Health care systems involve four inter-related features including a set of activities, a level of care, a strategies for organizing health care and a philosophy that permeates health care provision. This affects the configuration and focus of the entire health systems and development of communities’ better health status.1 These functions are mutually reinforcing and include contact with the service provider, continuity in care, comprehensiveness of available services and coordination with specialized services. The extent of resource availability and capacities required to implement such a package of services can either lead to a comprehensively planned out integrated health care delivery system or a selective, vertical programming. Such inadequacies in the national policy frameworks lead to competition between health programs, favoring some at the expense of others, weaknesses in continuum of care, disruption of routine health services and erosion of country level delivery capacity.2
Pakistan is among the three most populous countries in South Asia. It has made steady progress towards MDG 4 and 5 but is still not on track for achieving the targets by 2015. Though all MDGs impact upon the health situation of mothers and children, but the impact of malnutrition, communicable diseases and provision of water and sanitation facilities is more direct and profound and thus these targets need a simultaneous attention. These are presented in the table below
National Targets and Progress on MDGs 1, 4, 5, 6, 7: The National Health Policy 2001 written 7 years ago is not responsive to the current epidemiological trends and burden of diseases. Further there is no National Health Strategy which would elaborate on the either the current health needs or the future envisaged health problems. This is compounded by factors such as absence of evidence non availability neither on the burden of disease and epidemiology which would form the basis for next health policy and on absence of intra-sectoral coordination policy and working with an unregulated private sector.
To undertake a health systems reform in Pakistan, strategies need to gear towards improving management and accountability, ensuring responsive governance, strengthening core public health functions like monitoring, evaluations, having inter-sectoral actions rather than collaboration, costing and financing and encouraging risk pooling rather than out of pocket spending. Thus the health care delivery system of Pakistan has to have a new interface of socio political institutions rather than being the delivery points for bio medical interventions.
Table I: National Targets and Progress on MDGs 1, 4, 5, 6, 7 |
INDICATORS |
1990 |
2000 |
2006 |
2006 Target PRSP |
2010 Target MTDF |
2015 Target
MDG |
MDG 1 |
Malnutrition Prevalence, Weight for age ( % of children U5) |
- |
41.5 |
38 |
33 |
28 |
<20 |
MDG 4 |
Infant Mortality Rate |
102 |
77 |
783 |
63 |
65 |
40 |
Neonatal Mortality Rate |
56 |
52 |
543 |
|
|
|
Under-five Mortality Rate |
140 |
105 |
943 |
80 |
77 |
52 |
Immunization 12-23 months |
75 |
53 |
473 |
82 |
90 |
>90 |
MDG 5 |
Maternal Mortality Ratio |
550 |
350 |
2763 |
350 |
300 |
140 |
Births by Skilled Birth Attendance |
18 |
40 |
393 |
75 |
60 |
>90 |
Ante Natal Care |
15 |
35 |
613 |
50 |
70 |
100 |
Total Fertility Rate |
5.4 |
4.5 |
4.13 |
3.7 |
2.7 |
2.1 |
Contraceptive Prevalence Rate |
12 |
30 |
303 |
41.7 |
51 |
55 |
MDG 6 |
HIV prevalence |
<0.01 |
|
<0.01 |
|
|
<0.01 |
TB cases detected & cured |
- |
|
25% |
|
|
85% |
Malaria prevention & treatment |
|
|
25% |
|
|
75% |
MDG 7 4 |
Proportion of population (urban and rural) with sustainable access to a safe (improved) water source. |
53 |
69 |
66 |
70 |
76 |
93 |
Proportion of population (urban and rural) with access to sanitation |
30 |
45 |
54 |
55 |
70 |
90 |
|
|
Realizing the challenges, Pakistan Institute of Medical Sciences (PIMS) has newly established its Department of Public Health which aims to contribute to optimizing the health benefits for the people of Pakistan while recognizing other paradigms of resources, capacities and policies. The purpose of the public health department is to enhance the scope of knowledge base of health workforce and planners on issues related to health care delivery and its systems. It is also envisaged that this Department of Public Health will also play its vital role in bringing in knowledge to foster an environment of collaborative thinking for investment into the health sector.
The objectives of the Public Health Department, as envisaged to be achieved through short, medium and long term strategies, include
• Enhancing knowledge and skills of health workforces in the public and private sector of Pakistan;
• Demonstrating models for integrated health care delivery system;
• Operations research to provide evidence for policy dialogue and contributions in the health sector systems strengthening, innovate and robust health strategy and policy planning.
Pakistan Institute of Medical Sciences (PIMS) now has a critical mass of Public Health professionals who have a wide range of experience of dealing with planning, implementation of health programs, research and training. This group while in partnership with health care professionals and institutions will develop linkages, which will contribute towards the aim and objectives of the Public Health Department of Pakistan Institute of Medical Sciences. To conclude, there is need for coordinated and integrated public health approach to achieve the MDG target so as to improve the health of population of Pakistan.
References
1. Vuori, H. 1985. “The role of Schools in Public Health in the Development of Primary Health Care.” Health Policy
4: 221-30
2. Corker, RJ, Atun, RA, Mckee, M. 2004. “Health Care system Frailties and Pubic Health Control of Communicable Disease on the European Unions New Eastern order.” Lancet 963 (9418):
1389-92
3. Pakistan Demographic Health Survey 2006-07
4. National MDG Report 2005 |
