A lot has been said about the differences existing between the health services of rural and urban areas in Pakistan. Around of 60% of the Pakistani population lives in rural areas and 34% of them live in extreme poverty. Despite all the efforts made by the Pakistani government, today there’s still a big disparity among all sector’s health services. There are lots of conflicts inside local government systems. This has often been defined as the “Mixed health-system syndrome”.
After the 18th Constitutional Amendment, the control of the health system was given to each province. Nevertheless, it doesn’t have a central structure different from the Federal government. This situation has brought advantages and disadvantages.
This type of system has the particularity that both, federal and provincial governments have specific responsibilities and authorities. The planning and execution of health policies is separated. At this level, a good communication is crucial for the good work of the system and gaps on it give space to corruption and waste of resources.
Among the constitutional competences of the federal government are:
Spread of health information, global and interprovincial health coordination.
Trade of human resources and drugs / medicine policy and regulation.
After the Devolution Plan in 2000, health is constitutionally a provincial subject and districts are responsible for implementation. In this way provinces have administrative and financial autonomy over health sector. Provinces, trough the Provincial government, and districts, trough the District Health Management Team (DHMT), are responsible of developing and executing local strategies based on their own needs. DHMT concerns about all health matters of a district. Among its functions are: to identify and address the health problems in a district, to reach consensus-based decisions according to views and ideas exposed in the office, to improve the collaboration and cooperation with communities and the optimal utilization of human resources.
Rural Health Structure & Problems
Rural health in Pakistan is a fundamental part of the public health sector. The Provincial governments are responsible for developing and executing policies around it.
Currently, many healthcare options are available in rural areas. Public health in Pakistan is based on the principles of Alma Ata, establishing that it has to be primary-care focused.
So, the Pakistani government offers two kinds of health services. The first one acts in a community level and includes the Lady Health Worker program and the Village Based Family Planning Worker program. The second one is more complex in matter of infrastructure and includes, mainly, Rural Health Centers (RHC), Basic Health Units (BHU) and Maternal and Health centers (MCHCs). Both of them are actually, the structural core of the Pakistani primary health care system. Currently, according to WHO numbers, in all Pakistan there are 560 RHCs who serve a population of around 25000 to 50000 individuals and 5334 BHUs who serve a population of around 10000 to 15000 individuals. About five to ten BHUs are linked to one RHC in every catchment area. MCHCs are also part of the primary health services providing basic obstetric care.
Unfortunately, the lack of human resources, medical equipment and the extensive damage of infrastructure has stopped the progress of the most important pillar of the Pakistani health system. Because of this reason people who live in rural areas don’t have an adequate access to public health services and need to use the extremely expensive private system.
There are many areas to be improved in the Pakistani rural health system. The decentralization process promoted by the 18th Constitutional Amendment is an excellent opportunity to restructure health policies and try to get more in touch with the community needs.