed of collection ensures that it can be analysed by the chief minister and sent back into the districts to show which schools have met or missed their targets. They do this via smartphones, explains Sharif.

“We have 1,000 people visit schools every month to count the teachers present, collect data, take pictures from schools as evidence of the school performance, and this gets sent back in real time for analysis towards our performance improvement metrics,” he says. “This can then tell us in specific districts which schools were functioning, if teachers were absent and if students were present. We then have regular two-monthly stocktakes where we can map how we are progressing, set direction and consider where we need to go back and see why things aren't working as planned.”

Teacher appointments, too, are changing. These used to be influenced by politics but now all new teachers are appointed only on merit and this is making a big difference. “Our teachers are turning up to teach, with teacher attendance increasing from 82% to 92%, and our schools have been transformed into safe learning environments with over 45,000 basic facilities replaced, including fresh drinking water and electricity.”

A healthy improvement

Having seen the tangible impact in the education sector, attention was soon directed towards the province's healthcare system. Punjab's health department manages over 3,000 facilities, ranging from advanced teaching hospitals to basic health units - all providing healthcare free of cost. In a typical day, the primary and secondary facilities treat 138,000 patients. In addition, the department employs a workforce of nearly 48,000 community-based health workers to provide basic public health services to the rural population.

The primary healthcare road map was launched in April 2014 and focuses on a few high-impact reforms that will help save the lives of women and children. “Unless your nation's population is healthy, you can never be rich and never be progressive,” says Sharif. “And so last year we decided to get a regular health programme up and running - an exact replica of the education road map - and things are now improving slowly but surely. Unless these indicators improve then you will never get outputs out of your investments.”

The results in the past 18 months have been tangible and measurable: 700 basic health units have been upgraded to provide round-the-clock maternal services for expecting mothers, and more than 900 community vaccinators have been strengthened in order to ensure that children receive essential immunisations in their first year of life. Punjab has also embarked on an improvement plan for the 2,800 frontline primary care facilities around the province.

In February 2015, the secondary healthcare road map was launched, and involves 122 hospitals around the province. Mechanisms for regular hospital inspection and patient feedback are now in place and this has sparked new initiatives to improve hospital management and service delivery. To date, hospitals have seen a 30% increase of availability in specialists and overall improvement in the availability of critical medicines and supplies.

“The vaccinators are all monitored by remote technology and smartphones, and their attendance has gone up by about 25%,” says Sharif. “The number of women giving birth with a skilled birth specialist in attendance has also gone up from 5,000 a month to about 23,000 a month. We won't get the data on infant mortality until 2018 because it is on a big international timetable, but we expect a significant fall in the rates. And because we had learned from our experiences in education, our initial progress has been more rapid.”

He is also keen to stress the importance of his unannounced visits to hospitals. “These are a crucial opportunity to for me to gather facts about how things really are on a daily basis,” he says.  “One unannounced visit to one hospital can have consequence for 130 hospitals, especially if we find things like cleanliness issues.”

What's next?

A key priority going forward is for the reforms to be institutionalised, so they are truly embedded into the system for long after Sharif has stepped down from office. He believes that strong performance will set the tone. “I believe that the ultimate judges of these changes are the citizens themselves,” he says. “For example, if parents see that their children are happy and performing well then the clock will never be turned back, because the changes have whetted the appetite for more.”

But it's not just about embedding these changes. Reforming law and order is also looming large as a new priority, it transpires. “I see health, education, and law and order as a triangle,” he explains. “If you get these elements right then everything else falls into place.”



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  • The time to deliver is now. Sir Michael Barber reflects on the lessons learned and insights gained from a career at the heart of government delivery
  • Data to delivery. Former Maryland governor and Baltimore mayor, Martin O'Malley, tells us about a new approach to governance and delivery
  • From vision to reality. Government leaders worldwide share the objective of making an impact and getting things done but it's rarely straightforward - Hans-Paul Buerkner offers some advice
  • The God Revolution. Public impact is easier said than done, admits former UK Cabinet Secretary Lord Gus O'Donnell, who explains why impact is rarely viewed as a key priority among policymakers
  • Helping governments govern. The ultimate test of any government policy is whether it makes the difference it sets out to achieve, says Adrian Brown

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