Pakistan has gone through devolution of its services related public sectors including health sector with the 18th amendment in its constitution effective from June 28, 2011. The Federal Ministry of Health (MoH) has been dissolved and now the overall responsibility for health services policy direction and planning has been devolved to the provinces.
Pakistan is suffering from the following challenges related to Human Resources for Health (HRH):
- Rural/ urban maldistribution of health workers
- Weak HRH management system
- Shortage of HRH, mostly in rural areas
- “Brain drain” of skilled health workers to other countries
- A non-regulated private sector that operates primarily in urban areas
- Tenuous quality control and standardization of care
- Health information systems not inclusive of HRH
- Lack of a coordination mechanism for HRH stakeholders
(Pakistan Human Resources for Health: Establishing the Country Coordination and Facilitation Process in Pakistan with a Decentralized System, 2010).
Since devolution the major HRH challenges include:
- Reorganization of the HRH regulatory function and establishment of linkages and coordination between the Federation and the provinces in terms of formulation and regulation of HRH policies and decisions at the federal level
- Managing HRH liability as a consequence of devolution at the federal level. (Annual Progress Report Pakistan: Submitted by the Health Services Academy to the Alliance, 2012)
In spite of on-going challenges, recent achievements have been made, including:
- Work has begun on developing HRH strategies in 2 provinces (Punjab and Sind)
- The Pakistan Medical and Dental Council made it mandatory to develop an integrated and problem-based curricula
- New medical colleges in the private sector have opened
- A Ministry of Human Resource Development has been created
- All regulatory bodies have been exempted from devolution and a new Ministry of Regulation has been created which is expected to enhance the regulation and accreditation of HRH
- New salary packages have been approved for doctors
- Creation of an HRH Observatory by the Baluchistan Health Department
- Development of a website platform and other necessary IT support is in process with the aid of the Alliance.
(Progress Report on Collaboration between Global Health Workforce Alliance and Pakistan, Jan 2012)
COUNTRY COORDINATION AND FACILITATION (CCF) IN PAKISTAN:
The CCF phases vary by province. Previously, CCF was well established at Federal level, but due to devolution of health sector, provinces need independent HRH coordination mechanisms, strategies and plans. The provinces have been oriented on the CCF process and two provinces have established the CCF coordination mechanism while others are working in this direction.
Two provinces (Punjab and Sind) are developing their HRH profiles through engagement of the stakeholders, expected to complete by April 2012. In parallel the overall provincial health sector strategy is under development and the HRH plans will be linked to them. Currently, 2 provinces (Punjab and Sind) have at Phase 2 of the CCF process: HRH situation analysis. The province of Baluchistan has established the CCF Committee and completed phase 1, while other provinces are currently at initial stage.
Partners like One UN, WHO, JICA, GIZ and USAID are engaged in the HRH planning process. Pakistan has taken initial steps for implementation of the Global Code of Practice for recruitment of health personnel. (Progress Report on collaboration between Global Health Workforce Alliance (GHWA) and Pakistan, Jan 2012).
HEALTH WORKFORCE DATA
HEALTH SECTOR STRATEGIES / PLANS
- Health Policy for the Province of Sindh (2005):
- Health Sector Plans for Province of Punjab
- Province of Khyber Pakhtunkhwa Health Sector Strategy 2010 – 2017
COUNTRY CASE STUDIES AND OTHER DOCUMENTS
- Pakistan: WHO Global Code of Practice on International Recruitment of Health Personnel - Implementation Strategy Report, 2011
Pakistan’s Lady Health Worker Programme (2008)
Pakistan: Establishing an HRH Coordination Process (2011)
Pakistan Human Resources for Health: Establishing the Country Coordination and Facilitation process in Pakistan with a decentralized system
ALLIANCE MEMBERS WORKING IN PAKISTAN
- Centre for Health and Population Studies, Pakistan
- Church World Service-Pakistan/Afghanistan
- Deloitte Consulting LLP (Deloitte Consulting)
- Fatima Memorial System, Pakistan
- G. M. Khan Memorial Medical Centre & Maternity Home, Mirpurkhas, Pakistan
- Khyber Medical University
- National University of Sciences and Technology, Rawalpindi, Pakistan
- New York University College of Nursing Global
- Pakistan Institute of Medical Sciences