Implementing the district health system in the framework of primary health care in Pakistan: can the evolving reforms enhance the pace towards the Millennium Development Goals?

Abstract

There is growing renewed trust in primary health care as the best approach for ensuring equity in the delivery of essential health services. However, Pakistan with one of the most widely spread district health system networks in the region, has not delivered at the expected capacity. A series of health system reform agendas are now stipulated which include the promulgation of an essential health service package, public private partnerships and a people-centred focus. Nevertheless, success of these reforms will hinge on the ability of the three tiers of the government and other stakeholders to work together to improve the overall performance of the district health system. This paper provides an overview of the district health system infrastructure and organization of primary health care services in Pakistan, the evolving governance pattern and the operational significance and merit of health system pillars for effective service implementation.

A case study of outsourced primary healthcare services in Sindh, Pakistan: is this a real reform?

“…People’s Primary Healthcare Initiative (PPHI), formerly known as the Prime Minister Healthcare Initiative was started in October 2005 to contract out the first level healthcare facilities (FLCFs) in all four provinces to a semi-government body the Punjab Rural Support Program [6,7]. Successful experiences led the government to scale-up this contracting model for the rest of the FLCFs in other parts of the country.…”

Why is Pakistan vulnerable to COVID‐19 associated morbidity and mortality? A scoping review

“…54 Pakistan lacks a strong healthcare infrastructure. 21,[55][56][57] There are 5527 basic health units, 686 rural health centers and 5671 dispensaries in the country to serve the healthcare needs of a population of more than 207 million citizens. 19 In 2018, only one bed was available for 1608 patients.…”

“…63 Previous Pakistani evidences indicated major gaps in access to essential medicines in Pakistan driven by deficits in the pharmaceutical supply chain and ambiguous pharmaceutical regulations. 38,55,56,64,65 Unsurprisingly, due to sudden demand fluctuation, raw material availability issues and nontraditional distribution tactics several essential (such as antipyretic, analgesics and other flu and cough medicines) and life-saving medicines, facemasks, sanitizers and other protective equipment are currently short or scarcely available at high prices. 40 Taking into account this scenario, it will be a great challenge for the Pakistani government to fulfill the medicinal product related needs of the population, especially after the discovery of COVID-19 treatment and vaccination.…”

Situation Analysis of Health Care System of Pakistan: Post 18 Amendments

“…On the other hand, procurement and standard operating procedures of medicines, equipments and various technologies does not met technically set national guidelines. Similarly, there is no existing policy for the upgradation and replacement of equipments after they have completed their devaluation period, making the equipment compromised and nonfunctional [46]. According to telecommunication authority the use of internet and mobile phones in Pakistan has reached above 132 million, but public health sector has not devised any opportunity as an effective approach to spread health related information to the general public for the sake of prevention and treatment of diseases [47,12].…”