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Pakistan's National Health Policy: Quest For A Vision
... The supply of health care has historically been regulated collectively by federal and provincial governments with districts largely responsible for the execution (Home A Superintendent General for vaccination was nominated after Jenner's launch of the vaccine against smallpox, and a law to grant vaccination power was passed by the Government of India in 1880. Maybe, it was the government's initial assurance that eventually led to the elimination of smallpox (Lashari, 2004). In April 1896, with the incorporation of the Bengal Medical Service, the Bombay Medical Service and the Madras Medical Service, the Indian Medical Service of the East India Company gained an all Indian characteristic. ...
... A health policy was offered in 1990 after broad discussions. This policy described its goals to be achieved during the ten years (Lashari, 2004). National policies are included the Peoples Health Scheme of 1972, the National Health Policies of 1990, 1997, 2001, and 2009, Vision 2030, and National Health Vision 2016-2025. ...
... While, with an approximated cost of Rs.498 billion, SAP-II (1997-2012) was launched. The focus of SAP was on primary health, development of primary education, population welfare, sanitation, and rural water supply (Lashari, 2004). ...
Objective: A reviewing study of the health policy planning and formulation was initiated which explored the procedure of formulation of health policy and its implementation in Pakistan. The purpose of the study is to learn the procedure of health policy formulation and its implementation and to observe the issues in health system in Pakistan. Methodology: This study on health policy formulation was exploratory in nature. The research design was qualitative. The data was collected through secondary sources which includes research articles published in various journals and available on online sites. Moreover, data was also collected through books written on public policy by some foreign and local authors. Findings: The findings indicates that the planning and policy formation of the health sector in Pakistan is capable at the preparation level but not at the execution level. Implications: This paper recommends overcoming the health-related problems in Pakistan through formulation and implementation of sound, assertive and credible policies.
... The basis of Pakistan's current healthcare system was laid down in the 60s when primary, secondary and tertiary level facilities were organized as part of the tiered system of progressively higher levels of specialization connected by referral linkages. While most five-year plans mainly focused on preventive and primary level healthcare, some expansion in hospital sectors was evident especially in the 70s (Lashari T., 2004). ...
The importance of health systems has been reinforced by the commitment of Low- and Middle-Income Countries (L&MICs) to pursue the targets of Universal Health Coverage, Health Security, and to achieve Health-related Sustainable Development Goals. The COVID-19 pandemic has further exposed the fragility of health systems in countries of all income groups. Authored by international experts across five continents, this book demonstrates how health systems can be strengthened in L&MICs by unravelling their complexities and by offering a comprehensive overview of fundamental concepts, performance assessment approaches and improvement strategies to address health system challenges in L&MICs. Centred on evidence and advocacy this unique resource on health systems in L&MICs will benefit a wide range of audiences including, readers engaged in public health practice, educational programs and research initiatives; faculties of public health and population sciences; policymakers, managers and health professionals working for governments, civil society organizations and development agencies in health.
... The uncertainty of the political situation can have a negative impact on the progress of such projects: changes in government can mean certain projects are abandoned prior to completion. Poor governance is also an issue (Lashari, 2004). In Pakistan, prior to 2011, the Federal Ministry of Health was responsible for the healthrelated activity of each province. ...
... The analytical review by Dr. Talib Lashari of different health policies in Pakistan leads to the conclusion that these initiatives were nothing more than Government's attempts to institutionalize and regularize the drafting of policies. Deploring the irrationality of decision making regarding health policy in Pakistan, Lashari (2004) Lack of continuity of policies, lack of community participation, lack of government initiatives to bring the private health sector into the mainstream of health care, lack of good governance, and lack of the necessary skills and interest on the part of some stakeholders including public representatives and NGOs are some of the other negative factors. ...
The chapter depicts the cultural landscape of Bangladesh society in the
light of cultural theory as propounded by Thompson et al. (1990) and Hofstede
(1997, 2001), in a bid to comprehend how the dominant culture affects the
society and body politic of Bangladesh. What is the cultural configuration of
Bangladesh society? What is the dominant way of life as posited by Thompson?
Where does Bangladesh stand with respect to Hofstede’s four national cultural
dimensions? How do the broad cultural attributes of Bangladesh society
influence and shape political institutions and the behavior of politicians and
other major groups? Questions like these are addressed in this paper.
... The basis of Pakistan's current healthcare system was laid down in the 60s when primary, secondary and tertiary level facilities were organized as part of the tiered system of progressively higher levels of specialization connected by referral linkages. While most five-year plans mainly focused on preventive and primary level healthcare, some expansion in hospital sectors was evident especially in the 70s (Lashari T., 2004). ...
Governance of public sector hospitals has been a major challenge in Pakistan. A framework has been adapted to assess governance at the macro-and micro levels of decision making. At the macro-level, the experience of hospital autonomy to improve efficiency and quality of care has been inconclusive in the absence of proper rules and regulations. Following devolution in health, the provincial governments have instituted regulatory regimes for improved governance and have experimented with PPPs to improve management of district hospitals. At the micro-level, the focus has been on institutional aspects of hospital management. Most public hospitals face challenges related to human resource, financial and supply chain management; lack of information technology, poor quality of care, and lack of disaster preparedness and management capability. This paper offers three strategic priorities for policymakers to consider-first, demonstrate consistency and commitment in implementing policies related to hospital governance; second, launch a countrywide capacity development program for hospital managers; and third, establish e-governance to enhance accountability, transparency and performance of hospitals.
... 18 The total body adiposity was more closely associated with cardiovascular disease risk factors than overall adiposity as measured by BMI in studies on the Pakistani population. 19 -79 (heartfile) Additional health benefits can be gained through greater amounts of physical activity and fitness process. Moderate daily health and fitness can reduce substantially the risk of dying from cardiovascular disease, type 2diabetes, and certain cancers, such as colon cancer. ...
... The present study showed that though most of the parents and care givers of the children knew about polio vaccine drops and their advantages, but their information regarding the mode of transmission of the virus, leaves a lot to be desired. Among the major reasons for appearance of new cases of poliovirus in secured areas of Pakistan; is the lack of accuracy in polio vaccination coverage and unaccountability of responsible official (Lashari, 2004). The Expanded Programme on Immunization (EPI), Pakistan set its initial goal to provide immunization services to all the children of the world by 1990, during the first year of life. ...
Objective: Objective of this study was to evaluate the knowledge of population of union council cantonment Quetta, regarding polio disease.
Methodology: This study was a questionnaire based cross sectional study which was conducted in the general population of Union Council Quetta Cantonment. A total sample of the entire registered population of the Union Council was obtained. The data was analyzed on SPSS version 20. The questionnaire consisted of twenty questions aimed to assess the knowledge of people regarding polio disease.
Results: The present study showed that though most of the parents of the children knew about polio vaccine drops and its advantages, but information about the mode of transmission was unknown among them. The main reason for occurrence of new poliovirus cases in the secured areas of Pakistan is due to the lack of accurate polio vaccination coverage and unaccountability of responsible officials. As polio can only be prevented by polio vaccination, so effective polio vaccines and effective vaccination programs are two important factors, which have affected the national polio campaign.
Conclusion: In this study majority of study subjects had good knowledge about causes, diagnosis, and prevention of polio disease. It is concluded that knowledge is a key factor for the prevention and control of polio disease, it is obvious to plan and apply appropriate health education programs, seminars and interventions regardless of the level of education of the population, to propagate the knowledge and information about causes, symptoms, transmission and treatment of polio disease in the general population.
Keyword: Polio; knowledge; Pakistan; polio virus
... Developing countries like Pakistan face a host of social, economic and health-related problems, and much of their limited resources are spent on managing high morbidity and mortality caused by chronic diseases, many of which are easily preventable. [1] The burden of responsibility of improving the health of the population, however, cannot be the sole responsibility of the government. One strategy to increase societal responsibility for health is to increase awareness in youth about their civic role in society. ...
Background: Service-learning (S-L) is an educational approach that integrates community service with academic learning. S-L helps educate youth about their civic role and responsibility in society, and empowers them to tackle societal problems, strengthening communities through civic engagement. The objectives of this study were to demonstrate the effectiveness of S-L in fostering civic responsibility and communication skills in college students and to increase health literacy regarding iron-deficiency anemia (IDA) among both students and community women. Methods: This interventional exploratory study used a mixed methods approach. Thirteen first-year students from a women’s college participated in the project. The authors held small interactive group sessions to teach the students about IDA and communication skills. A questionnaire measured the students’ perceived knowledge about civic responsibility, communication skills, and IDA. The students then developed and delivered a health education campaign for sixty five community women and measured changes in the women’s health literacy about IDA. A focus group discussion was conducted to collect students’ reflections after the S-L experience. The changes in the civic responsibility and communication skills were determined by Wilcoxon rank test, while health literacy in women by a McNemar test. Results: Students showed significant improvement in all three constructs of civic responsibility and in perceptions of their communication skills. Increases in civic responsibility and in acquisition of knowledge emerged as the main themes of the focus group discussion with students. The community women showed substantial improvement in health literacy of IDA. Discussion: In this study, S-L achieves two purposes: (a) Increases students’ knowledge of health topics, their sense of civic responsibility and improves their communication skills, and (b) educates women in the community about common and preventable health issues. © 2015, Network: Towards Unity for Health. All rights reserved.
... Showing significant events in the healthcare sector of Pakistan Source: Five Year Plans; Health Economics and planning by Fazli Hakim Khattak as quoted byLashari (2004) and used with a couple of additions. ...
Hospital Autonomy Reforms were initiated in the 90s by the Government in the 17 teaching hospitals of the Province of Punjab, Pakistan with the claimed objectives of bringing efficiency and better services to the patients. A host of administrative, structural and financial changes were introduced in the hospitals involving huge amounts of public money. The hospitals were given autonomy from the erstwhile control of bureaucracy; and doctors instead of bureaucrats were entrusted the task of running the hospitals.
Conflicting views were expressed by media, politicians, doctors and public about the origin and progress of the initiative. This study tries to explain and capture the way the concept of hospital autonomy was understood, strategized about and enacted by the main stakeholders of the process including politicians, bureaucracy, hospital administrators and doctors. In doing so it takes the case study of Services Hospital, Lahore. It attempts to answer two questions: 1) How the policy of hospital autonomy was implemented at the Services Hospital Lahore, Punjab? and 2) Why the intervention got implemented the way it was implemented?
As the focus of the study was on understanding the dynamics of the process of implementation of the Autonomy Reforms which was a social process, so interpretive methodology was used for the study. And since the process went along different stages where different stakeholders were part of it, so a retrospective voyage alongside the process of implementation process of hospital autonomy reforms in Pakistan was undertaken to achieve this objective. This perspective takes autonomy as a subjective construct brought in existence by the interplay of various social actors/ stakeholders. So it was essential that the meanings of the different stakeholder about autonomy be understood so that a comprehensive story is reconstructed.
Moreover, mere reconstruction of the story might not answer the second question of the research so some general and specific contextual background information was acquired to explain why autonomy intervention got implemented the way it was implemented.
With reference to the first question the findings of the study are that Hospital Autonomy was an international reform package which was introduced in Pakistan by IFIs along with some countries. It was first implemented in the federal hospital experimentally and later in the provincial hospitals. Politicians and doctors were proponents of change while bureaucracy being the main looser of the scheme resisted it and eventually was able to reverse the process.
And with reference to the second question, the findings are that Pakistan has a colonial past. The objectives of the colonial government were to extract resources out of its colonies for which they needed control of law and order. To achieve such objectives they developed peculiar type of organizations i.e. civil and military bureaucracies. They were designed to rule the masses and collect revenue. These bureaucracies have still persisted along with their past rules and regulations, procedures, guidelines even after 65 years of its independence and with them persists their mindset towards public. With this mindset they were not willing to relinquish control of hospitals in favor of the doctors. So now after 14 years of its launch, the power to run the hospitals is back with the bureaucracy with doctors publicly responsible for the provision of health service to the public.
In this article, the authors discuss the evolution of the Iranian hospital management system after the Iranian Health Transformation
Plan (HTP). These changes point to “Decreasing “Out-of-Pocket” payments for the hospitalized patients in the hospitals”, “Enhancing the quality of hoteling services in the hospitals run by the Ministry of Health”, “Capacity building of public hospital managers”, and ultimately “establishing
independent hospitals”. The hospitals reform has significantly reduced patient out-of-pocket payments, increased productivity, reduced patient dissatisfaction, and promoted
fair access. Major problems in the way of these improvements are the lack of sufficient resources, waste bureaucracy and lack of managerial skills among
managers.
Over the past few years, the issue of what is meant by “good governance” has generated increasing attention and debate both at the national and international level [Streeten (1997)]. The role of state and how that role is to be exercised is appearing high on the agenda of politicians, policy-makers and academicians in the developing world. Governance has been defined by the World Bank as “the manner in which power is exercised in the management of the country’s economic and social resources” [World Bank (1994)]. The somewhat narrow scope of this definition has been broadened in recent years to “the sum of the many ways individuals and institutions, public and private, manage their common affairs” [Commission on Global Governance (995)] The Human Development Report [UNDP (1999)] goes beyond these definitions and gives a much more radical notion of good governance, underpinning the importance of peoples’ participation in shaping their own governance and development. This type of governance has been labeled as “humane governance”.
Evidence-based approaches are prominent on the national and international agendas for health policy and health research. It is unclear what the implications of this approach are for the production and distribution of health in populations, given the notion of multiple determinants in health. It is equally unclear what kind of barriers there are to the adoption of evidence-based approaches in health care practice. This paper sketches some developments in the way in which health policy is informed by the results from health research. It summarises evidence-based approaches in health at three impact levels: intersectoral assessment, national health care policy, and evidence-based medicine in everyday practice. Consensus is growing on the role of broad and specific health determinants, including health care, as well as on priority setting based on the burden of diseases. In spite of methodological constraints, there is a demand for intersectoral assessments, especially in health sector reform. Initiators of policy changes in other sectors may be held responsible for providing the evidence related to health. There are limited possibilities for priority setting at the national health care policy level. Hence, there is a decentralisation of responsibilities for resource use. Health care providers are encouraged to assume agency roles for both patients and society and asked to promote and deliver effective and efficient health care. Governments will have to design a national framework to facilitate their organisation and legal framework to enhance evidence-based health policy. Treatment guidelines supported by evidence on effectiveness and efficiency will be one essential element in this process. With the increasing number of advocates for the enhancement of population health in the policy arenas, evidence-based approaches provide the information and some of the tools to help with priority setting.
The political elements in health care policy derive from an observation that the health sector has historically been a "private government". With few exceptions (confined to European countries in the last several decades), the provision of medical services has been a private matter between supplier and consumer, between doctor and patient. Power lover ''well-being'' or personal health status was exercised by an active agent with specialized knowledge over a passive recipient without such knowledge or expertise. The concept of self-care obviously lies outside this political framework, although one might argue that the very act of removing oneself from a dyadic relationship is itself a political act. The novel change in recent history has been the willingness, the readiness of governments to enter the domain of hitherto private relationships in order to regulate behaviour of both providers and patients. The political mandate of proactive governments (howsoever they are selected) is exercised through their administrative machinery. Government agencies take the form of bureaucracies comprised of specialized roles based on the division of labour, which in turn are hierarchically arranged and accountable both within the organization and, sometimes, externally to political leaders.
List of Tables Preface Introduction: Politics and Health PART I: MODELS OF HEALTH CARE SYSTEMS The Entrepreneurial Model The Organic Corporatist Model The Social Democratic Model PART II: EXPLANATIONS OF PUBLIC HEALTH PROGRAMS Political Culture and the Meaning of Health Political Power and Policy Changes Rational Choice and Market Efficiency PART III: EVALUATIONS OF HEALTH POLICIES AND OUTCOMES Public Policies and Health Evaluating Public Health Policies Notes Index
Abstract : Community-Based Development,(CBD) is being currently proposed,as the main avenue to fighting poverty and circumventing,the shortcomings,of state -directed aid resources. Largely as a response to critiques of top -down development, most bilateral donors and big international organizations have indeed started to include participatory elements in the design
Heretofore, analysts have argued that one characteristic of mobilization in China is to provide uniformity in policy direction. This paper sets out to demonstrate that, in at least the public health area, a diverse set of public policies was pursued even in a period as apparently “radical” as the Great Leap Forward (1958–60). The reason for this policy diversity is that different segments of health policy were made in different political arenas, or institutional settings; the pressures, perceptions and resources which characterized one of these political arenas did not necessarily characterize another. The “failures” of the Leap did not simply arise from a ubiquitous “radical” assertion of power but, on the contrary, resulted from the inconsistencies in leadership and programme characteristic of diverse policy-making arenas. Because policy-making responsibility is divided among political arenas, political bargaining and conflict have characterized the allocation to them of different health issues; elaborate strategies have been devised by organizations in order to acquire and /or hold certain areas of policy and unburden themselves of others.
This book is the main text for post-graduate courses on South Asia's development, economic history and on its political economy. For researchers on Pakistan's economy, it is the key source for reference, and covers a huge and diverse array of data, literature reviews, commentary and analysis.
Heavy investment in many developing countries in the social sector including health is based on the premise that human capital is vital to the growth and development of a nation. However, Pakistan's spending on this sector has been one of the lowest in the region. In the present environment of high budget deficits, one does not expect substantial public funds to be forthcoming and diverted towards the social sector in the intermediate- or medium-term future. The critical issue facing the public sector should then be to design health policies which must be cost-effective and efficient. This study examines these health policy issues within the context of an optimisation framework for public health system, forecasts future upto (2002-03) and discusses an efficient optimal mix of health inputs, outputs, expenditures, and wage policies under alternative scenarios. The study recommends that, first, growth of health infrastructure building in the urban areas be slowed down in the short-term (two to three years), and some of the resources reallocated towards the rural sector either in terms of building new Basic Health Units or upgrading the existing Rural Health Centres. Second, not only attractive wage policies be formulated for health personnel, but the status of nurses in the public health system be also elevated by giving them higher grades. Third, for every rupee of development expenditure incurred, Public Health Department must plan or keep provisions for recurring outlays. All this reallocation of resources is feasible within the projected actual budget and it will lead to efficiency gains in the order of 8 to 10 percent for the entire public health system.
One of the manifestations of underdevelopment is malnutrition and unhygienic living conditions. These contribute to lowering productivity levels of labour thereby affecting both industrial and agricultural output. This gives rise to other problems such as unemployment, and underemployment which leads to falls in family income and a consequent decline in living standards. The cycle is then repeated. However, till the early 1970s most LDCs did not give due weightage to the improvement of health conditions as they felt that resources would be better utilised in the directly productive sectors of the economy, for example, agriculture and industry to name two. However, the last twenty years has seen, through the basic needs approach, the role that health can play in promoting development. Expenditures in the health sector came to be seen as investments in human capital. The benefits of such investment became apparent from the improvement in the quality of human resources which was reflected by increases. in productivity of the labour force as well as by increasing the length of the expected working life of labour. Thus the provision of better health facilities has a two-fold effect: first it increases the productivity of the existing labour force and, second it increases the quantity of human resources available in the future by increasing the length of working life. Keeping this in view, the Government of Pakistan's policy with regard to the provision of health can be summarised in a five-point agenda:
It is widely recognized that there is a discrepancy between principle and practice with respect to the health equity aim of public policy. This discrepancy is analyzed from two theoretical perspectives: the individualization of society and the fact that individual beliefs and values are connected to one's position in the social structure. These mechanisms influence both the choice of health policy measures and the normative judgements of preventive efforts, both of which tend to be consonant with the views of dominant social groups. In particular, we focus on the treatment of the ethical principle of autonomy and how this is reflected in health policy aimed at influencing health-related behaviour. We examine the current trend towards targeting health information campaigns on certain socio-economic groups and argue that it entails an ethical dilemma. The dominant discourse of the welfare state is contemplated as a means to understand why there tend to be a lack of emphasis on measures that are targeted at socio-economic inequalities. It is argued that there is no substantive basis in the individualized society for perceiving health equity as an independent moral principle and that the driving force behind the professed health equity goal may be in essence utilitarian.
International discussions of public health policy strategies in developing countries have been characterized by strong and conflicting positions. Differences regarding the means of health sector improvement can often be traced to differences about the ends, that is, the goals of the health sector. Three types of health sector goals are reviewed: health status improvement, equity and poverty alleviation, and individual welfare (utility) improvement. The paper argues that all three must be considered in developing health sector reform strategies in all countries. Highly normative policy positions often can be attributed a unidimensional affiliation with one health sector goal and denial of the relevance of the others. The current global interest in using cost-effectiveness analysis to set national health priorities is assessed in light of this eclectic approach. Examples are provided of how a health sector strategy based on cost-effectiveness would give sub-optimal solutions. These examples include situations where a private health care sector exists and provides some degree of substitution for publicly provided services; significantly high income elasticities exist for health care such that higher income beneficiaries may differentially capture public subsidies; and market failures exist in insurance. It is argued that these conditions are virtually universal in developing countries. Thus, rational policy development should explicitly consider multiple goals for the health sector.
Health planning is an essential function of the state. For it to be successful, a number of conditions need to be satisfied. In particular it needs to be flexible, participative and integrated with other decision processes. Despite some strengths, the health planning system in Pakistan has generally failed to provide the framework to allow such an approach. Links between strategic and operational planning have been weak; decision-making has been very centralized; there has been a lack of functional clarity; the respective roles of bureaucrats and politicians have been unclear; and, links between capital and recurrent budgets and between planning and implementation have been weak. As a result, there is a number of imbalances in the allocation of resources. The introduction of a revised health planning system for Pakistan is discussed. The constraints on such a system and an initial assessment of its success are presented.
The conceptions of the determinants of health change periodically. At certain times socioeconomic factors have figured predominantly in policy-making; at other times the emphasis has been largely on identifying the causes of disease and treating the sick. Theories about the determinants of health affect how illness is defined, what public policies are initiated, and how resources are allocated. The author believes it is time to integrate understanding of the determinants of health and the determinants of economic growth. Governments and their societies are mistaken to concentrate on the economics of business cycles rather than the long-term forces affecting economic growth, prosperity, and health and well-being. A society that handicaps large segments of its population during periods of major technological change may be handicapping its future economic growth. We now have a better understanding of the relationships among economic growth, prosperity, and health and well-being, and the need for a long-term, integrated perspective of health and economic growth. The author asks: can we make intelligent and wise use of this understanding? -from Author
The health care system in Pakistan is beset with numerous problems--structural fragmentation, gender insensitivity, resource scarcity, inefficiency and lack of functional specificity and accessibility. Faced with a precarious economic situation characterized by heavy external debt and faltering productivity, Pakistan's room to maneuver with health sector reform is quite limited. Although the recently announced Devolution Plan provides a window of opportunity, it must go beyond and introduce far-reaching changes in the health and social sectors. Regionalization of health care services in an integrated manner with functional specificity for each level of care is an essential step. Integration of current vertical programs within the framework of a need-based comprehensive primary health care system is another necessary step. Most importantly, fostering a public-private partnership to share the cost of basic primary health care and public health services must be an integral part of any reform. Pakistan must also make the health care system more gender sensitive through appropriate training programs for the service providers along with wide community participation in decision-making processes. Relevant WHO/World Bank/UNDP developed tools could be extremely useful in this respect. The article is based on a critical analysis of secondary data from the public domain as well as from various research projects undertaken by the Aga Khan University. It also draws from the experiences of health sector reform carried out in other countries, particularly those in the Asia-Pacific region. The purpose is to inform and hopefully influence, public policy as the country moves towards devolution.
All countries of the world confront complex dilemmas when dealing with their respective health sectors. In the industrialized democracies a seemingly insatiable demand for health care is outstripping supply, despite a relentless increase in the latter's share of national budgets and family incomes. Yet, there is little corresponding rise in general health indices, or even in human happiness about the quality of medical services. The inability of health services to deliver greater health for more money has ironically not blunted the public's appetite for them; rather, it has perversely increased it. Some of the evident reasons for this paradox are the following: (a) affluent humanity is less prepared than ever before to suffer minor ailments without drugs or other medical help; (b) demand for health care has been further stimulated by both new treatments for curable diseases and expanded coverage throughout the poorer levels of society; (c) new cures for old diseases come with ever higher price tags for their sophisticated technology so that much additional spending still saves few lives; and (d) the elderly, whose relative numbers in society are growing, require more routine medical care than the young. Clearly, health services in the developed North are victims of their own successes.
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