Pakistan's national health policy : issues in formulation and implementation
Date of Award
Master of Science in Health Policy & Management (MSc Health Policy & Mgmt)
Community Health Sciences
The need for health sector reform, emphasis on better health outcomes through poverty reduction efforts, process of devolution and participation in achieving Millennium Development Goals set by the United Nations are a few important factors that have generated debate on contemporary health policies in Pakistan, with a view to see relevance and responsiveness of policies towards achieving better health for the population. There is sufficient evidence that health is related to development and investing in health results in economic development, for example it has been proved that countries with higher Infant Mortality Rate have lower GDP growth rate than countries with lower IMR. In this background, health status of the population of Pakistan needs serious attention. With IMR at 85/1,000 LB, Mortality among Children under-five at l10/1,000 LB and MMR 350/100,000 LB. Pakistan's ranking is fairly poor. Such a low health status has pushed the country towards low human development level. This dismal health status compels researchers to look into health policy process. Therefore, an attempt is made through a qualitative study to analyze Pakistan's health policy. The country inherited a health care system skewed towards curative aspect neglecting preventive and promotional aspect since independence. As a result health services have been serving the upper strata of society who have capacity to pay, thus, leaving the poor and vulnerable in vicious cycle of poverty, hunger and diseases. Study of five-year plans reveals that many promises were made to work for preventive health and for improvement of health status, but these could not be materialized due to lack of direction and political will. Besides, there has been no health policy for larger part of country’s history. However, since 1970s some piecemeal efforts were made in this direction. Since 1990s three health policy documents were announced. For this study, five criteria were developed to analyze these documents. However, these policies do not fulfill these criteria completely. Furthermore, 18 individuals, representing different stakeholders were also interviewed. Data analysis was conducted through Nvivo software. The issues which became prominent in their opinion are: lack of evidence based policy and issues prioritization; lack of inter-linkages between policy and development; role of donors; role of stakeholders; curative nature of policy; resource allocation; issues related to WTO; issues of governance; centralized implementation; lack of continuity of policies; community participation and monitoring and evaluation. For this study a conceptual framework was developed which contains the idea of using health policy as intervention tool for underdevelopment, which can help enhance health status. It is further emphasized that civil society and other stakeholders must play their due role in policy process. In this regard a policy advocacy tool has been described. The study recommends some steps to be taken for comprehensive and participatory health policy. These include: decentralization of policy formulation; a Federal Commission on Health and Development headed by the president or prime minister; increase in health expenditure; effective use of existing allocation; village health committees; third party monitoring and evaluation and; private sector inclusion into health improvement efforts.
Lashari, T. H. (2003). Pakistan's national health policy : issues in formulation and implementation (Unpublished doctoral thesis). Aga Khan University, Karachi, Pakistan.