ISLAMABAD: Pakistan’s health sector is in a complete mess and has thus failed to respond to the needs of the people, yet the federal government’s health sector reforms proposed in 2015 by a team of experts engaged by the Planning Commission remain undiscussed even after passage of two years.
A government official, when approached, claimed that discussion on the said package will be held soon. Informed official sources told media that the reform body headed by PIMS chief Dr Javed Akram had recommended a detailed reform package mainly focused on the federal government’s jurisdiction. However, the PML-N government got no time to discuss and implement the scheme.
Documents available identified absence of adequate national health policy framework; dearth of inter provincial harmonization on health policy development; nonexistence of federal regulatory authority for coordination of international relationships; lack of national health information due to limited reporting mechanism; absence of aligning health strategies with financial forecasting; and, irregular donor coordination; fragmented functions and coordination activities as the major flaws of governance hurting the health sector.
The key challenges haunting service delivery in the health sector include ambiguity in transfer of vertical programs and their fiscal support to provinces; transfer of funds without appropriate technical guidance; challenges faced by national service delivery programs including adherence of contractual agreements by provincial governments, lack of inter-provincial harmony, ambiguous mechanisms for resource mobilization; donor preference for one window operation; and lack of progressive approach.
Regarding constraints about health information, the report says that there is neither any integrated centralized disease surveillance system in the country nor any effective mechanism available for inter-provincial information/knowledge sharing. It added that there is minimal use of information and evidence in planning, management and surveillance of diseases resulting in faulty and unrealistic decision making.
Following the 18th amendment, the health became the provincial subject but the provincial governments whose function was more focused on service delivery, including its organization, monitoring and evaluation, did not fully adjust to the changed role. “Devolving functions to the provincial level should have been in tandem with capacity building at several levels within the provincial administrative set-up,” the reform body observed, adding that following the 18th amendment there is an ambiguous role of the federal government in case of service delivery, HR, medicines and drug regulation. “Clarify in role of Federal Government is required,” the report said.
The report asks for enhanced spending on health sector but admitted though the provinces gain authority and funds, capacities remained weak. It adds that primary and secondary care is ignored and there is no attention to research and development.
For the ICT, the body recommended a model to integrate different health managers besides suggesting improvement in inter-provincial coordination. It also seeks assessment of gap between need for a health workforce, actual supply and population’s demand for health services. The report also asks for development of a centralized integrated disease surveillance system with a strong inter-provincial information sharing mechanism. Setting up a Pakistan Medical Laboratories Regulatory Authority has also been recommended for the regulation of medical laboratories for quality lab tests.
It also suggested the development of guidelines for good manufacturing practices, pre-qualification of medicines and standard treatment. Standardized central drug testing formal for registration of drugs and formation of pharmacovigilance system have also been recommended for provision of safe, effective and quality medicines.
To check patients load at the main hospitals, the reform body asked for the creation of referral system between primary/secondary health care system and tertiary care centres of ICT. For this purpose, the body asks for strengthening of all ICT Basic Health Units on basis of pilot model integration.
The body also asked for setting up of inter-organisational harmony between various regulatory bodies like Pakistan Medical and Dental Council, the College of Physicians and Surgeons Pakistan, Pakistan Nursing Council through clear visibility of role amongst them.