Date of Award

11-2023

Degree Type

Thesis

Degree Name

Master of Health Policy and Management

First Advisor

Dr. Muhammad Ashar Malik

Second Advisor

Dr. Shifa Habib

Third Advisor

Dr. Amir Sharif

Department

Community Health Sciences

Abstract

Background: Effective resource distribution in healthcare is crucial for public policy and governance, ensuring accessible health services. Priority-setting involves allocating resources among competing options. The 18th Amendment devolved healthcare in Pakistan, granting provincial governments more control over administrative, personnel, managerial, and financial resources. Public sector budgets are divided into development (new initiatives) and recurrent (routine activities). This research delves into these interconnected areas, examining their impact on healthcare resource allocation.
Objectives: The study had two main goals. Firstly, it aimed to assess the changing healthcare priorities by analyzing Sindh's Provincial Development Budget of Health Sector (PDB[1]HS) in pre-post to the 18th Amendment. Secondly, it sought to understand the priority-setting process within PDB-HS in the context of the 18th Amendment. Using both quantitative and qualitative analyses, the research explored how devolution influenced healthcare resource allocation and decision-making, illuminating shifts in healthcare priorities and their distribution in the region. Methods: The study used a mixed-method: sequential explanatory approach to investigate the effects of the 18th Amendment on healthcare resource allocation in Sindh, Pakistan. It began with quantitative analysis and examined the trends of resource allocation among sub-sectors and changes in the pre- and post-amendment periods. This was followed by the qualitative analysis, involving interviews with key stakeholders to assess the priority-setting process under the Barasa et al. framework and to explore the effects of the 18th Amendment. Data was collected from the Planning & Development Department (P&DD) and Health Department (DoH), Government of Sindh. Quantitative data, covering 2497 entities across fiscal years 2006-07 to 2022- 23, was adjusted for inflation with a base year of 2022. Qualitative data from nine senior-level officers gathered on a semi-structured interview guide was manually coded.
Results: The quantitative analysis revealed a real increase in PDB-HS allocation in Sindh after the 18th Amendment. Distribution trends of PDB-HS during the period of analysis expressed that secondary health care (SHC) received 45% of resources, followed by tertiary health care (THC) at 31%, and primary health care (PHC) at 24%. The post[1]amendment allocation trend for SHC was progressive in comparison with THC and PHC. Qualitative analysis indicated that the priority-setting process did not align with the applied framework (Barasa’ et al.), and it remained conventional even after the amendment. To improve this process, the study participants recommended its alignment with the principles of the framework.
Conclusion: In conclusion, the study highlighted the imperative for improved resource distribution and priority-setting in the health sector. Despite a few improvements after the 18th Amendment, such as increased budget and provincial autonomy, a more balanced emphasis on PHC is essential. The study argues for a shift from traditional priority[1]setting to evidence-based, transparent, and inclusive decision-making, stressing community involvement and stakeholders’ capacity-building. These policy recommendations aim to enhance healthcare efficacy, equity, and efficiency in Sindh, underscoring the need for research and improvement in resource distribution.

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1

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65

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