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History of Health care system of Pakistan

Dr Riffat Jehanzeb Coordinator MPH PHSA

HEALTH SYSTEM ORGANIZATION OF PAKISTAN


Brief History of the Health Care System Pakistan at the time of its independence in 1947 inherited a health care delivery system that was a legacy of colonial British period. This rudimentary system was in the shape of public health services and some curative services. It was essentially designed to prevent large scale epidemics and provide curative services for the population in large and medium sized towns, many of which were along the lines of communication or political or strategic consequences

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During initial phase (1947-1955), most important initial problem was the replenishment of staff. In addition to other programs, BCG vaccination campaign was launched with the support of UNICEF and two medical schools were opened in the West Pakistan.

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From 1955 onwards, developmental activities were affected in phases of five year and each phase was known as Five Year Plan

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During 1st Five Year Plan (1955-1960) 1. Six new medical colleges, including one for women were opened in both wings. 2. A nursing school was attached to each of these medical schools. 3. Postgraduate institutions were established. 4. A bureau was established to produce vaccines and sera.

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During 2nd five year plan (1960-1965), 1. Under the recommendations of a Medical Reform Commission, 2. Rural Health Center scheme to cover 50000 population by each unit, 3. Two Health Technicians Training Institutes were opened, 4. Family planning program, 5. And a malaria eradication program were launched.

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During 3rd five year plan (1965-1970) in addition to continuation of the aforementioned initiatives, witnessed 1. launching of Tuberculosis Control Program and 2. Small pox eradication programs. 3. The major infrastructure of the public health care system was set up in the 1970s. 4. Pakistan endorsed the "health for all by 2000" initiative which had been launched by the World Health Organization.

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5. Government launched an extensive infrastructure and

policy building initiative.

6. From the villages to the cities different levels of health care were started like the "Basic health units" for the villages.

7. The Tehsil headquarter hospital represented secondary health care, and district hospitals and teaching and referral units represented tertiary care units.

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8. Along with this a significant public health campaign was

launched for the first time, keeping in view local needs and WHO guidelines to meet the target. . These were : An expanded program of immunization to eradicate the prevalent infectious diseases; Malaria control program; Tuberculosis control program; Family planning program; Diarrhea and pneumonia control programs; and many others. 10. To monitor all these and to achieve further improvements and make sure the policy was being applied the national institute of health was created.

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During fourth five year plan (1970-1975),

1. Quota of medicines was substantially increased for major hospitals,


2. a generic name drug system was introduced to bring down the prices of medicines, 3. Eight state-owned fair price drug shops were opened, 4. Six new medical colleges, three new nursing schools, and one public health school were opened.

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The fifth five-year plan (1978-1983) was scheduled for 1975-1980, but to cover the deficiencies and to make a more realistic plan, the slight shift was made. Under a process of a Country Health Program (CHP), that aimed at improving 1. Planning and management of health services. 2. Under CHP it was recommended that rural health coverage be increased at least to 50%, in addition to others,

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3. Striking the communicable diseases, 4. Combating malnutrition, 5. Food adulteration and 6. Industrial hygiene were highlighted.

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During Sixth five-year plan (1983-1988), 1. Government launched extensive rural development program that provided sound base for Health for all by the year 2000.

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Seventh five year plan (1988-1993): Alma Ata declaration of 1978 remained the basis of all five years plan afterwards. 1. During seventh five-year plan, new health facilities (Basic Health Units and Rural Health Centers) were established,

2. A female medical technician school was established, and health facilities were provided with laboratory facilities.
3. Health facilities were linked with semi-skilled, trained paramedics termed as community health workers.

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4. Third health project was launched aiming at improving MCH services.

5. Second Family Health Project was started to improve the health of masses in general and that of women in particular. 6. Minimization of drug abuse, 7. Establishment of national school health services 8. and goiter control were other salient initiatives under this plan

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In Eighth five year plan (1993-1998), 1. Health management information system (HMIS), 2. Social action program (SAP), and Prime Minister Program for Family Planning and 3. Primary Health Care were launched

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During Ninth five year plan (1998-2003)

1. Decentralized Planning, levying user charges for financing, public private partnership and privatization of health facilities were the areas of programming.
2.The strategy of the plan was to consider the gains already achieved in the previous plan and to improve the quality of service by creating a balance of promotive, preventive and curative services and removal of management weaknesses of the health system

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1. In 2001 the government aimed to bring about Programmatic and Organizational and Management Reforms. These were to foster alleviation of poverty agenda of government, under health sector reforms, devolution had acquired immediate importance and major impetus was on district health system. 2. At federal level a policy analysis and reform unit is being established. 3. The Health Policy 2001 considered health sector investment as a part of governments Poverty Alleviation Plan. It gave more importance to primary and secondary health services as opposed to tertiary level health services in the past. 4. Good governance is seen as a basis of health sector reform to achieve quality health care

Functions of the Health Department (KPK) Present Status

I. Leadership and evidence-based direction setting for health sector. 1. Health policy and reforms. 2. Health planning, financing and budget.

Functions of the Health Department (KPK) Present Status

II. Health Support and Development. 3. Health promotion (a) Health education; and (b) Community involvement and advocacy.

Functions of the Health Department (KPK) Present Status

4. Disease Prevention and control: (a) Communicable diseases; and (b) Non-communicable diseases.

5. Occupational Health.
6. Environmental Health.

Functions of the Health Department (KPK) Present Status

7. Curative and rehabilitative care. (a) Primary, secondary and tertiary level curative services including mental health; and

(b) Rehabilitative care.


8. Health related preparedness and response to disasters

Functions of the Health Department (KPK) Present Status


III. Health Regulation and Enforcement. 9. Health personnel, facilities and services 10. Levying of fees and charges by medical professionals and facilities. 11. Quality assurance and control. 12. Facilities and services. 13. Drugs control. 14. Alternative systems of medicine.

Functions of the Health Department (KPK) Present Status

15. Food and sanitation: (a) Prevention and control of adulteration in food; and (b) Monitoring & reporting upon safe drinking water supply and sanitation services.

16. Devices and technology.

Functions of the Health Department (KPK) Present Status


IV. Management Support Services. 17. Health human resource planning. 18. Health human resource development: (a) Provision of quality medical and allied education; (b) Pre-service training of support medical and health professions; and (c) In-service training of health human resource.

Functions of the Health Department (KPK) Present Status

19. Health human resources management. 20. Logistics and procurement. 21. Internal audit and accounting in the Health Department.

Functions of the Health Department (KPK) Present Status

22. Legal services: (a) Propose medico-legal advice and litigation; (b) Propose law review, amendment, formulation relating to Health Department; and (c) Facilitate Law Department in litigation related to Health Department.

Functions of the Health Department (KPK) Present Status


V. Monitoring and evaluation. 23. Generation of evidence: (a) Performance assessment;

(b) Information and communication systems; and


(c) Health, medical and allied research. 24. Knowledge management for evidence based decision making.

Functions of the Health Department (KPK) Present Status

VI. Co-ordination on health related matters. 25. Ministries, Departments, Local and International Partners and donors.

Programs/Projects
HIV/AIDS Expanded Programme on Immunization TB Control Programme Prime Minister programme for prevention and control of Hepatitis Roll Back Malaria Programme National Maternal, Newborn & Child Health Program, Khyber Pakhtunkhwa National Program for Family Planning and Public Health Care Khyber Pakhtunkhwa

THANKS