Heartfile
Heartfile, an independent health sector think-tank that catalyzes health systems change & broader systems of governance to improve health & social outcomes
About You
About You
First Name
Sania
Last Name
Nishtar
Twitter URL
Facebook URL
About Your Organization
Organization Name
Heartfile
Organization Website
Organization Country
Pakistan
Country where this project is creating social impact
Pakistan
Is your organization a
Non‐profit/NGO/citizen sector organization
How long has your organization been operating?
More than 5 years
Has the organization received awards or honors? Please tell us about them
The organization’s founder, Sania Nishtar has received the following awards
• Rockefeller Foundation’s Global Innovation Award, 2011
• Medical Mission Hall of Fame; Toledo, Ohio; 2011
• European Society Population Science Award, 2005
• Featured at the Women in the World Foundation launch in New York, September, 2011
• Sitara-i-Imtiaz, Pakistan, 2005
• International Biographical Centre, Cambridge accolades: (International Health Professional of the Year 2007 and 2010; International Biographical Center, Woman of the year for 2010; IBC lifetime Achievement Award, 2010; DG’s leadership award for 2010; 2000 outstanding intellectuals of the 21st century, 2010; Ultimate achiever 2009 and 2010; Order of Distinction 2009; Lifetime Medical Achievement Award 2009; International Hippocrates Award for medial achievement 2009; Top 200 of the IBC 2009; Director General’s Leadership Award for 2009; 2000 Outstanding Intellectuals of the 21st century 2009; and others.
• American Biographical Institute, Washington accolades: (2009 Women of the Year Pakistan; Gold Medal for Pakistan 2009; Woman of the Year in medicine and healthcare 2009 medal; Order of Merit Representing Pakistan 2009; Legion of Honor 2009, and others)
• Listed in the following WHOs WHO lists (..in the World; …in Professional and business women, ..in Healthcare, …in Science and Engineering,... in Women of the world and others)
• Listed in the following Leading professionals of the World’s lists: Leading professionals of the World 2010; Top 100 health Professionals
• All Pakistan Quaid-e-Azam Merit Scholarship, 1989
• Best graduate of Khyber Medical College and gold medal, 1986
• President of Pakistan Student Award and gold medal, 1986
• University of Peshawar gold medal and merit scholarship, 1986
• Other academic awards lists on http://sanianishtar.info/awards.php#academc
• Featured in the Non-Governmental Individuals in Pakistan (NGIs)
• Listed in Marquis WHO WHO in the world
• Listed in Marquis WHO WHO in Asia
• Listed in Marquis WHO WHO in Health care
• Listed in Marquis WHO WHO in Science and Engineering
References - Please provide two references with a two-sentence biography, email address, and phone number for each
Dr. Abdul Ghaffar
Executive Director, Alliance for Health Policy and Systems Research
World Health Organization
+41 (79) 2493541
Prof. Samad Shera
President, Diabetic Association of Pakistan
+92 (21) 6616890
The information you provide here will be used to fill in any parts of your profile that have been left blank, such as interests, organization information, and website. No contact information will be made public. Please uncheck here if you do not want this to happen..
Innovation
Select the stage that best applies to your solution
Established (past the previous stages and has demonstrated success)
How long have you been in operation?
Operating for more than 5 years
The Need: What problem are you trying to solve?
Health systems in Pakistan haven't met the goal of universal coverage. It has not performed optimally & lags behind in meeting international targets. Health systems weaknesses, in particular governance issues are pervasive and adversely impact performance, escalating the socio-economic divide within the country. There is little national capacity to advocate change & reform. Heartfile is striving to bridge this gap through its policy advocacy for reform & trying to solve medical impoverishment. Public sector contribution towards total per capita health expenditure is 8.86 USD in Pakistan, compared with recommended 60.0 which can cover basic health care delivery. Out of pocket payments drive millions of poor people into medical impoverishment —40 million are at risk in Pakistan.
The Solution: What is your solution? Be specific!
Heartfile has two sets of solutions. One the one hand it operates as a civil society think tank, focusing on policy advocacy; as such it tries to catalyze change in Pakistan’s health system through its intellectual contributions. On the other hand, it also engages in practical initiatives to fill strategic priority gaps and helps develop and deploy solutions. Rigorous evaluation of these projects bring critical evidence into the public domain and by structuring projects for scale up, it ensures that these are rapidly institutionalized in Pakistan’s health system. Heartfile has developed a channel (Heartfile Health Financing) to protect such people from being pushed into poverty and foregoing care. This humanitarian intervention is also Heartfile’s practical inroad into health reform.
The Model: Walk us through a specific example of how your solution makes a difference; include your primary activities
1 Heartfile’s publication, the Gateway Paper: Health systems in Pakistan, a way forward inspired the development of a new health policy for Pakistan www.heartfile.org/mou_fed.htm
2 We were the first among developing countries to develop an integrated national plan for non-communicable disease from amongst the developing countries. This plan and the public-private partnership design, led by Heartfile was widely lauded internationally www.heartfile.org/hreforms.htm#CD
3 We developed the first consolidated reform plan for Pakistan http://sanianishtar.info/choked-pipes.php
4 We developed the 1st compendium of health statistics for Pakistan www.heartfile.org/hreforms.htm#HIS
5 Our health systems analyses are widely respected for their rigour & objectivity. The recent analysis in the post-18th Amendment devolution scenario being illustrative www.heartfile.org/18amendment.htm
6 The Heartfile-created tripartite partnerships with the Ministry of Health & WHO have set a precedent for public private partnerships in the health sector for Pakistan www.heartfile.org/napmou.htm
7 We have developed a model social protection system for health “Heartfile Health Financing” to bridge a strategic priority gap in Pakistan’s current social protection system. A successful pilot is being up-scaled nationally. Partnerships with the Pakistan Poverty Alleviation Fund (PPAF), & Pakistan’s National Database Registration Authority & strategic use of technology are enabling scale up http://heartfilefinancing.org
8 Our opinions on health systems issues in the country are widely respected and cited
The Marketplace: Who are your peers and competitors? Identify others also working to address the needs you are and what differentiates you from them. What challenges could these players pose to your success or growth?
We have no competitors. Our peers include other health sector policy advocacy organizations. There are a number of factors which make Heartfile stand apart - Heartfile holds intellectual independence paramount and to protect that it keeps at an arms length from the government it does not draw its resources from government systems. Most health organizations with a focus on policy advocacy, focus on a single thematic area. Such a narrow focus usually precludes attention to systemic challenges, which are at the heart of problems faced by the Pakistani and other developing country health systems. Heartfile’s focuses on these issues preferentially, in particular it drills deep into issues of lack of transparency & collusion, which other organizations are shy of addressing.
This Entry is about (Issues)
Social Impact
Founding Story: We want to hear about your "Aha!" moment. Share the story of where and when the founder(s) saw this solution's potential to change the world.
In 2008, Heartfile was already established as a leading health policy voice in Pakistan— but its contributions were largely intellectual and normative in nature. One particular incident led the founder to broaden the scope of operations into implementation. While signing of the proofs of her book, Choked Pipes, she met a person who had suffered from a fracture of his leg. The person could neither afford to pay for treatment nor stay away from his daily wage earnings. He opted for a quick and cheap option—to have his leg chopped off so that he could avoid further indebtedness and return to work.
The founder decided that she wanted to create an on ground project through which such people could be helped. But being a reformist in thinking she structured it in such a manner that it could also become an entry point to reform—interestingly the book that she has just sent off to the publisher, was on reform of the Pakistani health system. Heartfile Health Financing (HHF), was thus created.
Please describe the goal of your initiative; outline what you are trying to achieve
Heartfile Health Financing initiative facilitates financial access to healthcare for the destitute and protects the poor from catastrophic expenditures on health or from foregoing care. Over 40 million individuals are at the risk of spending catastrophically in Pakistan. Healthcare shocks are the most common economic shocks faced by households. On the other hand, this is also a developmental intervention.
The HHF system has been designed to overcome a systemic barrier in the existing system. The social impact of this one program Heartfile has launched, ranges from impact at the individual and household level to systems-wide impact. Heartfile’s initiatives in other streams have correspondingly created broad-based impact.
What has been the impact of your solution to date?
To date, 400 patients or 2,800 individuals have been protected from poverty. Systems have been developed as a replacement for Bait-ul-Mal, the state’s social protection system. A model for replication has been created. The impact can be illustrated through the story of one of the recipients:
“Shnea was ravaged by poverty and ill-health. She travelled a 500-mile journey twice from her home in Khost, Afghanistan to Islamabad, Pakistan on a horse driven cart seeking treatment for a curable heart condition. Her nails were blue due to low blood circulation and complain of breathlessness, a condition that can progressively cost her life. The treatment required a simple surgery that would have costed 200 USD for the blockage of an abnormal channel. On her 2nd trip she was accompanied by baffled family members that could niether afford her surgery nor had the means to go home with a sick child. The HHF project aims at actively seeking such patients and protect them from foregoing basic care"
What is your projected impact over the next five years?
Our project goals have been set firm from the beginning. We want to ensure that we can reach the maximum number of poor patients that are forced to spend catastrophically on healthcare. We want to ensure that they have the security of necessary healthcare. We want to address this problem as it has a nation-wise impact on social divides and prevalent poverty. Over the next five years we want to scale this program up nationwide, so that every public hospital will have access to it. In order to achieve this purpose, adaptations will have to be made in the process so that the current HHF platform can also cater to chronic and ongoing needs of patients as well emergency situations. With these additional features the full range of social protection services will be integrated with HHF.
Winning entries present a strong plan for how they will achieve and track growth. Identify your six-month milestone for growing your impact
expand our work to at least one province in Pakistan whilst providing protection to 7000 individuals from medical impoverishment
Identify three major tasks you will have to complete to reach your six-month milestone
Task 1
We would enroll more wards so that maximum number of individuals can be helped
Task 2
We would also enroll and train more volunteers which would help us make our project more efficient
Task 3
Identifying other diseases as a result of which people fall into medical poverty
Now think bigger! Identify your 12-month impact milestone
go to 2 provinces in Pakistan whilst providing protection to 14,000 individuals from medical impoverishments (2,000 patients)
Identify three major tasks you will have to complete to reach your 12-month milestone
Task 1
We would enrol more wards so that maximum number of individuals can be helped
Task 2
We would also enrol and train more volunteers which would help us make our project more efficient
Task 3
Identifying other diseases as a result of which people fall into medical poverty
Sustainability
Tell us about your partnerships
Our national partnerships are with partners that are part of the Pakistan Health Policy Forum. We have 3 MoUs with Pakistan’s Ministry of Health to develop policy frameworks; our MoU with Federal Bureau of Statistics of Pakistan led to creation of the 1st compendium of health statistics for Pakistan. Strategic partnerships have been built at the country level to help us upscale. We have partnered with international agencies like WHO, Clinton Global Initiative, WEF & Global Alliance for Vaccine Initiative.We have engaged international experts in our policy initiatives at various levels.
Are you currently targeting other specific populations, locations, or markets for your innovation? If so, where and why?
Heartfile innovations are recognized throughout the developing world. The Heartfile Health Financing program in particular has potential to be replicated in other developing countries with similar health systems. Through partnership with the Clinton Global Initiative, and WHO the potential of this initiative to be replicated in other countries is currently being explored. As this program is tailored so that the funds from donors are allocated to the beneficiaries in the most transparent way possible, it can benefit other countries with the same social health issues.
What type of operating environment and internal organizational factors make your innovation successful?
At Heartfile we have created a culture of learning and making modifications to our innovations as we go along. Our organizational environment is neither bureaucratic nor hierarchical. We reward performance and facilitate staff to overcome their weaknesses. At the organization we have policy of keeping our overheads lean and aim to make optimal use of technology to improve performance. We have a commitment to learn from evidence and focus on learning from processes as we go along to make the needed modifications to the program. We also have a policy to draw on relevant expertise as the need arises. We regard ourselves nimble and responsive and have the ability to adapt quickly to situations as evidence demands and as the need arises.
Please elaborate on any needs or offers you have mentioned above and/or suggest categories of support that aren't specified within the list
We will be able to share our experiences with other agencies and will be willing to assist with the “how to” of developing a think tank in a resource constrained environment. We will also assist with networking and capacity building.
 | 12 weeks agoLaura Spero said: The combination of designing and implementing practical interventions, while also conducting rigorous research on systemic health care ... about this Competition Entry. - read more > |
| 15 weeks agoSania Nishtar submitted this idea. |
