Factors affecting engagement of NGOS for health systems strengthening in Pakistan-developing a framework for meaningful public-private partnership

Date of Award


Document Type


Degree Name

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


Community Health Sciences


Background/Rationale Health system strengthening (HSS) can be defined as any array of initiatives and strategies that improves one or more of the functions of the health system and that lead s to better health through improvements in access, coverage, quality, or efficiency (Health Systems Action Network 2006). This has been evident now over a period of many years that public sector in Pakistan i s lacking in capacity in delivery and management of health services. Also, it is having issues in quality, efficiency and coverage of these services. Moreover, there has been a growing realization regarding the poor governance of public health sector due to corruption and also grossly under-financed and thereby under-utilized. Global and national development goals, donor agenda, existing public sector's capacity, bureaucratic and governance system, and dearth of resources has instituted a need for meaningful engagement of NGO and public sector for health system strengthening. There have been many examples where NGO sector has attempted to fill these gaps and this includes projects like TACMIL, FALAH and PAIMAN by USAID in which NGOs have been engaged at various levels with the public sector, they have resulted into positive results in better and quality provision of services, availability of health care staff at primary health care level, better management of the facilities etc. however, there has been many issues that has affected the collaborative working of public sector with NGO sector and undermined the positive outputs and outcomes. These issues are related to both the sectors and include lack of smooth coordination between the partners, issues of capacity of NGOs and public sector employees, unstable financing of projects and most importantly the issues of sustainability of the projects. To address these issues, there is a need to regulate the working of the NGO sector in addition to setting of strategies for these collaborative efforts which has been emphasized by many subject experts as well. The need for framework to engage the private/NGO sector properly to have better results and effective project management by the government itself has been often emphasized. To develop such a framework, one needs to have a clear understanding of the views and perspectives of the stakeholders involved in it, along with giving a thoughtful consideration to the evidences from the past and present of such engagements in th e country at various levels. This study has attempted to address both these needs by employing a qualitative methodology. Objectives I. To explore the perceptions of government and non-government stakeholders at the Federal and provincial level to involve the NGOs for Health System s Strengthening in Pakistan. 2. To catalogue the issues, challenges and success chronicles of previous NGO engagements in health sector from year 2000-2009 in Pakistan. 3. To recommend evidence based framework for meaningful engagement of NGO sector and Public private partnership for Health Systems Strengthening in Pakistan. Results Though both parties lack trust and confidence in each other, yet there is a realization of the importance of each other's existence and contribution in health systems strengthening in Pakistan. The study has informed the government policy makers about the modus operandi /framework of engaging the Non-Governmental Organizations for health systems strengthening in Pakistan. The framework has shown that selection of the right NGO to work in collaboration with public sector is the first step in the direction of a successful partnership. NGOs should be selected to in a competitive manner by the government on the basis of explicit standards and criteria. Further, while keeping the stewardship with the government a clear division of roles and responsibilities among the partners is crucial. Conclusion The policy and decision makers at the Federal level have a responsibility to set the directions to achieve the objectives and goals of the health sector in terms of responsive and efficient health care systems leading to improved health of the population on an equitable basis along with social and financial risk protection.

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