National Health Policy 2009 Pakistan

8/12/2019 National Health Policy 2009 Pakistan

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ZERO DRAFT 19 Feb 2009

National Health Policy2009

Stepping Towards Better Health

March 2009

Ministry of Health

Government of Pakistan


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orward !y the Minister of Health

ii


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"!!reviations

AI Avian InfluenzaAIDS Acquired Immune Deficiency SyndromeBHU Basic Health Unit

BISP Benazir Income Support ProgrammeBoD Burden of DiseaseCCB Community Citizen Board

C! Community id"ifeCP# Contraceptive Prevalence #ate

DA$%s Disa&ility Ad'usted $ife %earsDHDC District Health Development Center

DHIS District Health Information SystemDH( District Head (uarter D)H Department of HealthD)*s Directly )&served *reatment + short course

,m)-C ,mergency )&stetric and -eonatal Care,PI ,.panded Programme on Immunizations

,SDP ,ssential Service Delivery Pac/age0A*A 0ederally Administered *ri&al Areas

0BS 0ederal Bureau of Statistics0$C0 0irst $evel Care 0acility

0P 0amily Planning1DP 1ross Domestic ProductHI2 Human Immunodeficiency 2irus

HIS Health anagement Information System

H# Human #esourceIDUs In'ecting Drug UsersI-CI Integrated anagement of -e"&orn and Childhood Illness

I# Infant ortality #atioI*-s Impregnated *reated -ets

$B $ive Births$H2 $ady Health 2isitor $H! $ady Health !or/er 3, onitoring and ,valuationCH aternal and Child Health

D1s illennium Development 1oals

# aternal ortality #atio-CH aternal4 -e"&orn and Child Health)H inistry of Health*B0 edium *erm Budgetary 0rame"or/*D0 edium *erm Development 0rame"or/-CD -on5Communica&le Diseases-1) -on 1overnmental )rganization

-!0P -orth !est 0rontier Province))P )ut of Poc/etPHC Primary Health Care

PHDC Provincial Health Development Center

PDC Pa/istan edical and Dental CouncilP#C Pa/istan edical and #esearch Council

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P-C Pa/istan -ursing CouncilPPP Pu&lic Private Partnership

PP#A Pu&lic Procurement #egulatory AuthorityP#SP Poverty #eduction Strategy Paper

PS$ Pa/istan Social and $iving Standard easurement Survey

#HC #ural Health CentreSA#S Severe Acute #espiratory Infection

SBA S/illed Birth AttendanceS*I Se.ually *ransmitted Infections*B *u&erculosis

*H, *otal Health ,.penditure 6&oth pu&lic and private7*H( *ehsil Head (uarter

U8# Under five ortality #ateU- United -ations

!H) !orld Health )rganization!*) !orld *rade )rganization

iv


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#ontents

$% &eed for a &ew Health Policy

2% The State of Pakistan's Healtha% Health System Performance

!% Health Sector inancing

c% Health Sector Management and Governance

d% Monitoring( eval)ation and s)rveillance systems

*% "ssessment of progress of implementation of Health policy 200$

+% S)mmary of ,ey #hallenges in the Health Sector

-% )t)re .irection / Stepping Towards Better Healtha% Principles!% ision

c% Goal

d% Policy 1!ectives

e% Strategic Priorities

3% 4es)lts and indicators of s)ccess

5% Translating policy into action

6% "nne7)re

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vi

Vision

A health system that:

is efficient, equitable & effective

to ensure acceptable, accessible & affordable health services.

It will support people and communitiesto improve their health status

while it will focus on addressing social inequities

and inequities in health

and is fair, responsive and pro-poor,

thereby contributing to poverty reduction.

By considering 2006-07 as the benchmark year for the National Health Policy 2009, thegoernment of Pakistan, by 20!", is committed to#

ave additional !"",""" lives of children#

ave additional $%,""" lives of mothers#

&radicate polio#

&liminate measles and tetanus#

'revent additional ( million children from becoming malnourished#

'rovide s)illed birth attendance to more than %.* million pregnant women#

&nsure provision of family planning services to additional ( million couples.

Avert +* million of new - cases#

Immunie more than $$ million children against /epatitis - and other vaccine

preventable diseases# and

0each %" million poorest people of 'a)istan to ensure provision of essential

pac)age of service delivery.


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Draft National Health Policy 2009

Pakistan's &ational Health Policy82009Stepping Towards Better Health

% &eed for a &ew Health Policy

9: The &ational Health Policy 2009:;Stepping Towards Better Health;outlines a

shared resolve to ensure progress to"ards a healthy Pa/istan in "hich all citizens &enefit froma &etter "or/ing health care delivery system4 particularly the poorest: *he Policy &uilds uponthe -ational Health Policy a7 slo" progress inimproving health outcomes? &7 inadequate sector performance in improving coverage andaccess to essential health care services especially for the poor? and? c7 lac/ of synchronizationof various policy documents and their lin/ages "ith illennium Development 1oals6D1s7: *he inistry of Health initiated the process to develop a ne" health policy in


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maternal mortality 6deaths7 com&ined "ith high fertility results in one out of every GE "omendying from pregnancy related causes: alnutrition remains "idespread and unaddressed: Inaddition4 persisting &urden of infectious diseases is no" compounded &y increasing &urden ofnon5communica&le diseases:

8: Pa/istans population gro"th rate has declined from F in the late 9EG=s to thepresent estimated level of 9:EF per annum4 &ut it remains unaccepta&ly high: In


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among provinces and districts4 highlighting the need to rapidly e.pand the use of s/illed &irthattendants and deliveries in health facilities:

G: Pa/istan is having the largest ever cohort of the youth population: *he ongoingdemographic transition A summary measures that com&ine information on mortality and non5fatal health outcomes to represent the health of aparticular population as a single num&er:


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99: Pa/istan is still one of the four remaining countries4 "here polio is endemic and 99Gcases have &een reported in


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&een increased in rural areas "ith more than 88= rural health centers and 84== &asichealth units &esides 4@== dispensaries and E== aternal and Child Health 6CH7 centersin ur&an areas: *he information on private sector remains inadequate &ut a rough estimateis that there a&out


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motivated and inadequately compensated staff4 lac/ of adequate supportive supervision4 lac/of evidence &ased planning and decision ma/ing4 lo" levels of pu&lic sector e.penditures andits inequita&le distri&ution: In addition to factors internal to the sector4 e.ternal factors alsocontri&ute to poor health outcome including illiteracy4 unemployment4 gender inequality4social e.clusion4 food insecurity4 ur&anization4 environmental dangers4 lac/ of access to safedrin/ing "ater and inadequate sanitation:

Health #are inancing

9: Pa/istan continues to spend less on health than most other countries at the same levelof 1ross domestic product 61DP7: )ver the last 98 years pu&lic health e.penditures haveincreased &y 8=F in nominal terms4 ho"ever ta/ing into account population increase andinflation4 the real e.penditures as percentage of1DP have stagnated at =:@F: During last fiveyears 6&et"een


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"here government is more or less the sole provider4 &esides the provision of medico5legalservices:


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legal frame"or/ for disease reporting and lac/ s/illed manpo"er and resources for thisimportant function: In addition4 no pu&lic health la&oratory net"or/ e.ists e.cept a Pu&licHealth Division $a&oratory in -ational Institute of Health: *he inistry of Health iscognizant of the situation and undertoo/ a detail assessment: A detailed frame"or/ has &eendeveloped &ut not put in place: Some aspects of the plan are &eing implemented e:g: Atraining programme through 0ul&right fello"ships for researchers4 and communica&lediseases control has &een started to produce s/illed manpo"er for surveillance: *his "ouldentail development of a comprehensive system and &uild organizational capacity at federal4

provincial and district levels for its effective functioning:

Pharmace)ticals Sector


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is also need of rational use of drugs at the service delivery level "hich can only &e ensuredthrough a mechanism of supervision4 availa&ility of treatment protocols and appropriatetraining: *he procurement of drugs at federal level is &eing no" underta/en according to thePa/istan Procurement #egulatory Act 6PP#A7: *he procurement process and testing of drugquality is functional &ut the system needs to &e strengthened in terms of its effectiveness andtimeliness: In addition4 the process of procurement at all levels has limited internal controlsand monitoring mechanism to ensure value for money &eing spent:

Medical curricula for the health manpo"er do not match local healthneeds? ,ducational institutions are ill equipped to provide quality education using o&soletetraditional instructional methods and curricular formats resulting manpo"er not competentenough to function effectively in primary and secondary levels of health care settings: *hereis inadequate emphasis on use of information technology4 in communication methods4medical ethics4 or the &io5psycho5social model of health: #e5orientation of medical educationand curricula to address the a&ove challenges &esides focusing on pu&lic health4 preventionand promotion of health:

: *he mechanism for induction courses for different cadres in the health sector is notin place "ith very fe" such activities carried out &y isolated pro'ects: *he in5service trainingmechanism through Provincial Health Development Centers 6PHDC7 and District HealthDevelopment Centers 6DHDCs7 introduced during 9EE=s is partially functional: Similarlythere is no formal policy4 national standards or guidelines for structured implementation toupdate /no"ledge and s/ills of health care providers4 including programmes for continuingmedical education and systems of re5accreditation of doctors4 nurses and paramedics: )thercritical areas in "hich there is shortage of s/illed health "or/force include hospitalmanagement and management of health systems: Achieving the D1s "ill depend onfinding effective human approaches that can &e implemented rapidly: Systematic thin/ing inseveral areas is required to formulate "ays of recruiting and retaining health "or/ers "ith

opportunities for career development:

% Progress of mplementation of Health Policy 200$

: #evie" of the


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utilization has not changed much: Critical issues related "ith the health policy


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% S)mmary of ,ey #hallenges in the Health Sector:

@: In summary4 key challengesin the health sector are>

i: a/ing progress in current health sector programmatic reforms to achieve D1s and

tac/ling effectively ne"ly emerging and re5emerging health issues including non5communica&le diseases and disasters

ii: Improving access of essential and cost effective health services especially for the poorand vulnera&le

iii: ,mphasizing more on quality of care and services at all levels

iv: Protecting poor from catastrophic health e.penditures

v: Improving the institutional arrangements and management of health care deliverysystem

vi: Improving the availa&ility 6specially female7 and motivation of health "or/force

vii: Aligning outputs of the academic institutes in line "ith the needs of health system andimproving the quality of education and training:

viii:,ffectively engaging private health sector and civil society organizations to improvehealth outcomes

i.: Developing pharmaceutical sector and ensuring access to quality medicines

.: a/ing health system more responsive and accounta&le

.i: ,nsuring effective research4 monitoring 3 surveillance system to measure results andevidence &ased decision ma/ing at all levels

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% )t)re .irection / Stepping Towards Better Health

: Principles:Health is an essential prerequisite "ithout "hich individuals4 families4communities and nation cannot hope to achieve their social and economic goals: *he ne"

policy paradigm is &ased on health as a right as envisioned in the Constitution of Pa/istan and"ill &e driven &y the follo"ing /ey principles>

i: ,nsuring universal coverage of an essential pac/age of health interventions "ithouteconomic4 geographical4 social or cultural &arriers and is responsi&ility of the state?

ii: )vercoming social and economic inequities to improve health outcomes?

iii: Promotion of a results &ased culture ensuring a shift from a planning environmentconcentrated on the reporting of processes and outputs to outcomes?

iv: Provision of quality health care and ensuring gender sensitive and patient5centeredservices?

v: ,nsuring good governance4 promotion of meritocracy and transparency in everyaspect of health care management? and

vi: Promoting evidence &ased decision ma/ing "hich must prevail at every level of thehealth system so that policy development and actions deriving from policies arerelevant4 feasi&le4 resource appropriate and culturally and socially accepta&le:

G: *he principles are envisaged to &e applied to all aspects of health care and "ill &esupported &y emphasis on local 6district7 o"nership and leadership4 strategic coordination4

&uilding local capacity4 and e.panding partnership "ith private sector:

E: ision: *he Policy envisages a long term vision to reorient the health systemendorsing the concept of health for all strategy al&eit 5 a health system that: is efficient,equitable & effective to ensure acceptable, accessible & affordable health services. It will

support people and communities to improve their health status while it will focus on

addressing social inequities and inequities in health and is fair, responsive and pro-poor,

thereby contributing to poverty reduction.

=: Goal> *he overall goal of the policy is to improve health status of the people ofPakistan:

9: Policy 1!ectives:

-ational Health policy aims to improve health status of people of Pa/istan &y achieving thepolicy o&'ectives mentioned &elo" and it is envisaged that it "ill also help Pa/istan to ma/eprogress to"ards health related D1s:

i: ,nhancing coverage and access of essential health services especially for the poor?

ii: easura&le reduction in the &urden of diseases especially among vulnera&le segmentsof population?

iii: Protecting to the poor and under privileged population su&groups against catastrophichealth e.penditures and ris/ factors?

iv: Strengthening health system "ith focus on resources?

v: Strengthening ste"ardship functions in the sector to ensure service provision4equita&le financing and promoting accounta&ility?

vi: Improving evidence &ased policy ma/ing and strategic planning in the health sector:

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% Strategic priorities


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health services especially for the poor living in ur&an slums and e.ploring the optionof pu&lic private partnership:

G7 Productive community involvement at the health facility level "ill &e strengthened toimprove responsiveness:

E7 A comprehensive referral system &oth for emergencies and normal health careinvolving all levels of health care "ill &e developed and implemented:

$%B: Primary and Preventive Health #are Programmes:

1) ,ssential health services through the -ational ,.panded Programme onImmunizations 6,PI74 the $ady Health !or/ers 6$H!s7 Programme and the -ationalaternal4 -e"&orn and Child Health 6-CH7 Programme "ill &e e.panded "ithma.imizing synergies &et"een these interlin/ed programmes and further reinforcinglin/ages "ith the -utrition programme:

2) *he health sector "ill specially focus on provision of 0amily planning 60P7 services

through the healthcare net"or/ and community &ased lady health "or/ers &y> 6i7ensuring financing and provision of at least three modern contraceptive methods ands/illed manpo"er in all health outlets of Departments of Health 6DoHs7? 6ii7strengthening the provision of 0P services and products through the $H!s at thedoorstep of community4 and 6iii7 0ostering greater functional integration &et"een thet"o vertical institutional entities4 6Health and Population !elfare7 in order toma.imize synergies at the service delivery levels: *he main constraint to &e addressedthrough a&ove measures "ill &e to ensure commodity security and availa&ility ofcontraceptives in each and every health outlet:

3) In relation to maternal health4 inistry and Departments of Health "ill ensuretraining and deployment of the ne" cadre of community mid"ives through -ational-CH Programme and strengthening of round the cloc/ comprehensive and &asic,mergency )&stetrical and -eonatal Care 6,m)-C7 services:

4) Pa/istanNs nutrition outcomes have &een relatively stagnant over the last t"o decades:*he current glo&al increase in food prices4 "hich is affecting Pa/istan as "ell4 isli/ely to compromise these outcomes further: *he inistry and Departments ofHealth "ill develop a practical programme "ith an o&'ective of improving thenutrition status of "omen of child&earing age and children &elo" years &yimproving the coverage of cost effective nutrition interventions:

5) *o address the persistence challenge of child mortality at facility and communitylevel4 the -ational -CH and $ady Health !or/ers 6$H!7 Programmes "illimplement standard protocols for management of common childhood illnesses at

facility and community level respectively:6) Demand side interventions (cash transfer, vouchers scheme etc) will

be pilot tested (especially for delivery services and ! treatment)before lar"e scale replication of such interventions#

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Policy 1!ective 2: easura&le reduction in the &urden of diseases especially amongvulnera&le segments of population

: Pa/istan &ears a dou&le &urden of diseases? although the &urden of communica&lediseases4 childhood illnesses4 reproductive health pro&lems and malnutrition is high andremains to &e tac/ed4 non5communica&le diseases 6-CDs7 are fast emerging as the ma'orcontri&utors of death and disa&ility: *he ma'or &runt of all these diseases are &orne &y the

poor O communica&le diseases and malnutrition are commoner amongst the poor and thevulnera&le "hereas -CDs affect the economically productive "or/force4 lead to incomelosses4 lost productivity and are /no"n to &e the ma'or contri&utors to health shoc/s: *hefocus of the health policy "ill therefore &e to address all these disease dimensions throughfollo"ing policy actions>

Policy "ctions:

1) ,.panded Programme on Immunization 6,PI7 "ill respond to the system levelchallenges &y focusing on lo" performing areas4 attempting to reduce dropouts and

improving monitoring and supervision systems: $ady health "or/ers "ill &e involvedto deliver routine immunization services in their catchments areas: *he feasi&ility ofintroducing ne" cost effective vaccines "ill also &e e.plored:

2) Polio eradication "ill remain the priority of the government and efforts "ill &e madeto interrupt its transmission &y


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private and $) o address the "rowin" burden and spread of 7epatitis ! 9 , whichare mainly transmitted throu"h se- and blood, the $ational'ro"ramme for 7epatitis ontrol will review its strate"ic plan tofocus on primary prevention throu"h e-pandin" immuni?ation for

7epatitis ! in children, vaccination of hi"h@ris0 "roups, ensurin"provision of safe blood# ertiary hospitals will establish screenin"and dia"nostic centres and treatment facilities#

A) %hile discoura"in" irrational use of in;ections "ivin" practices, theuse of auto destructible syrin"es will be promoted in all healthfacilities, hospitals and pro"rammes in a phased manner with banon the use of routine syrin"es#

1B) he "overnment will develop and implement an nte"ratedDisease :urveillance :ystem by establishin" operationalsurveillance units at all levels with s0illed sta and bac0up networ0sof laboratories, ensurin" 'a0istan full the re+uirements in line with

international health re"ulations# s the system develops, e-istin"disease specic surveillance activities will be inte"rated alon" withoptions to include 7 surveillance and $D behaviours#

11) he scope of public health interventions will be broadened toaddress diseases that have remained ne"lected to date, but whichparado-ically are the leadin" causes of death and disability# $on@communicable diseases, which include in;uries, diseases of theheart, diabetes, cancers and chronic lun" conditions, aect theeconomically productive wor0force, result in income loss and lostproductivity# $D control strate"ies will be implemented focusin" onprimary prevention and reducin" ris0y behaviours includin"

smo0in", life styles and dietary habits#

12) Cmer"ency response system will be e-panded coverin" alllar"e cities in the initial phase# ll 7 and D7 hospitals wille-pand services to deal with emer"ency and trauma cases# edicalemer"ency technician trainin" pro"ramme will be launched#

9@


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Policy 1!ective *: Protecting the poor and under privileged population su&groups againstcatastrophic health e.penditures and ris/ factors

8: !hether it is glo&al financial crises or increased health e.penditures at householdlevel4 the impact on the poor and near poor is very serious4 as ris/ management options arelimited> the poor may need to sell productive assets4 nutritional standards are li/ely to fall andthe a&ility to spend on private healthcare "ill fall: n that situation morbidity andmortality rates rose# In countries li/e Pa/istan4 "hen the overall economy comes under

pressure4 a common feature is that spending on private healthcare falls as people see/ to shiftto pu&lic care: *he demand for pu&lic healthcare rises significantly at precisely the time thatgovernments feel the financial need to cut &ac/: In such situations it is the poor "ho arealmost al"ays squeezed out: *herefore4 to protect the poor from catastrophic healthe.penditures and ris/s4 the government "ill ta/e follo"ing policy actions>

Policy "ctions:

1) *he government "ill "or/ on the concept of a -ational Health Service: *hrough this4

the government "ill ensure the poorest people to access health services and moree.plicitly access to a doctor: *he scheme envisages using the data&ase of BenazirIncome Support Programme 6BISP7 and registering the poorest families at the level ofthe union council or su& district level and issuing a health card "ith &asic healthcharacteristics? the card "ill also entitle citizens to services 6not provided &y the state7through private providers: *he provider "ill refer cases of critical illness to districtlevel hospitals 6or "hatever higher tier that is required7: *he design4 modalities andstrategies "ill &e pilot5tested &efore nation"ide e.pansion:

2) *here "ill &e no user charges at primary level pu&lic health facilities: 0urtheremergencies services 6including medicines7 and delivery services in all pu&lichospitals "ill &e free of cost: #espective governments "ill determine user charges

only in referral hospitals to avoid unnecessary load of patients see/ing primary healthcare: Ho"ever4 those patients referred from primary health care facilities "ill &ee.empted of such user charges: )ther social protection initiatives 6Baat5ul5mal4 a/atetc7 "ill &e made availa&le for the poor:

3) *he government "ill provide free specialized care 6dialysis services4 eye surgery4treatment of heart diseases and other long term illness and disa&ilities7 to the poorest

people "ho are registered "ith BISP:

4) Cash transfer and vouchers schemes "ill &e tested &efore large scale replication toprotect poor from catastrophic e.penditures

5) Access to essential drugs "ill &e ensured in all pu&lic health facilities and hospitals:

Pharmacy &an/s for the poor "ill &e tested in selected hospitals: 0ree medicines forthe treatment of *B4 AIDS and alaria "ill &e made availa&le:

6) o avoid health ris0s and promote better health, inistry andDepartments of health will develop comprehensive inte"ratedbehaviour chan"e communication strate"y, which will focus on theneeds of the poor and vulnerable#

=) 7ealth insurance models will be piloted to create a mar0et whichmay later on be e-panded to the poorest se"ments with"overnment ?a0at sharin"#

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Policy 1!ective +: Strengthening health system "ith focus on #esources

@: In health sector4 access to health care provider and access to medicine are the t"oma'or demands of the people: Health systems ste"ardship functions on human resources andmedical products 6including medicines7 "ill &e a priority through follo"ing policy actions:

Policy "ctions:

+%": Health =orkforce

97 *he government "ill develop a comprehensive health "or/force policy &y


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+%B: Pharmace)ticals and Medical prod)cts

97 inistry of Health "ill announce a ne" prop5poor -ational Drugs Policy:


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9


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Policy 1!ective -: Strengthening ste"ardship functions in the sector to ensure serviceprovision4 equita&le financing and promoting accounta&ility

: Strengthening of health systems performance depends upon three vital functions4 i:e:service provision4 financing and promoting accounta&ility: Health System "ill &estrengthened through follo"ing policy actions>

Policy "ctions:

-%": Service provision !y p)!lic and private sector

97 inistry and Departments of Health "ill e.plore the option of esta&lishing Healthservices accreditation authority mechanism to ensure implementation and monitoringof essential service delivery pac/ages4 developing policy and legislation on pu&lic

private partnerships 6PPP74 regulating partnerships and addressing patient safetyissues:


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disaster relief eorts# inistry and Departments of 7ealth will ta0ethe initiative to build capacity of the health sector for disastermana"ement, devisin" an institutional arran"ement andimplementin" disaster mana"ement protocols* and plan at national,provincial and district levels for an eective emer"ency response#

-%B: inancing

97 *he government "ill remove all types of user fees for services at primary health carefacilities and community level4 "ith safety nets for the poor see/ing care at referralhospitals:


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Policy 1!ective 3: Improving evidence &ased policy ma/ing and strategic planning in thehealth sector:

G: Pu&lic health sectors decision5ma/ing cycle comprises of policy analysis4 goal andtarget setting4 resource allocation4 "or/ planning4 operational implementation and

performance assessment: *he overall purpose of the monitoring and evaluation system "ill &eto provide continuous information and management support to decision5ma/ing processes ateach decision5ma/ing levels of the health system:

Policy "ctions:

97 -ational Health Information System "ill &e reformed: It "ill &ase on a strategicframe"or/ and "ill consist of four pillars> i7 anagement Information Systems? ii7Surveillance System? iii7 Health Household Surveys? and iv7 #esearch:


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% 4es)lts and indicators of s)ccess

E: *he /ey performance indicators to measure implementation progress against /eypolicy o&'ectives are summarized in Anne.ure I: *he inistry of Health "ill "or/ closely"ith the Provincial Departments of Health and 0ederal Bureau of Statistic 60BS7 to ensurecollection of the data to tract trends and to disaggregate information &y gender and incomequintiles: inistry and Departments of Health "ill regularly monitor progress on "hat is

&eing achieved at different levels4 using clearly defined and measura&le output indicators foreach heath sector pro'ect:

8=: -ational Health Systems and Policy Unit esta&lished under the inistry of Healthand Health Sector #eform and onitoring 3 ,valuation units "ill &e esta&lishedstrengthened to serve the strategic function of generating evidence4 measuring results4dissemination and guiding the policy: *hese units "ill &e responsi&le to monitor progress onresults and report against indicators &y underta/ing regular health sector performanceassessments &y provinces and districts "hich "ill &e disseminated through oHs D)Hs"e&site and via media: *hese assessments "ould &ecome the &asis for federal and provincial

dialogue and setting resource priority especially focusing on those districts "hich areperforming lo" in district ran/ing:


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% Translating policy into action:

97 Pu&lic sector e.penditure on health "ill &e increased in line "ith 0iscal

#esponsi&ility Act


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"nne7)re 8

Health Sector Indicators 6Baseline4 Benchmar/s and *argets7 for -ational Health Policy sndicators

Baseline

2003805

Benchmarks and Targets

20098$0 20$08$$ 20$$8$2 20$28$* 20$*8$+ 20$+8$-

H


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H


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"nne7)re 8

Pakistan Health System: #ore )nctions and 4esponsi!ilities

#ore )nction ederal Provincial .istrict

S


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"nne7)re 8

C)#, Pac/age>

Curative care for common illnesses 6including first aid and provision of

essential medicines7

,PI 6plus7 services

Integrated anagement of -eonatal and Childhood Illness

-utrition advice services

Prenatal and postnatal care

Birth preparedness counselling

-e"&orn care

*reatment of diseases li/e malaria4 tu&erculosis4 hypertension4 dia&etes

and s/ins infection etc:

0amily Planning counselling and services including Intra uterine device

6IUD7 insertion and removal services Information and ,ducation for ,mpo"erment and Change 60amily

mem&ers4 pregnant "omen4 parents4 traditional care providers etc7

*raining and management support for community &ased lady health

"or/ers

Additional )ptional Services>


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Psychological reha&ilitation

Physical reha&ilitation

!% 4H# ?evel Package:

*his is envisaged as a health facility4 "hich is open

C)#, Pac/age>

Curative care for common illnesses 6including first aid and provision of

essential medicines7

,PI 6plus7 services

Integrated anagement of -eonatal and Childhood Illness

-utrition advice services

Prenatal and postnatal care Birth preparedness counselling?

Advanced la&oratory services

Blood &an/4 Blood screening and transfusion services

Promotion of Iodized salt

inor surgical operations

ental health services Psychological reha&ilitation

Physical reha&ilitation

*raining of mid"ives

c% 4eferral Hospital ?evel Package:

*his is envisaged as a hospital4 "hich is open

=


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edical4 surgical4 paediatric and gynaecological and anaesthesia 5 specialized

services in all *H(H: In addition to specialized services essential for all*H(H4 at least specialized services for ,-*4 ophthalmologic and cardiology"ould &e ensured in all DH(H:

Diagnostic services including la& 3 radiology

Comprehensive ,m)C services including post5a&ortion care

-e"&orn care including incu&ator care

*herapeutic feeding centres

Comprehensive family planning services including surgical sterilization

services for men and "omen

*raining of health care providers and paramedics

d% Tertiary #are ?evel Package:

In addition to Core and additional services offered at #eferral level hospital4 the follo"ingservices "ill &e implemented>

Support 3 delivery of all services offered at DH( and *H( hospital levelAll types of specialtiesAll diagnostic services*raining of medics and paramedicsPhysical reha&ilitation services including prosthesis

e% #omm)nity level 61rass root level through out5reach services7>

In addition to "hat has &een proposed &y the $H!s Programme4 the follo"ing additionalservices may also &e provided through $H!s>

,PI services

Psychosocial support Provision of clean delivery /its4 -utrition supplementation and 0irst aid 6plus7

etc

*he pac/age of services for community mid"ives "ill &e as prescri&ed &y the -ursingcouncil

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National Health Policy 2009 Pakistan

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