pakistan health care system

Date:7/15/2021 www. qadricohs.edu.pk FB Page: Qadri College of Health Sciences, Karachi, Sindh, Pakistan. 1
QADRI COLLEGE OF HEALTH SCIENCES, KARACHI
U-3, 1 OF 1
Community Health Nursing-I
Unit III: “Pakistan Health Care System”
GBSN Year.1 , Semester.2
By: Aftab H. Abbasi
RN, DCHN, BSN, MA, LL.B
Lecturer Nursing
Qadri College of HealthSciences Karachi

In this unit, students will be introduced to
Health Services / Organizations available in
Pakistan.
In addition students discuss health services
available within the Government / Private
Health Care System.
Furthermore, they will explore the roles of
the health team members within the system.
Unit III: Pakistan Health Care System

Unit objectives:
At the completion of this unit, students will be
able to:
1. Define the terms, system, and health care
system.
2. Identify the health services available to
community by Pakistan Government Health
Care System.
3. Explain the roles of health care team members
within the health care system.
4. Discuss the Devolution Plan of 2000.

DEFINITIONS OF TERMS:
SYSTEM:
A system is a group of interacting or
interrelated elements that act according
to a set of rules to form a unified whole. A
system, surrounded and influenced by its
environment, is described by its
boundaries, structure and purpose and
expressed in its functioning. Systems are
the subjects of study of systems theory.
( Wikipedia )

SYSTEM:
A set of principles or procedures according
to which something is done; an
organized scheme or method.
DEFINITIONS OF TERMS

HEALTH CARE SYSTEM:
It implies the organization of the people,
institution and resources to deliver health
care services to meet the health needs of
target population.
DEFINITIONS OF TERMS

PAKISTAN HEALTH SERVICE DELIVERY:
Introduction:
The health care delivery system in Pakistan
consists of public and private sectors. Under
the constitution, health is primarily
responsibility of the provincial government,
except in the federally administrated areas.
Health care delivery has traditionally been
jointly administered by the federal and
provincial governments with districts mainly
responsible for implementation.
Health Care System / health services by Pakistan Government

Service delivery is being organized through
preventive, promotive, curative and
rehabilitative services.
The curative and rehabilitative services are
being provided mainly at the secondary and
tertiary care facilities.
Preventive and promotive services, on the
other hand, are mainly provided through
various national programs; and community
health workers’ interfacing with the
communities through primary healthcare
facilities and outreach activities.

Some government / semi government
organizations like the armed forces,
parastatals such as Sui Gas, WAPDA,
Railways, Fauji Foundation and the
Employees Social Security Institution
provide health service to their employees
and their dependents through their own
system, however, these collectively cover
about 10% of the population.

1- Public sector:
Public sector health care system endeavors to deliver
healthcare through a three level healthcare delivery
system and a range of public health interventions.
First level includes:
Basic Health Units (BHUs) and Rural Health
Centers (RHCs) founding the fundamental of the
primary healthcare model.
Secondary care encompassed:
first and second referral facilities providing acute,
ambulatory and inpatient care through Tehsil
Headquarter Hospitals (THQs) and District
Headquarter Hospitals (DHQs).
Tertiary care including:
Teaching hospitals.

The public health activities have
persistently increased in terms of physical
infrastructure and workforce.
The national health infrastructure comprises
of 1201 hospitals, 5518 Basic Health
Units, 683 Rural Health Centers, 5802
Dispensaries, 731 Maternity & Child
Health Centers and 347 TB centers, and
the total availability of beds in these
health facilities is estimated at 123394.

In addition more than 95000 Lady Health
Workers are providing primary health care
services to the community through the
health houses.
Despite an elaborate and extensive health
infrastructure, the health care delivery
suffer from some key issues like the high
population growth, uneven distribution of
health professionals, deficient workforce,
insufficient funding and limited access to
quality health care services.

2- Private sector:
The rising population pressure on state health
institutions has allowed the private sector to
bridge the gap of rising demand and limited
public health facilities.
A number of private hospitals, clinics and
diagnostic labs has increased considerably
and is contributing health services in the
country. Majority of private sector hospitals
has sole proprietorship or a partnership
model of organization. Stand-alone clinics
across Pakistan are the major providers of
out-patient care majority of these clinics falls
in the sole proprietorship category.

The state provides healthcare through a
three-tiered / three levels healthcare
delivery system and a range of public
health interventions.

Three level healthcare delivery system:
1- Primary Health Care (PHC) Services:-
I- Basic Health Unit (BHU):
It is the first level of health care, (PHC)
considered to be necessary to maintain
adequate health and protection from
disease, for example Immunization, health
education, family planning and treating
minor illness.

Typically, each Union Council has a BHU
which has 2 beds and serves a
catchment population of about 10,000 to
25,000.
Staffing: Medical Officer, Dispenser,
Vaccinator, LHV etc.

II- Rural Health Centre/Clinic (RHC):
(RHC) program is intended to increase
access to primary care services for
Medicaid and Medicare patients in rural
communities, for example primary health
care (PHC) promotes health, immunization,
health education, family planning and
treating common/minor illness. RHCs can
be public or nonprofit healthcare facilities,
however, they must be located in rural,
underserved areas.

Have 10 to 25beds and serves a catchment
population of about 40 to 60 thousands.
Staffing: M/S, Medical Officer, Staff Nurse,
Dispenser, Lab: Technician, X-ray
Technician Vaccinator, LHV etc.

III- Some other examples of (PHC)
services:-
Urban Health Centers, Mother & Child
Health Centre (MCH Centers), Dispensary
etc.

2- Secondary Health Care (SHC)
Services:-
I- Taluka Headquarter Hospital
(THQ):
A hospital that serves for area of land with a
city or town with possible additional towns,
and usually a number of villages.
Provides curative services, as Gynecology,
Ophthalmology, Pediatrics, ENT,
Gastroenterology, General medicine etc.

Have 25 to 50 beds and serves a catchment
population of about 100,000 or more.
Staffing: M/S, Medical Officer, Staff Nurse,
Dispenser, Lab: Technician, O T
technician, X-ray Technician, Vaccinator,
LHV, Ward servants, Driver etc.

II- District Headquarter Hospital
(DHQ):-
The major health care facility in its region,
with large number of beds for patients who
need long-term care.
Provides intensive care, curative services,
as Gynecology, Ophthalmology, Pediatrics,
ENT, Gastroenterology, General medicine,
General Surgery etc.

The DHQ hospital provides promotive,
preventive, curative, advance diagnostics,
inpatient services, advance specialist,
rehabilitation and referral services.
Have above 100 beds and serves a catchment
population of 1 to 3 million.
Staffing: M/S, DMS, AMS, Specialist /
Consultant, Medical Officer, Staff Nurse,
Dispenser, Lab: Technician, O T technician,
X-ray Technician, Vaccinator, LHV, Ward
servants, Driver etc.

3- Tertiary Health Care (THC) Services:-
I- Provincial Hospital (Teaching Hospital) :-
Provincial Hospital is the biggest in province
level run by provincial government and
provides tertiary care services.
Some hospitals are affiliated with a university,
college, medical school, or nursing school
and offer health care to patients while
teaching medical students, physicians,
surgeons, and nurses. Teaching hospitals
are unique in that they employ physician
residents who are in training.

Provides special/intensive care, curative services,
as Gynecology, Neurology, Oncology,
Orthopedics, Ophthalmology, Pediatrics, ENT,
Gastroenterology, General medicine, General
Surgery, Rehabilitation services etc.
Some examples of provincial hospitals in Sindh:
Civil Hospital, Jinnah Hospital, Dow Medical
University etc.
Staffing: Chancellor, VC, Professor, Assistant
professor, senior registrar, M/S, DMS, AMS,
Specialist/Consultant, Medical Officer, Staff
Nurse, Dispenser, Lab: Technician, O T
technician, X-ray Technician, Vaccinator, LHV,
Ward servants, Driver etc.

II- Federal Hospital (Teaching Hospital):-
Medical facilities run by the federal
government.
Some examples of federal hospitals in Sindh:
JPMC, NICH, NICVD etc.
III- Specialized Health Facilities / Hospitals:-
Example: Mental health (Sir Cowasjee
Jehangir Institute of Psychiatry),
Rehabilitation centers, Skin Diseases
Hospitals, Dental, Eye Hospitals,
Kidney/Dialysis centers etc.

Definition of Health Care Team:
The health care team consists of a group of
people who coordinate their particular
skills in order to assist a patient or his
family.
Roles Of Health Care Team

HEALTH CARE TEAM MEMBERS:-
(Possible major members enlisted, some others may be
included according to job need and description)
1- Doctors, Medical officer, Women medical
officer.
2- Physician Assistants.
3- Nurses, Community health nurse.
4- Pharmacists.
5- Dentists.
6- Technologists and technicians, Medical
technologist, Health technician, X-ray
technician.

7- Therapists and rehabilitation
specialists, Physiotherapist.
8- Psychologist, Psychiatrist.
9- Emotional, social, religious and
spiritual support providers.
10- Administrative and support staff,
Clerical staff, Drivers, Housekeeping
staff.
11- Community health workers and patient
navigators.

A FOUR-LEVEL MODEL OF THE HEALTH
CARE SYSTEM:
In this model, adapted from Ferlie and
Shortell (2001), the health care system is
divided into four “nested” levels:
(1) Individual patient.
(2) The care team.
This includes professional care providers
(e.g., clinicians, Nurses, pharmacists, and
others), the patient, and family members.
Health Care Team Levels

(3) The organization.
(e.g. hospital, clinic, nursing home, etc.)
that supports the development and work
of care teams by providing infrastructure
and complementary resources.
(4) The political and economic environment.
(e.g., regulatory, financial, payment
regimes, and markets), the conditions
under which organizations, care teams,
individual patients, and individual care
providers operate (see Figure).

Definition:
Devolution is the statutory delegation of
powers from the central government of a
sovereign state to govern at a sub-national
level, such as a regional or local level. It is a
form of administrative decentralization.
( Wikipedia )
The Devolution Plan of 2000

An initiative that began in 2001 with the passage of
the Local Governance Ordinance.
under the Devolution Plan of the Government
of Pakistan in 2000,19 the districts have
been given comprehensive administrative as
well as financial autonomy in almost all
sectors, including health.
The districts are now responsible for
developing their own strategies, programs
and interventions based on their locally
generated data and needs identified.
Following the principles of Alma-Ata, the
public health care system is primary care
focused.

At the community level, the Lady Health
Worker (LHW) program of the Ministry of
Health, and the Village Based Family
Planning Worker (VBFPW) program of
Ministry of Population Welfare of
Government of Pakistan have been
established.
These programs gained an international
reputation due to their grass root
coverage plans.

Community Health Nursing
B. T. Basavanthappa
First Edition 1998
https://www.who.int/teams/social-determinants-of-health/declaration-of-alma-ata
http://www.emro.who.int/pak/programmes/primary-a-secoundary-health-care.html
http://www.emro.who.int/pak/programmes/service-delivery.html

By: Aftab H. Abbasi
RN, DCHN, BSN, MA, LL.B
Lecturer Nursing
Qadri College of HealthSciences Karachi

pakistan health care system

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