Term Report

On

Health Sector of Pakistan

Group Members
Muhammad Ahsan MBNBM-20-23
Muhammad Waseem Akram Shah MBNBM-20-37

Subject
Economics of Pakistan
Class
MBE NBE(MOR)
Semester
2nd

Institute of Management Sciences BZU Multan

 Table of Contents
Introduction ................................................................................................................................................. 3
SWOT Analysis ........................................................................................................................................... 8
Introduction to SWOT Analysis ............................................................................................................ 8
SWOT Analysis of Health Sector .......................................................................................................... 8
Strengths .............................................................................................................................................. 8
Weaknesses .......................................................................................................................................... 9
Opportunities....................................................................................................................................... 9
Threats ............................................................................................................................................... 10
Current Trends ......................................................................................................................................... 11
Recommendations ..................................................................................................................................... 13
References .................................................................................................................................................. 14
Introduction
Health participates the important function in influencing the human capital with the Better
health the competency and the output of the labor force is developed and eventually it adds to the
economic growth and directs the human benefit. Government’s subsidies the health care sector for
its people to achieve enhanced, more skillful, proficient and prolific human capital resources and
for this purpose the public sector pays complete or some part of the cost of utilizing health care
sector. Lamiraud, et al. (2005) argued that social health protection is an important instrument
aiming at fair burden sharing and reducing barrier underlining access to health care sector. Another
good cause for the government spending in distributing essential health care services is to reduce
burden of the diseases (BOD) in the productive years of the life. The social rate of return and the
BOD force the policy-makers to transfer the public resources towards basic health care facilities.
The government of Pakistan spends 3.1 per cent of its GDP on economic, social and community
services and 43 per cent is spent on debt servicing. About 0.8 per cent is spent on health care,
which is even lower than Bangladesh (1.2 per cent) and Sri Lanka (1.4 per cent). However, the
health status of the population has improved over the past three decades the rate of immunization
of children has more than doubled, and the knowledge of family planning has increased remarkably
and is almost universal. For over half the population (66 per cent) living in the rural part of the
country poverty coupled with illiteracy, the low status of women and inadequate water and
sanitation facilities have had a deep impact on health indicators. Beside limited knowledge of
illness and wellness, cultural prescriptions, perceptions of a health service and provider and social
barriers, cost has been a major barrier to the provision of an effective health service. This has
affected the physical and financial accessibility of the health services. The health care system in
Pakistan comprises the public as well as private health facilities.
Growth literature recognizes well the role of human capital in the development and
expansion of an economy. Education and health conditions are the main parameters against which
the status of human capital of any economy is gauged. It is well established that healthy people
may not only work more effectively and efficiently, but also dedicate more time to industrious
activities.
Numerous studies validate the significant positive relationship between health indicators
and economic growth. Better health indicators, especially in childhood, such as good nutrition for
infants and toddler and less exposure to infectious disease may improve their productivity in future
and develop a strong foundation for sustainable economic growth (Schultz, 2010; Currie, 2009).
Whereas, poor state of health in the economies, mostly owing to various infectious diseases may
hurt economic growth. Exposure to diseases may result into pre mature deaths and effect labor
productivity. This can have adverse effects on economic growth; even wealthy nations can be
impacted severely by such state of health indicators and may take much longer to observe strong
and healthy progress Chakraborty et al. (2010). By studying endogenous growth model and
incorporating infectious diseases such as influenza, meningitis, dengue, strep throat etc. concluded
that unhealthy workers affect the quality of work hence adversely affecting the growth of the
economy.
Some studies have come up with relatively weak relationship between health indicators
and economic growth in contrast to strong and significant relationship as discussed above. Ashraf
et al. (2008) argued that better health conditions may improve worker’s productivity and may
affect the GDP positively in the long run, however, rise in the population amid improved health
indicators in the developing countries may put negative economic effects as well. Acemoglu and
Johnson (2007) estimated impact of life expectancy on economic performance for 75 countries.
He found almost no evidence of positive effects of health indicators on GDP supporting neo
classical growth theory with the argument of decline in income per capita due to rising population
amid improved health conditions. However, he pointed out that his results may not be true for
current world scenarios as his study mainly analyzed the international epidemiological transition
around 1940s.
In the context of Pakistan, Ali et al. (2012) estimated strong positive relationship of human
capital (education enrolment, decline in infant mortality rate, and physical capital) with economic
growth. He estimated 2.47 percentage point decline in GDP as a result of 1 percent increase in
infant mortality rate. Similarly, Akram et al. (2008) also investigated long-term positive impacts
of health indicators (life expectancy, infant mortality rate, health expenditure and population per
bed) on economic growth.
These lessons are particularly relevant for developing countries while devising policy
options for sustainable economic growth and development as public spending on education and
health is relatively low in developing and less developed countries.
Pakistan is a developing economy and its real GDP growth is gaining momentum. Recent
years have witnessed highest growth over the last decades as highlighted by many flagship
publications on Pakistan economy. China-Pakistan Economic Corridor (CPEC), in this context, is
gaining much popularity in terms of providing immense economic opportunities.
CPEC is likely to contribute significantly in the economic development and provide
avenues to various sectors of economy to accelerate economic growth. Whereas, on the other hand,
state of country’s health is being questioned at various forums. Recently, Pakistan has been ranked
as the riskiest country to be born as per United Nations recent report. Fundamental health indicators
have been on a positive path for the past few years. However, despite this advancement, the pace
of progress is far low, when evaluated with the improvement recorded by regional countries. State
of education sector, on the other hand, is also poor. Education sector is facing various hurdles
including underinvestment, capacity deficient public sector together with costly and unregulated
private sector. Moreover, the aspect of quality education is also missing for long-term gains. Given
the adverse state of human capital, Pakistan’s ranking in Human Development Index has also
dropped from 119th to 147th.
In light of the established theories on positive impact of human capital on economic growth
and development, this note aims to analyze the state of health sector in Pakistan, both in terms of
basic health indicators and health infrastructure, for sustainable economic growth in Pakistan as
mentioned earlier.
In the public sector, under the Devolution Plan of the Government of Pakistan in 2000,19
the districts have been given comprehensive administrative as well as financial autonomy in almost
all sectors, including health. The districts are now responsible for developing their own strategies,
programs and interventions based on their locally generated data and needs identified. Following
the principles of Alma Alta, the public health care system is primary care focused. At the
community level, the Lady Health Worker (LHW) program of the Ministry of Health, and the
Village Based Family Planning Worker (VBFPW) program of Ministry of Population Welfare of
Government of Pakistan have been established. These programs gained an international reputation
due to their grass root coverage plans. These workers are supported by an elaborate network of
dispensaries and basic health units (BHU) (serving 10 000–20 000 population) and rural health
centers (RHC) (serving 25 000–50 000 population). The next levels of referral are the taluka/tehsil
hospital (serving 0.5–1 million population), and the tertiary level hospital (serving 1–2 million
people). The nationwide network of medical services consists of 796 hospitals, 482 RHCs, 4616
BHUs and 4144 dispensaries. However, these basic level facilities have restricted hours of
operation are often located distant from the population. Manpower is constituted of approximately
90 000 doctors, 3000 dentists, 28 000 nurses, 6000 Lady Health Visitors and 24 000 midwives.
Only 25 per cent of the BHUs and RHCs have qualified female health providers. Arshad et al.
(2016)
In private sector, there are some ascribed outlets and hospitals but also many unregulated
hospitals, medical general practitioners, homeopaths, Hakeem, traditional/spiritual healers, Unani
(Greco-Arab) healers, herbalists, bonesetters and quacks. Non-governmental organizations
(NGOs) are also active in the health and social sector. In urban parts of the country, some public–
private partnership proposals exist through franchising of private health outlets. These have been
successful to a large extent in raising the level of awareness of positive health behavior among the
people. For instance, the increasing contraceptive prevalence rate is due to the efforts of NGO
sector and the LHWs of the government. Nevertheless, primary health care activities have not
brought about expected improvements in health practices especially of rural population groups. In
some areas of rural Pakistan, more than 90 per cent of deliveries are performed by untrained or
semi-trained dais or Traditional Birth Attendants (TBAs). Among other diverse and multi-faceted
reasons, a poorly functioning referral system may be partly to blame. Given the complex nature of
the health care delivery system in Pakistan and the limited resources available to the health care
sector, it is essential for the various sectors to plan and work together to improve the health of
Pakistanis. Thus it is important to understand the health seeking behavior of the population and
the factors driving this behavior (Shaikh & Hatcher, 2007)
In south Asia, magnitude of household out of pocket expenditure on health is at times 80%
of the total amount spent on health care per annum. Economic capability to use health services has
not been very different in Pakistan too. For health expenses in Pakistan, 76% goes out of pocket.
This very factor also decides the measure of ability of a person or a family as a whole to satisfy
their need for health care. The cost has undoubtedly been a major barrier in seeking appropriate
health care in Pakistan. This complexity is reflected in the health seeking behavior including the
use of home prescriptions and self-medicating with medicine borrowed from a neighbor or
purchased from the chemist shop. In NHS, little difference is observed in terms of health service
utilization by economic status. This insignificant difference in trends of utilization of health
services between rural and urban population does not reflect that both strata of population enjoy
the same health status. Though rural poor have more needs yet they actually lack quality services
and need based treatments. The distance separating patients from the nearest health facility has
been remarked as an important barrier to use, particularly in rural areas. In NHS, findings reveal
that at least 5% go to hakims, homeopaths and faith healers. This representation looks very
diminutive because the traditional beliefs tend to be intertwined with peculiarities of the illness
itself and a variety of circumstantial, economic and social factors. Nearest and most available
health provider in a rural proximity would be a non-formal practitioner, who would be consulted
mainly because of the low cost incurred. Household economics certainly limit the choice and
opportunity of health seeking (Shaikh & Hatcher, 2007)
SWOT Analysis
Introduction to SWOT Analysis
Every organization requires continuous improvements in its day-to-day processes for better
performance and excellent quality of working. This can be done if all the factors that influence the
working of the organization are properly identified and defined. Such factors are divided into
internal factors (Strengths & Weaknesses) and external factors (Opportunities & Threats). The
assessment and evaluation of these factors is done by using an exploratory scientific technique
named as SWOT analysis. So, SWOT analysis can be defined as: “SWOT Analysis is an
examination and evaluation of an organization’s internal strengths and weaknesses, its
opportunities for growth and improvements and the threats the external environment poses to its
survival and working (Terzic, Vukasinovic, Bjegovic, & Janicic, 2010).”
SWOT Analysis of Health Sector
SWOT analysis and evaluation technique was initially intended to present an overall
systematic analysis of businesses that were related to organizations other than healthcare, but it
has proven its usefulness and advantages in healthcare organizations as well. Recent years have
experienced its increased use and great impact in healthcare industry (Ali & Horikoshi, 2002). It
is pertinent that healthcare organizations also require improvement and innovation for increased
performance, quality and optimum functionality. For this purpose, progressive adjustments and
up-gradations are a necessity to acquire. To identify areas for improvements, SWOT analysis has
been a helpful and successful tool that was ignored by healthcare organizations for many years
(Nishtar, 2006). The sorting and categorization of organizational data in Healthcare systems can
be illustrated as under:
Strengths
Strengths are those internal factors that support and illustrate extraordinary performance of
a healthcare organization e.g., extra ordinary IT infrastructure, highly qualified and experienced
healthcare professionals, state of the art equipment’s, excellent services, etc.
Elaborate network of over 10000 public sector primary health care facilities and public
sector hospitals that can be effectively used to provide high-quality health care, Large number of
medical and allied institutions in the public and private sectors that provide training to health
professionals in the country , Training and deployment of more than 100000 Lady Health Workers
recruited by the public sector has increased access of the population to primary health care services
particularly in remote areas, The pharmaceutical industry of Pakistan is fairly large and can cater
for local needs in addition to export of medicine, Following devolution, all the provinces have
developed their health sector strategies and plans aiming at universal health coverage.
Weaknesses
On the contrary, weaknesses are those internal factors that hinder the working capability
and negatively affect the performance of a healthcare organization. They can be mismanagement
of resources, lack of financial resources, incompetent healthcare professionals, outdated
equipment’s, etc.
Serious underfunding of the health sector—the public sector spends 0.5% of GDP on
health, the government health expenditure per capita is approximately US$7, and the share of out-
of-pocket spending is almost 60% , A constitutional amendment to abolish the federal Ministry of
Health in 2011 led to fragmentation of health functions at the federal level and unclear
communication channels between the federal and provincial levels, Limited capacity and wide
variation among the provincial health departments to shoulder new responsibilities under the
devolved set-up, Primary health care infrastructure is under used due to the poor quality of services
and nonfunctioning facilities, staff absenteeism and lack of medicines, Large unregulated private
health sector comprising general and specialist clinics, pharmacies and diagnostic centers that
provide curative services, Shortage of cadres such as nurses and paramedical staff and
misdistribution of health workforce, Substandard/spurious/falsely-labelled/falsified/counterfeit
medicines area major public health problem, The health information system is fragmented; flow
and feedback of information are not streamlined; surveys are undertaken sporadically; and
information is generally not used for decisions
Opportunities
Opportunities are those factors that are external to healthcare organizations. They provide
initiatives for improvements. Examples include collaborations with other organizations for better
services, plans for better organization and management, new funding programs for better IT
infrastructure, effective training and informative programs for community development, etc.
The recent establishment of Ministry of National Health Services, Regulation and
Coordination can help consolidate and reorganize federal health functions and reengage with
provinces, Commitment of the new democratic government to increased accountability and
transparency and being responsive to the needs of the public, Increasing role of nongovernmental
organizations working in health as think tanks, advocates and providers of health care, Improved
coordination among parastatal organizations that are involved in the delivery of health care for
their employees., Renewed efforts to strengthen district health system that ensures effective health
care for the local population, Experience with interventions such as contracting, vouchering and
cash transfer schemes should be made use of in improving access and quality of health services,
Continued and increasing commitment of development partners to support the health sector.
Threats
Threats are those external factors which are considered to be potential risks or dangers that
could cause harm to the quality of working and performance of healthcare organizations.
Economic instability, rapidly changing technology, budget deficits, un-necessary political
intervention, and political insecurity are some of the related examples (Marilyn & Nixon, 2010)
(Wijngaarden, Wijk, & Scholten, 2012).
Lack of security and safety that impedes delivery of priority public health programmes in
different parts of the country, Poor economic situation of the country has negative impact on the
health budget, Rapid urbanization, epidemiological transition and dual burden of disease; inability
of the health system to respond, Health determinants such as high levels of illiteracy, population
growth, unemployment, poverty and pervasive inequities put an additional burden on an
underperforming health system, Inability to implement the social security system for the poor in
an effective way, Ineffective regimes and mechanisms for regulation of the private health sector
to control quality and cost of care, improving quality of health professionals training deployment,
fair distribution, skills mix and acute shortages in some cadres
Current Trends
National health security is increasingly threatened in Pakistan due to population growth, rising
urbanization, environmental pollution and change in lifestyle of people, among other factors.
Access to good health can contribute positively to the economic and social development of a
country. Thus, key issues that impact the health status of people ought to be addressed through a
diverse set of policy tools. To secure better health outcomes, both short- and long-term measures
are the need of the hour. Good nutrition also has a direct impact on the overall health and quality
of life. The present government is committed to improving the health care facilities and provision
of good nutrition for effectively utilizing the human potential of the country.
The challenges to the health system will be further exacerbated by the direct and indirect impact
of the COVID-19 pandemic. The pandemic has posed considerable health risks to an already
vulnerable population living in the country with inadequate healthcare infrastructure.
Regional Comparison
Governments adopt various public health programmes in reducing the incidence of disease,
disability, effects of aging, and other physical and mental health conditions. World Health
Organization (WHO), a United Nations agency, has been actively involved in promoting and
protecting healthcare worldwide. The WHO interventions in crisis situations include helping
devise response mechanisms to health emergencies. The world has adopted various health
initiatives/programmes to fight deadly diseases like malaria, tuberculosis, HIV/Aids, diabetes,
cancer, heart diseases, etc. Public health vaccination programmes have made strides in promoting
health, including the eradication of smallpox and controlling the spread of Polio around the world.
Pakistan is an active global partner for disease prevention, universal immunization, and
improvement in health care infrastructure, etc. The country has improved health indicators over
the last three years.
Health Expenditure
Cumulative health expenditures by federal and provincial governments in FY2019
increased to Rs 421.8 billion from Rs 416.5 billion last year, showing a growth of 1.3 percent. As
% of GDP, it is 1.1 percent.
Challenge of COVID-19 Outbreak
The pandemic was confirmed to have reached Pakistan on 26 February 2020, when the first
patient in Karachi tested positive while returning from Iran. Since then, the pandemic has spread
through foreign and domestic transfusion. However, due to timely measures taken by the
government in collaboration with provinces, the outbreak has so far been prevented from getting
worse. Till May 02, 2021, so far 830K confirmed cases with 722K recoveries and 18070 deaths
recorded in the country. The government is employing available public, community, and private
sector capacity to rapidly scale up the health system to prevent the spread of COVID-19. The
government has constituted a high-level National Coordination Committee (NCC) headed by the
Prime Minister that evaluates the evolving situation on day-to-day basis to effectively curb the
spread of the virus in the country. The National Disaster Management Authority (NDMA) and
NHSRC have leading roles in combating the spread of a pandemic. A Command-and-Control
Center has also been established to ensure effective coordination among the federal and provincial
governments to control COVID-19. The disease outbreak information management system has
been strengthened, and a comprehensive hospital information management system has been
ensured as the basis for the early detection of outbreaks. Disease surveillance & Response Units
(DSRU) has also been strengthened at the district level and collaborated with Emergency
Operations Centers (EOC) at the provincial level. Hospitals and laboratories in the major cities
have been designated to collect the samples from suspected cases on bio-safety and bio-security
standards. Quarantine facilities have been established all over the country to prevent the spread of
the pandemic. The availability of relevant supplies, PPEs, and lab agents for safe collection,
storage, packing, and transportation of samples from the designated hospitals to the National
Reference Lab/ designated is being ensured.
The COVID-19 pandemic is the biggest public health challenge the world has faced in recent
times. No health system in the world can cope with COVID-19 once the rate of spread gets beyond
a certain point. The Government of Pakistan is, therefore, constantly monitoring the COVID-19
situation in the country and accordingly taking all possible appropriate measures in collaboration
with provincial governments and development partners to mitigate its adverse effects on the
economy. The government is also committed to providing efficient, equitable, accessible and
affordable health services to the people of Pakistan with the aim to create a productive workforce
for the future that could efficiently contribute to the development of the country.
Recommendations
A healthy and functioning healthcare delivery system mandates mutually supportive and
symbiotic relationship and integrates primary, secondary and tertiary care. Such integration and
several strategies could be planned and implemented to improve healthcare delivery system of
Pakistan. Following are the key recommendations to improve Healthcare sector of Pakistan.
1. It would be better to move away from curative biomedical model towards more extensive and
holistic approach. Other factors such as environment, social and cultural aspects need to be
concurrently addressed to improve the health of people.
2. It would be highly beneficial, if policy making is decentralized and delegated to districts,
because they can adopt better and realistic approach for the problems they encounter on daily basis.
3. More resources should be kept into capacity building of the administrators at district level to
understand contemporary health issues, because the root causes of problems are not addressed
while formulating policies, due to lack of knowledge about concerned place and population.
4. All stakeholders should be involved in planning, decision and implementation of programs at
all levels to ensure efficiency and sustainability of programs.
5. Better monitoring and evaluation tools should be constructed to get valuable and unbiased
feedback to policy makers and implementers.
6. Other key measures can be taken to improve Healthcare sector of Pakistan; control population
growth, increase literacy rate, increase health budget, control corruption in public health projects,
regionalization of Healthcare services, and promote health education, proper check on quackery
and exchange of human resource and knowledge with developed countries.
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