Since joining the UHC 2030 Global Compact in 2018, Pakistan has made notable progress towards Universal Health Coverage (UHC).[1] However, half of the population still lacks access to most essential health services. To address this, the Government of Pakistan, in partnership with the World Health Organization (WHO) and other stakeholders, is working to improve access to essential services, increase financial risk protection, and promote equity in health care. A pivotal development in this journey was the 2021 high-level Primary Health Care for Universal Health Coverage (PHC4UHC) mission, organized by WHO, which recommended the development of a Model of Care for UHC rollout. Following this, WHO assisted Pakistan in piloting a Primary Health Care (PHC) oriented Model of Care in Islamabad and Charsadda, focusing on the implementation of a comprehensive UHC Benefit Package. This approach yielded notable improvements in the health sector, particularly in noncommunicable diseases and maternal-child health. The first phase of this project, spanning from 2021 to 2023, has been successfully completed, with future expansions planned based on the recommendations of the evaluation team. This initiative has placed WHO in leading position to support the government for initiating implementation of essential package of health services (EPHS / UHC BP) to advance UHC, which is aligned with WHO’s GPW 13, Country Cooperation Strategy 2020-25 and National Health Vision of the Country. Its success in phase 1 has made it a good potential model to expand it at national level for implementing UHC BP / EPHS.

How did Pakistan, with the support of WHO, achieve this?

The partnership began with the Primary Health Care for Universal Health Coverage (PHC4UHC) mission in March 2021, led by WHO and with eight partners from the SDG3 Global Action Plan (GAP). This mission focused on assessing the existing primary health care (PHC) system in Pakistan, exploring sustainable health financing options, and planning an effective rollout of the Universal Health Coverage Benefit Package (UHC BP). The initiative culminated in a national forum where representatives from both the federal and provincial levels, together with the eight SDG3 GAP partners, signed a joint statement. This statement underscored their commitment to strengthen primary health care as a means to advance towards Universal Health Coverage in Pakistan.[2]

“The Government of Pakistan is committed to strengthen PHC for achieving Universal Health Coverage (UHC) and the health-related Sustainable Development Goals (SDGs). We are thankful to the WHO Pakistan for supporting us in kickstarting implementation of UHC benefit package through PHC Oriented Model of Care. We hope that this will be a role model for country wide implementation of UHC BP.“

-Dr Nadeem Jan, Federal Health Minister, Pakistan

After the 2020 endorsement of the Universal Health Coverage Benefit Package (UHC BP) and the Essential Package of Health Services, WHO, along with various development partners, assisted Pakistan in creating health service packages tailored to each province. The WHO Pakistan team, supported by the WHO Regional Office and headquarters, led the pilot of the PHC oriented Model of Care in Islamabad Capital Territory (ICT) and Charsadda districts. This involved facilitating brainstorming discussions among all stakeholders, which resulted in a comprehensive plan for implementing the approach and a 'theory of change' framework. This framework included key indicators for monitoring the intervention.

^{Handing over of equipment and supplies to the District Health Office, Charsadda, during a monitoring visit led by WHO Pakistan and the Department of Health, Khyber Pakhtunkhwa teams.}
Photo credit: WHO Pakistan

The Model of Care is designed to offer a holistic approach to health and encourages intersectoral collaboration to enhance integrated service delivery. It addresses a broad spectrum of health concerns, including communicable and noncommunicable diseases, nutrition, mental health, maternal and child health, and focuses on social determinants by promoting health education and improving water, sanitation, and hygiene (WASH) services in schools.

With financial assistance from WHO, fifteen model health facilities across two districts were revitalized and upgraded. This involved the installation of WASH facilities, staff rooms, electricity, furniture, medical equipment, and the creation of patient waiting areas. WHO also developed comprehensive training modules and manuals and prepared master trainers. This initiative enabled healthcare workers to receive multidisciplinary training for delivering prioritized interventions under the Essential Package of Health Services. The training emphasized strengthening community engagement and adopting a family practice approach. These centers are now proficient in screening for conditions such as tuberculosis (TB), hepatitis, HIV/AIDS, and sexually transmitted infections (STIs). Health professionals from 15 primary sites and four hospitals underwent extensive training in patient safety, community engagement, and family practice methodologies. The effectiveness of these trainings, implemented via a trickle-down approach, was closely monitored by District Health Offices and WHO teams.

Additionally, WHO enhanced referral mechanisms and provided essential equipment to five nearby hospitals, ensuring their readiness for advanced screening, service delivery, and referral processes. Intersectoral cooperation extended to pilot schools, providing WASH facilities and health education sessions to promote healthy behaviors. WHO supplied WASH-related materials, refurbished school facilities, and initiated health awareness sessions through local health workers.

The project's success was reflected in improved health markers: better-trained workforce, enhanced facilities, stronger inter-sectoral ties, and increased access to essential health services. The pilot garnered recognition on various platforms, including WHO’s regional meetings, ‘RC69[3] and RC70’[4], WHO’s Regional Health Alliance[5], and the SDG3 GAP 2022 annual report.[6] A July 2023 evaluation affirmed its achievements.

“Primary Health Care (PHC) is the cornerstone of sustainable and resilient health systems for achieving Universal Health Coverage (UHC) and the health-related Sustainable Development Goals (SDGs). I appreciate government of Pakistan for its commitment to 2030 Agenda for Sustainable Development and for prioritizing reforms in the areas of PHC for UHC. WHO stands committed to continue its support for strengthening PHC based health systems in the country.”

- Dr Palitha Mahipala, WHO Representative in Pakistan