Withdrawing assistance: Rural healthcare initiative in limbo as centre backs off

Published: February 9, 2014
Letter from cabinet division asks province to hand over resources purchased from federal fund. PHOTO: FILE

Letter from cabinet division asks province to hand over resources purchased from federal fund. PHOTO: FILE


Having already devolved the health ministry to respective provinces, the federal government has now decided to shut down the Peoples Primary Healthcare Initiative (PPHI) project across the country. The projects K-P chapter, however, has refused to wind up.

Inspired by the success of the initiative in Punjab, the centre, in association with all provincial governments in 2005, had decided to expand the ‘contracted out management’ of primary healthcare infrastructure throughout Pakistan.

It was then decided that rural support organisations of the respective provinces would be assigned management of rural primary healthcare infrastructure based on the models in place in Lodhran and Rahim Yar Khan.

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In Khyber-Pakhtunkhwa (K-P), the management of primary healthcare infrastructure was duly transferred to the Sarhad Rural Support Programme (SRSP). This strategy to hand over the initiative on contract was first billed as the Presidents Primary Healthcare Initiative in 2005. In May 2008, however, it was renamed Peoples Primary Healthcare Initiative.

The rural support programmes (RSPs) were the preferred partners of provincial governments because all RSPs have ex-officio government directors on their boards. This underwrites a level of trust and confidence and RSPs have implemented numerous government projects in many sectors.

SRSP managed 625 basic health units across 21 districts in K-P and in agencies of the Federally Administered Tribal Areas (Fata) for delivery of PPHI. It employed 273 new male doctors, 54 new female doctors, 139 new male paramedics and 53 lady health visitors.

Time to let go

An official of the K-P health department wishing to remain anonymous said on January 8 the Islamabad Cabinet Division sent letters to all provinces directing them to shut down operations and return all vehicles and other equipment.

The official added that around Rs4 billion was allocated for the project in K-P as a non-auditable amount. He claimed Pakistan Tehreek-e-Insaf’s central leader has a role to play in the RSP, stressing the provincial government be allowed to continue with the project.

The official revealed that K-P chief minister and health minister have also been requested to extend the project under the name of Khyber-Pakhtunkhwa healthcare initiative, but the government is yet to respond.

Speaking to The Express Tribune, Health Sector Reforms Unit Chief Dr Shahbina Raza confirmed the health department received the cabinet division’s letter.

Raza said the health ministry was devolved to the provinces after the 18th Amendment, and that according to the letter, the province has the authority to continue this project from their own resources. However, the letter mentioned that all the vehicles and other equipment which were purchased from the federal fund were to be handed over to the centre.

The Health Sector Reforms chief revealed that now the K-P government has to decide whether or not to continue the project.

Counter narrative

A PPHI official, on the other hand, claimed the cabinet division has not issued any letter regarding the closure of the project across the country. He claimed the project will continue in all the provinces and has already initiated various health activities.

He maintained the health project is a historical step which will ensure health facilities for the poor at their doorsteps. The official revealed PPHI is planning on extending the initiative to far-flung areas of K-P with the help of the provincial government and dismissed news about the cabinet division letter as baseless.

Published in The Express Tribune, February 9th, 2014.

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