Pakistan is the fifth most populous country in the world, with a population of around 212 million in 2018. Most health services in the country are concentrated in tertiary and secondary hospitals; Pakistan’s universal health coverage (UHC) index is 45 out of 100. Despite some increases in the health budget in recent years, the health system is underfunded. Other challenges include limited human resources, poor health infrastructure, fragmented procurement mechanisms, an unregulated private sector, weak health information systems and frequent health emergencies.
©Sebastian Liste / NOOR for WHO
As a direct result of discussions on the
GAP, the Global Fund, Gavi, GFF, UNICEF, the World Bank and WHO have planned a joint appraisal mission to strengthen PHC and health financing by aligning financing, technical assistance and support for priorities identified by Pakistan’s federal and provincial ministries of health.
Pakistan’s PHC system is underpinned by the flagship Lady Health Worker Programme, through which more than 90 000 community health workers provide basic health services to 115 million people who would otherwise lack access, mainly in marginalized, remote, rural and urban slum communities.1 The programme also plays a key role in making referrals to health facilities and increasing the uptake of public health initiatives, such as the Expanded Programme on Immunization. This focus on the most marginalized communities and those who are left behind underpins the SDGs and the GAP.
In its National Health Vision 2016–2025, Pakistan pledged to increase federal and provincial allocations to health to 3% of gross domestic product and identified better coverage and more functional PHC services as a strategic priority for the federal and provincial governments to achieve UHC. In parallel, several initiatives have been launched to reduce financial hardship by introducing federal and provincial social health protection for poor families. The Ministry of National Health Services Regulation and Coordination is steering planning with the provinces to scale up PHC, including promotion of a national family practice model, evaluation of the Lady Health Worker Programme to identify barriers and opportunities for scaling up and upgrading and digitalizing the district health information system. Pakistan plans to roll out new UHC benefit packages for community and PHC centres and for first- and tertiary-level hospitals in mid-2020.
The GAP agencies are learning from and building on existing collaborations in Pakistan, such as the National Immunization Support Project, through which Gavi and the World Bank have already aligned financing. Discussions among the agencies on providing joint support for scaling up PHC in line with the National Health Vision began in July 2019, led by the WHO Country Office. These focused on the design and financing of expanded UHC benefit packages for different settings. Additional opportunities for joint support were identified and discussed after presentations to the GAP PHC accelerator working group and the GAP Sherpa group in January 2020, including scaling up PHC interventions in demonstration districts; engaging private physicians in a family practice approach; strategic realignment of human resources for health; mapping and aligning federal and provincial resources; strengthening public financial management; and reforming the Lady Health Worker Programme based on development of a strategic framework and investment case. Other opportunities include strengthening existing health coordination mechanisms, such as the Population, Nutrition and Development Partners Forum and the federal and provincial inter-ministerial health committees.
As Gavi, the Global Fund, GFF and the World Bank open new funding windows over the next year, these signatory agencies and other partners, such as the Global Polio Eradication Initiative, are exploring opportunities for alignment to support health systems strengthening and delivery of essential health services at the primary care level. As a direct result of discussions on the GAP, the Global Fund, Gavi, GFF, UNICEF, the World Bank and WHO have planned a joint appraisal mission to strengthen PHC and health financing by aligning financing, technical assistance and support for priorities identified by Pakistan’s federal and provincial ministries of health. The mission, which has been delayed by the COVID-19 pandemic, will be led by the Government of Pakistan with support from WHO and UNICEF as co-leads of the GAP PHC accelerator working group and Gavi, the Global Fund and the World Bank as co-leads of the GAP finance accelerator working group.
Joint and coordinated support under the auspices of the GAP will help to reduce the burden on Pakistan of managing multiple donors and funding streams, ensure that technical support for PHC is aligned with the country’s Health Vision and help to lay the foundation for better access to health care for the Pakistani people.
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1. Lady Health Worker Programme, Pakistan. Performance Evaluation. London: Oxford Policy Management, UNICEF and Ministry of National Health Services Regulation and Coordination of Pakistan; September 2019.