chap 2 – choked pipes health system is defined as ‘comprising all the organizations,...
TRANSCRIPT
*You are a future
healthcare leader!
*What is the role of a leader?
*What is a problem?
*What are the health problems of
Pakistan?
*What would be your priority as a healthcare
leader and reforms would you suggest?
Chap 2 – Choked Pipes
*Health Systems in Pakistan
Health system is defined as ‘comprising all the organizations, institutions and resources that are devoted to producing health actions.
*Health System
1. Service Delivery
2. Health Workforce
3. Information
4. Medical Products
5. Vaccines & Technologies
6. Financing, Leadership, and Governance
*6 Building Blocks
*Urban-Rural % ?
Rural65%
Urban35%
Pakistan Population Rural-Urban
*Literacy% ?
*Literacy
Literate46%
Illetrate54%
Literacy Rate
*Below 15 years age % ?
Below 15 years37%
Above 15 years63%
Age
*Health Coverage in Pakistan?
* Health Coverage in Pakistan
Armed Forces4%
Publicly Mandated
Private Means12%
Government10%
Members of Judiciary & Legislature
0%
Safety Nets0%
Corporate Sector
1%
Out-of-pocket Payments73%
Health Coverage
‘A health system in which out-of-pocket payments and market provision of services predominates as means of financing and providing services, respectively in an environment where publicly financed government health delivery coexists with privately financed market delivery.’
*Mixed Health System
Tertiary Care
Secondary Care
Primary Health Care
*BHU?
Basic Health Unit: a medical facility situated in the smallest administrative unit of government (Union Council) with an average catchment population of 10,000 – 20, 000
*BHU
*RHC?
Rural Health Center: an upgraded PHC facility located at the sub-district administrative unit at the junction of four or five Union Councils; the population served ranges from 20,000-500,000
*RHC
*FLCF?
First Level Care Facilities: comprise BHUs and RHCs
*FLCF
*MCHC?
Maternal and Child health Centre: MCH Centre of the Department of Health
*MCHC
*FWC?
Family Welfare Clinic: family planning facility of the Ministry of Population Welfare
*FWC
*LHW?
Lady Health Worker: village-based female community health worker
*LHW
*THQ?
Tehsil Headquarter Hospital: secondary level hospital
*THQ
*DHQ?
District Headquarter Hospital: secondary level hospital
*DHQ
Over 12,000 FLCF in Pakistan
30% of which are non-functional
*Primary Health Care
90,000 community-based female Lady health Workers
Prevention, maternal and child health, and related family planning services to 55% population.
*Lady Health Workers
2740 Family Welfare Clinics (FWC) of Ministry of Population Welfare
*Family Welfare Clinics
965 Public Hospitals in Pakistan
*Total Public Hospitals?
* Systems of Medicine in Pakistan
Sytstem of Medicine
Modern Western Allopathic System
Tibb-e-Unani, Ayurvedia and Homeopathy
• Ambulatory Clinics
• Maternity Homes
• Private Dispensaries
• Diagnostic Facilities
• Private Hospitals
• Few large sophisticated private sector hospitals in major population centers.
• <10 private hospitals can be compared favourably with international hospital standards.
* For-Profit Healthcare Sector
• NGOs
• Charitable Organizations
• Trust-funded Organizations
• Pakistan’s largest and most effectively functioning ambulance network is owned and operated by a charitable trust – the Edhi Foundation.
• Family Planning Association of Pakistan – Rehnuma
• HIV/AIDS
• 74 large charitable hospitals with over 7000 beds
* Non-profit Healthcare Sector
*Trend of Some Health Indicators
in Pakistan
*Total Fertility Rate
5.4/woman
4.1/woman
1990-91
2006-07
*Under-Five Mortality Rate
117/1000 live births
94/1000 live births
1986-90
2002-06
*Child Immunization
47%
35%
2006
1990
‘Although there have been some improvements in the health status of the Pakistani population over the last 62 years, key health indicators lag behind in relation to the international targets articulated in the Millennium Declaration and in comparison to averages for low income countries.’
*Compendium of Health Statistics
*Triad of Determinants
Inadequate State Funding
Burgeoning Unregulated
Private Sector
Lack of Transparency in
Governance
*Let’s see who is good at making guesses!
*Pakistan’s Key Health
Indicators
*Life Expectancy (years)
63.8*Life Expectancy
(years)
*Dependency Ratio (%)
68.7*Dependency Ratio
(%)
*Total Fertility Rate
4.1*Total Fertility
Rate
*Contraceptive Prevalence Rate
%
29.6*Contraceptive Prevalence Rate
%
*Pregnant Women Receiving at least
one ante-natal consultation %
61%
*Pregnant Women Receiving at least
one ante-natal consultation %
*Women who receive care from
Skilled Birth Attendants %
39%
*Women who receive care from
Skilled Birth Attendants %
*Neonatal mortality Rate
(per 1,000)
54*Neonatal
mortality Rate (per 1,000)
*Infant Mortality Rate (per 1,000)
78*Infant Mortality Rate (per 1,000)
*Under-five Mortality Rate
(per 1,000)
94*Under-five Mortality Rate
(per 1,000)
*Fully-immunized children %
47%*Fully-immunized
children %
*Tuberculosis Treatment
Success Rate %
84%*Tuberculosis
Treatment Success Rate %
*Confirmed Number of Polio
Cases
58*Confirmed
Number of Polio Cases
*Prevalence of Viral Hepatitis %
7.4%*Prevalence of Viral Hepatitis %
*Prevalence of Smoking (18+) %
15.75%*Prevalence of Smoking (18+) %
*Leisure Time Physical Inactivity
(18+) %
91.5%*Leisure Time
Physical Inactivity (18+) %
*Prevalence of Overweight &
Obesity (18+) %
38.5 %
*Prevalence of Overweight &
Obesity (18+) %
*Prevalence of Central Obesity
(18+) %
48.35%
*Prevalence of Central Obesity
(18+) %
*Prevalence of HTN (18+) %
13.7 %
*Prevalence of HTN (18+) %
*Prevalence of Diabetes (25+) %
7.65 %
*Prevalence of Diabetes (25+) %
*Doctor-Population Ratio
1:1,326*Doctor-Population
Ratio
*Nurse-population Ratio
1:22,662
*Nurse-population Ratio
*Dentist-population Ratio
1:3,039*Dentist-
population Ratio