Devolution, Governance & Health Mohsin Saeed Khan Ph.D,
MPH, MBBS
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Health OutcomesNumbers/annum Newborn births4,773,000 Newborn
deaths272,330 Infant deaths377,440 Under-five deaths (includes
newborn and infant deaths)473,000 Number of Infants Born
Low-Birth-Weight906,870 Number of Maternal deaths23,865 SourcePDHS
2006-2007
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Total Public Sector Expenditure in Billions (Rupees)
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Per Capita expenditure on Health in Pak Rupees
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Health Expenditure as % of GDP
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Health system assessment Approach, USAID
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Devolution Road Map Ministry of Health since 1970 2001 under
the Local Government Ordinance; Province to Districts July 1, 2011,
18 th Constitutional Amendment abolished seven federal ministries
including Ministry of Health and transferred their roles to other
federal ministries, divisions, and the provinces.
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Devolution Road Map vacuum as the devolved functions were not
detailed out in any plan of action. The functions that have been
retained at the federal level were distributed to different
ministries without setting up a coordination mechanism.
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The Federal Ministry of Health Till June 30, 2011, MoH
responsible for (i) stewardship functions, including national
policy and planning; (ii) regulation and standardization including
pharmaceutical; (iii) medical Education; (iv) research and
information; (v) central health establishment and hospitals; and
(vi) health care provision by managing preventive and infectious
disease control (eleven vertical programs), curative health care
through tertiary care.
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Fragmentation 1.Planning and Development Division, 2.Economic
Affairs Division, 3.Capital Authority Development Department,
4.Ministry of Inter Provincial Coordination, 5.Ministry of National
Regulations and Services, 6.Cabinet Division, 7.Federal Bureau of
Statistics, and 8.Provinces.
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Provinces Health Strategies in Khyber Pakhtunkhwa, Sindh and
Punjab Vertical Program Management without ownership
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Programmatic Challenges Issues of coverage (scope & scale)
Poor access to health services Non-availability of adequate human
resource Population growth Low allocations for health Weak
inter-sectoral interventions Duplication of efforts
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Service & Performance Challenges Financial instability No
accountability for poor performance Political interference Issues
of equity Skilled HR
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Confusion, Chaos & Collapse coordination, international
relationships, national and cross border surveillance, national
information on health, international reporting coordination with
and among provinces, donor coordination, financial forecasting and
resource mobilization, and quality assurance
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Actors Politicians Out Focused Beurocrats Input Focused
Technocrat Process oriented Research & Development Specialists
/ Institutions Driven by TORs Donors Guided by their own sets of
priorities
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So where do we want to go Vision !!!!!!!!! Not on priority list
Burden of Disease (outcome) Not in the planning process Fiscal
Space Management systems and organizational structures What is
beyond MDGs
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IK IK Syndrome
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On bottlenecks Remember that in bottles, the neck is always on
the top!
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Insight from a blind woman There is nothing more pathetic than
a man with eyesight but has no vision.
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Our best thinking got us here. The problems that we face cannot
be solved by the same level of thinking that created them. Albert
Einstein
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Way Forward Embrace Error Redefine Roles Deliver Services
Mobilize Resources Unpack Research
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THE WISDOM OF TAO XVII RULERS Of the best rulers The people
only know that they exist, The next best they love and praise, The
next they fear; And the next they revile. When they do not command
the people's faith, Some will lose faith in them, And then they
resort to oaths! But of the best when their task is accomplished,
their work done, The people all remark, "We have done it
ourselves." Source: The Wisdom of China and India by Lin
Yuntang
