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Health service delivery

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A photo of a lady health worker meeting with a family Lady health workersThe public health service delivery infrastructure in Pakistan is fairly good, with 5000 basic health units, 600 rural health centres, 7500 other first-level care facilities and over 100 000 lady health workers providing primary health care services across the country. These are complemented by 989 secondary care hospitals, at tehsil and district levels, responsible for the referrals.

The recent devolution in health has hugely increased the responsibilities of provincial departments of health. Extensive WHO support for capacity-building is required to ensure that the provincial health authorities can deliver at the expected level to improve health conditions, especially for population groups with the least access to health.

Lady health workers

Community participation is a key aspect of the extension of health services to rural areas and urban slums through the deployment of 110 000 lady health workers covering almost 60% to 65% of the target population. 

The lady health worker programme contributes directly to MDGs 1, 4, 5 and 6 and indirectly to 3 and 7. The main programme objectives include improvement of maternal, newborn and child health, provision of family planning services and the integration of other vertical health programmes. Recently, lady health workers have been trained in selected districts for independent Expanded Programme on Immunization vaccinations.

To improve programme performance and quality of care, there should be increased emphasis on the family planning component, strengthening of the knowledge and skills of the lady health workers, sustained logistics and more robust management oversight and support. Hence, continued commitment for improved service delivery and capacity building of the lady health workers is required particularly in the recent context of devolution.

Essential health services package

The development and costing of the essential health services package was undertaken through WHO in the last biennia. The aim was to implement standardized integrated primary health care in first-level care facilities. This was linked to the draft national health policy (2010) for national implementation linked to overall approval of the policy.

The essential health services package concept has been implementationed as minimum service delivery standards in Punjab. However, there is a need to determine the requirements for implementation of the essential health services package, including a costing review. This may also advocate for enhancement of the total funding allocation for health in Pakistan.

Private health sector

The private health sector accounts for 70%–80% of health care delivery through a network of private providers. However, lack of standards and quality of care at all levels of service delivery and the absence of regulation compromise health care delivery outcomes in this sector.

Health services