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DEVOLUTION PLAN AND HEALTH CARE IN PAKISTAN

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Title: DEVOLUTION PLAN AND HEALTH CARE IN PAKISTAN


1
DEVOLUTION PLAN AND HEALTH CARE IN PAKISTAN
CHALLENGES AND CONSTRAINTS
Dr. Babar T. Shaikh The Aga Khan University,
Karachi, Pakistan.
2
VISION
  • Health is a basic human right and must be
    available and accessible in an affordable
    framework to all. To this end, an integrated
    approach to public health in the district will
    combine preventive, promotive and curative health
    at all levels. Reductions in demand of curative
    care, would be translated into improvements in
    its quality.
  • Promoting good governance in health sector, by
    meaningful and consistent emphasis on prompt,
    equitable and professional services delivery,
    must become a cardinal principle of the
    department.

3
Devolution, Decentralization, Debundling
It is the transfer of authority, or disposal of
power in public planning, management and decision
making from the national level to sub- national
levels or from a higher to lower levels of
government.
4
Main Objective philosophical ideological
Providing the means for community participation
and local self-reliance and ensuring the
accountability of government officials to the
population.
5
DEVOLUTION OF POWERS IN HEALTH DEPARTMENT
OBJECTIVES
  • Empowerment of the people at the grass root
    level.
  • To make the District the dominant level of
    decision making in health department.
  • Improve the quantity and quality of health care
    delivery to the people close to their door steps.
  • Integrated approach to public health, combining,
    preventive, promotive and curative health at all
    levels.

6
RESPONSIBILITIES/ FUNCTIONS AT THE DISTRICT LEVEL
  • Prevent and Control Communicable Diseases and
    Non Communicable Diseases.
  • Food Sanitation.
  • Maintain medical and health statistics under
    HMIS.
  • Reproductive Health.
  • Health and Nutrition Education.
  • Environmental and Occupational Health.

7
RESPONSIBILITIES/ FUNCTIONS AT THE PROVINCIAL
LEVEL
  • Make Health Policy for the Province.
  • Legislate on Provincial health Issues.
  • Drugs control under the Drugs Control Act.
  • Monitoring and Regulatory functions of
    Medical and Para Medical institutions.
  • Health Research and related Health information
    gathering.

8
RESOURCE/ASSETS DISTRIBUTION FOR THE DISTRICT
  • Type-A or B DHQ Hospital hospitals.
  • Type-C Tehsil HQ hospitals.
  • Type-D Civil Hospitals
  • RHCs.
  • BHUs.
  • Sub Health Centres.
  • MCH centres.
  • Dispensaries.
  • Districts will be encouraged to establish their
    own Nursing,
  • LHV and Paramedical Training Institutes in due
    course.

9
PROGRESS SO FAR
  • Posts in Directorate General of Health Services
    have been re-designated
  • Budgets according to the new requirements.
  • All DHOs and ADHOs have been briefed by the
    department twice on its approved Devolution plan.
  • Briefing was held for both DHOs and DCs of all
    districts by Health Department
  • All DHOs have been instructed to work as a team
    with the DCs at the district level
  • All DHOs have been asked to develop lists of
    their assets for distribution

10
ADMINISTRATIVE STRUCTURE
DISTRICT
District Coordination Officer
EDO Finance and Planning Health
Public Health
District Headquarters Hospitals
Basic Rural Health Centre
Mother Child Health
Population Welfare
11
FUNCTIONS OF EXECUTIVE DISTRICT OFFICER
  • Ensure that the business of the department and
    offices placed under his administrative control
    is carried out in accordance with the relevant
    laws and rules.
  • Co-ordinate and supervise the activities of the
    relevant offices.
  • Ensure efficient services delivery by
    functionaries under his control.

12
DISTRICT HEALTH MANAGEMENT TEAM
What is the purpose of a DHMT ? P Develop a Team
approach P Share and Exchange Views P Reduce the
workload of the DHO P Optimize Utilization of the
Human Resources P Improve Cooperation and
Collaboration among stakeholders
13
How is a DHMT Constituted ?
P     DHO P     Other District Managers P
    Public Sector Health Care Providers P    
Private Sector Health Care Providers P Community
or its elected leaders
14
Role of DHMT
  • Sharing of experiences and exchanging of views
    ideas.
  • Taking responsibilities and improving technical
    efficiency by supporting, assisting.
  • Improve cooperation and collaboration with the
    Government and private health related sectors.

15
OUTCOMES
  • Well-defined structures have been developed and
    resources allocated.
  • Meaningful partnerships at provincial,
    district, tehsil and community level, through the
    establishment of DHMT,THMT and citizen boards.
  • Detailed mapping of resources and services need
    to be developed.
  • In planning and implementation of program a
    right based and integrated approach needs to be
    developed.
  • Meaningful action and capacity building would
    be required at all levels.

16
HEALTH EXPENDITURE SITUATION AT PRESENT
  • Almost 100 is out-of pocket
  • Includes formal and informal private sector
  • Questionable quality of care
  • Considerable expenditures on unnecessary and
    inappropriate (sometimes unsafe) care
  • Inequity in financing of care
  • No regulation or standards on fee charged
  • Reliable information not available

17
ADVANTAGES OF DEVOLVED SYSTEM IN HEALTH CARE
  • Administrative and financial powers to district
    authorities / local bodies representative.
  • Involvement in devising the programs relevant to
    the local needs and priorities.
  • Strategies and plans acceptable for the community
    and matching to their socio cultural and socio
    economic background.

18
  • User willingness to pay for PHC in the public
    sector services, if they receive improved care.
  • The districts can recover substantial costs and
    can retain the incomes.
  • Creating sense of ownership.
  • Strengthening of FLCF, answering many primary
    health problems like high IMR, high MMR and
    morbidity and male involvement.

19
CRITERIA FOR ALLOCATING DISTRICT BUDGETS
  • Population Size
  • Socio-economic Development
  • Health Infrastructure
  • Health Needs / Problems (BOD Estimation)
  • Performance Evaluation based on
  • predetermined indicators
  • Combination of Above

20
CHALLENGES AND CONSTRAINTS
  • Political willingness of provincial and district
    governments to work in the new system.
  • Defining their administrative roles with limits
    and jurisdiction.
  • Distribution of financial powers between
    Provincial and District representatives.
    (dependency of districts on provinces for how
    long?)

21
  • Financial and administrative capacity of the
    district government.
  • Resentment against the status quo at the
    provincial level and fear of loosing authority.
  • Lack of trust and losing the profit.
  • Status of Public Service Commission, Medical
    colleges and Tertiary hospitals.

22
THE INTERNATIONAL DEVELOPMENT TARGETS
1. A reduction by one half in the proportion of
people living in extreme poverty by 2015 2.
Demonstrated progress towards gender equality
and the empowerment of women by elimination
gender disparity in primary and secondary
education by 2005 3. A reduction by two-thirds
in the mortality rates for infants and children
under age 5 and reduction by three-fourths in
maternal mortality - all by 2015
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