PRIMA HEALTH CARE IN

PAKISTAN

Ms. Alina Hameed

Lecturer
Lahore School of Nursing
The University of Lahore

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Unit Objectives

3. Discuss application of PHC in Pakistan?

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 VISION
• Health is a basic human right and must be
available and accessible in an affordable
framework to all. To this end, an integrated
approach to public health in the district will
combine preventive, primitive and curative
health at all levels. Reductions in demand of
curative care, would be translated into
improvements in its quality.

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Main Objective:
Philosophical & ideological

Providing the means for community

participation and local self-reliance and
ensuring the accountability of
government officials to the population.

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 DEVOLUTION OF POWERS IN
HEALTH DEPARTMENT
• Empowerment of the people at the grass root
level.
• Improve the quantity and quality of health care
delivery to the people close to their door steps.
• Integrated approach to public health, combining,
preventive, primitive and curative health at all
levels.

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RESPONSIBILITIES/ FUNCTIONS
AT THE DISTRICT LEVEL
• Prevent and Control Communicable Diseases
and Non Communicable Diseases.
• Food Sanitation.
• Reproductive Health.
• Health and Nutrition Education.
• Environmental and Occupational Health.

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RESPONSIBILITIES/ FUNCTIONS
AT THE PROVINCIAL LEVEL
• Make Health Policy for the Province.
• Legislate on Provincial health Issues.
• Drugs control under the Drugs Control Act.
• Monitoring and Regulatory functions of
Medical and Para Medical institutions.
• Health Research and related Health
information gathering.

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ADMINISTRATIVE STRUCTURE:
DISTRICT

District Coordination Officer

EDO: Finance and Planning Health

Public Health
District Headquarters Hospitals
Basic Rural Health Centre
Mother & Child Health
Population Welfare 8
 OUTCOMES
• Well-defined structures have been developed
and resources allocated.
• Meaningful partnerships at provincial, district,
tehsil and community level.
• Detailed mapping of resources and services
need to be developed.
• In planning and implementation of program a
right based and integrated approach needs to be
developed.
• Meaningful action and capacity building would
be required at all levels.
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 HEALTH EXPENDITURE
SITUATION AT PRESENT
• Almost 100% is out-of pocket
• Includes formal and informal private sector
• Questionable quality of care
• Considerable expenditures on unnecessary and
inappropriate (sometimes unsafe) care
• Inequity in financing of care
• No regulation or standards on fee charged
• Reliable information not available

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 ADVANTAGES OF DEVOLVED
SYSTEM IN HEALTH CARE
• Administrative and financial powers to district
authorities / local bodies representative.
• Involvement in devising the programs relevant
to the local needs and priorities.
• Strategies and plans acceptable for the
community and matching to their socio cultural
and socio economic background.

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• User willingness to pay for PHC in the public
sector services, if they receive improved care.
• The districts can recover substantial costs and
can retain the incomes.
• Creating sense of ownership.
• Strengthening of FLCF, answering many
primary health problems like high IMR, high
MMR and morbidity and male involvement.

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 CRITERIA FOR ALLOCATING
DISTRICT BUDGETS
• Population Size
• Socio-economic Development
• Health Infrastructure
• Health Needs / Problems (BOD Estimation)
• Performance Evaluation based on
predetermined indicators
• Combination of Above

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 CHALLENGES AND
CONSTRAINTS
• Political willingness of provincial and district
governments to work in the new system.
• Defining their administrative roles with limits
and jurisdiction.
• Distribution of financial powers between
Provincial and District representatives.

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• Financial and administrative capacity of the
district government.
• Resentment against the status quo at the
provincial level and fear of loosing authority.
• Lack of trust and losing the profit.
• Status of Public Service Commission, Medical
colleges and Tertiary hospitals.

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THE INTERNATIONAL
DEVELOPMENT TARGETS
1. A reduction by one half in the proportion of
people living in extreme poverty by 2015
2. Demonstrated progress towards gender
equality and the empowerment of women by
elimination gender disparity in primary and
secondary education by 2005
3. A reduction by two-thirds in the mortality
rates for infants and children under age 5 and
reduction by three-fourths in maternal
mortality - all by 2015
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 References:

 Allender, J. A., &Spradley, B. W. (2010). Community Health

Nursing: Promoting and Protecting the Public's Health (7th ed.).
Philadelphia: Lippincott Williams &Wilkins.
 Anderson, E. T., & McFarlane, J. M.(2008). Community as partner:
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Williams &Wilkins.
 Basavanthappa, B. T. (2008). Essentials of Community Health Nursing
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 Clark, M. J. D. (1999). Community Health Nursing Handbook Value Pack.
Stamford: Prentice Hall.
 Hitchcock, J. E., Schubert, P. E., & Thomas, S. A. (2003). Community
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Thomson/Delmar Learning.
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 Hunt, R. (2001). Introduction to Community-Based
Nursing(2nd ed.). Philadelphia: Lippincott Williams &
Wilkins.
 Naidu, K. M. (2010). Community Health Nursing. India:
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