The Significance of Developing Functional Public Health System in Pakistan

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Dr Hafeez Ahmad

The public health system is the network of public, private, and voluntary entities that contribute to the delivery of essential public health services within a jurisdiction. The public health system recognizes the roles and interactions of all these entities in improving the health and well-being of the community or state. The governmental public health department is a major player in the public health system, but it needs to provide more than the full spectrum of essential public health services. The essential public health services are a set of activities that guide the public health practice.

The importance of a public health system for a country, especially for a developing country, is manifold. The public health system can:

Prevent and control the spread of infectious diseases, such as COVID-19, tuberculosis, malaria, and HIV/AIDS, that pose a major threat to the health and economy of developing countries.
Promote healthy behaviours and lifestyles, such as nutrition, physical activity, hygiene, and immunization, that can reduce the burden of non-communicable diseases, such as diabetes, cardiovascular diseases, and cancers, that are also rising in developing countries.
Address the social and environmental determinants of health, such as poverty, inequality, pollution, and climate change, that affect the health outcomes and vulnerabilities of the population, especially the marginalized and disadvantaged groups.
Strengthen the health system and improve the access, quality, and affordability of health care services, especially primary health care, that can meet the diverse and evolving health needs and demands of the population.
Enhance the health security and resilience of the country by preparing for and responding to public health emergencies, such as natural disasters, epidemics, and conflicts, that can disrupt the normal functioning of the society and the economy.

Therefore, it is critical to develop a public health system in Pakistan. Some recommendations for developing a public health system for Pakistan are:

Increase the budgetary allocation for health as a percentage of GDP and mobilize domestic and external resources to finance the public health system in a sustainable and equitable manner.
Improve the health system’s readiness and capacity, especially in the public sector, by investing in human resources, infrastructure, equipment, supplies, and information systems to deliver essential public health services at all levels.
Ensure the continuity and coordination of public health interventions, regardless of the change in the political regimes, and foster partnerships and collaboration among different sectors, stakeholders, and levels of governance to address the complex and interrelated public health challenges.
Reduce the reliance on donor funding and align public health priorities and policies with national and international commitments and frameworks, such as the Sustainable Development Goals and the Universal Health Coverage Agenda.
Promote accountability and transparency in the public health system by establishing clear roles and responsibilities, monitoring and evaluation mechanisms, and feedback and grievance redressal channels for the service providers, managers, administrators, and policymakers.

Health is a devolved subject in Pakistan. Therefore, strengthening the provincial health departments is critical for ensuring the public health system in Pakistan. The capacity of provincial health departments, district health management teams, and medical human resources is crucial for the development and implementation of a functional public health system in Pakistan. Therefore, it is essential to provide leadership and management training to the provincial and district health authorities, as well as mentoring and coaching by the district health advisors, to improve their skills and competencies in planning, budgeting, monitoring, evaluation, and supervision of public health activities. It is also significant to strengthen the health information system and disease surveillance system by integrating the various vertical and horizontal data sources, improving the quality and timeliness of data collection and reporting, and enhancing the use of data for evidence-based decision-making and policy formulation.

Health human resources are critical for a functional health system. Therefore, their capacity should be improved by training and equipping them with technical and administrative techniques and methods. Accordingly, it is significant to expand and retain the health workforce, especially in rural and remote areas, by increasing the production and recruitment of qualified health professionals, providing incentives and motivation schemes, and offering continuous professional development and career progression opportunities. Furthermore, promoting collaboration and coordination among different sectors, stakeholders, and levels of governance, by establishing clear roles and responsibilities, fostering partnerships and networks, and aligning public health priorities and policies with national and international commitments and frameworks is vital. It is also vital to mobilize and allocate adequate and sustainable resources for public health by increasing the budgetary allocation for health as a percentage of GDP, diversifying the sources of health financing, and ensuring the equity and efficiency of health expenditure.

These methods and plans can enhance the capacity of provincial health departments, district health authorities, and medical human resources for Pakistan’s functional public health system, which can ultimately improve the health outcomes and well-being of the population. Apart from technical, scientific and administrative improvements, political will is critical for the development of a functional public health system in Pakistan. Political will is the commitment and determination of political leaders and policymakers to pursue a course of action that can achieve a desired goal or outcome. In the context of the public health system in Pakistan, political will is essential for the following reasons. Political will can help to increase the budgetary allocation for health as a percentage of GDP, which is currently very low (around 1%) compared to other countries in the region and the world. This can enable the public health system to mobilize and allocate adequate and sustainable resources for providing essential health services to the population, especially the poor and vulnerable groups.

Political will can help to improve the health system’s readiness and capacity, especially in the public sector, by investing in human resources, infrastructure, equipment, supplies, and information systems to deliver essential public health services at all levels. This can also help to address the issues of quality, access, and affordability of healthcare services, which are often compromised in the private sector. Political will can help to ensure the continuity and coordination of public health interventions, regardless of the change in the political regimes, and foster partnerships and collaboration among different sectors, stakeholders, and levels of governance to address the complex and interrelated public health challenges. This can also help to align public health priorities and policies with national and international commitments and frameworks, such as the Sustainable Development Goals and the Universal Health Coverage Agenda.

Political will can promote accountability and transparency in the public health system by establishing clear roles and responsibilities, monitoring and evaluation mechanisms, and feedback and grievance redressal channels for the health system’s service providers, managers, administrators, and policymakers. This can also help to reduce the corruption, inefficiency, and mismanagement that often plague the public health system in Pakistan.

Lastly, political will is a key factor for developing the public health system in Pakistan, as it can help to overcome the institutional and socioeconomic barriers that hinder the progress toward universal health coverage and improved health outcomes for the population.

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