Health systems and the govt’s role

While its promising that the government realises importance of social security, there is need for lot more to be done

Although it is promising to see that the government and its development partners are bringing in new approaches to improve the performance of the health sector in Pakistan, the sustainability of these initiatives remains questionable even for the experts involved. This, however, does not mean that the proposed reforms offer no improvements or that they will fade with the passage of time. Results will remain far more effective in the long term if these initiatives are institutionalised into government systems.

Two decades of global efforts to introduce health sector reforms in developing countries, with particular reference to Pakistan, have mostly been ad hoc, standalone and vertical. An already fragmented health sector with scarce resource allocation from the budgetary cake each year has been tried and tested several times with reforms which were neither guided through a systems approach nor based on evidence from previous experiences. This resulted in the implementation of programmes either through direct funding by the government or through donor and development partner assisted initiatives, lacked strategic direction or policy guideline.

Devolution of powers to the provinces proved to be the big bang for the health sector in Pakistan; provinces previously relying on national direction found themselves lost when faced with the task at hand. This is when sanity prevailed and the health sector was rescued through development of strategies specific to this sector. These strategies were provincially guided with overarching public and private sector focus. Major reforms like initiation of a social health insurance model, development of minimum health service delivery packages, development of quality assurance mechanisms, introduction of financial management reforms, and monitoring and evaluation systems for judging performances were recommended. The current implementation status of these strategies varies amongst the provinces and the federating units.

Implementing the agenda laid down in these strategies, which were developed with a wide consensus is what can fill the institutional gap. Additionally, these strategies place the government in the driver’ seat; it directs its resources and those coming from the donors and development partners to a unified strategic direction hence creating a system which is sustainable and not driven by independent factors.

Furthermore, the government is currently taking steps to broaden the taxation base which is a praiseworthy step. However, extending taxation to the informal sector and widening the enrollment of taxpayers puts enormous responsibility on the government. Countries with high taxation or a wide taxation base provide free education and health care to its population as in the case of the Scandinavian welfare model, where all citizens have equal rights to social security. Various services are available to citizens free of charge; this includes education for all, national health insurance, child and youth allowance, maternity benefit, holiday pay and disability benefits which include assistance to individuals who cannot support themselves financially due to a disability. This model, however, is in no way near to the concept of an Islamic social welfare state, establishing which should be our ultimate aim. It can be argued that health facilities are already being provided free of cost to a large section of the population, but this provision lacks equity and is far from the standards that the Scandinavian countries provide. The least the government can do is provide equity-based healthcare services to all irrespective of their financial status, on standards that meet the criteria of one for all. Given the desire, the richest section of the population can opt for private health insurance or pay for the exclusive services they use.

While it is promising that the government realises the importance of social security and has launched the social health insurance programme, there is need for a lot more to be done. It is hoped that it will take steps towards quick institutional reforms.

Published in The Express Tribune, August 21^st,  2015.

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