The Socio Economic Performance Report, Khyber Pakhtunkhwa (2015-16) Health Department Government of Khyber Pakhtunkhwa
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Health Department
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The Socio Economic Performance
Report, Khyber Pakhtunkhwa (2015-16)
Health Department Govt; of Khyber
Pakhtunkhwa
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Introduction
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Overview
Improved health status of individuals adds to the
socio-economic productivity of a society and the nation at large. Health
Systems aim to improve the health status of individuals, families and
communities, to defend the population against what threatens its health,
protect people against the financial consequences of ill-health, provide
equitable access to people-centered care and make the individual attain the
highest possible health status to live a socio-economic productive life in
the community. The Department of Health developed Khyber Pakhtunkhwa Health
Sector Strategy 2010 - 2017 based
on the strategic directions and priorities outlined in the National Health
Vision.
The Department of Health Government of Khyber
Pakhtunkhwa is headed by Secretary Health who is assisted by One Special
Secretary , two Additional Secretaries and a Chief Planning Officer. The
Additional Secretaries who are assisted by 4 Deputy Secretaries, 13 Section
Officers, One Deputy Director (IT) and one Computer Programmer deal with
health matter related to establishment, administration and current budget.
The Chief Planning Officers who is assisted by 3 Senior Planning Officers, 5
Planning Officers and one Economist deal with new developments in the health
sector. A small project called Health Sector Reforms Unit (HSRU) was
established in the Department to carry out research activities and work on
reforms being introduced in the Health Department. The Chief of HSRU, heads
the unit and is assisted by one Deputy Chief and four Coordinators.
Health
Department's further break up and allied institutes are as under:
Directorate General Health Services (DGHS),
Provincial Health Services Academy (PHSA), Medical Faculty, Medical Teach
Institutes (MTIs), Pharmacy Council, Health Care Commission (HCC) , Health
Foundation , Khyber Medical University. Further at district level the Health
Department has District Health Offices and District Headquarter Hospitals.
Health Department Khyber Pakhtunkhwa has a total of 1594 Health Care Facilities /
Hospitals of different categories which include; 09 Teaching Hospitals,
21 District Head Quarter Hospitals , 23 Tehsil Head Quarter Hospitals, 06
Women & Children Hospitals , 04 Category C Hospitals , 20 Category D
Hospitals, 43 Civil Hospitals , 04 Police Hospitals , 04 Jail Hospitals , 784
Basic Health Units , 447 Civil Dispensaries, 92 Rural Health Centers , 23
Health Sub Facilities , 56 Mother Child Health Centers, 24 Leprosy Centers,
35 TB Centers in the province.
The Department has a workforce of around 60,000 employees, that include; 997
Specialists , 7,986 Medical Officers, 274 Dental Surgeons, 352 Health
Managers, 3,707 Nurses, 15,000 LHWs, 1,450 CMWs, 14,542 Paramedics and others
staff at the health care facilities across Khyber Pakhtunkhwa.
Functions of the Health Department
I. Leadership and evidence-based direction setting
for health sector
i.
Health policy and reforms.
ii.
Health planning, financing and
budget.
II. Health Support and Development.
iii.
Health promotion
(a) Health education; and
(b) Community
involvement and advocacy
iv.
Disease Prevention and control
(a) Communicable diseases; and
(b)
Non-communicable diseases
v.
Occupational Health
vi.
Environmental
Health
vii.
Curative and
rehabilitative care.
(a)
Primary, secondary and tertiary level curative services including mental health; and
(b)
Rehabilitative care
viii.
Health
related preparedness and response to disasters
III.
Health Regulation and Enforcement
ix.
Health personnel,
facilities and services.
x.
Levying of
fees and charges by medical professionals and facilities.
xi.
Quality
assurance and control.
xii.
Facilities
and services.
xiii.
Drugs
control.
xiv.
Alternative
systems of medicine.
xv.
Food and
sanitation:
(a) Prevention and control of adulteration in food; and
(b) Monitoring & reporting upon
safe drinking water supply and sanitation
services
xvi.
Devices and
technology
IV. Management Support Services.
xvii.
Health human
resource planning.
Health human resource development: (a) Provision of quality medical and allied education;
(b) Pre-service training of
support medical and health professions; and
(c) In- service
training of health human resource
xviii.
Health human
resources management.
xix.
Logistics
and procurement.
xx.
Internal
audit and accounting in the Health Department
xxi.
Legal
services:
(a) Propose
medico-legal advice and litigation;
(b) Propose law
review, amendment, formulation relating to Health
Department; and
(c) Facilitate
Law Department in litigation related to Health Department.
V. Monitoring and evaluation
xxii.
Generation
of evidence:
(a) Performance assessment;
(b) Information and
communication systems; and
(c) Health, medical and
allied research
xxiii.
Knowledge
management for evidence based decision making.
VI. Co-ordination on health related matters with Ministries, Departments, Local
and
International Partners and
donors
Vision
/Objectives of Health Department
Mission
The mission of the Department of Health Government
of Khyber Pakhtunkhwa is to protect the Health of all citizens in Khyber
Pakhtunkhwa Province.
Vision
The Department of Health will reorganize the
Health Sector in Khyber Pakhtunkhwa Province with clear distinction between
regulation, financing and provision of health services in order to achieve
the optimum benefit within the available resources for the people of Khyber
Pakhtunkhwa Province. The government’s role as a guardian for the health of
the citizens of Khyber Pakhtunkhwa Province is to regulate according to
international standards the quality of health care services and health care
providers and medical training institutions.
Goal
The goal of the Health Department Khyber
Pakhtunkhwa is to improve the health status of the populations in the province
through ensuring access to a high quality, responsive healthcare delivery
system which provides acceptable and affordable services in an equitable
manner. The priority areas of health from the Comprehensive Development
Strategy have been formulated into five health outcomes. These are:
Outcome 1:
Enhancing coverage and access to essential health services especially for the
poor and vulnerable.
Outcome 2: A
measurable reduction in morbidity and mortality due to common diseases
especially among vulnerable segments of the population.
Outcome 3:
Improved human resource management
Outcome 4: Improved
governance and accountability
Outcome 5:
Improved regulation and quality assurance
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Situation Analysis
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Khyber Pakhtunkhwa has a population of over 25
million out of which more than 31% live below the poverty line and almost 50%
are illiterate. The health indicators demonstrate a serious need to improve
the service delivery in terms of both coverage and quality.
The Maternal Mortality Rate in KP is 275 per
100,000 live births, infant mortality rate is 63 per 1,000 live births and
the Under Five Mortality Rate is 75 per 1,000 live births. Total fertility
rate @ 5.6 is one of the highest in the country. The ratio of Lady Health
Workers per client is 923:1 and that of doctors is 5230:1 per patient.
There are 92 Rural Health Centres and 784 Basic Health
Units in the province which are not enough to cater to the rising population,
the coverage being especially low in the rural areas, where the average
distance to a primary healthcare facility is 10 km, three times more than in
the urban centres.
Staff shortages and non-availability of medicines
are some of the prevalent systemic issues. According to the Community Information Empowerment and
Training Survey 2004, only 9% of the patients who had used a government
medical facility were able to receive all the prescribed medicines.
According to Pakistan Demographic and Health
Survey (PDHS) 2012-13, in KP 60.5 percent women consulted a skilled
healthcare provider for antenatal care; and this proportion was even lower in
rural areas (55.9 percent). Less
than half (48.3 percent) of the total deliveries in the province were
conducted by a skilled birth attendant; and the situation was even worse in
the rural areas of the province (44.1 percent). Furthermore, 52.3 percent
children in KP were fully immunized.
The proportion of children who did not receive any vaccine was 12
percent, as compared to the national average of 5.4 percent.
KP spends approximately US$6.4 per head on health
expenditure and patients have to rely largely on the Out Of Pocket Expenditure,
which constitutes 76.6%6, one of the highest in the country.
Public spending on health is limited due to the
overall budget constraints and only 7.1% of the provincial budget (Rs. 38
billion) was allocated to the health sector in 2015, despite the increase in
the federal transfers resulting from the 7th NFC Award which raised the
overall envelope for KP to 14.62%.
Health Financing in KP Health is one of the
priority areas for the Government of Khyber Pakhtunkhwa and the government
has considerably increased the budgetary allocation for the sector during the
period from 2013-14 to 2016-17.
Sector allocation has shown annual growth rate of
56.9% and has increased from PKR 32.8915 billion in 2013-14 to PKR 42.616
billion in 2016-17 but this still constitutes only 8.43% of the total
provincial budget. Per capita health expenditure has also shown an annual
growth rate of 56.9% from PKR 1,154.22 to 1,493.29.
Analysis of the budget for the period 2013-14 to
2016-17 indicates that the development budget on an average constitutes 33%
of the total sector budget and the remaining 67% budget is allocated for the
operational expenses i.e. the current budget. Current budget is mainly tied
up in the fixed costs. The major element of the current budget is the employee
related expenditure which constitutes 76.4% of the total current budget over
the period of four years.
The Department of Health has been effectively
utilizing the budget and the utilization rate of the department has been on
average 92% during three years from 2013-14 to 2015-1618.
However, the fiscal space for ensuring universal
health coverage is highly constrained with the result that the province has
limited flexibility to finance health services. Hence a shift toward Public
Private Partnership (PPP) is a natural and appropriate policy option and can
lead to the achievement of the health service delivery targets as set out in
the Provincial Strategy; provided workable initiatives are implemented
through reputable institutes / organizations in the province.
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Reform Agenda of Government of Khyber Pakhtunkhwa
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Reforms Initiatives in Khyber Pakhtunkhwa
2013 - 2017
Health is key priority sector for Government of Khyber Pakhtunkhwa and
major focus is bringing systematic changes to build strong institutions that
can deliver quality services. Government of Khyber Pakhtunkhwa initiated
Health Reforms in year 2013. Improving performance of the health sector under
the following areas/heads:
I.
Institutions' building :
i. Khyber
Pakhtunkhwa Health Foundation (KPHF)
§
KP Health Foundation Act 2016
§
Health Foundation restructured
to become prime agent for Public Private
Partnerships (PPPs)
ii. Health
Care Commission (HCC) Khyber Pakhtunkhwa
§
Health Care Commission Act 2015
§
The ex-Health Regulatory
Authority (HRA) is in process of
transformation into to a vibrant Organization; HCC Khyber Pakhtunkhwa;
entrusted with the role to regulate public and private sector
health facilities in the
province.
§
Developed Standards for ensuring Quality of Services at
Primary and
Secondary
Health Care Facilities
§
And a mechanism for regulating
both public and private sectors through the
Health
Care Commission to meet service demands as per standards described
in the Minimum Health Service Delivery Package
(MHSDP)
iii.
Medical Teaching Institutions
(MTIs) Reforms
§
Khyber Pakhtunkhwa Medical
Teaching Institutions Reforms Act, 2015
§
Autonomous and fully empowered
boards of Governors formed at each MTI
level
§
Improved utilization of
hospital resources, quality of healthcare services,
financial performance and
medical performance
§
Enhanced utilization of services in the public
sector autonomous
institutions
iv. Social
Health Protection (SHP)
§
SHP is state sponsored insurance scheme for the deserving population
§
Social Health Protection
Program expanded to all the 25 districts of
Khyber
Pakhtunkhwa
§
SHP's Sehat Insaf Cards are in process of distribution on the
analogy
BISP in all districts of Khyber
Pakhtunkhwa.
§
Enhancing the coverage to 50%
of population with a cost of Rs. 5.4 billion
(2 years).
§
This will benefit 1.8 million
households i.e. 12 million individuals.
§
The covered cost per
family is enhanced to Rs 210,
000 with a tertiary care
add-on of PKR 300,000 per family.
§
The package include
post-delivery transport cost and referral transport
v.
Independent Monitoring Unit (IMU)
§
Monitoring and supervision on
modern ICT tools in real-time
§
To reduce staff absenteeism,
improve quality of services and conduct patients
interviews using latest smart phones
vi. Drugs
and Food Regulation
§
KP Food Safety Authority Act
2014
§
Food Safety Authority
established, is in process of implementation
§
KP Protection of Breast-Feeding
and Child Nutrition Act, 2015 has been
Implemented through the Health Department Provincial Drugs Inspectors
vii. Pharmaceutical / Medicines Sector
Control
§
Drug Inspectors fully mobilized
across KP and Rs 28million allocated to ease
out their mobility.
§
Provincial Quality Control
Board decided almost 2000 in numbers that were
lying pending for want of decision since 2005.
§
Khyber Pakhtunkhwa Pharmacy
Council issued 2800 licenses of various
categories for retail, wholesale and distribution of drugs in order to
resource pharmacies with qualified human resource, thereby strengthening
the economic base of the society.
viii. Revised
Health Management Structure
§
Up-gradation / restructuring of
226 positions at provincial and district management
level
§
Bio metric system for
attendance operational at DGHS Office, Secretariat,
Teaching Hospital
§
E-Office system implemented at
provincial level
ix.
District Management Committees
for District Hospitals
§
Hospital Management Committees
at District level with involvement of with
the District Government and
Community Representatives / Stakeholders
x.
Emergency Services:
§
Government has allocated Rs 1
billion per year since 2013-14 for providing
free emergency medicines. More than 20 million patients are benefiting
annually
xi.Treatment
of Chronic Diseases:
§
To provide free treatment to
Diabetic and Renal diseases patients the Govt
of Khyber Pakhtunkhwa has
allocated Rs 925 million so far.
xii.
Increase Immunization Coverage:
§
Government allocated Rs 6.17
billion for Immunization Support Programme
for five years benefiting 2.3 million children of Khyber Pakhtunkhwa
xiii. Treatment
of cancer patients
§
Government of KP allocated an
additional Rs 1.9 Billion for free treatment
of cancer patients
xiv. Establishment of Gajju Khan, Swabi and Nowshera
Medical Colleges
xv. Improvement and beautification of Medical Teaching
Institutes (MTIs) and refurbishment of District Head Quarter Hospitals
xvi. Standardization of District Head
Quarter Hospitals and THQ Hospitals
xvii. Injured
Persons & Emergency (Medical Aid Act) 2014
xviii. Human
Organ Transplantation Act, 2014
II.
Primary Health Care
§
Integrate the full range of
Primary Healthcare (PHC) specially MNCH, immunization
and other Preventive services at the BHU and make BHU the
hub of all PHC
§
Forty six BHUs for 24/7 MCH
services in the province and work in this
regard
has been initiated in 34 BHUs.
§
Mobile health services (MCH)
are launched in District Mansehra, Nowshera,
Charsadda, Peshawar, Haripur, Mardan and Swat
§
Minimum Health Services Delivery
Package (MHSDP) introduction in Primary
Health Care Facilities of Khyber Pakhtunkhwa
III.
Human Resource Recruitment and
Sustainability
§
The present Government has
created over 22,000 posts out of which
15000 have been created in current
budget year 2016-17
§
Vacant Positions filled in
all cadres in all the districts across Khyber
Pakhtunkhwa
§
Incentive Packages for Health Care Workers
To
motivate the health work force this government is spending an additional
amount of Rs 5.46 Billion which includes incentive packages
for doctors, Trainee Medical Officers, House Officers, Nurses and
Para-medics.
§
PHSA Mandate revised; Promotion tied trainings of different cadres
launched
at PHSA; further resources would be allocated to ensure
sustainability
§
Human Resource Information
System (HRIS) established / developed
linked
with PIFRA and FMIS, staff capacities
built with
generation
of information for all cadres in HR Unit established
at DG Office
resourced with HR Specialists.
§
Service structure revised
for cadres and amended service rules where
required
and measures for their in-time
implementation
§
Master plan for Human
Resource Management; HRD Plan developed;
HR
Retention Strategy in place
§
To improve the quality of
Paramedics Training; Post Graduate courses
are
started with the collaboration of KMU
IV.
E-Health
§
E-health / telemedicine
PC1 has been approved and is in process of
administrative
approval.
§
The PC1 project includes
o
Feasibility Study for this
innovative intervention
o
Service contract with
Service provider after feasibility on pilot basis in two districts
o
Toll free helpline
o
Performance management
through KPI
o
HMC Hospital computerized
o
Maternal Child Health
awareness increased using electronic communication tools
In
addition to Health Sector Reforms Chief Minister also announced certain special
initiatives to further improve Health Status of the population of the province.
These initiatives include :
1)
Establishment of Insulin Bank (Insulin for life)
2)
Health Insurance for Critical Illnesses
3)
Improving Maternal and Child Health- Incentivised
anti-natal, natal and postnatal
care
4)
Immunization Services
5)
Improvement of Emergency Services
Previously Ongoing Reforms / Initiatives
1.
Rules of Business of Health Department were revised; Restructuring as
per functions mentioned therein is awaited
2.
Health Sector Strategy- approved; operational plans being prepared and
needs to be implemented
3.
Procurement reforms are underway
4.
Skill Development Program for nurses and physiotherapists is ongoing
at PHSA; Skill Development Program for doctors and technicians may be
launched
5.
District Conditional Grant was successfully implemented; it needs to
be replicated and scaled up in other districts
6.
GIS training conducted; there is need to establish a small GIS unit at
Planning cell to facilitate planning and rationale decision making
7.
Water and Sanitation-policy, strategy and action plan inputs, given to
concerned department; implementation is awaited
8.
Financial Management reforms under way
Other Recent Developments
1.
Dengue Fever Prevention and Control, a project has been approved worth
Rs 59 Million
2.
Integrated HIV/AIDS , Hepatitis and Thalassemia Control Program
PC1; worth Rs 500 m approved and
is in process of implementation.
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Challenges / Gaps
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1)
Khyber Pakhtunkhwa always took lead in health reforms and piloting of innovative health care
models in Pakistan. But sustainability and scaling up of the new initiatives has
been a challenge. Political instability,
lack of ownership by the successors, commitment level of the health
professionals and unstable financial sources are some of the reasons.
2) The fast-growing
population in the province has implications for the health sector both in
terms of human and financial resources. There is need to allocate more
resources both financial and human for increasing coverage of quality
services to the population, improve health outcomes by refurbishment and
renovation of health facilities, appointment of skilled staff against the
vacant and new positions.
3) Capacity building of the
existing health providers so as to utilize the available resources
efficiently; especially of the management cadres , if desired targets are to
be achieved.
4)
Despite a huge investment in health infrastructure in the last decade,
the health facilities are still not enough, especially in the rural areas,
for catering to the needs of increasing population.
5)
Non-availability of medicines is also among the prevalent systemic
issues. Equitable funds allocation and efficient Procurements and Supply
Chain Management (PSM) is needed
to address these grave issues.
6)
Private sector or out of
pocket expenditure on health care is highest in Khyber Pakhtunkhwa among all the
provinces of Pakistan. Improved quality and availability of services in the
public hospitals are a few of the measures that would possibly flip this
ratio.
7)
Disproportionate allocation of sector budget , the development budget
constitutes 33% and the remaining 67% budget is allocated for the operational
expenses i.e. the current budget. Current budget is mainly tied up in the
employee related expenditure which constitutes 76.4%17 of the total current
budget.
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Recommendations and way forward
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1.
Focus on maternal and child health care and coverage of critical
illnesses
2.
Improving governance through restructuring if required, and upgrading
Basic Health Units, Rural Health Centers, and Tehsil Headquarter Hospitals.
3.
Targeting of the districts with the lowest health indicators
4.
Revitalization of the Health Foundation setting a clear policy direction in favor of entering into
public private partnerships in healthcare service delivery.
5.
Improving access of essential and cost effective health services
especially for the poor and vulnerable
6.
Protecting poor strata of population from catastrophic health
expenditures
7.
Emphasizing more on quality of care and services at all levels
8.
Improving the institutional arrangements and management of health care delivery system
9.
Improving the availability (specially female) and motivation of health workforce
10.
Aligning outputs of the academic institutes in line with the needs of
health system and improving the quality of education and training.
11.
Effectively engaging private health sector and civil society
organizations to improve health outcomes
12.
Develop pharmaceutical sector and ensuring access to quality medicines
13. Ensure effective
research, monitoring & surveillance system to measure results and
evidence based decision making at all levels.
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