Systems Effects of Save the Children Emergency Health & Nutrition Projects: Pakistan

Save the Children US’ Department for Global Health implemented an embedded case study of health systems effects of Save the Children projects in two countries, Sudan and Pakistan, to identify opportunities for emergency health programs to strengthen systems during their implementation. This report covers Pakistan, where Save the Children implemented emergency programs to respond to the needs of some of the world’s largest populations of refugees and internally displaced people following a series of large-scale natural disasters, and crises.

Save the Children projects showed a deliberate and successful effort to integrate emergency health services into the existing health system through close coordination with the Ministry of Health (MOH), particularly at the local level. Health facilities were handed back to the MOH after upgrades and staff capacity building, triggering increased federal health financing to the state. Projects contributed health systems support and possibly strengthening by training human resources, task shifting, improving service readiness, developing and expanding the role of community-based platforms, strengthening data use for decision making at the local level, and implementing quality improvement. Documents and informant information showed intentions to maximize systems strengthening opportunities, but we found only limited documentation and formal evaluation of the potential systems effects, with unaddressed important questions regarding supply chain management, and financial sustainability.