Post-devolution issues: Call for unified vision to streamline health policy

Public-sector allocations for health are just 0.4 per cent of GDP.

ISLAMABAD: One of the major fallouts of devolution has been lack of a national vision that reflects the shared aspirations for improving healthcare provision.

In the post-devolution scenario, the Ministry of National Health Services Regulation and Coordination (NHSRC) is still grappling with bringing greater clarity into its role and responsibilities.

Officials at the NHSRC maintain that the 18th Amendment had made the role of the ministry uncertain at the national level, leaving many areas in need of renewed policy outlooks, coupled with a comprehensive action plan.

NHSRC Health Director General Dr Assad Hafeez said that the provincial health departments and NHSRC were still in the process of taking up their new roles as provided for in the provincial and federal legislative lists.

He said that as the Millennium Development Goals would reach their deadline at the end of this year, giving way to the sustainable development goals next year, thus creating an even more pressing need for a “national vision document for the year 2015-16”.

In a draft vision statement shared with The Express Tribune, Dr Hafeez highlighted several concerns and key issues that needed to be addressed through such a policy document.

For example, the draft states that the recent public-sector allocations for the fiscal year 2015-16 suggested further reduction in health spending to less than 0.4 per cent of the GDP, which required collective federal and provincial efforts to address.

Moreover, it points at significant disparities in the capacities of the provinces, which necessitate national oversight to monitor and correct increasing interprovincial healthcare inequities.

The draft states that a shared national vision was required to cater to public health challenges created through cross-border outbreaks, management of national disasters, quality assurance of medicines, regulation of health professionals, and achieving overall uniformity of standards across provinces.

It further suggests developing an integrated health information sharing system to monitor progress at the national level.

Since Pakistan is a signatory to various international treaties and regularly participates in a number of global health forums, the draft states that this makes it all the more important to have a shared national vision representing views of provincial and federal health institutions.

Pakistan is expected to report annually to the World Health Organisation (WHO) on a selected list of indicators. To fulfill such requirements, development partners have been requesting for a national perspective on health.

Dr Hafeez said that several steps had been proposed by the health ministry to develop the document.

He said that the proposed measures included establishing of core teams of focal persons at the federal and the provincial levels, organising a national-level workshop and getting endorsements through the Ministry of Law and the Ministry of Inter-Provincial Coordination.

The draft clearly states that the health ministry did not seek to impinge upon provincial autonomy in the process of developing a national vision document, but rather only sought to streamline health activities at the federal and provincial levels.

Published in The Express Tribune, July 23^rd, 2015.