HEALTH SECTOR

PRESENTED TO: SIR ZIA ABBAS RIZVI

PRESENTED BY:

SIDRA AHMED 7877

SAROSH AHMED 7889

KULSOOM AUNALI 7899

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LETTER OF ACKNOWLEDGEMENT

It is a matter of great satisfaction that all our efforts ended with this thorough report based on
HEALTH SECTOR OF PAKISTAN. Here, we would like to state that firstly, it was a blessing
of The Almighty Allah that we completed this report without any barriers and shortcomings in
between. Secondly, this report came to a successful end due to the joint efforts and cooperation
of all group members who worked hard to make it better,

Last but not the least, we would to thank Sir. Zia Abbas Rizvi whose guidance and teaching
backed us all the way while preparing this report. His teachings are something, which we will
always carry with us ahead and make the most use of it wherever possible.

Regards,

Sidra Ahmed
Sarosh Ahmed
Kulsoom Aunali

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Contents
LETTER OF ACKNOWLEDGEMENT ...................................................................................................... 2
ABSRACT........................................................................................................................................................ 4
INTRODUCTION ............................................................................................................................................. 5
LITERATURE REVIEW ..................................................................................................................................... 7
HYPOTHESIS: ................................................................................................................................................. 9
CONCLUSION............................................................................................................................................... 11
RECOMMENDATIONS: ................................................................................................................................ 12
APPENDIX .................................................................................................................................................... 14
REFERENCES ................................................................................................................................................ 20

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ABSRACT
Pakistan’s health care system is bounded with various problems / issues. Problems like gender

insensitivity, inefficiency, lack of functional specificity, accessibility and resource scarcity are

the major prevailing problems. These problems are further enhances due to the economic

situation that is mixed with heavy external debt. No doubt, the recently announces devolution

plan for health sector provides us an opportunity in order to gain and to make our health system

the best one. Health is an important issue that should be catered properly in order to make the

overall system effective as well as efficient. Pakistan being a nation must adopt well defined

processes in order to make the health system effective that can lead in providing basic health care

system to every individual in this nation. Various training programs can help in this regard.

Apart from this, WHO/UNDP and World Bank well developed tools can also be useful in this

regard.

If we look at the other side, what our economy is doing towards the health sector? According to

the budget 2010-2011 Rs. 16944.5M has been allocated for the health sector. In Pakistan, there

are around 906 hospitals, 4554 dispensaries, 2590 basic health units and 552 rural health centers.

In our nation, only 27% of people gain the health services, while the rest are not getting the

adequate health care. This is a phenomenon that is lead by rich people. Only rich people are

getting the best medical services while the rest are suffering.

In this report, we have summarized our research related to the health sector in Pakistan and along

with this we have drawn a hypothesis that lead towards the results. Our hypothesis is related to

the corruption in the health sector of Pakistan.

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INTRODUCTION
Health is an important issue that has various possible implications on individuals as well as on

the country as a whole. In order to make the health sector functional, government is the only

power that can make it functional and prolonged. Various world development reports depicts that

there is an increase in the health system not only in the developed countries but also in the

developing countries. But, health related situation in Pakistan is still poor. Why in Pakistan the

health system is poor when a lot of budget is allocated towards it? Answer is very simple. Our

government is not playing an important role towards it and along with this, corruption is

included. When a huge amount of money is allocated for the health sector and still problem

exists, the only possible outcome is corruption that is making Pakistan’s health sector poor.

It is nation’s responsibility to improve the health system and to make it better and better.

According to the World Development Report (1993, pp.17), some of the benefits of an improved

health system are mentioned below:

i. Human capital is determined by health

ii. It helps in improving the productivity as well as efficiency of the labor

iii. Health plays an important role and there is a positive relationship between economic

growth and the public sector expenditures

iv. In order to gain efficient, productive and effective human capital resources, the

foremost responsibility is of the government to make its health care system effective

v. Public sector plays an important role in order to maximize the facilities of health

system

vi. In developing countries, healthy people are more eager and better to learn and grasp

knowledge

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vii. Better nutrition and health enhance the labor productivity

viii. Better health system decreases the rate of diseases

ix. If best health care system is provided from the scratch, less money will be needed for

the treatment cost

x. Government should try to improve the health care system with the help of public and

private sector

In any nation, health strategy should be constructed on the basic principles of equity, easy access to the

basic healthcare, accountability, effective leadership as well as coordination among the leaders and

government. In Pakistan no doubt there are numerous new projects that aimed in improving the health

system of the nation. Some of the projects are mentioned below:

i. National programs for family and planning.

ii. PSDP increased the allocation for health by 66% from Rs 13.99 billion to Rs 23.15 billion in yr

2009/2010

iii. Prime Minister’s Emergency plan in order to control the diseases has been launched. Cost of the

project id Rs 11 billion for the next 5 years

iv. Tax rate declined to zero on supply as well as import of wheelchairs for special people

v. As per WHO, tobacco taxation has been increased

In Pakistan, people are suffering from various diseases. While doing our research, we came to know

that people are suffering from various diseases that are really harmful for themselves and for those who

are around them. People are not getting the right medical aid and thus they are suffering from various

problems. The main issue is lack of resources. Pakistan is a nation that spends billions of Rs in health

sector but still poor are not getting the right medical aid at right time. This worse situation is only

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because of the corruption and thus we have moulded our paper towards this hypothesis which will be

further described in detail.

Major health issues that most of the poor people faced are:

i. Malaria

ii. Tuberculosis

iii. Intestinal diseases

iv. Venereal diseases

v. Skin diseases

In Pakistan one of the major causes of death is major diseases that most of the people faces and is not

getting the treatment. Below mentioned chart depicts some major diseases that lead towards death.

(TABLE 1 – APPENDIX)

LITERATURE REVIEW
In all over the world, an overall health care system is basically characterized by the mixed

system of public as well as private financing along with the delivery of care. According to the

health expenditure, in around 19 countries in Asia, more than the half of the total health spending

is private i.e. out of pocket payment and same is the situation in around 15 countries of Africa.

China, Pakistan, India, Bangladesh and Nigeria are included in this section. In order to make the

health system effective and efficient various activities are taken under consideration in order to

make an overall health system effective one. Various countries are working in this area and thus

are providing the best possible services. Some of the activities are listed below:

i. Thorough analysis of the potential and stamina of private sector in order to enhance

health supply chain.

ii. Detailed macroeconomic analysis of the public as well as private health spending.
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iii. Making the health system for poor effective.

iv. Web based programs in order to deal with the issues related to the health.

v. Global scan programs in order to regulate and monitor the health system of the world.

Corruption is a prevailing issue in health sector of Pakistan. No doubt, many other nations are

also facing some issues related to the health sector but, Pakistan is the only nation where every

sector is bounded by corruption and misleading and health is one of the major sector in which

there is no proper governance, no proper methods and the leaders are grasping the money thus,

poor are suffering a lot.

Various surveys in Pakistan depicts that there is a common thinking related to the corruption that

it is now a days known as a common issue in the health sector. Along with this, corruption is no

doubt one of the greatest challenges towards the good governance. In Pakistan one of the most

common examples related to the corruption in the health sector is the absenteeism of the health

care personnel. People are not working with zeal and zest. In most of the areas, health workers

are assigned some tasks and are given with basic salaries too, but work is not being done in a

proper manner because no one is there to keep an eye on them. Another kind of major corruption

example related to the health sector is the illegal user fees which is regularly charged and is thus

one of the major burdens on the poor. Along with this, corruption in the pharmaceutical sector is

one of the prevailing factors. People are not giving taxes and thus imposing heavy charges on the

lay man. Thus poor are being burdened from every side and rich are getting best medical

services.

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HYPOTHESIS
Ho - Corruption exists in the health sector in Pakistan

H1 – Corruption does not exist in health sector in Pakistan

ANALYSIS

Corruption Perceptions Index 2008 was 2.5 (134th out of 180 countries) (source: GCR 2009).

A low perception index indicates that the country is highly corrupted and this is what the above

mentioned index reflects that Pakistan is ranked as highly corrupted. This high corruption rate is

greatly found in the health sector of Pakistan. Our health is highly prone to corruption due to the

system’s lack of transparency (figure 3). Lack of transparency leads to mismanagement of funds

and resources, leading to lack of accountability of the top management and lack of productivity

of human resource working in this sector, which further leads to bad quality of health services

provided to people. This chain in other words can be summed up by calling it ‘corruption’.

Corruption starts due to inefficiency at governance and regulatory stage. Though there isn’t any

evidence of leakages during transfer of funds at the top regulatory level but the leakage of fund

and theft exists at various levels. Thus medical practitioners in Pakistan pursue with their

personal agendas compromising public interest at all levels. This leads to equal services provided

to people especially in government hospitals where the doctors do not find it necessary to attend

patients and sit at home thus absenteeism rate is high and further they also charge high fees for

services for which they are already receiving remuneration from the government. The fees they

charge above the actual rate are usually left unaccounted and thus counted as informal payments

paid to the corrupted doctors and nurses. Then publicly employed doctors are not allowed to

serve privately but they do so and since there is no check and balance they do not pay much

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attention to patients in public hospitals. They take disadvantage of lack of check and balance in

the system to the extent that they waive off the exemptions given to the poor by law and thus

they do not receive proper medication or are left un-attended. Many private clinics and

dispensaries have sprung up which lead to further deterioration of health of the people. People do

not have access to drugs and medicines at fair prices as no regulatory authority monitors this and

huge price variances are often and so this list of acts that leads to corruption in Pakistan goes on

(refer table 1) but even if we compare internationally Pakistan is highly ranked. According to

table 3 statistics informal payments were 96% in Pakistan as compared to 55% in Bangladesh

and 25% in India. Whereas the informal payments as percentage of half-monthly per-capita

income was 75% in Pakistan, 225% in Bangladesh and 60 % in India.

The average per capita income in Pakistan being so low the health coverage provided should be

more but this is not the case (figure 2), 73% people are paying out of pocket payments and the

common people only account for 0.32% who falls in the safety nets.

Thus the whole health system of Pakistan is corrupted starting from top level politics to doctors

and nurses serving in hospitals.

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CONCLUSION
From the analysis it is clear that corruption poses a serious threat to the health sector. It hinders

good performance by over throwing the formal processes. It generates economic distortions and

inefficiencies, especially when new competition wants to enter the market. It reduces the quality

of government services and infrastructure and increases budgetary pressures on the government.

Majority of the officials that are a part of this sector have great authority, little accountability and

willfully determined incentives. The more activities these officials control, the more

opportunities open up for corruption. These officials go for a self-serving bias, rather than public

serving. Corruption in our part of the world cannot just be tackled by facilitating the health

sector. Ideally we should be adopting a holistic approach that includes all the other sectors, but

there are a few measures that can be taken as a start.

The first is to reduce the role of the government in the health sector, mainly to limit authority

Secondly, we need to increase the transparency at all levels and make proper use of the

accountability bureau.

Thirdly, the sector needs to revise the terms of employment. Jobs should be available strictly on

merit to promote competition, and hence, efficiency.

All these efforts should be backed by a strong political will.

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RECOMMENDATIONS
 The first and foremost step should be to strengthen the anti-corruption agencies and

linking them with the health sector. The media, the bureaucrats, the politicians and the

administrative hierarchy should play a special role in this, so as to broaden the anti-

corruption measures.

 A proper and transparent reward system should be formed for the employees in the public

health sector, in order to ensure good performance and better accountability.

 The most important system that this sector needs is proper documentation. The system

needs to be technologically leveraged to track each and every expenditure; from the

buying of inventories in the supply chain to the wages of the workers. A nationwide

database would help to track leakages and eliminate abuses such as paying ghost workers.

 In the area of drugs, very special care should be taken. Currently, there are 22

pharmaceutical companies operating in Pakistan, producing over 3000 drugs out of which

only 40 are essential. The government needs to enlist these 40 drugs and limit the amount

of the companies so that no other drugs are allowed to be produced. Also a Quality

Control department should be formed which makes and implements policies related to the

pricing and quality of these drugs, especially the issue of spurious drugs, expired and

inadequate drugs. Strict penalties should be adopted for those who violate these policies.

 At the service level, administrative and fiscal autonomy should be given to the hospital

management which could help bring about efficiency and increased accountability.

Authority such as the hiring and firing of staff and rewarding for performance and

discipline should be given to the management.

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 Liberalization. Provincial autonomy should be given as far as the health sector is

concerned, as it will help manage this system easily.

 Public-Private Partnership. The sector should not be privatized completely, but rather,

both should go hand in hand to achieve economically sound results.

 Increase competitiveness. This will help in removing the monopoly power of any one

government office. It also decreases extortion.

 Hot lines and other modes of protection. This is a system whereby regular citizens can

complain and report against any act of corruption that they witnessed. This can help

improve the accountability a great deal.

 Training and workshops. These can offer an effective venue for changing the thoughts

about corruption. The employees in this sector can gain formal and proper training to

tackle the different modes of corruption.

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APPENDIX

TABLE 1

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TABLE 2
CLASSIFICATION OF MODES OF CORRUPTION - MONETARY AND NON-MONETARY

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TABLE 3

CROSS COUNTRY COMPARISON OF THREE CORRUPTION RELATED INDICATOR RELEVANT TO THE

HEALTH SYSTEMS-2007

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TABLE 4

PROPORTION WHO MAKE INFORMAL PAYMENTS AMONG USERS OF HEALTH SERVICES

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TABLE 5

PREVENTION OF CORRUPTION (HEALTH SECTOR)

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FIGURE 1

CORRUPTION IN HEALTH SECTOR: RISK AREAS AND CONSEQUENCES

FIGURE 2: POPULATION RECEIVING COVERAGE FOR HEALTH

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REFERENCES

http://www.u4.no/themes/health/causesandconsequences.cfm

http://www.who.int/healthsystems/topics/research/55Heartfile_HEF_POC.pdf

http://www.nab.gov.pk/Public_info_material.asp#iMP_dOC

Governance and Corruption in Public Health Care Systems by Maureen Lewis, Jan.
2006

http://www.u4.no/training/incountry-open/pakistan-materials/health-sector-corruption-pakistan.pdf

http://sanianishtar.info/pdfs/CP-PB.pdf

http://www.ispub.com/journal/the_internet_journal_of_world_health_and_societal_politics/volume_7
_number_1_33/article/governance-and-health-sector-development-a-case-study-of-pakistan.html

http://www.heartfile.org/pdf/22_Corruption.pdf

http://cat.inist.fr/?aModele=afficheN&cpsidt=13839790

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