Pakistan Health Statistics Quiz

National Model of Health System

• Pakistan's healthcare system is a mixed system, combining public and private sectors.
• A mixed health system combines elements of both public and private healthcare sectors to provide medical services to the population.

Mixed Health System (Details)

• The public sector includes government-funded hospitals, clinics, and basic health units.
• These facilities often face insufficient funding, lack of modern equipment, and shortages of essential medicines.
• The private healthcare sector in Pakistan is well-developed, serving a substantial portion of the population, notably in urban areas.
• Private hospitals, clinics, and individual practitioners often offer better quality services but can be expensive and inaccessible to many, particularly those from lower-income backgrounds.

Decentralization

• Decentralization is defined as the transfer of authority and responsibility from the central government to subordinate offices or quasi-independent government organizations.
• Decentralization takes two forms:
  • Deconcentration: Shifting power from central offices to peripheral offices within the same administrative structure (e.g., provincial health departments to district offices).
  • Delegation: Shifting responsibility and authority to semi-autonomous organizations (e.g., a hospital's board of governors).
  • Devolution: Shifting responsibility and authority to separate administrative structures, such as an elected local government.

Healthcare System in Pakistan (Local Government)

• Under the Local Government, District Health Managers and District Health Management Teams (DHMTs) are required to develop District Health Plans.
• These plans prioritize problems, establish realistic objectives and targets, and specify interventions, activities, and budgeting.
• Planning aids monitoring and evaluation of health activities in districts.

Healthcare System: Effectiveness

• Effectiveness depends on the availability and accessibility of human resources, materials, and finances.
• A balanced healthcare system provides a continuum of services throughout a person's life cycle, encompassing health promotion, disease prevention, diagnosis, treatment, and rehabilitation.

Pakistan Indicators

• Population under 15 years: 34%
• Population over 60 years: 7%
• Infant mortality rate/1000: 55
• Maternal mortality rate/100,000: 280
• Crude birth rate/1000: 30
• Crude death rate/1000: 6.3
• Fertility Rate (F.R): 3.2
• Immunization coverage: 65%

Pakistan Diseases

• Communicable, MNCH, and Nutritional diseases: 41%
• Non-communicable diseases: 59% (Breakdown of non-communicable diseases: CVDs 21%, Injuries 16%, Cancer 6%, Diabetes 2%, Respiratory diseases 7%, Other chronic diseases 7%)

Health Workforce

• Registered Doctors (2012): 2,47,566; (2023): 1,52,368
• Registered Dentists (2012): 27,428; (2023): 11,649
• Registered Nurses (2012): 1,02,855; (2023): 77,683
• 2017: Population per Doctor: 997; Population per Dentist: 10,658; Population per Bed: 1584

Organization of National Health System in Pakistan

• The Ministry of Health oversees both public and private sectors, with Public-sector divided into health regions.
• The private sector consists of for-profit and not-for-profit organizations (NGOs, philanthropists).

Healthcare System in Pakistan (Public v Private)

• Before 2011 amendments, the healthcare mainly operated through the Ministry of Health, however, with the amendments, responsibility shifted to provincial Health Departments.
• Currently, the private sector accounts for approximately 80% of outpatient visits.

Health Care Delivery System of Pakistan

• A diagram illustrates the structure with Federal, Provincial, Ministries, and private sector organizations like hospitals, clinics and individual practitioners.

Government Commitment in Changes in National Health Policy

• Pakistan initially focused mainly on curative services.
• The Alma-Ata Declaration shifted the focus toward primary healthcare.
• Provision of PHC services has reached 70% of the rural population.

Partnership in MDGs

• Pakistan became a signatory to the United Nations' Millennium Development Goals.
• Increased collaborations between UN organizations, the Pakistani government, and private donors.
• Projects include National TB control program, family planning, and school nutrition.

Government Vertical Programs

• Pakistan launched Expanded Program on Immunization (EPI) in 1978 and partnerships with Global Alliance for Vaccines and Immunization (GAVI).
• The Lady Health Worker training initiative aims to improve primary healthcare services in underserved areas, primarily women and children.

Health Financing

• Current Health Expenditure: 2.95% of GDP (2020).
• The out-of-pocket system is the most significant funding mechanism.
• Private insurance, external funding, and NGOs play a part alongside general taxation.
• 70% of the population seeks healthcare treatments within the private sector.

Health Financing (Internal and external)

• Key internal entities in Pakistan's healthcare system are NGOs, like HANDS, Shiffa Foundation, and Aga Khan Health Services Pakistan (AKHSP).
• Major external funding comes from USAID, and the UK Department for International Development.
• Funding contributes to various health programs such as National Tuberculosis Control Program and the HIV/AIDS program.

Health Financing (Coverage)

• A circle graph visualizes the coverage percentage by different stakeholders in Pakistan.
• Significant proportions are covered by un-funded members of different organizations.

Tiers of Public HC Delivery System

• Pakistan has a tiered system of healthcare delivery.
  • Tertiary care is provided by teaching hospitals (30 in Pakistan).
  • Secondary care is at District/Tehsil Headquarters.
  • Primary care includes Basic Health Units, Rural Health Units, and outpatient departments.

Primary Healthcare

• Pakistan has a large infrastructure for primary healthcare.
  • Basic Health Units (BHUs)
    • Rural health centre (RHCs)
• These facilities have roughly 100,000 lady health workers across Pakistan providing health services to communities.

Secondary Healthcare

• The PHC services are supported by numerous hospitals, located at tehsil and district levels for referrals. (989 THQ/DHQs hospitals).

Tertiary Healthcare

• There are 30 teaching hospitals in Pakistan, predominantly focusing on curative services.

Service Delivery Organization

• Pakistan has public health services arranged for preventive and promotive activities (often through PHC centers and outreach activities).
• Curative and rehabilitative services are primarily delivered via secondary and tertiary care facilities.

Private Sector

• Rising population pressures encourage a greater role by the private health sector to address increased demand.
• private hospitals, clinics and diagnostic labs are rapidly emerging and complementing the existing public sector facilities.

Health System Medical products & Technologies

• Pakistan's pharmaceutical industry is expanding, with 411 registered manufacturing businesses and 30 multinationals.
• Public health facilities face frequent issues with medicine shortages partly due to the insufficient medical equipment, which are often not maintained and updated.

Health System Information, Communication & Technology

• After devolution, the health information architecture in Pakistan has become fragmented.
• Vital registration and reporting of notifiable diseases are lacking nationally.
• However, some private health sectors and armed forces hospitals are well-equipped, and HMIS (Health Management Information Systems) is present.

Strengths of Health System of Pakistan

• Pakistan has a well-developed outreach-based system for primary healthcare via Lady Health Workers (LHWs), Lady Health Visitors (LHVs), and Community Midwives (CMWs).
• Public-Private Partnerships (PPPs) have demonstrated positive results. (e.g., National TB Control program).
• The role of the provincial governments in delivering healthcare services has increased.
• Pakistan has achieved considerable success in realizing the MDG targets.

Weaknesses of Health System of Pakistan

• The health system's governance is fragmented, and accountability is a key issue.
• Accessibility to healthcare services varies geographically and is not uniform.
• There are infrastructure shortcomings and insufficient resources (including medicine, equipment, personnel).
• Limited spending on healthcare affects access and quality while financial burden on individuals is extremely high.
• Existing data collection and reporting on public health are fragmented, and there are insufficient resources.