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2Ministry of Health
Social Indicators of IPRSP - Health(Baseline, Target and Current Position)
21 in 13 districts
0199 (Year 2000)
Polio cases reported in one year
58(LHW-MIS)
8532Target Population covered by LHWs (%)
37(HMIS)
4023Utilization rate of FLCF (%)
35(PIHS-IV 2001-02)
5031Coverage of prenatal care (%)
53(PIHS-IV 2001-02)
8549Routine Immunization coverage of children (%)
24(PIHS-IV 2001-02)
2519Births attended by Skilled personnel (%)
105(PRHFPS 2000-01)
82111Under 5 Mortality Rate (per 1000 lb)
82(PIHS-IV 2001-02)
6589Infant Mortality Rate (per 1000 lb)
Current Position
Target (2003-04)
Baseline (1998-99)
PIHS-III
Core Health Indicators in IPRSP
3Ministry of Health
National Health Programs(Health is a Provincial subject but National Health Programs involving Federal/ Provincial
partnership are being implemented in priority health areas)
Rs. 302 million for 5 years11. National Nutrition Programme
Rs. 273 million for 5 years10. National Malaria Control Programme (RBM initiative)
Rs. 188 million for 5 years9. National TB Control Programme
Rs. 774 million Rs. 2.85 billion for 5 yr
8. National AIDS Control Programme • Enhanced HIV/AIDS Control Programme (2003-08)
Rs. 788 million for 6 years7. Women Health Project (Federal Component)
Rs. 9104 million for 9 years6. The Lady Health Workers’ Programme
Rs. 857 million for 2 years5. Elimination of MNT in high risk districts
$ 44 million for 5 years4. Strengthen routine EPI with GAVI grant
$ 28 million for 5 years3. Introduction of Hepatitis-B vaccine in EPI with GAVI grant
$ 8 million /year2. Polio Eradication Initiative
Rs. 5366 million for 5 years1. National EPI Programme
CostNational Health Programs
4Ministry of Health
Total Government Expenditure on Health(Federal plus Provincial)
(Rs. in billion)Public Sector Health Expenditure
(Federal plus Provincial) Fiscal Year
Development Expenditure
Current Expenditure Total Expenditure
As % of GNP
1996-97 1997-98 1998-99 1999-00 2000-01 2001-02
6,485 6,077 5,492 5,887 5,944 6,688
11,857 13,587 15,316 16,190 18,337 18,717
18,342 19,664 20,808 22,077 24,281 25,406
0.75 0.70 0.71 0.70 0.70 0.74
2002-03 Allocation 6,609 22,205 28,814 0.78
Source: Planning and Development Division; Economic Survey 2001-02.
5Ministry of Health
Allocation of Fed. Health PSDP
Rs. in million
Fiscal Year Allocation for Federal Health PSDP % of Federal PSDP
1999-00 2000-01 2001-02 2002-03
2464.781 2742.974 4213.892 3309.247
2.12% 2.28% 3.24% 3.67%
Source: Budget book
6Ministry of Health
Federal Health PSDPAllocation and Expenditure (2001-03)
Rs. in million
2001-02 2002-03 Programme/ Project Budget
Request Actual
Allocation Expenditure Budget Request
Actual Allocation
National Program for FP & PHC 2232 2256 1770 2466 1791 National EPI Programme 912 696 250 1200 500 Rollback Malaria Initiative 105 146 97 156 31 TB Control Program 20 131 2.6 90 25 HIV/AIDS Control Program 94 184 177 100 100 Enhanced HIV/AIDS Control Programme
- - - 550 150
Nutrition Project - 50 14 50 50 Women Health Project 233 100 89 237 237 Reproductive Health Project - - - 20 20 Others: 2309 650 269 4734 405
Grand Total MOH-PSDP: 5905 4213 2669 9,603 3309
7Ministry of Health
Federal Health PSDP Expenditures (1995-2002)
(Million Rs.)
Fiscal Year Federal Health PSDP Expenditures
1995-96 1996-97 1997-98 1998-99 1999-00 2000-01 2001-02
1852 1802 1581 2024 2193 1790 2669
Source: Economic Survey
8Ministry of Health
Expenditure on Health –Comparison with Other Countries of the Region
Country THE as % of GDP - 2000
GHE as % of THE - 2001
Per capita THE in US $ - 2000
Per capita GHE in US $ - 2000
Bangladesh 3.8 36.4 14 5 Egypt 3.8 46.1 51 24 India 4.9 17.8 23 4 Indonesia 2.7 23.7 19 5 Iran 5.5 46.3 258 119 Pakistan 4.1 22.9 18 4 Sri Lanka 3.6 49 31 15 Thailand 3.7 57.4 71 41
Source: World Health Report 2002, World Development Report 2002 THE – Total Health Expenditure GHE –Government Health Expenditure OOP - Out of Pocket Expenditure
9Ministry of Health
Health Care Delivery Infrastructure
HUMAN RESOURSE FOR HEALTH:Doctors: 96,248 (1,506 persons / Doctor)Dentist: 4,622 (31,371 persons / Dentist)Nurses: 40,019 (3,623 persons / Nurse)LHVs: 5,669 Lady Health Workers: 70,000
Hospitals : 106Small Hospital : 520General Practitioners: 20,000Maternity Homes : 300Dispensaries : 340Laboratories : 450Health Care NGOs : 254
Hospitals : 906Dispensaries : 4,590RHCs : 550BHUs : 5,308MCH Centers : 862TB Clinics : 285 Total Hospital Beds : 98,264
(1,443 persons / bed)
PRIVATE SECTORPUBLIC SECTOR
10Ministry of Health
National EPI Programme
To immunize children against six communicable diseases to reduce child morbidity and mortality.
• GAVI support of $72 million over five years.• Hepatitis-B included in routine EPI schedule.
• Fully immunized (12-23 months ) - based on recall and recordsTotal Urban Rural
Pakistan 53% 70% 46%Punjab 57% 76% 51%Sindh 45% 64% 33%NWFP 57% 70% 55%Balochistan 24% 36% 22%
Source : (PIHS- 2001-02)
11Ministry of Health
Polio Eradication InitiativeEradication of Polio by end 2003• In 2000, new strategies were adopted
–Increased government involvement from outside the MoH at the urging of the National and Provincial leadership.–Door to door strategy.–Extra rounds added.
• In 2001, further intensification–High-risk areas identified through AFP surveillance network.–Additional personnel and resources–Additional rounds in high-risk areas.
• Year Cases1999 5582000 1992001 1192002 852003 (till May) 21
12Ministry of Health
High prevalence rate of the Hepatitis-B in Pakistan (5 to 7 % of the population).
• All children <1 year being immunized against hepatitis-B.• Hepatitis -B vaccination included in routine EPI in all
Districts.• Ultimately will lead to reduction of prevalence of
Hepatitis-B, Cirrhosis, malignancies and other complications.
Introduction of Hepatitis - B Vaccination
13Ministry of Health
Vaccination against Maternal and Neonatal Tetanus
To reduce high neonatal and maternal mortality because of Maternal and Neonatal Tetanus.
• Three rounds have been completed in 55 districts.• 3.9 million Child Bearing Age (CBAs) were immunized
against MNT. • Vaccination in 65 high risk districts is being carried out in
phase III.• Request for Phase IV has been made to JICA
14Ministry of Health
The Lady Health Workers’ Programme (National Programme for F P & PHC)
Major Programme launched to reduce high Infant Mortality, Maternal Mortality and Fertility Rate in the country.
Provision of Promotive, Preventive and Curative services at the doorstep of the community through 100,000 LHWs.
• 70,000 LHWs working in 123 districts of the country. (Selection of 20,000 LHWs started in 2002-03).
• Merger of VBFPWs of Population Division and Lady Health Workers Cadre of Ministry of Health completed.
• The Programme is having a significant impact on a range of health outcomes. A result that is very rarely found in community health programs of this size.
• New PC-1 of the Programme for the period 2003-08, costing Rs.22.4 billion submitted for approval of ECNEC.
15Ministry of Health
Women Health Project
To reduce high Maternal Mortality through• Developing 20 women friendly districts and strengthening of
District Health Management..• Provision of Comprehensive Emergency Obstetric Care
Services in 20 districts.• Recruitment of 8000 LHWs in 20 districts.• Developing midwifery cadre at community level.• Strengthening advocacy, social mobilization and health
education for women health.• Strengthening of Schools/ Colleges of Nursing.
16Ministry of Health
National HIV/AIDS Control Programme
Pakistan is a low prevalence but a high risk country for an HIV/AIDS epidemic. Programme launched to
– control HIV/AIDS cases;– promote blood safety by strengthening safe blood transfusion.
• Extensive Information, education and communication campaign.• Support to 47 HIV surveillance centers throughout the country (About
3.25 million tests performed). • 3.652 million blood screening tests conducted• 1765 HIV cases and 233 AIDS cases have been reported• Enhanced HIV/AIDS Control Programme with the World Bank assistance
has been approved at a cost USD $ 47.00 million.• Safe blood ordinance in place.
17Ministry of Health
TB Control Programme
Pakistan has the sixth largest burden of tuberculosis in the world. The TB incidence @ 177 per 100,000 population.
Programme launched– to control TB through DOTS strategy, international best practice.– to achieve 85% cure rate and 70% case detection rate.
• 69 districts covered under DOTS. • Strengthening of referral laboratories, provision of drugs,
surveillance system and training. • All districts and 100% coverage will be achieved by 2005.
18Ministry of Health
Malaria Control Programme
About half a million malaria cases occur annually.Malaria is a re-emerging disease with high endemicity in
Sindh and Balochistan. Falciparum malaria has registered an increase in Sindh (57%), with overall burden 33%.
Rollback Malaria (RBM) initiative launchedto control malaria morbidity and mortality by reducing annual parasite rate to 50% by 2010.
• 40 high risk districts identified• Implementation started in 19 districts• Expansion of RBM intervention in all districts by 2006• Pilot projects for Impregnated bed nets initiated
19Ministry of Health
50% of CBA women, 45% of mothers and 29% of children are anemic. 37% of children are underweight for age.
PC-1 on Nutrition Project (2001-06) approved at the cost of Rs. 302 million, which includes:
• Nutrition through PHC; Micro-nutrient Supplementation; IEC; Nutrition Research.
• Vitamin A and Iron /Folic acid supplementation to mothers through LHWs.
• Promotion of use of iodized salt.• Training of LHWs on micronutrients supplementation, Lactation
management and Nutritional Education.
National Nutrition Programme
20Ministry of Health
• National Programme on Perinatal and Newborn Care;• National Programme of Community Midwives;• Non-Communicable Diseases Control Project;• Health Management Information System;• Policy Analysis and Research Unit;• National Health Facility (NHF) – DFID;• Early Childhood Development (ECD) Project – ADB;• Global Fund to Fight AIDS, TB and Malaria.
New Initiatives in Health – In Process