Policy process for health sector reforms: a case study of Punjab Province (Pakistan)

Abstract

The health sector in the Punjab (Pakistan) faces many problems, and, the government introduced reforms during 1993-2000. This paper explores the policy process for the reforms. A case study method was used and, to assist this, a conceptual framework was developed. Analysis of four initiatives indicated that there were deviations from the government guidelines and that the policy processes used were weak. The progress of different reforms was affected by a variety of factors: the immaturity of the political process and civil society, which together with innate conservatism and resistance to change on the part of the bureaucracy resulted in weak strategic sectoral leadership and a lack of clear purpose underpinning the reforms. It also resulted in weaknesses in preparation of the detail of reforms leading to poor implementation. The study suggests a need for broadening the stakeholders' base, building the capacity of policy-makers in policy analysis and strengthening the institutional basis of policymaking bodies.

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?

“…In Pakistan, similar to many other developing countries, the district health system has been facing a range of governance challenges impeding the organization, implementation and management of essential health services; poorly supported by weak strategic and operational planning, irregular monitoring and supervision, an inadequate accountability system and insufficient community participation and intersectoral action [10,[25][26][27]. The Pakistan Devolution Plan under the Local Government Ordinance 2001 aimed to make the districts answerable to the elected chief executive of the district (District Nazim) for better governance and improved service delivery.…”

Integrated care in action: opening the “black box” of implementation

“…On the one hand, the outcomes of these policies vary significantly, and no clear patterns between the features of a policy and the success (or failure) of its implementation have been highlighted (Lapão and Dussault, ). On the other hand, the policy makers typically define structures and expected outcomes of integration (Tarin et al ., ; Hansson et al ., ) and overlook the processes that should be put into action to achieve them (McNaught, ; Anessi‐Pessina and Cantù, ). These two conditions (i.e., outcome heterogeneity and unclear guidelines for policy operationalization) contribute to make the process of integrated care policy implementation a sort of “black box”, whose functioning is not fully known and—as such—cannot be coherently controlled and supported.…”