The 18th Amendment in the 1973 Constitution has devolved health planning, service delivery and programme implementation to the provincial level.  

The National Health Vision 2025 aims at universal access to quality essential health services and ensuring financial protection, focusing on vulnerable and delivered through resilient and responsive health systems. 

The National Health Vision is articulated on the health system functions and is aligned with the health-related Sustainable Development Goals (2030).   

WHO supports the development of a monitoring framework for the national health vision, design of provincial health sector strategies and capacity-building in health policy and strategic planning.

Background

The 1973 Constitution of Pakistan is based on the parliamentary system of governance and considers Pakistan as a federation comprising different units like 4  provinces and 4 administrative areas. This constitution has two lists of responsibilities. List-1 which includes subjects like defense, foreign policy etc is the responsibility of federal government. List -2 which include subject like rural development, local government, health education etc is the responsibility of provincial government. A 3rd list called the concurrent list of responsibilities was also kept in the constitution for a limited period of time. The concurrent list included subjects which became the joint responsibility of both federal and provincial government.  Health was also included in the concurrent list and a federal ministry of health was looking after this subject until 2011 when 18th Amendment in the constitution was implemented and federal ministry of health was dissolved along with 21 other ministries. 

After the 18th amendment the provinces in addition to service delivery and programme implementation also became responsible for strategic planning. To meet the new responsibility of strategic planning all the provinces established health policy units and also developed provincial health policies; WHO provided technical support in this process of devolution. However; some federal function in health became fragmented and distributed between different ministries and divisions. In 2012, WHO fielded a high-level mission to assess the effects of devolution in health. The mission highlighted the fragmentation of federal health functions and lack of a national entity to represent Pakistan at international forums. In 2013, using this report a federal ministry of Health Service regulation & Coordination was created.

National policy and strategic planning

The last approved national health policy of health of Pakistan dates back to 2001. However, this policy was a brief programmatic description and was not a real policy document. So, the ex MoH tried to revise it in 2009 with the help of WHO. A country wide dialogue took place and a draft policy was developed but in view of 18th Amendment it could not be promulgated. Instead; all the provinces developed their own health strategies. All the provincial health strategies used WHO health system framework of six building blocks to design their strategies. These strategies still await costed and financed implementation plan. However; these strategies provide good guidelines for planning at the provincial level.

Gap of one national policy & plan at the country level was felt and federal ministry of Health Service regulation & Coordination developed a National Health vision 2025 because the Millennium Development Goals [MDGs] came to a close towards the end of December 2015 and gave way to the more ambitious Sustainable Development Goals [SDGs], especially Goal 3 in the context of health, the need for a national vision for health is becoming a key priority. There is a clear rationale for the shared national vision to strengthen the collective voice of provincial and federal governments in support of population’s health.

National Health Vision 2025 

The vision of National Health vision 2025 is to improve the health of all Pakistanis, particularly women and children, through universal access to quality essential health services and ensuring financial protection, with a focus on vulnerable groups, and delivered through resilient and responsive health systems.  

The purpose of National Health vision 2025 is to provide an overarching national vision an agreed upon common direction, harmonizing provincial & federal efforts, inter-provincial efforts and intersectoral efforts for achieving the desired health outcomes and to create an impact. It provides a jointly developed account of suggested priority actions to achieve the common vision and which gives a guideline of best practices for the provinces/ areas to carve their respective policies and initiatives within their domains.

The National Health vision 2025 has been designed in line with WHO health system framework using the 6 thematic pillars; Health Financing, Health Service delivery, Human Resource for Health, Health Information Systems, Governance, Essential Medicines & Technology and an addition area of Cross-sectoral linkages.  WHO provided the support through its development process of conceptualization, advocacy and technical inputs. National Health vision 2025 will provide future directions for national health planning and health sector governance in Pakistan. 

WHO support

WHO is providing support in:

• developing the monitoring and evaluation plan for the National Health Vision 2025
• reviewing provincial health sector strategies
• conducting capacity-building in strategic planning.