The Hub & Spokes Model in Pakistan
Submitted by: Mr. Rasheed Ahmed, Humanitarian Analyst, UNFPA Pakistan Country Office UNFPA Pakistan Country Office
Email: [email protected]
Introduction to the project
Pakistan - Balochistan Province
September 2018 - May 2020
The hub-and-spoke model arranges the distribution of healthcare services into a network with a secondary care hospital (hub) at the centre, which is complemented by first-level care facilities and mobile outreach units (spokes) which offering less services. This network allows for a better delivery of healthcare services and a better redirection of patients to the adequate facility. The secondary care hospital also acts as a management hub and supports the spokes.
- To protect and promote sexual and reproductive health and rights of Afghan refugees and host communities focusing on women, adolescents and youth in District Pishin.
- Increased access to, and utilization of, sexual and reproductive health and psycho-social support services for refugees and host communities.
- Realized and attained responsibility of the government health system to extend sexual and reproductive health (SRH) care and services to Afghan refugee women, adolescents and young girls.
- Equipped and functional infrastructure of government health facilities close to Afghan Refugee Camps.
- Increased partnerships among public and private service providers to improve efficiency and to reduce cost and burden on the government health system.
An existing Public Private Partnership (PPP) Model between Government, Department of Health (DoH) and People’s Primary Health Care Initiative (PPHI) in Balochistan facilitated the implementation of the Hub & Spoke Model in District Pishin.
District Pishin is a district with the highest number of Afghan Refugees living both in Camps and in urban settings with a ratio of 40:60% (camps:urban).
Department of Health
People's Primary Health Care Initiative
Population Weallfare Department
Challenges and how they were overcome
The PPP model between DoH and PPHI is providing primary health care services through first level care facilities. All the first level care facilities are administered by PPHI with funding support from the government. Whereas, secondary care hospitals are directly administered by DoH.
The initial challenge in Hub & Spoke Model was to link a secondary care hospital (Hub) with first level care facilities and mobile outreach units (Spokes). The second challenge was to establish a blood bank to ensure that the secondary care hospitals are providing all 9 signal functions of Comprehensive Emergency Obstetric and New-born Care Services (CEmONC).
Moreover, to conduct C-Sections and for general anaesthesia, engaging specialist services was another challenge.
How they were overcome
To ensure that Hub & Spoke Model is administered by PPHI, a special notification was issued from the office of the Secretary Health, Department of Health in Balochistan to hand over administrative control of one secondary care hospital to PPHI.
UNFPA has supported PPHI and DoH by providing additional financial support to establish a blood bank.
For C-Sections and general anaesthesia, UNFPA with funding support from DFAT has arranged two women medical officers (existing staff of the hospital) to be trained for six months to conduct C-Sections and for general anaesthesia.
Results of the Good Practice
- 60% of the refugee population living in urban areas of the district have access to improved SRH & psycho-social support services.
- 40% of refugees living in the camps have improved access to services through two mobile service units which are provided by Population Welfare Department (PWD)-Balochistan which will visit the camps twice a week.
- Referrals from the camps will be received at secondary care hospitals.
How the project meets the GCR Objectives
Objective 1: Ease the pressures on host countries
UNFPA with financial support from the government of Australia (DFAT) in collaboration with PPHI, Department of Health and Population Welfare Department is implementing the Hub & Spoke Model. The purpose of this model is to increase service delivery efficiency through decentralized management of services, reduce cost through partnerships and resource sharing and to interlink service delivery and referrals through a continuum of care arrangement.
In the Hub and Spoke Model, provision of SRH and psychosocial support services are placed as the highest priority. The Hub and Spoke Model undertakes the following key functions:
- SRH and psychosocial support services for Afghan Refugees and host community focusing on women, adolescents and young girls.
- Harmonizing government health care systems with Afghan refugee community support structures in the camps.
- Facilitating equitable access to SRH services for Afghan refugees living in the camps (40%) and those living among host community (60%). The model has made special arrangements to reach vulnerable and marginalized groups - in particular women and adolescent girls.
The Hub & Spoke Model is also an operational arrangement of static and outreach SRH and psycho-social support services from first level care facilities and mobile service units that are arranged like a wheel, linked to a central hub which is a secondary care hospital. In this case, RHC Khanozai (Upgraded hospital) with a catchment population of around 43,000 is selected as a Hub which is connected with Basic Health Unit (BHU) Nighanda, BHU Balozai, BHU Yousaf Kach, BHU Nana Sahib, BHU Rod Mulazai and two Mobile Service Units for Sukharkhawb and Saranan Afghan Refugee Camps (Camps with population of around 78, 000). The hub which is Khanozai Rural Health Center is providing 24/7 SRH and psychosocial support whereas basic health units are providing BEmONC and other SRH services as part of routine BHU operations. BHU’s refer complicated cases that require specialist attention.
As part of the initial arrangement, UNFPA has equipped these centers with additional support for female health care providers. PPHI, PWD and DoH have established a partnership under an agreement to share resources. In the partnership, PWD’s role is very important as it has offered mobile services unit support for outreach activities to Afghan Refugee camps.
In the model, the secondary care hospital is also the management hub which ensures arrangement of staff and services at spokes. Since first level care facilities cannot afford to recruit doctors, one female medical officer from the hub deploys on rotation to each of the spoke facilities. Similarly, one doctor also joins the mobile medical unit for delivering SRH services in camps. The hub also manages medicines and family planning commodities for the whole model. The management at hub works in consultation with Afghan Refugee Camps management for organizing outreach services on a regular basis.
PPHI will continue this project. World Bank in consultation with DoH is planning to replicate four additional Hub & Spoke Models.