DEVOLUTION AND HEALTH

Ms Sadia Umer
Generic BSN,PGN,MBA,MphilCHN
 Health is a basic human right and must be available and accessible
in an affordable framework to all. To this end, an integrated
approach to public health in the district will combine preventive,
promotive and curative health at all levels. Reductions in demand of
curative care, would be translated into improvements in its quality.
 Promoting good governance in health sector, by meaningful and
consistent emphasis on prompt, equitable and professional services
delivery, must become a cardinal principle of the department.
 Devolution, Decentralization, Debundling

 It is the transfer of authority, or disposal of power

in public planning, management and decision
making from the national level to sub- national
levels or from a higher to lower levels of
government.
 It is the transfer of authority, from a higher to lower

levels of government
 Devolution plan 2000
 On 14 August 2000, President Musharraf initiated
Decentralization reforms ,the local government system was put
forward. There were three categories, the district government, the
Tehsil government and the union government
 Abolished the positions of Divisional Commissioner and Deputy
Commissioner replacement with District Coordination Officer
(DCO) at District level
 Separation of Police and judicial powers from District
Administration
 Essential basic services devolved from provincial governments to
Local Government Health, Education, Agriculture, Revenue, etc.
DCO and other district level officers accountable to Nazim and
District Assembly, as well as to Chief Secretary.
Intergovernmental Framework for Providing Health Services

 Prior to devolution, the delivery of health services was the responsibility of

the provincial governments.
 The provinces provided these services by posting staff at the district and sub-
district levels. Medical staff reported to the Director General-Health’s (DG-
Health) Office through various Directors (Health).
 With the passage of the Local Government Ordinance in 2001, health was
almost entirely devolved to the District Governments, with the exception of
the large teaching hospitals (with attached medical or dental colleges), which
remained under the direct control of the provincial government.
 At present, control over medical staff is exercised both by DG-Health at the
provincial level and by the Executive District Officer-Health (EDO Health) at
the district level,
 DEVOLUTION OF POWERS IN HEALTH DEPARTMENT
OBJECTIVES
• Empowerment of the people at the grass root level.
• To make the District the dominant level of decision making in health
department.
• Improve the quantity and quality of health care delivery to the
people close to their door steps.
• Integrated approach to public health, combining, preventive, promotive
and curative health at all levels.
RESPONSIBILITIES/ FUNCTIONS AT THE DISTRICT
LEVEL

•
Prevent and Control Communicable Diseases and Non
Communicable Diseases.
• Food Sanitation.
• Maintain medical and health statistics under HMIS(Health
management and information system)
• Reproductive Health.
• Health and Nutrition Education.
• Environmental and Occupational Health.
RESPONSIBILITIES/ FUNCTIONS AT THE
PROVINCIAL LEVEL
• Make Health Policy for the Province.
• Legislate on Provincial health Issues.
• Drugs control under the Drugs Control Act.
• Monitoring and Regulatory functions of Medical and Para Medical
institutions.
• Health Research and related Health information gathering
ADMINISTRATIVE STRUCTURE:
DISTRICT

District Coordination Officer

EDO: Finance and Planning Health

Public Health
District Headquarters Hospitals
Basic Rural Health Centre
Mother & Child Health
Population Welfare
 Health Secretariat representative

A District Coordination Officer (DCO)

2 Executive District Officers (one urban and one rural)

2 medical superintendents at sub-district level

3 medical officers working at BHU level

FUNCTIONS OF EXECUTIVE DISTRICT OFFICER

 Ensure that the business of the department and offices placed

under his administrative control is carried out in accordance with
the relevant laws and rules
 Co-ordinate and supervise the activities of the relevant offices.
 Ensure efficient services delivery by functionaries under his control.
ADVANTAGES OF DEVOLVED SYSTEM IN HEALTH CARE

 Administrative and financial powers to district authorities / local bodies

representative.
 involvement in devising the programs relevant to the local needs and
priorities.
 Strategies and plans acceptable for the community and matching to their socio
cultural and socio economic background.
 User willingness to pay for PHC in the public sector services, if they receive
improved care.
 The districts can recover substantial costs and can retain the incomes.
 Creating sense of ownership.
 Strengthening of FLCF, answering many primary health problems like high IMR,
high MMR and morbidity.