Resource allocation and the enhanced National Aids Control Programme : decision maker's perspectives

Date of Award


Document Type


Degree Name

Master of Science in Health Policy & Management (MSc Health Policy & Mgmt)


Community Health Sciences


Limited resources, whether public or private, demand prioritisation among competing needs to maximize productivity. Annual health expenditure in Pakistan has rarely exceeded $ 18 per capita; with a public sector share of only 26Yo for the provision of services to a population in excess of 140 million; proper utilization of constrained resources becomes essential. Although an important issue, little work has been done to develop an understanding of how resources are distributed and which factors determine the distribution; to this end, the Enhanced National AIDS Control Program was studied. This program was chosen because of its importance at the regional and local levels which are predicted to witness an explosive growth in the number of HIV cases in the near future and efforts are being made to address the issue at the national level. Objective: Identify perceptions of decision makers about the process of resource allocation within the Enhanced National AIDS Control Program. Study Design: A qualitative study was undertaken and in-depth interviews of decision makers at provincial and federal levels responsible to allocate resources within the program were conducted. Study Findings: HIV was not considered to be a priority issue by all study participants; some thought external funding for the program was accepted because of poor foreign currency reserves and donor agency influence rather than being guided by local need. Political influence from the federal government and donor agencies was thought to manipulate the distribution of funds within the program, although a well-laid out procedure to determine allocation of public resources is in existence. Lack of collaboration among departments involved in decision making, a pervasive lack of technical expertise aided by paucity of information, in a general atmosphere of adhoc decision making were thought to reduce resistance to external pressures. Principles of resource allocation, whether equity or efficiency based, were thought to bear no influence 10 on how resources are allocated; decision makers also expressed reservation in assigning extensive funds from meager health budgets to taboo diseases like HIV. Conclusion: Development of a unified program vision through a consultative process and advocacy is necessary to understand goals to be achieved, may enhance program ownership and develop consensus about how money and effort should be directed. Enhancing public sector expertise in planning and budgeting is essential not just for the program, but also to reduce reliance on external agencies for technical support. Strengthening the available database for effective decision making is required to make financial allocations based on real, rather than perceived needs. With a large part of HIV program funding diverted to NGOs, it becomes imperative to develop public sector capacity to administer contracts, coordinate and monitor activities of the non-governmental sector.

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