Health Care systems Pakistan Dr Mohammad Aman Khan

Health Care systems Pakistan Dr. Mohammad Aman Khan 25. 09. 17

Leaning objectives • The participants will be able to – Know different partners in health. – Levels of healthy care with differentiating points – PHC with its functions – Other sectors than Government in health care – Summary of health structure and functions

Partners in Health Improving Individual / Health Family Community Governments / NGOs / Private

“Health is a state of complete physical, mental, spiritual and social well being, and not merely the absence of disease or infirmity”

Government systems in Pakistan • Federal Government • Provincial Governments • Local Governments (started in 2014) Each government level has some health responsibility

June 2011 • 18 th Amendment in the constitution of Pakistan • Health POLICY by Federal Government, implementation by Provincial Government • From July 2011 responsibilities and resources shifted to provincial Government • From 2014, Local Governments have an important role in health delivery systems? ? ?

Province: Department of Health • • Minister and Secretary Health, Policy level decisions Additional and Deputy S H Section officer with support staff and D G Health (Planning and management) • Teaching and training institutes • (Medical colleges, nursing and paramedic training schools) • Meedical Teaching Institutes (HMC, KTH, LRH, ATH, GMC, SMC, BMC)

The Local Government (District Health System) in the context of devolution after 2014 • Very important • District Nazim / Deputy Commissioner. • (Planning, Implementation, Monitoring, data collection, analysis, interpretation, evaluation and planning)

Levels of health care • Primary (BHU, RHC, LHWS ) 60 -80 per district • Secondary (THQ, DHQ hospitals) 1 -4 per district • Tertiary (Teaching hospitals) 1 -3 per division

• LHW 1000 (Health hou) • BHU 10000 • RHC • TH Q • DHQ 30 -50 thous. 2 lacs. 10 lacs.

Divisions and districts in KP • 1 Peshawar – 1. Peshawar – 2. Nowshehra – 3 Charsada (Tertiary centres 4 in Govt, 4 in Private) 2 Mardan 4 Mardan (Tertiary) 5. Swabi 3. Kohat 6. Kohat (Tertiary centre) 7. Karak 8 Hangu

Divisions and Districts in KPK • 4 Malakand – 9 Swat (Tertiary centre) – 10 Shangala – 11 Lower Dir – 12 Upper Dir – 13 Chitral – 14 Buneer – 15 Malakand 5 Bannu 16 Bannu (Tertiary Centre) 17 Lakki Marwat

• 6 Hazara – – – 18 Abbotabad (1 Govt, 3 -4 Private sector) 19 Mansehra 20 Battagram 21 Haripur 22 Kohistan 23 Torgahar 7 D I Khan 24 D I Khan (Tertiary) 25 Tank

Functions of secondary levels (THQ and DHQ hospitals) • Managing referrals from PHC • Surgical / medical interventions (advanced) • Training for Human Resource for Health (Nurses, paramedics, )

Provincial Comprehensive Health Care Services District NGDO’S Evaluate District Line Departments Plan District Comprehensive Health Care Services Monitor District Health Care Budget Implement District CBOs

Health care System in Pakistan All the three tiers are important Primary Secondary Health Care Complex Training some cadres CENTRE OF EXCELLENCE Tertiary Health Care District Comprehensive health Care Programme • HRD (CME, CPD, CED) • Specialized Care for referred cases • Research and Development Primary Health Care Service Delivery Community Detect Diagnose &Treat Community Diagnose Treatment Ref Community Diagnose suspect refer

Health systems A well-functioning health system working in harmony is built on having • trained and motivated health workers, • a well-maintained infrastructure, and • a reliable supply of medicines and technologies, • backed by adequate funding, strong health plans and evidence-based policies. http: //www. who. int/healthsystems/en/ 24. 9. 17

THE DECLARATION OF ALMA ATA 1978 Health for all

Health For All (1978) “the attainment by all peoples of the world, a level of health that will permit them to lead a socially and economically productive life”.

PRIMARY HEALTH CARE (PHC) ‘Primary Health Care is essential health care based on practical, scientifically sound and socially acceptable methods and technology, made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and selfdetermination.

Functions or elements of PHC 1. Education on health problems and how to prevent and control them. P 2. Development of effective food supply and proper nutrition. P 3. Maternal and child healthcare, including family planning. P 4. Adequate and safe water supply and basic sanitation. P 5. Immunization against major infectious diseases. P 6. Local endemic diseases control. P 7. Appropriate treatment of common diseases and injuries. C 8. Provision of essential basic medication. C

Elements of P H C • 1. EDUCATION • Education regarding common diseases in the catchment population may reduce the occurrence of disease. • (measles, polio, malnutrition, taking medicine of hypertension preventing stroke / heart attack etc)

2. PROPER NUTRITION : Nutrition is another essential component of health care. WHO works to prevent malnutrition and starvation and to prevent many diseases and afflictions. (Nutrition during pregnancy, breast feeding, young children supplementary balanced diet, low salt diet)

Malnutrition; Predisposing Factors Mother’s Education : More common in illiterate mothers Socioeconomic conditions: More common in poor (Clustering) land less laborers Malnourished Baby mother at young age Girl malnourished children

3. CLEAN WATER & SANITATION : Clean water and basic sanitation can reduce the spread of disease. A supply of clean, safe drinking water, and basic sanitation measures regarding trash, sewage and water cleanliness can significantly improve the health of a population, reducing and even eliminating many preventable diseases.

4. MATERNAL & CHILD HEALTH CARE (MCH) Ensuring comprehensive and adequate health care to children and to mothers, both expecting and otherwise, is another essential element of primary health care. By caring for those who are at the greatest risk of health problems, WHO helps future generations have a chance to thrive and contribute globally. Sometimes, care for these individuals involves adequate counseling on family planning.

5. IMMUNIZATION : By administering global immunizations, WHO works to wipe out major infectious diseases, greatly improving overall health globally.

6. LOCAL DISEASE CONTROL : Prevention and control of local diseases is critical to promoting primary health care in a population. Many diseases vary based on location. Taking these diseases into account and initiating measures to prevent them are key factors in efforts to reduce infection rates.

7. ACCESSIBLE TREATMENT : Getting health care quickly is important Another important component of primary health care is access to appropriate medical care for the treatment of diseases and injuries. By treating disease and injury right away, caregivers can help avoid complications and the expense of later, more extensive, medical treatment.

8. DRUG PROVISION : Proper medication By providing essential drugs to those who need them, such as antibiotics to those with infections, caregivers can help prevent disease from escalating. This makes the community safer, as there is less chance for diseases to be passed along.

What is Universal Health Coverage (UHC)? • UHC means that all individuals and communities receive the health services they need without suffering financial hardship. • It includes the full spectrum of essential, quality health services, from health promotion to prevention, treatment, rehabilitation, and palliative care.

• UHC enables everyone to access the services that address the most important causes of disease and death, • and ensures that the quality of those services is good enough to improve the health of the people who receive them.

Protecting from poverty • Protecting people from the financial consequences of paying for health services out of their own pockets reduces the risk that people will be pushed into poverty because unexpected illness requires them to use up their life savings, sell assets, or borrow – destroying their futures and often those of their children.

• Good health allows children to learn and adults to earn, • helps people escape from poverty, and provides the basis for long-term economic development.

Thank you