National health policy, Pakistan National Health Policy 2009

Muhammad Waseem Sajjad (MWS) M.Phil. Public Policy PIDE School of Public Policy [email protected]

• Budget of health is 0.42% of GDP.

• Per capita health expenditure is 37 dollar

• The aim of the health policy in 2009 was to cover these MGDS goals.

• Human Resources Issues

• Health information issues

• Governance Issues

• Health budgetary issues

• Service quality issues.

National Health Policy 2009

Adopt appropriate health technology to deliver quality services

Human Resource Development and Management

Generate reliable health information to manage and evaluate health services

Governance and Accountability

Development and Provision of an essential health services package

Enhancement of health budgets and provision of social safety nets


• PHC outlets are unreliable

Staff problem

Infrastructure issue

Lack of medicine

• attitude of service providers are not patient centered.

• Curative rather than preventive


• HR in health care is not planned

• Lack of skilled staff especially midwife

• Service structure for health workers are poor


• Inadequate infrastructure

• Lack of appropriate, relevant and functional medical equipment.

• Unsafe blood transfusions and poor laboratory standards are also a challenge.

• No mechanism for misuse of new equipment.


• Provinces have up to 40% more funds, but

– Weakly planned process of reforms

– Slow transfer of funds

• Poor resource tracking

• Compilation of provincial health accounts is a key challenge

• With only 0.25% GDP spent on health, increase in financial outlay is an imperative.


• Lack of integrated disease surveillance system

• Lack of inter-provincial info sharing mechanisms

• Absence of collated info and irregular reporting

• So there is limited utilization of info and evidence for – Planning in national

programs – Assessment of health

services – Surveillance in case of

disease security


• Absence of adequate policy framework

• Increase in private sector .

• Absence of government regulation on private sector.

• Creation of good administration and fair governance.

• External influence on our policies.

• Strikes of staff

• The GoP did not have any Health Policy since 1947 to 1990.

• Once again, the 2009 policy turned out to be a failure since the devolution of Ministry of Health.

• In 2011, there came the provincial health policies. • National Health Policy of 2009 had ‘no delegation of

power’, therefore it was only a draft. • The provinces demanded for ‘allocate efficiency’ to

be kept with them. – We’ll decide how much we generate

• Technical Efficiency – How to spend that money, which the Federal did not agreed.

• After MDG commitments, the international pressure perused Govt. to identify key areas in Health Sector, there were ‘agendas’ formulated in 2001 (not policy) which identified 10 key areas.

• In 2009, those 10 key areas.

– Prevention of infectious diseases, Awareness, safe water generation, safe motherhood)

• Aggressive decentralization, communal involvement.

– Responsibilities were delegated to communities instead of DHO. (provision of Ambulances as PPP)

• Up gradation of BHU’s in RHU’s from Intl. donors at Governance level. – Improving health technology.

– Ratio of Nurses to Doctors.

• Innovation in Health Technology.

• The 2009 health policy provided basis for ‘National Health Vision 2015’.








• Work Together: Package for PHC services

• Primarily focus on:

Preventive Care Curative

Maternal and Child Health preventive

nutrition promotion

• Integrate different services

• Regulate private sector Pilot Project in Islamabad

All over Pakistan


• Forecast their HR requirement for next 10 years

• Rely physician expanders and doctor

• maintain a database of health human resource

• nationwide campaigns to promote the permanent roles that nurses,

midwives

• the teaching institutions will reorienting their curricula and training

• each district will be linked to a teaching institution


• DHIS operational by 2010 and will develop a national MIS

• Initiate a national integrated disease surveillance system

Pilot project on hepatitis program All disease

Utilize the information for EBPM


• Appropriate regulation for quality service

• health technology assessment cells will be established.

• A National Blood Transfusion Authority will be established to ensure safe transfusion services.

• Supply insure through modern technology


• allocate budgets for health on the basis of per capita costs

• develop joint strategies aimed at

enhancing Official Development Assistance

(ODA) funding and will coordinate the

expenditure of external (ODA) resources

to minimize duplication and wastage.


• review constitutional and legislative roles and responsibilities

• defining national approaches to govern the health system

• monitoring and evaluation at all level

• facilitate research and development activities.

• assess and evaluate the various models piloted across Pakistan to recommendation new projects.

• Draft of National Health Policy-2009

• Highly centralized policy formulation

• Stakeholder involvement

• Vertical intervention by federal create disharmony

• Gap between theory and practice

• Lack of monitoring & evaluation mechanism

• Not evidence based decision making

• Curative health care vs. preventive HC.

• Public-private partnership

• Need multi-sectorial approach

Healthcare

National health policy, Pakistan National Health Policy 2009