Running head: HEALTH SYSTEM 1

Title of Report: Health system

Date of Submission: 3 December 2021

Prepared for: Ma’am Moneeza Batool

Prepared by:

 FA21-BAF-025 Muhammad Haris Arshad

 FA21-BAF-031 Hassan Nawaz

 FA21-BAF-050 Usman bin Bashir

 FA21-BAF-088 Muhammad Usman Haider

 FA21-BAF-023 Syed Saif

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Executive summary:
Our project was about health system of different countries but mainly Pakistan and many

complications faced by people are caused by our own local authorities. Suggestions have been

made in order to increase the efficiency of Pakistan’s health system. Bad health system can be

really dangerous for a country and can cause serious health crisis among people living in it.

Introduction provides an overview of what a health system is and it’s components.

Introduction gives an idea of health system’s timeline and how it is developed by different

countries and nations. How it reflects country’s economy and etc.

In literature, it explains that how writers, journalists have written so many books and articles

about is that tells the reader that there has been a lot of research done in our area of research.

Methodology includes all the research and information provided by world bank regarding the

Healthcare system of Pakistan and comparing the information with other countries.

In discussion, we have discussed the main problems with our health system and how it is

getting worse and worse day by day due to ignorance of government authorities.

Recommendation gives points on how to improve the health system and how it will effect in

delivering integrated output to citizens.

Table of contents:
Executive summary:.......................................................................................................................................2

Introduction:...................................................................................................................................................3
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Background Information:...............................................................................................................................4

Regulatory Authorities:..................................................................................................................................4

Health Delivery system:.................................................................................................................................5

Primary Healthcare...............................................................................................................................5

Secondary Healthcare...........................................................................................................................5

Tertiary Healthcare...............................................................................................................................6

Challenges & Hurdles in Health System:......................................................................................................8

Health Policies of Pakistan:...........................................................................................................................9

National Health Programs:...........................................................................................................................10

Loopholes & Weaknesses in Health System:..............................................................................................11

Conclusion:..................................................................................................................................................12

Recommendations:.......................................................................................................................................13

References:...................................................................................................................................................14

Introduction:
A health system or a health care system in an organization of institutions, resources, and people

optimized and trained to deliver services to meet the health-related needs of specific groups in a

population. Today, there is a variety of healthcare systems around the globe. The organizational
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structures of these healthcare systems are as old as countries and cultures on this planet. Primary

healthcare and public health measures require every nation to develop and adopt the means

necessary to design a system that helps with their needs. Different countries develop healthcare

planning based on different parameters such as government, unions, NGOs, religious

organizations, and other coordinated bodies to deliver health services. In all social, institutional

structures, the healthcare system reflects the country's history, culture, and economics in which

they evolve. These parameters define the universal standards of performance and set a

comparison between different nations.

Background Information:
The health system in Pakistan is complex and complicated because of the division on federal,

provincial, and private sector [8] [9]. The hierarchy of the healthcare system in Pakistan is a

vertically managed disease-specific system. Different healthcare facilities perform duties as

provincial or district health departments, social security hospitals, Non-Profit-Organizations and

private organizations, including research institutes and hospitals[2]. Pakistan’s healthcare system

is also marked based on urban-rural inequalities in the deliverance of facilities and an imbalance

in the health workforce. The flaws in the health system are the result of an insufficient number of

health managers, nurses, and paramedics, especially in bordering areas [3] [12]. The Healthcare

system in Pakistan is currently composed of around 10,000 health facilities with Basic Health

Units (BHUs) and Rural Health Centers (RHCs) with a capacity of 30,000 to 45000 people [6].

Pakistan has taken initiatives to support the state regarding family planning and primary health

care to provide communities with many different outreach services related to reproductive health

and high-risk patients to specialized facilities. [6]

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Regulatory Authorities:
Pakistan Medical Council (PMC), Pakistan Council of Homeopathy, Pakistan Nursing Council,

Council of Tibb and Ministry of National Health Services, Regulation & Coordination. Most of

the health programs come under the direct rule of provincial Government instead of Federal

government after the 18th amendment.

Health Delivery system:

Primary Healthcare

Primary healthcare is the first healthcare level with modes of initial patient-doctor interactions.

This medium of healthcare provides curative and preventive healthcare services. Union Council

levels all across Pakistan offer Basic Health Units (BHUs) and serves a population of up to

25,000. BHUS provides the population with preventive and curative services. Maternal & Child

Health (MCH) services also perform under the umbrella of BHUs. BHUs provide clinical,

logistical, and managerial support to Lady Health Workers (LHWs). RCHs support bHUs,

LHWs, and MCH centers with additional referrals of inpatient services [11].

Secondary Healthcare

The intermediate level of healthcare provides technical, therapeutic, and diagnostics services

with specialists and hospital admission facilities. Secondary healthcare serves at district and

tehsil levels. These healthcare levels are commonly referred to as Tehsil Head Quarters (THQs)

and District Head Quarters (DHQs). THQs are responsible for serving a total of 0.5 to 1 million

population, normally a capacity of only 40-60 beds. They provide basic health care and

comprehensive emergencies. DHQs located in a district serve even a greater population of 1-3

million people with preventive, curative, diagnostics, inpatient, and referral services [11].
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Tertiary Healthcare

A more specialized, equipped, and immersive healthcare hospital comes under the Tertiary

healthcare unit. These units provide specialized healthcare services for inpatient and emergencies

and referrals from primary and secondary health professionals [11].

Health Indicators comparison (HDI)

Country Life IMR per Under 5 Population

expectancy 1000 mortality growth rate

(2013) (2013) rate per %

1000 (2013)

(2013)

Pakistan 66.6 69 85.5 1.92

India 66.5 41.4 52.7 1.24

Bangladesh 70.7 33.2 41.1 1.22

Sri Lanka 74.2 8.2 9.6 1.22

Nepal 68.4 32.2 39.7 1.17

Bhutan 68.3 29.7 36.2 1.62

China 75.4 10.9 12.7 0.49

Malaysia 75 7.2 8.5 1.62

Indonesia 70.8 24.5 29.3 1.21

Philippines 68.7 23.5 29.9 11.73

Thailand 74.4 11.3 13.1 0.43

Source: World Bank

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According to World Bank, Pakistan has a highest growth rate in Asia of 1.92%, much higher

than India, Bangladesh and China. Pakistan is also at top in grim achievement of under 5

mortality rate of 85.5 per 1000. Whereas, life expectancy of Pakistan is second lowest in Asia,

only India is below Pakistan with the difference of 0.1 in the year of 2013 [5].

Regional Countries health expenditure (% of GDP)

Country Year 2014

Pakistan 0.919

India 1.407

Bangladesh 0.787

Sri Lanka 1.964

Nepal 2,338

Bhutan 2,615

China 3.095

Malaysia 2.3

Indonesia 1.076

Philippines 1,615

Thailand 5.615

Source: World Bank

World Bank report also bring attention to the total health expenditure in relative to percentage of

GDP with Pakistan being the second lowest country spending as little as 0.919 in 2014, while

Thailand being on top, spent 5.615 percent of its GDP on health in the same year.
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Challenges & Hurdles in Health System:

Scarcity of resources, inequality, insufficient and untrained HR, disparities between regions,

poor structural management, gender insensitivity, and undeveloped border regions contribute to

the problems in the healthcare structure in Pakistan. A system designed by political streamline

with implementations from health professionals on the ground leads to different theoretical and

practical realities [1]. The Primary Healthcare system is often seen as jam-packed with rural

populations but insufficient funds supply and shortage of resources in terms of medical personnel

and equipment. Other issues also contribute to the flaws in the health system being lack of

research and development of technology, reliability, and transparency throughout the national

health system causes unaffordable trouble to the flow of services. These interruptions keep piling

up amid a growing population and more severe disease occurrence [1]. Policies introduced by the

authorities are often not mature and difficult to implement without removing root-cause

problems. The worsening situation is a mixture of many human-made factors such as negligence,

corruption, political interference, lack of accountability, and low performance forgo [13]. The

illiteracy level in Pakistan among the common population also adds a burden to the healthcare

system with little information and implementation of clinginess, disease prevention, basic

knowledge of health education, poor sanitation, and lack of public interest towards personal

hygiene.

Health Policies of Pakistan:

The first National Health Policy by the government was introduced in 1990, forty-three years

after independence. The health expenditures were aimed to be taken as high as 5% of GNI. The
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government announced plans to put attention towards clean water facilitation and family

planning to improve health. [7]. The second National level health policy was announced in 1997;

this time, it was focused on providing information and education to the public about the

prevention of AIDS/HIV, road traffic accidents, TB, Cancer, diabetes, and mental health. The

third policy was implemented in 2001 based on the agenda of Health for All (HFA), putting

enlarged emphasis on ten key areas in the medical field, including reduction of communicable

disease, addressing potential failures on primary/secondary health systems, promotion of gender

equality, improvements in drug manufactory and correction of discrepancies between rural and

urban areas [7]. A joint federal and provincial vision (2016-2025) was agreed on and launched

with a vision to improve all citizens' health and put a special focus on children and women in the

country. The mission also stated to deliver quality health services throughout the country without

division in society but very little has been done.

National Health Programs:

The poor health indicators of Pakistan are a result of a struggling economy. However, some

programs were implemented to ensure the timely availability of resources to prevent and cure

diseases. The government introduced the Family Planning scheme, which helped 80 million

people from rural areas [10]. Extended Programs on Immunization (EPI) was launched in 1978

to reduce mortality and morbidity against various fatal diseases by offering immunization

vaccines. The national control center for TB achieved success in limiting disease spread and

mortality. National AIDS Control Program (NACP) formulated its first framework in a joint

venture with the provincial government in 2001, followed by a 2nd and third frameworks

focusing on the treatment of HIV patients and prevention of disease. Malaria control programs
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are effective since the 1950s, and drug abuse control programs were made part of the program in

2010 by the Ministry of Narcotics. The National Health department also actively campaign for

other programs with a special focus on preventing blindness, cancer treatment, tobacco control,

Nutrition program, and Maternity issues.

Loopholes & Weaknesses in Health System:

One of the grass-root level problems shredding the whole healthcare system of Pakistan is a

shortage of trained staff. Although there are doctors, nurses, and paramedics available in densely

populated areas to a remote corner of the country, not every single one is trained and qualified

enough to carry out the duties included in their job description, and this becomes a notion of a

wider problem. While assessing how much health facilities, laboratories, ambulances, or modern

equipment are required without prior training of the person responsible for using this equipment.

The ground realities are far different in Pakistan compared to developed countries' success

stories, while most policies are formulated based on the experience of other countries with their

healthcare system. The underlying difference in terms of culture, religion, and social dimensions

is just as important as the economic aspects of a policy, and these differences can also undermine

any effort to up-raise the country's healthcare standards. The formulation of policies in Pakistan

also faces a conflict between the choices of environmental and cultural or traditional biomedical

models to prevent disease. The disharmony and clash in the hierarchal order of the healthcare

system itself cause a barrier to its growth. The policymakers and the staff on the ground to

implement those policies are often found not in the line of communication with each other.

Similarly, Monitoring, evaluation, and reform teams are also not as efficient and productive as

they should be. Monitoring teams are not enabled with the power to pause, relocate or assess
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assets on the ground and can only present reports in the form of evaluation to the authorities. The

process of reforming and making the system efficient lacks staff's opinion on the ground and is

decided on a higher level, this causes a series of failures small enough to ignore, but they have an

impact big enough not to let the overall system grow as much as expected.

Conclusion:
The Healthcare system in Pakistan faces an abundance of problems in all branches and levels,

affecting the overall performance and efficiency of the system. The Healthcare system of any

country is one of the most important and sensitive systems, and it should be given importance to

thrive and grow to make lives better. The one task needed to be done on an urgent basis is the

decentralization of the system. With the help of decentralization, the opportunities can be

delivered to remote areas in a more productive order. Reforms in the primary and secondary

health care sector require restructuring and evolution. Assets maintenance, buildings, finance,

technology, and research lack the attention they require. A more profound monitoring system is

needed to achieve success and quality because evaluation plays an important role.

Recommendations:
An ideal healthcare system is hard to achieve, but it should be highly functional, responsive, and

healthy to deliver supportive and integrated output to citizens. It should be a refined relationship-

based model to improve people’s lives. Following are the key recommendations to improve the

health system of Pakistan [4].

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1. A more realistic and holistic approach should be implemented in primary and secondary

healthcare systems instead of relying on biomedical models. Factors such as social,

cultural aspects, and environment require continuous assistance for improvement [5].

2. The policymaking process and SOPs implementation should be decentralized and handed

over to districts to better cope with the ground realities so that the policies can become

adopted [5].

3. The strength of resources should increase significantly, and while forming policies,

addressing the issues like training and extensive education of healthcare staff should also

be of keen importance [5].

4. All the authorities and stakeholders involved in planning, decision-making, and execution

should be on one page while forming policies to implement the vision [1].

5. Better monitoring and evaluation tools should be constructed to get desired results [5]

paper.

References:

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from https://www.researchgate.net/publication/7562976

[2] Akbari, A. H., Rankaduwa, W., & Kiani, A. K. (2009). Demand for public health care in

Pakistan. The Pakistan Development Review, 48(2), 141-153. doi:10.30541/v48i2pp.141-

153

[3] Akram, M. (2007). Health care services and government spending in Pakistan.
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[4] Analysis of Healthcare Delivery system: Pakistan vs United States. (2014). Retrieved from

aeirc-edu.com website: http://aeirc-edu.com/wp-content/uploads/11download-full-

paper.pdf

[5] Contents. (2012). Health Policy, 104(1), CO4. doi:10.1016/s0168-8510(11)00260-0

[6] Ghaffar, A., Kazi, B., & Salman, M. (2000). Health care systems in transition III. Pakistan,

part I. An overview of the health care system in Pakistan. Journal of Public Health,

22(1), 38-42. doi:10.1093/pubmed/22.1.38

[7]Health Policy: What does it mean in Pakistan? (n.d.). Retrieved from

http://www.phmed.umu.se/digitalAssets/76/76123_inlag a---halema-masoud.pdf

[8] Javed, S. A., Liu, S., Mahmoudi, A., & Nawaz, M. (2018). Patients' satisfaction and public

and private sectors' health care service quality in Pakistan: Application of grey decision

analysis approaches. The International Journal of Health Planning and Management,

34(1). doi:10.1002/hpm.2629

[9] Medical ethics: Lessons learnt from the past and the way forward for the future based on

Milgram. (2016). International Journal of Science and Research (IJSR), 5(3), 2163-2165.

doi:10.21275/v5i3.nov162440

[10] National program for family planning and primary health care Pakistan: A SWOT analysis.

(2016, October 28). Retrieved from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3842797/

[11]Primary & secondary health care department. (2016, October 26). Retrieved from

https://www.pshealth.punjab.gov.pk/Services.aspx

[12] Who. (n.d.). Retrieved from

https://www.who.int/country-cooperation/what-who-does/strategies-and-briefs/en/
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[13] Health expenditure, public (% of GDP). (n.d.). Retrieved October 25, 2016, from

http://data.worldbank.org/indicator/SH.XPD.PUBL.ZS?l

ocations=PK