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HEALTH STATUS

NATIONAL HEALTH POLICY 2001

IMPORTANT TABELS

PIPHRO ACTIVE IN HEALTH FOR:
Reducing morbidity and mortality for the population groups at greatest risk;
Having individuals improve their health behaviour;
Having individuals identify and solve (to the maximum extent possible) their health and related problems utilising existing resources; demonstrate how affordable collaboration between public and private sectors can result in dramatic reductions and solution of serious health problems.

HEALTH STATUS

Health conditions have improved in Pakistan over the past decades resulting in increase in average life expectancy for both male and female. Health infrastructure, at both primary and secondary level has expanded and accessibility of health services to general masses has improved. However, compared to other developing countries in general and the countries of the region in particular, health services still lag behind. A quarter of the population has no access to general health care services whereas only 60 percent women have access to pre and postnatal services in their vicinity. The health seeking behaviour is also alarmingly discouraging especially among pregnant women who do not go to health professionals for check-ups. Most of them assume that they are healthy and therefore do not require visiting a doctor or health service provider during pregnancy. Over three-fourths mothers deliver at home and are often attended by untrained traditional birth attendants.

Maternal mortality is high and is estimated between 300-400. Infant and child mortality is on decline but is still very high compared to other countries in the region. About one-third women are anaemic and about the same proportion of children are severely malnourished. According to official sources, the immunisation coverage is around 70 percent and still requires lot of efforts and motivation to make it universal. The government aims to increase the immunisation coverage to 80 percent by the year 2005 and full coverage reached by 2010. It also aims to eradicate Polio by 2002. The total number of HIV cases reported by December 31, 2000 is 1549 while there were 202 AIDS cases.

A number of health programmes are under implementation which include National Programme for Family Planning and Primary Health Care; Extended Programme of Immunisation; National AIDS Control Programme; Malaria Control Programme; Tuberculoses Programme; Women Health Project; National Hepatitis-B Control Programme; Cancer Programme; Genetic Disease Screening Programme; Drug Abuse Master Plan. The government is also taking a number of steps to overcome malnutrition. These include the Micro-nutrient Deficiency Control Programme; Promotion and Protection of Beast-feeding; Vitamin A Deficiency Control Programme; Anaemia Control Programme; Iodine Deficiency Disorder Control Programme and Nutrition Programme under SAP II.

NATIONAL HEALTH POLICY 2001

The Federal Cabinet endorsed the National Health Policy on June 11, 2001. The policy provides an overall national vision for the Health Sector based on �Health for all� approach. It aims to implement the strategy of protecting people against hazardous diseases; of promoting public health; and of upgrading curative care facilities. The policy identifies a series of measures, programmes and projects as the means for enhancing equity, efficiency and effectiveness in the health sector through focussed interventions.

Key features of the policy

Health sector investments are viewed as part of Government�s Poverty Alleviation Plan;

Priority attention is accorded to primary and secondary tiers of the health sector; and

Good governance is seen as the basis for health sector reforms to achieve quality health care.

Specific Areas of Reforms

To achieve the vision of �Health for All� the policy identifies following ten areas under which specific modalities are to be implemented to achieve specific targets within ten years. Following are the specific areas:

1.Reducing widespread prevalence of communicable diseases

a. Preventive and promotive health programmes with clear spheres of responsibility of the federal and provincial governments;

b. Expansion of EPI programme by introducing Hepatitis-B vaccine from July 2001;

c. Strengthening of routine EPI facilities by providing cold-chain equipment over five years period;

d. Observing National Immunisation Days against Polio to ensure WHO certification by 2005;

e. Implementation of National Programme for immunising mothers against Neonatal Tetanus in 57 selected high-risk districts of the country over three years;

f. Introduction of new National Programme against Tuberculosis based on DOTS (Directly Observed Treatment Short Course) mode of implementation;

g. Implementation of new National Malaria Control Programme, focussing on malaria microscopy through upgraded basic health facilities and early diagnosis with prompt treatment and selective sprays; and

h. Prevention of HIV transmission through health education; surveillance system; early detection of Sexually Transmitted Infections (STIs); improved care of affected persons; and promotion of Safe Blood Transfusion. A uniform law will be enacted to set up Blood Control Authorities in the provinces:

2. Addressing inadequacies in primary / secondary health care services

The main inadequacies are identified as inadequate equipment and medical personnel at BHU/RHC level and major shortcomings in emergency care, surgical services, anaesthesia and laboratory facilities at tehsil and district hospital level. Lack of referral system is also a major problem.
The implementation modalities will include following:

a. Utilisation of trained Lady Health Workers to provide health care to the un-served population. This would ensure family planning and primary health care services at the doorstep of the population through an integrated community-based approach;

b. Deployment of 71000 Family Health Workers under the National Programme for Family Planning and Primary Health Care and increasing this force to 100,000 by the year 2005;

c. Improvement of district/tehsil hospitals under a phased manner. A minimum of 6 specialities (Medicine, Surgery, Paediatrics, Gynae, ENT and Ophthalmology) will be made available at these facilities;

d. Up-gradation of district and tehsil hospitals to the desired standard through Provincial Master Plans;

e. Performance of RHCs/BHUs will be reviewed. Adequately functioning facilities will be strengthened by filling up staff positions and allocation of financial resources, while poorly performing facilities will be contracted out to the private sector or other alternative uses explored;

f. A model referral system will be developed and implemented in selected districts of each province and replicated countrywide by 2005.

3.Removal of professional / managerial deficiencies in the district health system

Weak supervision and monitoring system at the district level and vacant position of doctors and paramedics at the primary and the secondary health facilities and specialist positions at the tehsil and district level were identified as deficient areas.
Following modalities are to be implemented:

a. Adequate financial and administrative powers to District Health Officers under the Devolution Plan;

b. Appointment of DHO on merit based criteria;

c. Improved working and living conditions for doctors, nurses and paramedics in rural areas;

d. Compulsory rural medical service for two years for in-service Medical Officers for promotion to higher grade;

e. Compulsory rural medical service for two years by specialists serving in non-teaching hospitals before consideration for promotion to higher grade;

f. For postgraduate programmes preference to be given to those Medical Officers who have completed two years of rural medical service;

g. Medical Officers and health workers to be trained in anaesthesia and obstetrics to address the acute shortage of trained staff in these areas;

h. Institutionalisation of mega-hospitals under autonomy arrangements;

i. Replacement of private practice of specialists by the system of institutional practice in maga-hospitals. Respective governments to frame rules for this purpose.

4. Promotion of greater gender equity in the health sector

Implementation modalities include the following:

Improved safe motherhood services for mothers and focussed reproductive health services to childbearing women through a lifecycle approach will be provided at doorstep;

Increased access to primary health services through lady health workers programme;

Emergency Obstetric Care facilities to be provided through establishment of �Women-Friendly-Hospitals� in 20 districts under Women Health Project;

Establishment of referral system between the village level and the health care facilities up to district hospital level under the Women Health Project;

More job opportunities for women as LHWs, midwives, LHVs and Nurses by increasing enrolment in Nursing Schools, Midwifery Scools and Public Health Schools;

5. Bridging the basic nutrition gaps in the target-population i.e. children, women and vulnerable population groups

Implementation modalities include:

a. Vitamin supplementation to be provided to all under-5 children along with Oral Polio Vaccine (OPV) on National Immunisation Days through EPI network;

b. Provision of iodised salt and fortified flour and vegetable oil by addition of micronutrients like Iron and Vitamin-A;

c. Food fortification programme under Nutrition Project in co-ordination with local food industry;

d. Provision of Nutrition Package through 100,000 Family Health Workers which includes Vitamin-B Complex Syrup, Ferrous fumerate and Folic Acid to deserving persons, especially childbearing women and sick family members; and

e. Mass awareness and health education programmes will be run through multi-media.

6. Correction of urban bias in the health sector implementation modalities

Every medical college, both in the public and private sectors will be required to adopt at least one district / tehsil hospital or primary health facility in addition to the teaching hospital affiliated to it. This will entail mandatory visits on rotation basis by faculty / medical students to spend more time in rural settings while helping to provide selective specialist cover to the beneficiary population. Detailed schemes on these lines will be chalked out by the provincial governments / Boards of management of medical colleges.

7. Introduction of required Regulations in the Private Medical Sector to ensure standard equipment and services in private health facilities as well as private medical colleges and Tibb/Homoeopathic teaching hospitals

Implementation modalities include:

a. Enactment of laws/regulations on accreditation of private hospitals, clinics, and laboratories;

b. Ensure adherence to PMDC approved standards by private medical colleges before students are admitted;

c. Amendment of existing law on Tibb and Homoeopathy to recognise degree and postgraduate level courses in Traditional Medicine

d. Development of appropriate framework for encouraging private-public sector co-operation in the health sector, especially for operationalising un-utilised or under-utilised health facilities through NGOs, individual entrepreneurs or doctors� groups.

8. Creation of mass awareness about public health matters

Implementation modalities include:

a. Optimal use of multimedia to educate people about health and nutrition

b. Airing programmes on health and nutrition on electronic media in co-ordination with Health and Education Ministries, National Institute of Health, Health services Academy and national Programme Authorities of Anti-TB, Malaria and HIV/AIDS Control Projects;

c. Establishment of Nutritional Cell in the Ministry of Health with required nutrition experts and mass communication specialists;

d. Training of Family Health Workers in inter-personal skills to improve advocacy regarding family planning and primary health care;

e. Greater participation of NGOs and civil society in Mass Awareness

9. Improvement in Drug sector to ensure the availability, affordability and quality of drugs in the country

Implementation modalities include:

a. Encouragement of multinational and national companies for local manufacturing of drugs;

b. Prioritising local manufacturing of imported drugs which are in short supply;

c. Balanced and fair pricing policy to encourage investment in the pharmaceutical sector;

d. Strengthening market surveillance capacity and quality control and up-gradation of laboratories at Karachi and NIH, Islamabad

e. Limited availability of free life-saving drugs in emergency and casualty departments in hospitals. Provision of free life-saving drugs to poor people through Zakat system. Free health package will be available to target population through family Health Workers.

10. Capacity building for Health Policy Monitoring in the Ministry of Health

A policy Analysis and Research unit will be set up in the Ministry of Health which will monitor health policy implementation in the key areas. The unit will also provide technical facilities to Provincial Governments on need basis.

IMPORTANT TABELS

AVAILABILITY OF HEALTH , HOSPITALS BEDS TO POPULATION IN PAKISTAN (1995-2000)

Name of Year	Population/Doctor	Population/Dentist	Population/Nurse	Population/Midwife	Population/LHV	Hospitals Beds
1995	1769	44,823	5,530	5,897	29,465	1,437
1996	1,708	43,153	5,117	5,852	28,769	1,471
1997	1,616	40,134	4,423	5,805	27.628	1,447
1998	1,613	38,712	4.048	6,032	26,885	1.471
1999	1,567	35,287	3,793	6,091	25,751	1,484
2000	1,525	33,421	3,709	6,194	28,432	1,486

FOOD, CALORIES & PROTEIN VAILABILITY PER-CAPTIA IN PAKISTAN (1949-50 TO 1999-00)

Items	Units	1949-50	1979-80	1989-90	1995-96	1996-97	1997-98	1998-99	1999-00
Cereals	Kg	139.3	147.1	164.1	156.9	157.9	159.9	172.7	173.3
Pulses	Kg	13.9	6.3	5.4	6.2	5.9	5.9	7.0	6.7
Sugar	Kg	17.1	28.7	27.0	26.4	28.9	32.8	32.4	27.0
Milk \	Ltr	107.0	94.8	107.6	121.1	123.9	147.3	148.0	147.8

Pakistan International Peace & Human Rights Organization Nindo Shaher District Badin Sindh Pakistan

PIPHRO ACTIVE IN HEALTH FOR:

Pakistan International Peace & Human Rights Organization
Nindo Shaher District Badin Sindh Pakistan