Improving Public Health Delivery in Punjab, Pakistan: Issues and Opportunities

Abstract

Pakistan has a large and dispersed primary public health system that gives citizens access to trained doctors and staff, and to subsidized medicines. However, both the use of these facilities and health outcomes remain low. Improvements in information and communications technology provide exciting opportunities to leverage technology to improve management. This paper presents a detailed qualitative and quantitative study of the institutional context in which such interventions in the public health sector in Punjab would be trialed. We describe the structure and management of primary healthcare facilities, present selected results from a survey of a representative sample of basic health units, and identify some key issues. We also report and discuss officials’ responses to the question of how services might be improved.

Social determinants and causes of child mortality in Pakistan: Analysis of national demographic health surveys from 1990 to 2013

“…Of note, there are nearly 2800 primary health‐care units available to rural communities in the public sector of Punjab province. High mortality rates could be due to uneven distribution of health facilities, staff and doctors within the catchment area, as well as shortages of essential drugs . In Balochistan, there are about 1376 public health facilities, with the high child mortality potentially due to deficiencies in infrastructure, intermittent supply of drugs and consumables, and lack of trained staff and functional equipment.…”

“…High mortality rates could be due to uneven distribution of health facilities, staff and doctors within the catchment area, as well as shortages of essential drugs. 1,21 In Balochistan, there are about 1376 public health facilities, with the high child mortality potentially due to deficiencies in infrastructure, intermittent supply of drugs and consumables, and lack of trained staff and functional equipment. Infection control practices have also been found to be inadequate in the service provision areas of all health facilities, presumably due to lack of materials and equipment required for waste collection, personal protection and waste treatment.…”

Contracting out of basic health facilities in Pakistan: Are the lessons generalizable?

“…Since the launch of the pilot programme in 2003, a growing number of studies have confirmed that handing over the management of BHUs to PRSP improved service delivery (Callen et al, 2013;Hatcher, Shaikh, Fazli, Zaidi, & Riaz, 2014;Usman et al, 2015). The indicators used by these studies to measure improved efficiency include patient turn-out, staff attendance and availability of medicines.…”

Chapter 8. Public Service Delivery for Rural Development

“…In the case ofMCHCs, the numbers have even decreased in recent years. In addition, inadequate public funding for both recurrent and development-related costs has resulted in health facilities that have a lack of basic equipment and medicines, insufficient expertise in the management (Arif et al 2010), poorly compensated health professionals who engage in dual (government and private) practices as a norm, and weak quality control and standardization of care (UNICEF 2012;Callen et al 2013). Consequently, the population has turned to an unregulated private sector as the basic provider of health services.…”

“…Prior studies explain why government healthcare facilities are underutilized by women. Reasons include a lack of female staff, staff absenteeism, 11 undersupply of medication and equipment, and long distances to such facilities (Arif et al 2010;Callen et al 2013). For Pakistan overall, Nishtar et al (2013) report that the doctor-to-nurse ratio is 2.7:1 instead of the desired 1:4, and the rural ratios are likely far higher.…”