Pakistan: Potential to achieve universal coverage for health

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1 Pakistan: Potential to achieve universal coverage for health The Bocconi initiative on attaining universal health coverage May 14, Milan, Italy Sania Nishtar Heartfile, Pakistan

2 Pakistan: a snap shot Location: South Asia Population: 170 million 65% rural population 36.9% below the age of 15 years 29% population below poverty line Off track in meeting MDGs GDP per capita: 1000 US$ Low ranking on HDI

3 Health status: the double burden of disease h e a r t f i l e. o r g

4 Health status Health indicators Life expectancy Total Fertility Rate Contraceptive Prevalence Rate Pregnant women receiving at least one ante-natal consultation Women who receive care from Skilled Birth Attendants Neonatal Mortality Rate Infant Mortality Rate Under-Five Mortality Rate Fully-immunized children Tuberculosis Treatment Success Rate Prevalence of viral hepatitis in the general population Prevalence of smoking (over 18 years of age) Prevalence of central obesity (over 18 years of age) Prevalence of diabetes (over 25 years of age, Doctor-population ratio Nurse-population ratio Dentist-population ratio Households with toilet systems Households with government garbage disposal services Values 63.8 years 4.1 children per woman 39.0 percent 61.0 percent 39.0 percent 54 per 1, per 1, per 1, Percent 84 percent 7.4 percent percent percent 7.65 percent 1:1326 1:22,662 1:3, percent 37 percent h e a r t f i l e. o r g

5 Factors determining health status

6 A stylized representation of healthcare delivery systems operating in Pakistan

7 The public healthcare system

8 The quantum of private sector outreach Access to healthcare services in the Mixed Health System h e a r t f i l e. o r g

9 The mixed health systems syndrome

10 Health systems performance assessment Adjusted Probabilities of Reproductive Health indicators by quintiles of wealth index (n=10,023) (Adjusted for rural- urban residence, mother's education, father's education, mother's occupation and father's occupation) h e a r t f i l e. o r g Alam and Nishtar. In press 2010.

11 Health systems performance assessment Population receiving coverage for health (%) h e a r t f i l e. o r g

12 New estimates for public and private health financing

13 Catastrophic expenditures on health

14 Can universal coverage be achieved in a country like Pakistan Oppertunities The existence of a country specific health systems reform agenda Movement towards judicialization of rights A free an open media with likely knock on effect on improving governance Constraints Lack of policy consistency Broader issues of governance and macroeconomics h e a r t f i l e. o r g

15 The Reform Agenda Reforming Pakistan Mixed Health System

16 The Reform Agenda five areas of focus Broader systems constraints within the remit of the political economy Increasing the base of public sources of financing for health (formal and informal sector) and management reengineering of public service delivery Market harnessing regulatory approaches in order to broaden the first point of contact in Primary Health Care as well as enable purchase of services in order to achieve equitable access to care. Institutional reform of state agencies mandated in a health role Strategic use of technology

17 Reform of governance

18 The Reform Agenda five areas of focus Broader systems constraints within the remit of the political economy and overarching social policy reform Increasing the base of public sources of financing for health (formal and informal sector) and management reengineering of public service delivery Market harnessing regulatory approaches in order to broaden the first point of contact in Primary Health Care as well as enable purchase of services in order to achieve equitable access to care. Institutional reform of state agencies mandated in a health role Strategic use of technology

19 Phase-wise implementation of the reform agenda Step I Developing a national consensus on the reform agenda Increasing public financing for health. Step II Bracing the health information system Pulling a thread through existing evidence Step III Strengthening institutions Honing norms policy, institutional and legislative sphere Mainstreaming technology Step IV: prototyping alternative service delivery and financing mechanisms Step V: scale up

20 Can universal coverage be achieved in a country like Pakistan Oppertunities The existence of a country specific health systems reform agenda Movement towards judicialization of rights A free an open media with likely knock on effect on improving governance Constraints Lack of policy consistency Broader issues of governance and macroeconomics h e a r t f i l e. o r g

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