*You are a future

healthcare leader!

*What is the role of a leader?

*What is a problem?

*What are the health problems of

Pakistan?

*What would be your priority as a healthcare

leader and reforms would you suggest?

Chap 2 – Choked Pipes

*Health Systems in Pakistan

Health system is defined as ‘comprising all the organizations, institutions and resources that are devoted to producing health actions.

*Health System

1. Service Delivery

2. Health Workforce

3. Information

4. Medical Products

5. Vaccines & Technologies

6. Financing, Leadership, and Governance

*6 Building Blocks

*Urban-Rural % ?

Rural65%

Urban35%

Pakistan Population Rural-Urban

*Literacy% ?

*Literacy

Literate46%

Illetrate54%

Literacy Rate

*Below 15 years age % ?

Below 15 years37%

Above 15 years63%

Age

*Health Coverage in Pakistan?

* Health Coverage in Pakistan

Armed Forces4%

Publicly Mandated

Private Means12%

Government10%

Members of Judiciary & Legislature

0%

Safety Nets0%

Corporate Sector

1%

Out-of-pocket Payments73%

Health Coverage

‘A health system in which out-of-pocket payments and market provision of services predominates as means of financing and providing services, respectively in an environment where publicly financed government health delivery coexists with privately financed market delivery.’

*Mixed Health System

Tertiary Care

Secondary Care

Primary Health Care

*BHU?

Basic Health Unit: a medical facility situated in the smallest administrative unit of government (Union Council) with an average catchment population of 10,000 – 20, 000

*BHU

*RHC?

Rural Health Center: an upgraded PHC facility located at the sub-district administrative unit at the junction of four or five Union Councils; the population served ranges from 20,000-500,000

*RHC

*FLCF?

First Level Care Facilities: comprise BHUs and RHCs

*FLCF

*MCHC?

Maternal and Child health Centre: MCH Centre of the Department of Health

*MCHC

*FWC?

Family Welfare Clinic: family planning facility of the Ministry of Population Welfare

*FWC

*LHW?

Lady Health Worker: village-based female community health worker

*LHW

*THQ?

Tehsil Headquarter Hospital: secondary level hospital

*THQ

*DHQ?

District Headquarter Hospital: secondary level hospital

*DHQ

Over 12,000 FLCF in Pakistan

30% of which are non-functional

*Primary Health Care

90,000 community-based female Lady health Workers

Prevention, maternal and child health, and related family planning services to 55% population.

*Lady Health Workers

2740 Family Welfare Clinics (FWC) of Ministry of Population Welfare

*Family Welfare Clinics

965 Public Hospitals in Pakistan

*Total Public Hospitals?

* Systems of Medicine in Pakistan

Sytstem of Medicine

Modern Western Allopathic System

Tibb-e-Unani, Ayurvedia and Homeopathy

• Ambulatory Clinics

• Maternity Homes

• Private Dispensaries

• Diagnostic Facilities

• Private Hospitals

• Few large sophisticated private sector hospitals in major population centers.

• <10 private hospitals can be compared favourably with international hospital standards.

* For-Profit Healthcare Sector

• NGOs

• Charitable Organizations

• Trust-funded Organizations

• Pakistan’s largest and most effectively functioning ambulance network is owned and operated by a charitable trust – the Edhi Foundation.

• Family Planning Association of Pakistan – Rehnuma

• HIV/AIDS

• 74 large charitable hospitals with over 7000 beds

* Non-profit Healthcare Sector

*Trend of Some Health Indicators

in Pakistan

*Total Fertility Rate

5.4/woman

4.1/woman

1990-91

2006-07

*Under-Five Mortality Rate

117/1000 live births

94/1000 live births

1986-90

2002-06

*Child Immunization

47%

35%

2006

1990

‘Although there have been some improvements in the health status of the Pakistani population over the last 62 years, key health indicators lag behind in relation to the international targets articulated in the Millennium Declaration and in comparison to averages for low income countries.’

*Compendium of Health Statistics

*Triad of Determinants

Inadequate State Funding

Burgeoning Unregulated

Private Sector

Lack of Transparency in

Governance

*Let’s see who is good at making guesses!

*Pakistan’s Key Health

Indicators

*Life Expectancy (years)

63.8*Life Expectancy

(years)

*Dependency Ratio (%)

68.7*Dependency Ratio

(%)

*Total Fertility Rate

4.1*Total Fertility

Rate

*Contraceptive Prevalence Rate

%

29.6*Contraceptive Prevalence Rate

%

*Pregnant Women Receiving at least

one ante-natal consultation %

61%

*Pregnant Women Receiving at least

one ante-natal consultation %

*Women who receive care from

Skilled Birth Attendants %

39%

*Women who receive care from

Skilled Birth Attendants %

*Neonatal mortality Rate

(per 1,000)

54*Neonatal

mortality Rate (per 1,000)

*Infant Mortality Rate (per 1,000)

78*Infant Mortality Rate (per 1,000)

*Under-five Mortality Rate

(per 1,000)

94*Under-five Mortality Rate

(per 1,000)

*Fully-immunized children %

47%*Fully-immunized

children %

*Tuberculosis Treatment

Success Rate %

84%*Tuberculosis

Treatment Success Rate %

*Confirmed Number of Polio

Cases

58*Confirmed

Number of Polio Cases

*Prevalence of Viral Hepatitis %

7.4%*Prevalence of Viral Hepatitis %

*Prevalence of Smoking (18+) %

15.75%*Prevalence of Smoking (18+) %

*Leisure Time Physical Inactivity

(18+) %

91.5%*Leisure Time

Physical Inactivity (18+) %

*Prevalence of Overweight &

Obesity (18+) %

38.5 %

*Prevalence of Overweight &

Obesity (18+) %

*Prevalence of Central Obesity

(18+) %

48.35%

*Prevalence of Central Obesity

(18+) %

*Prevalence of HTN (18+) %

13.7 %

*Prevalence of HTN (18+) %

*Prevalence of Diabetes (25+) %

7.65 %

*Prevalence of Diabetes (25+) %

*Doctor-Population Ratio

1:1,326*Doctor-Population

Ratio

*Nurse-population Ratio

1:22,662

*Nurse-population Ratio

*Dentist-population Ratio

1:3,039*Dentist-

population Ratio