health presentation lahore 3

8/14/2019 HEALTH Presentation Lahore 3

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HEALTH SYSTEMS IN

PAKISTANAchievements, Challenges and

the Way forward

Dr Assad Hafeez FCPS, FRCP, PhD

Chief Health systems & Policy Unit

Federal Ministry of Health

Dec 2009


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Contents of the presentation

Health and poverty

Resources for health in Pakistan

Health systems in Pakistan Health indicators and targets

Achievements, Challenges and the Way

forward Essential Health Services Package


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Health: A basic human right


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NATURAL CAPITAL

20%

PHYSICALCAPITAL

15%

CAPITAL

64%

Health as a capital

ILL HEALTH

Weakened HR capacity

MORE POVERTY

Human Capital

65%

THE VALUE OF HUMAN CAPITALWORLD BANK ASSESSMENT ON TOTAL WEALTH OF 192 COUNTRIES

Source: Sustainability and the Wealth of Nations, World Bank 1996


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Health Economic growth

10% increase in

life expectancy

Effect more pronounced where life expectancies are lower

0.4 % increase in

economic growth

=

Source: Commission for Macroeconomics and Health, WHO, 2000


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Total Expenditure on Health(Federal &Provincial)

YearDevelopment Non-development Total Health

Expenditure

as % of GDP

2003-04 8.5 (25.9%) 24.3 (74.0%) 32.8 0.58

2004-05 11.0 (28.9%) 27.0 (71.0%) 38.0 0.57

2005-06 16.0 (40.0%) 24.0 (60.0%) 40.0 0.51

2006-07 20.0 (40.0%) 30.0 (60.0%) 50.0 0.57

2007-08 27.0 (45.0%) 32.0 (53.3%) 60.0 0.57

2008-09 33.0(45.5%) 41.1(54.5%) 74.0 0.55

Rs in Billions

Source: Economic Surveys of Pakistan


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Financing Health

Indicator

Pak Afgh India Bangl

Year 2006

Total health expenditure (THE) as % of GDP 2.6 9.2 3.6 3.2

General government exp. on health as % of THE 33.6 32.4 25 31.8

Private expenditure on health as % of THE 64.5 67.6 75 68.2

General government expenditure on health as % of totalgovernment expenditure

7.5 6.2 3.4 7

Social Security expenditure on health as % of Generalgovernment expenditure on health

0.3 0 4.9 0

Per capita THE (US$) 19.37 27 29 12

Per capita government expend. on health (US$) 6.50 9 7 4

Source: National Health Accounts 2005-6


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Financing Health

28%

5%

65%

3%

Contributions to health care

Tax

Donors

Out of pocket

Others

Source: National Health Accounts 2005-6


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Health Investment by GoP & Partners

MoH & DoHs

74%

MoPW5%

UN system

5%

Bilaterals

6%

Multilateral

10%

GoP (MoH & DoHs)= Rs 45 billions

Partners= Rs 11 billions

Partners

21%

Source: Inventory of H & P Investment Pakistan, GoP & WHO 2005


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2006 POPULATIONREFERENCE BUREAU

Health Delivery SystemIntegrated Rural Health Complex

Basic HealthUnits

Rural HealthCenters

DistrictHeadquarters

Hospital

TertiaryHospitals

PopulationServed

Referral Centers

100,000 300,000

25,000 50, 000

5,000 10,000

Health Care Providers

Specialists, Doctors,Nurses, ParamedicalStaff

Specialists, Doctors,Nurses, ParamedicalStaff

Doctors, Nurses,Paramedical Staff

Paramedical StaffLHWs


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Burden of Disease

Mortality (Deaths) by Cause and Gender

0 50000 100000 150000 200000 250000 300000 350000

Communicable diseases

Maternal /Perinatalcond

Nutritional deficiencies

Diabetes

Cardio-vasculardiseases

Neuro-psy

Neoplasms

Other Non-Comm

InjuriesFemales

Males

Source: WHO, 2007


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12 Current Approach to Reduction ofMaternal and neonatal Mortality

Age Pyramid

35 million

Ages 15-49

33 million

Ages 15-49


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13 Current Approach to Reduction ofMaternal and neonatal Mortality

Age Pyramid

62 million

Ages 15-49

58 million

Ages 15-49


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Health related MDGs

MDG

indicator

Baseline

1990

Current

status

Targets

2015

Under 5 mortality 140 94 52

IMR

120 78 40MMR 550 276 140

Births SBAs 18% 39% 90%

HIV prevalence


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1990 2007 2015

Progress in IMR110

78

55

40

Current rate of change= 2.10/yr

Required rate of change=3.40/yr Ref: PDHS 2008.


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Achievements

Lady Health Worker Program expanded

National Health Accounts

New Health Policy 2009 Hepatitis control program reviewed

Expansion of infrastructure

Enhanced financial resources


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Major Challenges

Low investment in health

Rapidly increasing population

Double burden of disease Emerging and re emerging diseases

Absence of social safety nets

Sub optimal performance of healthsystems

Unregulated private sector


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Way forward

National Health Policy

Public private partnership

Social Security nets for poor Universal health coverage

Essential Health services Package


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Essential Services Package

Describes and defines functions of differentlevels of the health system, as well asresources and procedures to deliver them

Functions Curative, Preventive, Promotive, Rehabilitative

Resources Workforce, equipment, technology

Procedures Guidelines, SOP, Quality management


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Components of EHP

Maternal Newborn care

Family planning

Child health and immunization Non communicable conditions

Emergency management

Community outreach and preventive care Health education

Referral linkages

Management and Health information


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The ESP Matrix

MDG

CommunityHealth Indicators

IndividualPerformance

Indicators

The Community Health Team

Community

Health Team

Essential Services Package

Promotion Prevention Cure Rehabilitation


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Outcomes of successful

implementation of ESP Provision of universal access

Social security net

Poverty traps reduced Equitable health care for all

Clear resource layout

Public accountability Basis for public private partnership

Tool for quality control

BASIS OF NATIONAL HEALTH SERVICE


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HEALTH

A case for increased investment

Basic services in ESP would require 10-13 $ percapita government expenditure to ensureuniversal coverage

NHA 2005-06 shows current governmentexpenditure of 6.5 $ per capita i.e. 0.6% of GDP

An increase to 1.2 to 1.5 % of GDP in next 5years will ensure universal coverage of essentialhealth services to all Pakistanis


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Key to universal access

ESPFinancing

HRH

Information

Technology

Governance


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Summary

Pakistan has major health problemscontributing to increased poverty

Financial and non financial constraints areprimary challenges

Increased investment along with betterhealth systems performance is required

ESP implementation has a potential toachieve the MDG targets by targeting thepoor and provision of universal health

coverage


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health presentation lahore 3

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