The health system in Pakistan is currently going through several reforms at the federal, provincial and district levels particularly to improve the delivery of health services to the population. These reforms are part of the overall development framework that endeavors to raise the importance given to the social sectors, particularly the health sector, in the country to address their poor performance despite a high level of economic growth in recent years. For these reforms to be successful, it is essential that these are based on clear evidence, are aligned to an overall vision for health development, and make a difference to the health of the population that is in greatest need for essential health services.

Health system reforms are concurrently being undertaken in the two provinces visited by the mission. In NWFP, the reforms range from financing of the health sector, contracting out and improving the quality of health services, and developing a policy on human resource. The reform process is assisted by the World Bank with technical assistance from the German Agency for Technical Cooperation and DFID. In Punjab, the reform process is focusing on improving primary health care services by providing financial incentives and improving salaries of health professionals, creation of positions for midwives and lady health workers at BHU levels, provision of medicines and continuous professional development. There is however lack of harmonization among the provinces in the reform process and the federal government has so far not fulfilled its coordination function.

The regulatory systems are either weak (for licensing) or non existent (accreditation). The Pakistan Medical and Dental Council (PM&DC) is responsible for registration, licensing and evaluation of the medical and dental practitioners, curriculum review, evaluation and approval of educational institutions in these two categories, and many other regulatory activities. Although the membership of the Council is broad covering most professions and including 52 members from almost all stakeholders, its coordination capacity to streamline the new policies and practices and to provide valid evidence on different aspects of human resources production seems to be weak. PM&DC has recently been through a period of turmoil and its independent role has been questioned by the Ministry of Health. How well the PM&DC fulfills its roles and functions in the new situation is uncertain.

At a national level 80% of the population has access to local health services in rural areas and 100% in cities. There are significant regional variations. Health investment is low and more than 75% of health financing is out of pocket. This situation is improving and in 2005-06 the total expenditure on health had increased by 16% from the previous year.

http://gis.emro.who.int/HealthSystemObservatory/PDF/HealthSystemReviewMissionReports/Pak HSD Mission Report Draft Ver 1 0 March 30 2007.pdf (updated 2007) (accessed on 20.06.2011)

(Validated 2011)