Lecture 10- Health System of Pakistan PDF

National Model of Health System Ms Rubab Zulfiqar Lecturer Public Health NUMS  MIXED HEALTH SYSTEM A mixed health system combines elements of both public and private healthcare sectors to provide medical services to the population...

National Model of Health System Ms Rubab Zulfiqar Lecturer Public Health NUMS  MIXED HEALTH SYSTEM A mixed health system combines elements of both public and private healthcare sectors to provide medical services to the population The healthcare system in Pakistan is a mix of public and private sectors.  MIXED HEALTH SYSTEM The public healthcare system includes government- funded hospitals, clinics, and basic health units. However, these facilities often suffer from insufficient funding, lack of modern equipment, and shortages of essential medicines. The private healthcare sector in Pakistan is well- developed and caters to a significant portion of the population, especially in urban areas. It includes private hospitals, clinics, and individual practitioners. Private healthcare facilities often offer better quality services but can be expensive and inaccessible for many people, particularly those from lower-income backgrounds.  Healthcare System in Pakistan Under the Local Government set up, District Health Managers and the District Health Management Teams (DHMT) would be required to develop District Health Plans based on an appropriate Situation Analysis of the District Health System. These plans would assist the managers to prioritize problems, set realistic objectives and targets, select the appropriate strategies and interventions, spell out the activities to be undertaken, and give a budget and sources of financing for effective implementation of the plan. It would also facilitate the process of monitoring and evaluation of health related activities in the districts. Currently, such planning is not taking place in the districts.  Health Care System… Effectiveness depends on availability and accessibility of Human, Materials & Finance resources. In the balanced HC system people receive a continuum of services throughout life cycle.  Health promotion  Disease prevention  Diagnosis  Treatment  Rehabilitation Health Systems 12/26/2024 6  Country Health Profile…. PAKISTAN INDICATORS1 Population under 15 years 34% Population over 60 years 7% Infant mortality rate/1000 55 Maternal mortality 280 rate/100,000 Crude birth rate/1000 30 Crude death rate/1000 6.3 Fertility Rate (F.R) 3.2 Immunization coverage 65% Kumar S, Bano S. Comparison and Analysis of Health Care Delivery Systems: Pakistan versus Bangladesh. J Hosp Med Manage. 2017, 3:1. 12/26/2024 Health Systems 7  Country Health Profile…. PAKISTAN DISEASES1 Communicable, MNCH, and 41% Nutritional diseases Non-communicable diseases 59% CVDs 21% Injuries 16% Cancer 6% Diabetes 2% Respiratory diseases 7% Other Chronic diseases 7% Kumar S, Bano S. Comparison and Analysis of Health Care Delivery Systems: Pakistan versus Bangladesh. J Hosp Med Manage. 2017, 3:1. 12/26/2024 Health Systems 8  Health Workforce HEALTH MANPOWER 2012 2023 Registered Doctors 1,52,368 2,47,566 Registered Dentists 11,649 27,428 Registered Nurses 77,683 1,02,855  Health Workforce HEALTH MANPOWER 1 2012 2017 Population per Doctor 1,162 997 Population per Dentist 15,203 10,658 Population per Bed 1647 1584 1. 2016-17 WHO 12/26/2024 Health Systems 10 Organization of National Health System in Pakistan 12/26/2024 Health Systems 11  Healthcare System in Pakistan Healthcare in Pakistan is administered mainly in the private sector which accounts for approximately 80% of all outpatient visits The public sector was until recently led by the MoH, which was abolished in June 2011 under 18th amendment and health responsibilities were devolved to provincial Health Departments which are the main implementers of public sector health programs. 12/26/2024 Health Systems 12 12/26/2024 Health Systems 13  Government commitment in changes in National health policy Pakistan started its journey with limited the focus of National health policy on curative services. After the Alma Ata Declaration, paradigm of health shifted to primary health care This resulted in provision of PHC services in all urban population with 70% of rural population having health facilities within 5 kilometers  PARTNERSHIP IN MDG: Pakistan took an initiative by becoming signatory body to achieve the eight Millennium Development Goals (MDGs) adopted in 2000 by the United Nation (UN) Members for the improvement of human life and health condition. PARTNERSHIP OF PUBLIC AND PRIVATE SECTOR: The Government of Pakistan became pioneer country in the world to establish a national public and private partnership to struggle towards achieving MDG’s. This partnership was between the United Nations Development Program (UNDP), civil-society organizations and private donors, both in Pakistan and abroad. (National TB control program, family planning program and school nutrition program) GOVERNMENT VERTICAL PROGRAMS: Major initiative taken by Pakistan in the health sector is to reduce child and maternal mortality with the help of foreign aid funds.  Expanded Program of Immunization: o Expanded Program on Immunization (EPI) was launched in 1978 o Global Alliance for Vaccines & Immunization (GAVI)  Lady Health Worker training initiative: o one of the successful Programs of public health sector in Pakistan o Main goal was to provide primary health care to the underserved population and mainly women and children and provide healthcare services such as family planning services at doorsteps o LHWs served as a bridge between the communities and the health facilities  HEALTH FINANCING Current Health Expenditure: 2.95% of GDP (2020) The out-of-pocket mechanism, general taxation is the major source of government’s financing for health Private insurances, NGOs, external funding agencies and world funding. 70% of the population seek treatment in private sector and only 30% uses public sector hospitals.  HEALTH FINANCING The main internal NGOs and agencies contributing in the health system are HANDS, Shiffa Foundation, and Aga Khan Health Services Pakistan (AKHSP). The external funding agencies in Pakistan are USAID, and Department for International Development, UK National Tuberculosis Control Program, EPI programs, diagnostic kits for the HIV/AIDS program, and Hepatitis program is governed by donor agencies at Pakistan.  Tiers of Public HC Delivery System 12/26/2024 Health Systems 20  Health System Profile Pakistan 12/26/2024 Health Systems 21 Tiers of Public HC Delivery System.. Primary health care Pakistan has a relatively large PHC infrastructure. This includes,  BHU 5000  RHC 600  other first-level care facilities 7500  lady health workers 100 000 providing services across Pakistan. 12/26/2024 Health Systems 22 12/26/2024 Health Systems 23 12/26/2024 Health Systems 24  Tiers of Health Delivery System.. Secondary Health Care The PHC services are supported by a network hospitals, at tehsil and district levels, for referrals.  THQ/DHQ 989 12/26/2024 Health Systems 25 12/26/2024 Health Systems 26  Tiers of Public HC Delivery System.. Tertiary health care There are 30 teaching hospitals in Pakistan. These hospitals mainly provide curative services and to a limited extent some preventive services. 12/26/2024 Health Systems 27 12/26/2024 Health Systems 28  Service delivery organization Public Service delivery is organized as  Preventive & Promotive Services Mainly provided through various national programs; PHC centers and outreach activities.  Curative & Rehabilitative Services Provided mainly at the secondary and tertiary care facilities. 12/26/2024 Health Systems 29  Private sector The rising population pressure on state health institutions has allowed the private sector to bridge the gap of rising demand and limited public health facilities. A number of private hospitals, clinics and diagnostic labs has increased considerably and is contributing health services in the country. Stand-alone clinics across Pakistan are the major providers of OPD care 12/26/2024 Health Systems 30  HEALTH SYSTEM MEDICAL PRODUCTS & TECHNOLOGIES The pharmaceutical industry of Pakistan is rapidly developing and has 411 registered manufacturing divisions and 30 multinational companies across the country. It meets approximately 80% of country’s demand and 20% are being imported The Drug Regulatory Authority of Pakistan (DRAP) is the authority that set policies, rules, and control pharmaceutical companies Most of the public health facilities suffer from frequent stock out of medicines which ultimately force patients and general public to produce drug of their own through out-of-pocket expenditure Procurement and standard operating procedures of medicines, equipments and various technologies does not meet technically set national guidelines  No existing policy for the upgradation and replacement of equipment after they have completed their devaluation period, making the equipment compromised and nonfunctional.  HEALTH SYSTEM INFORMATION, COMMUNICATION & TECHNOLOGY After devolution, Pakistan’s health information architecture has been fragmented Vital registration and notifiable disease reporting through the legislative framework for health information is also absent at the national level. But certain private health sectors and armed forces hospitals in the country are well equipped with latest technologies, have HMIS and properly managed and developed infrastructure No well-defined policy and plans for technology implementation, telemedicine, and infrastructure development The concept of e-health has been implemented in the rural areas of Pakistan e.g. Gilgit-Baltistan  Strengths of Health System of Pakistan In the health policy of Pakistan, the overall wellbeing of an individual and social, physical and mental health are addressed as measures of quality of life. The concept of Healthcare delivery shifted towards primary healthcare in Alma Ata. The government covered almost 70% of rural population and healthcare facilities were provided to them in their vicinity. Pakistan became the member country in achieving MDG goals with UN and is determined to improve health indicators defined by UN. The major strength of HCDS of Pakistan is an outreach primary health care services delivered at the community level by Lady Health Workers (LHWs), Lady Health Visitors (LHVs), and Community Midwives (CMWs) who have earned success and trust in the communities  Strengths of Health System of Pakistan Pakistan has been a pioneering country in encouraging Public Private partnership (Nationa TB Control program, family planning and school nutrition program, EPI, MCH) Pakistan under article 18th amendment the health care services are the obligations of provisional government except for the federal area. The public health delivery system functions through a three layer approach primary, secondary, and tertiary Government has introduced autonomous bodies to serve the population (NICVD, SIUT, GIMS, SMBB Trauma Centre)  Weaknesses of Health System of Pakistan Lack of Health System Governance and Accountability  Fragmented Health System  Weak Regulatory Framework Limited Access to Healthcare  Geographical Disparities  Infrastructure Shortcomings Quality of Care  Substandard Facilities  Shortage of Skilled Personnel Financial Constraints  Limited Healthcare Spending:  High Out-of-Pocket Spending: Fragmented Data Systems Public Health Challenges  Thank You 12/26/2024 Health Systems 37