Health promoting hospitals : needs and strategies for Pakistancby Asif Raza Khowaja.

Date of Award


Document Type


Degree Name

Master of Science in Epidemiology & Biostatistics (MSc Epidemiology & Biostats)


Community Health Sciences


Background: A Health Promoting Hospital (HPH) entails hospitals to get closer to the communities to cater to their health needs. HPH provides quality healthcare services and organizes health promotion activities to promote health of the patients, staffs, and community. Besides, it requires hospitals to provide healthy workplace for its employees. The literature suggests, the transition towards HPH is evident in Western Europe and its network has expeditiously been spreading in other developed countries. However, any such hospital (accredited as HPH) is nonexistent in developing countries including Pakistan. Therefore, the aims of this study were to explore: Healthcare stakeholders' concept ual understanding about health, health promotion and HPH. Healthcare stakeholders' perceive d needs for HPH in Pakistan. Context specific strategies for HP H in Pakistan. Methodology: This study was conducted from July- August 2007. It employed the qualitative exploratory research design. This study was conducted in purposively selected three settings i.e. hospitals (01 Public and 01 Private hospital), Department of Health, Sindh, Ministry of Health Islamabad, and UN as well as donor agencies based in Karachi. Similarly, the KI and FGD participants were also purposively selected from these settings. The data was collected through 11 face-to-face semi-structured KI interviews; hospital administrators, health policy makers, and the representatives from UN and donor agencies were interviewed. Additionally, two focus group discussions were also conducted with healthcare providers, one each at a public and private hospital. The transcribed data was analyzed using the QSR NVivo 2.0; nodes representing themes were generated and data was coded on the nodes to develop models. Results: The results showed that participants in both KI interviews and FGD thought of health promotion as a concept synonymous to health education. However, participants with a public health background had a more holistic view of health promotion than those with a non-public health background. The HPI1 was greatly perceived as beneficial for patients, staff, community and hospitals. Considering the benefits of HPH and the triple burden of diseases, HPH was perceived as the 'need of the hour' for Pakistan. Our analysis further revealed that the major barrier to work on any health promotion initiative was the curative mindset of administrators and policy makers. Moreover, the lack of proper structures at hospitals, lack of resources, lack of multisectoral collaboration, and lack of demand for health promotion from community were identified as hurdles for HPH. In contrast, devolved primary healthcare structures, established task forces at the hospitals, closer working relationship of hospital staff and communities, and support from donor agencies were perceived as enabling factors for HPH. Conclusion: It was recommended that the hospitals should work on three priority areas, healthy physical structure, safety and security of patients and staff, and quality of services. Moreover, the Department of Health and MoH were recommended to provide logistic support and policy guidelines to the hospitals, whereas, UN and donor agencies should provide technical and financial support for initiating HPH in Pakistan. Furthermore, it was highlighted that operationalizing HPH required identification of key personnel at all levels, mass advocacy, motivation, policy initiatives at the Hospital, National and Provincial levels, multisectoral collaboration, publicity, and performance incentives to sustain HPH initiative in Pakistan.

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