BARGAINING AND INFLUENCE SKILLS

Group Assignment

Submitted To
Dr. Muhammad Majid Khan
Submitted By
(GROUP-01)
Saleiha Sharif
Seemab Chaman
Muhammad Aamir

Date
11 June, 2019
2
 CRISIS OF PAKISTANI HEALTH CARE SYSTEMS

Saleiha Sharif, Seemab Chaman & Muhammad Aamir

PhD Scholars – COMSATS University, Islamabad

Introduction

Health systems have a vital and continuing responsibility for people’s health throughout the
lifespan. They are crucial to the healthy development of individuals, families and societies
everywhere. The real progress in health towards the United Nations Millennium
Development Goals and other national health priorities depends vitally on stronger health
systems based on primary health care (WHO, 2003).

Improving health is clearly the main objective of each health system, but it is not the only
one. The objective of good health itself is really twofold: the best attainable average level –
goodness - and the smallest feasible differences among individuals and groups – fairness.
Goodness means a health system responding well to what people expect of it, and fairness
means it responds equally well to everyone, without any kind of discrimination (WHO,
2000).

According to the World Health Organization (WHO) 2000, 2002 & 2003 reports, each
national health system should be directed to achieve three overall goals: good health,
responsiveness to the expectations of the population, and fairness of financial contribution.
Progress towards them depends crucially on how well systems carry out four vital functions.
These are: service provision, resource generation, financing and stewardship. Comparing the
way these functions are actually carried out provide a basis for understanding performance
variations over the time and among countries. There are minimum requirements which every
health care system should meet equitably: access to quality services for acute and chronic
health needs; effective health promotion and disease prevention services; and appropriate
response to new threats as they emerge (emerging infectious diseases, ageing of the
population and growing burden of non-communicable diseases and injuries, and the health
effects of global environmental changes).

Health systems have contributed enormously to better health for most of the global
population during the 20th century and beyond. Today, health systems, in all countries, rich
and poor, play a bigger and more influential role in people’s lives than ever before. Health
Systems of some sort have existed for a long time as people have tried to protect their health
and treat diseases. Traditional practices, often integrated with spiritual counseling and
providing both preventive and curative care, have existed for thousands of years and often
coexist today with modern medicine. Many of them are still the treatment of choice for some
health conditions, or are resorted to because modern alternatives are not understood or
trusted, or fail, or are too expensive. Health systems have undergone overlapping generations
of reforms in the past 100 years, including the founding of national health care systems and
the extension of social insurance schemes. Later the promotion of primary health care came
as a route to achieving affordable universal coverage – the goal of health for all. In the past

3
two decades there has been a gradual shift of vision towards what WHO calls the “new
universalism”. Rather than all possible care for everyone, or only the simplest and most basic
care for the poor, this means delivery to all of high-quality essential care, defined mostly by
criteria of effectiveness, cost and social acceptability. This shift has been partly due to the
profound political and economic changes of the last 20 years or so with the transition from
centrally planned to market-oriented economies, reduced state intervention in national
economies, less government control, and more decentralization (WHO, 2000).

Health Care Services and Health Services Organizations

Health care is the total societal effort, organized or not, whether private or public, that
attempts to guarantee, provide, finance, and promote health. Health care consists of measures,
activities and procedures for maintaining and improving health and living and working
environment, rights and obligations acquired in the health insurance, as well as measures,
activities and procedures which are undertaken in the field of health care for maintaining and
improving people's health, prevention and control of the diseases, injuries and other disorders
of the health; early detection of the diseases and conditions of the health, timely and efficient
treatment and rehabilitation, by application of professional medical measures, activities and
procedures. It changed markedly during the 20th century moving toward the ideal of wellness
and prevention of disease and disability[CITATION Placeholder1 \l 1033 ].

Delivery of health care services involves the organized public or private efforts that assist
individuals primarily in regaining health, but also in preventing disease and disability
[ CITATION Placeholder1 \l 1033 ]. Delivery of services to patients occurs in a variety of
organizational settings (“patient” is anyone served by a health services organization). Health
services is a permanent countrywide system of established institutions, the multipurpose
objective of which is to cope with the various health needs and demands of the population
and thereby provide health care for individuals and the community, including a broad
spectrum of preventive and curative activities, and utilizing, to a large extent, multipurpose
health workers. All health services organizations can be classified by ownership and profit
motive [CITATION Rak92 \l 1033 ].

Historically, hospitals and nursing facilities have been the most common and dominant health
services organizations engaged in delivery of health services. They remain prominent in the
contemporary health care systems, but other health services organizations have achieved
stature. Among them are outpatient clinics, imaging centers, free-standing emergency care
and surgical centers, large group practices, and home health agencies. Multi-organizational
systems, both vertically and horizontally integrated, are wide-spread. Health maintenance
organizations, sickness funds, preferred provider organizations, and managed care systems
are financial and delivery arrangements that became prominent in USA and some European
countries, in the 1980s and 1990s. These various health services organizations and others face
new environments containing a wide range of external pressures, including new rules and
technologies, changed demography and ageing, accountability to multiple constituents, and
constraints on resources. As a result, health services organization must allocate and use
resources more effectively and strive for continuous improvement and excellence in an

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increasingly restrictive environment (Donev, Kovacic, & Laaser , 2003; Rakich, Longest, &
Darr, 1992).

Health Systems

In today’s complex world, it can be difficult to say exactly what a health system is, what it
consists of, and where it begins and ends. It means that the boundaries between health and
welfare systems are not sharp and clear. Health system includes all the activities with the
purpose to promote, restore and maintain health. It means that the health system is the
complex of interrelated elements that contribute to health in homes, educational institutions,
workplaces, public places, and communities, as well as in the physical and psycho-social
environment and the health and related sectors. A health system is usually organized at
various levels, starting at the most peripheral level, also known as the community level or the
primary level of health care, and proceeding through the intermediate (district, regional or
provincial) to the central level. The intermediate and central levels deal with those elements
of the health system that provide progressively more complex and more specialized care and
support. Health system infrastructure includes services, facilities, institutions or
establishments, organizations, and those operating them for conducting the delivery of a
variety of health services and programs. They provide individuals, families, and communities
with health care that consists of a combination of promotive, protective, preventive,
diagnostic, curative and rehabilitative measures. Health resources are all the means of the
health care system available for its operation, including manpower, buildings, equipment,
supplies, funds, knowledge and technology. Health sector includes governmental ministries
and departments, organizations and services, social security and health insurance schemes,
voluntary organizations and private individuals and groups providing health services.
Intersectoral action is an action in which the health sector and other relevant sectors
collaborate for the achievement of a common goal. Different sectors should be closely
coordinated in the health actions. Multisectoral action is usually the synonymous term to the
intersectoral action, the intersectoral emphasizing the element of coordination and the
multisectoral the contribution of a number of sectors (Donev, Kovacic, & Laaser , 2003;
Donev, Ivanovska, Lazarevski, & Ruzin, 2000).

The panel defines “health systems” broadly, to encompass the full continuum between public
health (population-based services) and medical care (delivered to individual patients). As
outlined in previous Institute of Medicine reports (e.g., 2011 report), health systems involve
far more than hospitals and physicians, whose work often focuses on tertiary prevention
(averting complications among patients with known disease). Both public health and clinical
medicine are also concerned with primary and secondary prevention. The health of a
population also depends on other public health services and policies aimed at safeguarding
the public from health and injury and attending to the needs of people with mental illness
[ CITATION Aro09 \l 1033 ]. There is mounting evidence that chronic illness care requires
better integration of professions and institutions to help patients manage their conditions, and
that health care systems built on an acute, episodic model of care are ill equipped to meet the
longer-term and fluctuating needs of people with chronic illnesses[CITATION Woo13 \l 1033

5
]. Wagner, Austin, & Von Korff (1996) were among the first to document the importance of
coordination in managing chronic illnesses.

Health systems are defined by WHO, as comprising all the organizations, institutions and
resources that are devoted to producing health actions. A health action is defined as any
effort, whether in personal health care, public health services or through intersectoral
initiatives, whose primary purpose is to improve health (WHO, 2002). Formal health
services, including the professional delivery of personal medical care, are clearly within these
boundaries. So are actions by traditional healers and all use of medication, whether
prescribed by a provider or not and home care for the sick people, especially in developing
countries and rural areas where between 70% and 90% of all sickness is managed (WHO,
2000-2002). Such traditional public health activities as well as health promotion and disease
prevention provided by different sectors, and other health-enhancing interventions like road
and environmental safety improvement, are also part of the system. Beyond the boundaries of
this definition are those activities whose primary purpose is something other than health –
education, for example – even if these activities have a secondary, health-enhancing benefit.
Hence, the general education system is outside the boundaries, but specifically health-related
education is included. So are actions intended chiefly to improve health indirectly by
influencing how non-health systems function – for example, actions to increase girl’s school
enrolment or change the curriculum to make students better future caregivers and consumers
of health care [ CITATION Placeholder1 \l 1033 ].

Nearly all the information available about health systems refers only to the provision of, and
investment in, health services: that is, the health care system, including preventive, curative,
rehabilitative and palliative interventions, whether directed to individuals or to populations
[ CITATION Placeholder1 \l 1033 ]. Efforts are needed to quantify and assess those activities
implied by the wider definition, so as to begin to gauge their relative cost and effectiveness in
contributing to the goals of the health system. Even by this more limited definition, health
systems today represent one of the largest, most complex and most costly sectors in the world
economy. Global spending on health care was about 8% of world gross domestic product
(GDP), in the first decade of the 21st century. According to OECD, the U.S. health care costs
in 2010 eat up 17.6 percent of GDP or $8,233 spent on health per person. The average
spending on health care among the other developed OECD countries was $3,268 per
person[CITATION Wor17 \l 1033 ] .

Today’s health systems are modeled to varying degrees on one or more of a few basic designs
that emerged and have been refined since the late 19th century [ CITATION Placeholder1 \l
1033 ]. One of these aims was to cover all or most citizens through mandated employer and
employee payments to insurance or sickness funds, while providing care through both public
and private providers. Much debate has centered on whether one way of organizing a health
system is better than other, but what matters about a system’s overall structure is how well it
facilitates the performance of its key functions. Socioeconomic growth of societies followed
by the demographic expansion and increasing of the life expectancy, as well as the
epidemiological transition with predominance of chronic non-communicable diseases caused
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subsequent changes of the needs and demands of an aging population. It was followed by
creation of more organized and institutionalized healthcare systems instead of the earlier
fragmented services of competing health professionals and health institutions. Today, health
facilities and human resources are unequally distributed within and between countries.
Lower-income countries have three to four times lower rates of doctors and nurses than high
income countries, and access to clinical services is still limited to certain groups and wealthy
people. In these countries, community health workers act as first-line contacts of the health
system.

Successful health system requires resources in order to provide health services to people. The
cost of health care comes from health financing which considers as how resources are
generated and used in a health system. This principle is in line with WHO universal health
coverage policy [ CITATION Ath14 \l 1033 ]. According to the reports of Planning
Commission and Ministry of Health, Pakistan is the sixth most populous country in the world
with approximately 206 million population, with around 64% of the population living in the
rural areas. Health service delivery system in Pakistan was federally administered in the past,
however after 18th amendment there was devolution of power from federal government to
provincial governments which shifted the implementation of health programs through
provincial governments. This created an opportunity to do reforms within system in order to
make people friendly policies so that the goals of equitable health system can be achieved.

As per the report of World Bank (2015), the health and population characteristics in Pakistan
are high fertility, low life expectancy, a young age structure, high maternal and child
mortality, high incidence of infectious and communicable diseases, and wide prevalence of
malnutrition among children and women. The country is undergoing a demographic
transition, which is characterized by a change from high mortality and high fertility to lower
mortality but still relatively high fertility.

Health system in Pakistan faced the challenges of governance, finances, service delivery,
human resources, introduction of new technologies and coping with huge burden of supplies
requirement specially medicines. After devolution, the functions of provincial government
were modified and the provincial governments are responsible of making policy, approving
laws on health issues, drug control, recruitments, planning and implementing health programs
in the province. The federal government does the monitoring and regulatory function, health
research, gathering health related data, negotiate with donors on possible avenues of support,
participate in international meetings, manage federally controlled hospitals and offices, and
procurements [ CITATION Ath14 \l 1033 ].

Burden of Disease

In Pakistan, pulmonary tuberculosis in adults continues to be a major pubic health problem,

acute respiratory tract infections are common and malaria remains a potential threat.
However, injuries, cardiovascular diseases, cancer and diabetes are emerging as major
public health problems. Pakistan is at the beginning of an ‘epidemiological transition’, as a
result of which it will need to face not only the challenges generated by infectious diseases,
but also an increasing burden as a result of non-communicable diseases, as per the National

7
Heath Policy (2014).

Health Care Provision

Under the Pakistani constitution, health is primarily the responsibility of the provincial
governments. The Federal Government is, however, responsible for planning and
formulating national health policies, although the responsibility for implementation rests
largely with the provincial governments. The federal Ministry of Health is responsible for
the implementation of some vertical prevention programmes on AIDS and malaria, and
extended programmes for immunization.

Health care provision in Pakistan comprises private and public services. The private sector
serves nearly 70 per cent of the population, (World Bank Report, 2015) is primarily a fee-for-
service system and covers the range of health care provision from trained allopathic
physicians to faith healers operating in the informal private sector. Neither private nor non-
government sectors work within a regulatory framework and very little information is
available regarding the extent of the human, physical and financial resources involved
[ CITATION Gha00 \l 1033 ].

The public sector comprises more than 10 000 health facilities ranging from Basic Health
Units (BHUs) to tertiary referral centres. At present, a BHU covers around 10 000 people,
whereas the larger Rural Health Centres (RHCs) cover around 30 000–45 000 people. In
Pakistan, Primary Health Care (PHC) units comprise both BHUs and RHCs. The Tehsil
Headquarters Hospital covers the population at sub-district level whereas the District
Headquarters Hospital serves a district, as its name suggests. Currently there are 22 tertiary
care facilities in Pakistan, which are mostly teaching institutions located in the major cities
[ CITATION Kha96 \l 1033 ].

Less than 30 per cent of the population uses the facilities of the PHC units and some studies
indicate that, on average, each person visits a PHC facility less than once per year.The
reasons for their under-utilization, as identified by both managers and consumers, are the
relative lack of health care professionals and especially women, high rates of absenteeism,
poor quality of services and inconvenient location of PHC units [ CITATION Kha96 \l
1033 ].

Recent Initiatives

In the paper of Ather & Sherin (2014), it is clearly stated that the relatively poor state of
health and social indicators has prompted a rethinking of national health policy guidelines
and the initiation of the Social Action Programme Project (SAPP). The state of Pakistan’s
national finances has always resulted in reduced expenditure on health, particularly on the
non-salary portion of the budget. This has led to a decline in the quality of care and service
provision, as a result of a reduction in the development of human resources and non-
availability of drugs and supplies.

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 Social Action Programme Project (SAPP)

SAPP is a national programme to improve provision and quality of basic social

services by addressing issues of access to services, standards, accountability and
responsiveness to clients, and sustainable expenditure. The central focus of SAPP is
to strengthen the policy-making and management capacity of the line departments
and increase expenditure, especially on the non-salary portion of the budget. SAPP
was launched by the Government of Pakistan in 1992–1993 in collaboration with
the provinces, federal areas and donor organizations to bring an accelerated, co-
ordinated and concerted improvement in social indicators, primarily focusing on four
key social sectors: (1) primary health care; (2) primary education; (3) rural water
supply and sanitation; and (4) population welfare.

Public–private partnerships

In a recent health policy development, the government has allocated some funds to a
number of Health Foundations. These are organizations that give grants to physicians
for the establishment of ‘private’ hospitals in the rural areas. The funds are provided
by the government as a loan with minimal interest, which will provide for the
establishment of hospitals and clinics in the private sector, especially in the rural
areas.

The management of non-functional primary health care facilities would be given to

the local NGOs or community- based organizations (CBOs) under this initiative. This
is a separate initiative under which local NGOs and CBOs are asked to manage those
public sector health care facilities that are rarely used because of geographical
inaccessibility or non- availability of health staff for whatever reason. The
government provides the allocated budget for these facilities, and the managing
NGOs and CBOs provide incentives for staff and may generate additional funds to
make the system sustainable. The government continues to provide its share of the
running costs, but the management of the NGOs and CBOs operate these facilities as
non-profit organizations. However, the management can introduce user charges to
make the system sustainable.

National health card scheme

This will be a government-sponsored, prepaid, managed health care scheme for rural
and under-served urban areas to be supervised by DHGs through NGOs and CBOs.
The management of the NGOs and CBOs will serve as ‘intermediary’ institutions to
sell health cards to families in the areas, negotiate and draw up contracts with health
care providers, and manage and supervise the scheme at local level.

Thus, creation of an integrated primary health care system, delivering essential clinical and
minimum public health services, as suggested by the World Bank and advocated by the
MOH, should be a key component of health system reforms. The actual contents of such an
essential minimum package should depend on the most urgent health care priorities, and

9
available financial and human resources. The political and economic situation in Pakistan is
such that it is very important to implement the planned health care reforms, especially the
decentralization process being carried out, at least partially or in pilot districts, so that their
positive benefits can be established. Health sector reforms should be implemented and
results obtained urgently before particular interest groups and bureaucratic inertia undermine
the impetus for reforms. For successful implementation and continuation of health sector
reforms, the concepts of ‘total quality management’ and ‘good governance’ need to become
an integral component of health system management. Moreover, Government should have
to focus the aligned and associated services like facilitation of basic education, so as to
ensure the successful implementation of programmes and systems.

Research Question

Are we able to ameliorate our healthcare system with new initiatives taken by Government
of Pakistan?

A recent WHO survey depicts that, in every three hours, a child dies helplessly in Pakistan
due to lack of basic healthcare and first aid services. Also, malnutrition was the grave issue
for children under 5; the most recent estimates by the United Nations Food and Agriculture
Organization (FAO) state that 37.5 million people in Pakistan are not receiving proper
nourishment. According to UNICEF, “If malnutrition in children is above 15%, it must be
declared as an emergency and the necessary action must be taken. But the level of child
malnutrition in Pakistan has crossed threshold level and has reached up to 17.5 %.”

Now, malnutrition largely contributes to high mortality rate, a catalyst for infectious diseases
among children and is like that of in Ethiopia, Darfur, and other African countries.
Moreover, according to UNICEF health survey statistics, under 5 mortality rate is 75/1000
live births, over 25% of all newborns in Pakistan have low birth weight, 33.03% of children
under the age of 5 are underweight, 53.38% of the children are stunted and wasting has been
reported in 11.52% of the children, which clearly shows that the nutritional status in this
country is poor. Malnutrition in Pakistan is usually associated with poverty and the main
causative factors include low consumption of food and foods with low nutritional value. The
policymakers should know that their inaction in eradicating malnutrition has a lasting legacy
on the future development of children and has been linked to low birth weight and birth
defects, mental and physical health problems, and educational outcomes.

Facts

 According to the report, the year 2018 has also remained highly infectious
year and HIV/AIDS has become a terrible health challenge with 150000
cases positive for HIV including 40000 women, who have the tendency to
vertically transmit the virus to their babies during pregnancy; hence doubling
the disease burden.

 Similarly, Tuberculosis and Viral Hepatitis have wreaked havoc on the

massive population. Pakistan ranks fifth amongst TB high-burden countries
worldwide. Approximately 420,000 new TB cases emerge every year and

10
 half of these are sputum smear positive. It accounts for 61% of the TB burden
in the WHO Eastern Mediterranean Region. Likewise, Hepatitis has a
population pool of about 13 million chronic hepatitis B and C carriers.

 Furthermore, even though it has been eliminated from the world, Poliovirus
is still prevalent in Pakistan and its re-emergence is a major public health
threat to the world; yet there still exist taboos regarding the polio vaccination
in northwestern Pakistan under the garb of religion. In 2017, we have 8
positive cases of Poliomyelitis and even with the spending of huge budget,
the number of cases increased in the coming years. It is ironic that in
Afghanistan, importations of wild poliovirus from Pakistan occurred.

 Moreover, the lack of prior preparedness and disaster management tactics at

the local and governmental level have contributed to the emergence of many
infectious diseases, malnutrition in children and the deterioration of health
conditions of many children, woman and elderly population.

Apart from it, the number of cases of non-communicable diseases has also increased. The
three entirely preventable diseases Diabetes Mellitus, Cancer and Hypertension have been
the major killers in Pakistan. According to International Diabetes Federation, Pakistan will
be among top five countries within next few years with 11.5 million people living with
Diabetes Mellitus. Similarly, Hypertension League reports that 50 percent of adults suffer
from hypertension and it has been a major killer because hypertensive people are at high risk
of developing Cardiovascular Diseases. Lastly, the mortality rate due to Cancer especially
Breast & Lung Cancer has remained high in 2018 with total increase of 0.2 million cases.

Cases as an Example

It is recognized that in both developed and developing countries, the standard of health
services the public expect are not being provided. A very high proportion of the population in
many developing countries including Pakistan, and especially in rural areas, do not have any
access to health services, which can be used by only the privileged few and urban dwellers.
Although there is the recognition that health is a fundamental human right, there is a denial of
this right to millions of people who are caught in the vicious circle of poverty and ill-health.
In short, there has been a growing dissatisfaction with the existing health services and a clear
demand for better health care[ CITATION Ath14 \l 1033 ].

Improving health services in poor communities might involve changing the incentive
structure for public providers. Introducing incentives in the public sector is often difficult due
to non-flexibility of civil service rules. Along with that, numerous facts reflect that doctors
and paramedical staff are not satisfied or content with their current benefits rendered to them
for their hard and diligent work.

The recent wave of persecution faced by doctors is not something new. Over the years,
medical practitioners, mostly young doctors, have been victims of intolerance and abuse –
both verbal and physical – at the hands of patients and their attendants. Of the many problems
that surround Pakistan’s healthcare chassis, the issue that needs to be addressed on a priority
basis is the safety and wellbeing of doctors in public hospitals. According to official reports,
11
only one doctor is available in Pakistan for every 6,325 people. This ratio is worsening
rapidly owing to the unsafe working environment. With each passing day, more young
doctors are opting to work in health systems outside Pakistan where they are provided
workplace safety, respect, and adequate compensation, which reflects on their medical
journey and long working hours. The doctors who choose to stay in Pakistan either cannot
bear the expenses of going abroad or have domestic compulsions that prevent them from
moving to other countries.

Taking the recent case of the Young Doctors Association (YDA) of Sindh, who had boycotted
the outpatient departments (OPD) of government hospitals. They demanded that the
provincial government increase their salaries, allowances and health insurance to the same
levels as those offered to government doctors in Khyber Pakhtunkhwa and Punjab.

On that situation, provincial health minister Dr Azra Fazal Pechuho called the striking doctors
for negotiations and assured them of a salary hike however; the doctors insisted on issuing a
notification. After struggling hard, Sindh chief minister’s adviser Barrister Murtaza Wahab
assured the protesters of raising their salaries equivalent to those of doctors in Punjab.
Advisor said that the demands will be met within a week. After the declaration, the doctors
announced to begin work in hospitals. Finally, the matter settled after the announcement of
Sindh chief minister’s adviser.

Pakistan’s polio eradication campaign is facing a range of challenges due to a poor health
infrastructure, managerial and operational deficits and serious inequities in immunisation
coverage across the country. Conflict and insecurity have been particularly damaging to polio
eradication efforts in recent years, especially in FATA and KP, the main reservoirs of wild
poliovirus in the country. Operation Zarb-e-Azb, a military offensive launched in 2014
against militants in FATA, has re-established access to vaccination teams and enabled more
intensive SIAs, translating to a significant reduction in reported cases of poliomyelitis in
2015. Pakistan’s polio eradication effort can capitalize on these gains by addressing the gross
inequities in its strategy and infrastructure, help shift perceptions against vaccination through
more concerted community engagement and education initiatives, and address vaccine
hesitancy using tools such as mass-media campaigns. Strengthening collaborations with
influential religious leaders and organisations can also help mitigate the religious and
political dimensions of vaccine hesitancy in Pakistan. Addressing these social and systemic
deficits is critical to eradicating polio from Pakistan and achieving the GPEI’s objectives.

Pakistan’s polio eradication campaign provides important lessons for the delivery of future
global health initiatives; the role of traditional social and religious norms and their wider
diplomatic, security, economic and social repercussions in an era of increasing globalisation
should not be underestimated in achieving global health outcomes and fostering broader
socioeconomic development.

Conclusion

It is now widely recognized that health outcomes are deeply influenced by a variety of social
factors outside of health care. The dramatic differences in morbidity, mortality, and risk

12
factors that researchers have documented within and between countries are patterned after
classic social determinants of health, such as education and income [ CITATION CSD08 \l
1033 ], as well as placed-based characteristics of the physical and social environment in
which people live—and the macrostructural policies that shape them.

With regard to public health expenditure, the average expenditure on health, since 1949-50,
remained around 0.6 percent of the GDP. Whereas, allocation for developmental expenditures
has always been low as compared to current expenditures and within the developmental
expenditures, the utilization of the budget is geared towards enhancement of physical
infrastructure only. Thus, showing that government policies seem to lack the competence to
address the issues regarding quality of health facilities and capacity building.

Policy makers’ entire focus on the CPEC related activities, provision of improved
infrastructure will boost the growth momentum helping in achieving target growth rates in
the short term. However, going forward, the goal of economic development may not be
achieved if the state of neglected human capital prevails and no attention is given to training
Pakistani talent for skills and innovations. In the light of growing consensus on the significant
positive effect of healthy human capital on economic growth and development, most
neglected areas of human capital (weak public education and health system) may provide
hindrances to persistent economic growth in the economy.

Health statistics in Pakistan show serious gaps in public service delivery. A similar pattern of
below the mark governance was also highlighted in the study titled as “Quality and
Effectiveness of Public Spending on Education in Pakistan”, which shared missing aspects
and prerequisites of long-term gains in terms of capacity building of human resources.
Similarly, multiple layers of health sector, stemming from assisting staff to skilled staff to
highly skilled professionals requires solid reforms. There is a dire need to explore the array of
opportunities, which can benefit the sector many folds, once adequate attention, and
resources are allocated.

It is imperative that policy makers may prioritize their focus towards adequate and quality
provisioning of public education and health services in order to build a solid foundation for
long-term economic growth. As highlighted by Brempong and Wilson (2004), “government
is relatively inefficient in the provision of education and health sectors. This means that
higher allocation of budget to a specific sector not necessarily will bring improvement in
social outcome, unless specific measures are implemented to correct the underlying
inefficiency in spending”.

In order to have a meaningful outcome in terms of comparable parameters, priority should be

to follow international best practices. There is no quick fix that can be obtained by spending
money, bringing foreign aid, investing in infrastructure etc., if standards in human capital are
not enhanced and maintained at that level.

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