Punjab Health Sector Mapping

By: Laila Rubab Jaskani, Pakistan

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Background

• Punjab comprising of more than 95 million populations is more than 50% of Pakistan

• Health inequities and inequalities exist within and between the districts

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Broad Health Policy Objectives

• “Provision of affordable, accessible and quality health/RMNCH to the people of Punjab in an equitable manner”

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Punjab Health Department

The Provincial Health Department operates under the administrative control of Secretary Health, Punjab who is the head of provincial Health Department. The Health Department has two main functions;

1. Policy-making

2. Regulatory function.

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Punjab Health Profile

• Punjab constitutes more than half the population of Pakistan. In spite of extensive network of health care facilities, health status of the people of the province as a whole is below the desired level.

• Infant mortality rate is 77 per 1000 live births.• Under 5 mortality rate is 112 per 1000 live births.• Maternal mortality ratio is estimated to be 300

per 100,000 live births, lower than the national figure 350.

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Malnourished children in Punjab

• Four million malnourished children in Punjab,• A third of all pregnant women are estimated to

have iron deficiency anemia. • Over 34 percent of children under the age of five

years are short for their age; • over 10 percent are under weight for their age

and over half anemic.

Malnutrition is a major contributor to infant and maternal deaths.

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Health Services

• The services for Punjab are provided through a well designed infrastructure.  Health Department across the province is divided into:

• 2,461 Basic Health Units (BHUs) • 293 Rural Health Centers (RHCs) • 88 Tehsil Headquarters Hospitals (THQs) • 34 District Headquarter Hospitals (DHQs) • 23 Teaching/ tertiary Care Hospitals

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Health Departments Punjab

• Department of Health• MNCH Program• Punjab Nutrition Program• EPI Program• CDC Department• PSPU-Punjab• PHSRP

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Major Barriers to MDGs 4 & 5

Availability of Health Care Providers Accessibility of MNCH services in terms of physical,

social and economic access Issues regarding availability of MNCH related

medicines, supplies and equipments Capacity of HCPs Governance and accountability Women empowerment Evidence based advocacy to raise community

awareness

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Management Reforms

Strengthening the role of Punjab Health Foundation underway for the development of private sector

In pursuance of LGO 2013 and take devolution further to districts establishment of “District Health Authorities” under process

Establishment of Punjab Health Care Commission to regulate Public & Private health care delivery system

Multi-sectoral Nutrition Initiative

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Service Delivery Reforms

• Development of EPHS & MSDS for PHC and Secondary level

• An integrated RMNCH and Nutrition Program- PC-1 approved

• Strengthening of referral services by provision of rural ambulances. PC-1 has been approved.

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Health Care Programs in Punjab

• Epidemics Prevention and Control Program • Extended Program on Immunization (EPI) • National Maternal and Child Health Program • National Programme For Family Planning & Primary Health Care • Nutrition Program • Prevention and Control of Hepatitis • Punjab AIDS Control Program (PACP) • Punjab Health Sector Reforms Programme (PHSRP) • Rollback-Malaria Program • TB Control Program • District Health Information System (DHIS) Program • Health Education Program

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Influencing departments

• Planning & Development– Chief Health/Emergency under Member Social

Services in P&D Board– Public Private Partnership Cell (Assistant Chief Social

Sectors, Health & Education)– Punjab Resource Management Program – Policy and Strategic Planning Unit– Punjab Information and Technology Board

• Women Development, Population Welfare, Law and Parliamentary Affairs, Social Welfare and Baitul Mal

• Institutional Reform Group (IRG)

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Punjab Health Organogram

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Policy and Strategic Planning Unit

• The need of Policy and Strategic Planning Unit (PSPU) was identified mutually by Health Department and donors. Therefore, the need to have a body working closely with the Department of Health on policy analysis, strategic planning, data analysis, identifying issues and challenges was acknowledged.

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Objectives of PSPU Punjab

• The main objectives of PSPU are:• Public-Private mix of human resource • Steering committee to approve policies

 

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PSPU Punjab Projects

• School Health and Nutrition Program• Punjab Millennium Development Goals Program• Knowledge Management• e-Monitoring• Chief Minister's Initiative for Health Care• Punjab Health Sector Strategy•  

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Conclusion

• Despite devolution of powers at the local level, the health system remains centralized and not able to respond to the organizational and governance challenges resulting in ineffective use of already scarce resources and its ability to deliver.

• Devolution remains incomplete with weak accountability mechanisms and management capacity at the district level.

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Recommendations

• The public health system needs re-organization based on management principles, with the federal and provincial governments focusing on its core stewardship functions of policy, regulation, monitoring and evaluation, standard setting and moving towards quality service delivery both by the public and private sector.

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Punjab Map

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References:

• http://health.punjab.gov.pk/• http://pspu.punjab.gov.pk/pmdgp