The 2020 GAP progress report highlighted Pakistan’s efforts to implement pledges in the country’s National Health Vision 2016-25 to increase health spending and quality and coverage of PHC to achieve UHC, including through the rollout of costed UHC benefit packages for community and primary health care centres and secondary and tertiary hospitals by mid-2020; evaluation and strengthening of the country’s flagship Lady Health Worker Program; strengthening and digitization of the District Health Information System; development and implementation of a national family practice model; and health financing reforms. A year ago, discussions between GAP agencies, other development partners and the government of Pakistan were specifically focused on supporting the final design and approaches to financing the UHC benefit package.
To further advance these efforts, a joint mission to Pakistan by agencies from the GAP PHC and sustainable financing for health accelerator working groups, including WHO headquarters, regional and country offices, was planned in 2020, but the mission was delayed due to the COVID-19 pandemic. Nevertheless, the UHC benefit package was endorsed by the government in October 2020 and the country has continued work over the last year with support from GFF, UNICEF, World Bank and WHO to develop a draft UHC investment case focusing on baseline and coverage targets of key interventions in four clusters (RMNCAH, infectious disease, NCDs and health services) based on 88 priority district-level interventions selected for immediate implementation.
Other opportunities for financing primary health care are also emerging, including through the upcoming National Health Support Project supported by the World Bank, GFF and other partners, building on the success of National Immunisation Support Project (NISP) co-funded by the Bill and Melinda Gates Foundation, Gavi, USAID and the World Bank.
The joint GAP “PHC for UHC Mission to Pakistan” eventually took place during the first week of March 2021. The mission was co-hosted by the Government of Pakistan and the WHO country office with support from the WHO Office for the Eastern Mediterranean Region. Participants included the federal and provincial governments, Gavi, GFF, Global Fund, UNAIDS, UNFPA, UNICEF, the World Bank, other local and international development partners and civil society organizations. The key objectives of the mission were to review progress in PHC and health financing reforms towards UHC and to agree on a medium-term, multi-partner support agenda, including opportunities to leverage existing external financing. Following a series of meetings with political leaders and policy makers in health and finance, planning and development sectors at federal and provincial level, as well as thematic discussions and field visits, the GAP agencies issued a joint statement in which they renewed their commitment to a more aligned approach towards PHC for UHC. The agencies specifically affirmed their intention to:
- Align technical support to foster government stewardship in implementing its national strategies, plans and reforms in order to optimize the impact of their collective investments, focusing especially on aligning support for implementation of the UHC benefit package in accelerated districts;
- Align their support to government monitoring systems based on evidence generated through programmatic data and research and build national capacity for assessment based PHC improvement, based on the PHC Measurement and Improvement Initiative (PHCMI) launched recently in Pakistan; and
- Strengthen multi-partner and multi-stakeholder coordination mechanisms, including empowering communities to enable their meaningful involvement, to support the government to develop a national “PHC for UHC Compact” that sets out agreed contributions and ways of working for all health partners.
As the next step, GAP agencies and other partners will develop an action plan to deliver on these commitments and work with the government towards developing a national “PHC for UHC Compact” in connection with the UHC2030 Global Compact.
In addition, an agreement was reached to develop a health financing framework at the national level based on UHC and to formulate a national/provincial health financing strategy with support from partners under a technical working group on health financing. The development of the strategy will be supported by a fiscal space analysis (World Bank), health system financing assessment (World Bank), strengthening of public financial management for health (World Bank), a health financing matrix (WHO) and cross-programmatic efficiency analysis (Gavi, Global Fund and WHO). The GAP SFH accelerator working group will serve as a platform for engaging partners in development of the health financing strategy.