Community Health Nursing-I

Unit III: “Pakistan Health

Care System”
GBSN Year.1 , Semester.2
By Mr Asif Ali Lashari
RN, DP, PostRN BScN
Nursing Lecturer
Unit III: Pakistan Health Care System

In this unit, students will be introduced to:

• Health Services / Organizations available in
Pakistan.
• In addition students discuss health services
available within the Government / Private Health
Care System.
• Furthermore, they will explore the roles of the
health team members within the system.
 Unit III: Pakistan Health Care System
Unit objectives:
• At the completion of this unit, students will be able
to:
1. Define the terms, system, and health care system.
2. Identify the health services available to community
by Pakistan Government Health Care System.
3. Explain the roles of health care team members
within the health care system.
4. Discuss the Devolution Plan of 2000.
Unit III: Pakistan Health Care System

DEFINITIONS OF TERMS:
SYSTEM:
• A system is a group of interacting or interrelated
elements that act according to a set of rules to
form a unified whole.
• A system, surrounded and influenced by its
environment, is described by its boundaries,
structure and purpose and expressed in its
functioning. Systems are the subjects of study of
systems theory.
DEFINITIONS OF TERMS
SYSTEM:
• A set of principles or procedures according to
which something is done; an organized scheme
or method.
DEFINITIONS OF TERMS
HEALTH CARE SYSTEM:
• It implies the organization of the people,
institution and resources to deliver health care
services to meet the health needs of target
population.
Health Care System / health services by
Pakistan Government
PAKISTAN HEALTH SERVICE DELIVERY:
Introduction:
• The health care delivery system in Pakistan consists
of public and private sectors. Under the
constitution, health is primarily responsibility of the
provincial government, except in the federally
administrated areas.
• Health care delivery has traditionally been jointly
administered by the federal and provincial
governments with districts mainly responsible for
implementation.
Health Care System / health services by
Pakistan Government
• Service delivery is being organized through
preventive, promotive, curative and rehabilitative
services.
• The curative and rehabilitative services are being
provided mainly at the secondary and tertiary care
facilities.
• Preventive and promotive services, on the other
hand, are mainly provided through various national
programs; and community health workers’
interfacing with the communities through primary
healthcare facilities and outreach activities.
Health Care System / health services
by Pakistan Government
• Some government / semi government
organizations like the armed forces, parastatals
such as Sui Gas, WAPDA, Railways, Fauji
Foundation and the Employees Social Security
Institution provide health service to their
employees and their dependents through their
own system, however, these collectively cover
about 10% of the population.
Health Care System / health services by
Pakistan Government
1- Public sector:
• Public sector health care system endeavors to deliver healthcare
through a three level healthcare delivery system and a range of
public health interventions.
First level includes:
• Basic Health Units (BHUs) and Rural Health Centers (RHCs)
founding the fundamental of the primary healthcare model.
Secondary care encompassed:
• first and second referral facilities providing acute, ambulatory and
inpatient care through Tehsil Headquarter Hospitals (THQs) and
District Headquarter Hospitals (DHQs).
Tertiary care including:
• Teaching hospitals.
Health Care System / health services by
Pakistan Government
• The public health activities have persistently
increased in terms of physical infrastructure and
workforce.
• The national health infrastructure comprises of 1201
hospitals, 5518 Basic Health Units, 683 Rural Health
Centers, 5802 Dispensaries, 731 Maternity & Child
Health Centers and 347 TB centers, and the total
availability of beds in these health facilities is
estimated at 123394.
Health Care System / health services by
Pakistan Government
• In addition more than 95000 Lady Health Workers
are providing primary health care services to the
community through the health houses.
• Despite an elaborate and extensive health
infrastructure, the health care delivery suffer from
some key issues like the high population growth,
uneven distribution of health professionals, deficient
workforce, insufficient funding and limited access to
quality health care services.
Health Care System / health services by
Pakistan Government
2. Private sector:
• The rising population pressure on state health
institutions has allowed the private sector to bridge
the gap of rising demand and limited public health
facilities.
• A number of private hospitals, clinics and diagnostic
labs has increased considerably and is contributing
health services in the country. Majority of private
sector hospitals has sole proprietorship or a
partnership model of organization. Stand-alone clinics
across Pakistan are the major providers ofout-patient
care majority of these clinics falls in the sole
proprietorship category.
Health Care System / health services by
Pakistan Government
• The state provides healthcare through a three-tiered /
three levels healthcare delivery system and a range of
public health interventions.
Health Care System / health services by
Pakistan Government
Three level healthcare delivery system:
1- Primary Health Care (PHC) Services:-
I- Basic Health Unit (BHU):
• It is the first level of health care, (PHC) considered to be
necessary to maintain adequate health and protection
from disease, for example Immunization, health
education, family planning and treating minor illness.
• Typically, each Union Council has a BHU which has 2
beds and serves a catchment population of about
10,000 to 25,000.
• Staffing: Medical Officer, Dispenser, Vaccinator, LHV etc.
Health Care System / health services by
Pakistan Government
II- Rural Health Centre/Clinic (RHC):
• (RHC) program is intended to increase access
to primary care services for Medicaid and
Medicare patients in rural communities, for
example primary health care (PHC) promotes
health, immunization, health education,
family planning and treating common/minor
illness. RHCs can be public or nonprofit
healthcare facilities, however, they must be
located in rural, underserved areas.
Health Care System / health services by
Pakistan Government

• Have 10 to 25beds and serves a catchment

population of about 40 to 60 thousands.
• Staffing: M/S, Medical Officer, Staff Nurse,
Dispenser, Lab: Technician, X-ray Technician
Vaccinator, LHV etc.
Health Care System / health services by
Pakistan Government
III- Some other examples of (PHC) services:-
• Urban Health Centers, Mother & Child Health Centre
(MCH Centers), Dispensary etc.
Health Care System / health services by Pakistan Government

2. Secondary Health Care (SHC) Services:-

I. Taluka Headquarter Hospital (THQ):
• A hospital that serves for area of land with a city or
town with possible additional towns, and usually a
number of villages. Provides curative services, as
Gynecology, Ophthalmology, Pediatrics, ENT,
Gastroenterology, General medicine etc.
Health Care System / health services by
Pakistan Government

• Have 25 to 50 beds and serves a catchment

population of about 100,000 or more.
Staffing: M/S, Medical Officer, Staff Nurse,
Dispenser, Lab: Technicien, OT technician, X-ray
Technician, Vaccinator, LHV, Ward servants, Driver
etc.
Health Care System / health services by
Pakistan Government
II- District Headquarter Hospital (DHQ):-
• The major health care facility in its region, with large
number of beds for patients who need long-term
care.
• Provides intensive care, curative services, as
Gynecology, Ophthalmology, Pediatrics, ENT,
Gastroenterology, General medicine, General
Surgery etc.
Health Care System / health services by
Pakistan Government
• The DHQ hospital provides promotive, preventive,
curative, advance diagnostics, inpatient services,
advance specialist, rehabilitation and referral
services.
• Have above 100 beds and serves a catchment
population of 1 to 3 million.
• Staffing: M/S, DMS, AMS, Specialist / Consultant,
Medical Officer, Staff Nurse, Dispenser, Lab:
Technician, O T technician, X-ray Technician,
Vaccinator, LHV, Ward servants, Driver etc.
Health Care System / health services by
Pakistan Government
3. Tertiary Health Care (THC) Services:-
I. Provincial Hospital (Teaching Hospital) :-
• Provincial Hospital is the biggest in province level run
by provincial government and provides tertiary care
services.
• Some hospitals are affiliated with a university,
college, medical school, or nursing school and offer
health care to patients while teaching medical
students, physicians, surgeons, and nurses.
• Teaching hospitals are unique in that they employ
physician residents who are in training.
Health Care System / health services by
Pakistan Government
• Provides special/intensive care, curative services, as
Gynecology, Neurology, Oncology, Orthopedics,
Ophthalmology, Pediatrics, ENT, Gastroenterology,
General medicine, General Surgery, Rehabilitation
services etc.
• Some examples of provincial hospitals in Sindh: Civil
Hospital, Jinnah Hospital, Dow Medical University etc.
• Staffing: Chancellor, VC, Professor, Assistant
professor, senior registrar, M/S, DMS, AMS,
Specialist/Consultant, Medical Officer, Staff Nurse,
Dispenser, Lab: Technician, OT technician, X-ray
Technician, Vaccinator, LHV, Ward servants, Driver
etc.
Health Care System / health services by Pakistan
Government
II- Federal Hospital (Teaching Hospital):-
• Medical facilities run by the federal government.
• Some examples of federal hospitals in Sindh: JPMC,
NICH, NICVD etc.
III- Specialized Health Facilities / Hospitals:-
• Example: Mental health (Sir Cowasjee Jehangir
Institute of Psychiatry), Rehabilitation centers, Skin
Diseases Hospitals, Dental, Eye Hospitals,
Kidney/Dialysis centers etc.
Roles Of Health Care Team
Definition of Health Care Team:
• The health care team consists of a group of people
who coordinate their particular skills in order to
assist a patient or his family.
Roles Of Health Care Team
Roles Of Health Care Team
HEALTH CARE TEAM MEMBERS:-
(Possible major members enlisted, some others may
be included according to job need and description)
• 1. Doctors, Medical officer, Women medical officer.
• 2. Physician Assistants.
• 3. Nurses, Community health nurse.
• 4. Pharmacists.
• 5. Dentists.
• 6. Technologists and technicians, Medical
technologist, Health technician, X-ray technician.
Roles Of Health Care Team
• 7. Therapists and rehabilitation specialists,
Physiotherapist.
• 8. Psychologist, Psychiatrist.
• 9. Emotional, social, religious and spiritual support
providers.
• 10. Administrative and support staff, Clerical staff,
Drivers, Housekeeping staff.
• 11. Community health workers and patient
navigators.
Health Care Team Levels
A FOUR-LEVEL MODEL OF THE HEALTH
CARE SYSTEM:
• In this model, adapted from Ferlie and Shortell
(2001), the health care system is divided into four
“nested” levels:
(1) Individual patient.
(2) The care team.
• This includes professional care providers (e.g.,
clinicians, Nurses, pharmacists, and others), the
patient, and family members.
Health Care Team Levels
(3) The organization.
• (e.g. hospital, clinic, nursing home, etc.) that
supports the development and work of care teams
by providing infrastructure and complementary
resources.
(4) The political and economic environment.
• (e.g., regulatory, financial, payment regimes, and
markets), the conditions under which organizations,
care teams, individual patients, and individual care
providers operate (see Figure).
Health Care Team Levels
 The Devolution Plan of 2000
Definition:
• Devolution is the statutory delegation of powers
from the central government of a sovereign state to
govern at a sub-national level, such as a regional or
local level. It is a form of administrative
decentralization.
The Devolution Plan of 2000
• An initiative that began in 2001 with the passage
of the Local Governance Ordinance. under the
Devolution Plan of the Government of Pakistan
in 2000,19 the districts have been given
comprehensive administrative as well as financial
autonomy in almost all sectors, including health.
• The districts are now responsible for developing
their own strategies, programs and interventions
based on their locally generated data and needs
identified. Following the principles of Alma-Ata,
the public health care system is primary care
focused.
The Devolution Plan of 2000
• At the community level, the Lady Health Worker
(LHW) program of the Ministry of Health, and
the Village Based Family Planning Worker
(VBFPW) program of Ministry of Population
Welfare of Government of Pakistan have been
established.
• These programs gained an international
reputation due to their grass root coverage
plans.
Community Health Nursing
B. T. Basavanthappa
First Edition 1998
https://www.who.int/teams/social-determinants-of-health/declaration-of-alma-ata
http://www.emro.who.int/pak/programmes/primary-a-secoundary-health-
care.html
http://www.emro.who.int/pak/programmes/service-delivery.html