An overview of the health system in Pakistan over the past 70 years offers evidence of efforts for better service delivery as well as challenges and impediments in this regard. The challenges have spread over a wide area including policy formulation, financing (or lack thereof), coordination of available resources and implementation at the level of end users – the people seeking healthcare. Attempts have been made to fill policy, financing and implementation gaps through different approaches, including participation of donor agencies and private sector. It has been argued that for health reforms to deliver, these must be strategic and outcome- and equity-oriented, with a comprehensive long-term focus on strengthening of health systems because programme-based interventions depend critically on the robustness of the health systems in the first place and are, hence, no alternate to these systems.
The last National Health Policy of Pakistan was approved in 2001. While a draft policy was developed in 2010, it was not approved due to the then ongoing process of devolution. In August 2016, the federal and provincial governments finally agreed on a common National Health Vision (NHV) for the entire country after years of controversies over health issues and disagreements over the regulation of health departments. The document incorporates suggestions from public sector stakeholders, the private sector, UN agencies, donors and academia, and has been endorsed by representatives of all provinces and federating units. NHV aims to bring the country’s health policy frameworks in line with Pakistan Vision 2025 (such as increasing health spending to 3 percent of the GDP), international health priorities and provincial realities within the framework of constitutional roles in the post-18th Amendment scenario.
The NHV notes that donor funding has been minimal in recent years with less than two percent of the total national health expenditure and underscores the need for better alignment and coordination of donor assistance with government’s strategies. Detailed policy options for coherent channeling of donor support for achieving improved outcomes and avoiding wastage of resources, however, have not been outlined.
Multilateral and bilateral donor agencies and development partners, offering financial and technical assistance for improving healthcare delivery in Pakistan include ADB, CIDA, DFAT, DFID, GTZ, IDB, IFRC, JICA, RCS, UNAIDS, UNDP, UNICEF, USAID, WB, WFP and WHO. Foreign aid, as a percentage of total health sector funding, has ranged from 3.5 to 16 percent in different years as shown in able 1.
Support from donors also comes in the form of technical assistance, specifically from UN agencies, and in kind contributions such as mobile health units, drugs, vaccines and diagnostic kits. There are other donors as well, including, for example, the Gulf States, overseas Pakistanis, philanthropists, INGOs and leading private sector entities providing resources to country in social sector areas including health, directly or through corporate social responsibility. Main fields of donor intervention are shown in Figure 1:
To meet the need for healthcare in Pakistan, private sector’s role has increased over the years. In the year 2009-10, it was reported that 87.6% of the population accessed healthcare from the private sector and 12.3% from public sector. In the wake of weak regulations and societal trends, however, the private sector has very few accredited outlets and there has been a mushroom growth of largely unregulated hospitals and small-scale medical units, general practitioners and clinics, homeopaths, Hakeems, Unani (Greco-Arab) healers, herbalists, traditional/spiritual healers, bonesetters and quacks. Some NGOs have been active in the health sector and there are few public-private partnerships (PPPs) and franchising of private health outlets.
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