6. WHY DIFFERENT COUNTRIES RESPONDED DIFFERENTLY DURING
PUBLIC HEALTH EMERGENCIES e.g. DURING COVID-19 PANDEMIC ?
7. It is important to look for how fast the country has been able
to bend the Pandemic curve hence reducing the rate of spread
of the disease. It can bee seen that USA failed to bend the
curve earlier hence resulted in high morbidity and mortality
due to COVID-19.
9. To a large extent among comparable economies these
differences could be explained by the performance of their
“Health System”
So
WHAT IS A HEALTH SYSTEM?
10. WHOSE
PRIMARY/MAIN
FUNCTION IS TO:
PROMOTE GOOD HEALTH
RESTORE GOOD HEALTH
MAINTAIN GOOD HEALTH
ADDRESS THE HEALTH
NEEDS OF PEOPLE WITH
DISABILITIES
ALL THE ACTIVITIES
SUCH AS
LEADERSHIP
PEOPLES
FINANCING
ORGANIZATIONS
INSTITUTIONS
POLICIES
ACROSS ALL SECTORS
(Private & Public)
HEALTH SYSTEM CONSISTS OF
11. So according to WHO:
A health system consists of all the organizations, institutions, resources and
people whose primary purpose is to improve health. This includes efforts to
influence determinants of health as well as more direct health-improvement
activities. The health system delivers preventive, promotive, curative and
rehabilitative interventions through a combination of public health actions and
the pyramid of health care facilities that deliver personal health care — by both
State and non-State actors. The actions of the health system should be
responsive and financially fair, while treating people respectably. A health
system needs staff, funds, information, supplies, transport, communications
and overall guidance and direction to function. Strengthening health systems
thus means addressing key constraints in each of these areas.
12. This broad definition of Health System means that:
Health Leaders are responsible not only for healthcare but are also
accountable for health outcomes beyond healthcare.
16. NORMALLY EACH HEALTH SYSTEM HAS 05
COMPONENTS/FUNCTIONS
1) Stewardship(Leadership):- It plays a critical role in overall direction of the health system through
policies, regulations, and leads the health sector.(Leadership, Governance, Planning, Epid.Surveillance,
Intersctoral influence & regulations).
2) Financing: It includes how the health system is funded ( Revenue collection) , how funding is aggregated
(Risk pooling) & strategic purchasing.
3) Health Service Provision: It includes all private/public service deliveries and interventions (PHC, Hospital
care, solo practices, Dental care, MNCH, Immunizations, Mental health program, OPDs etc.)
4) Patients & Population: Even though they are not part of health functions they are the reasons why
systems exists.
5) Inputs: Human resources, Pharma & Medical equipment.
18. Health system of a country is considered to be efficient when:
There exists equitable access to healthcare services.
It is capable of timely responding to population health emergencies.
The system can influence policies for better health outcomes.
19. HOW “HEALTH SYSTEM” OF A COUTRY IS MONITORED AND
ASSESS?
HEALTH SYSTEM OF ANY COUNTRY IS COMMONLY ASSESSED BY USING
WORLD HEALTH ORGANIZATION FRAMWORK THAT HAS SIX BUILDING
BLOCKS.
20. What is a Health system framework?
Frameworks are tools that are used universally to describe the health
system and its components in a standard way.
26. Health Trends in Pakistan
• Infant Mortality Rate (IMR) Infant Mortality Rate (IMR) measures the
mortality below one year of age. It is defined as the number of infant
deaths during a calendar year per 1000 live births in the same year. Infant
Mortality is an important indicator to judge socio- economic conditions,
cultural factors, status of hygiene and availability & utilization of medical
services.
Infant Mortality Rate has been declining in Pakistan but it is still high. Infant
Mortality Rates are much higher in rural areas 59 than in urban areas 50.
27. Health Trends in Pakistan
• Neo-Natal and Post-Neo-Natal Mortality Rates Mortality during the
first year of life is divided into two main period’s i.e. Neo-natal
Mortality occurring within the first month and, Post-Neonatal
Mortality occurring during the remaining 11 months.
The mortality within the first month after birth is very high in 2020
where as the Neo-Natal Mortality in rural areas is higher than in the
urban areas.
28. Number of Health workers per 1000 persons
There are 245,987 registered doctors, 27,360 registered dentists and 116,659 registered nurses in these facilities
together.
Government is committed to increase its critical workforce from 1.45 to 4.45 per 1,000 persons, in line
with World Health Organization (WHO) guidelines. With a population growth rate of 1.9 percent.
32. Utilization of Health facilities of Pakistan during 2019-2020.
77% of the mothers across Pakistan
who had given birth went to pre-
natal consultation during 2019-2020.
33.
34. WEAKNESS OF HEALTH SYSTEM OF PAKISTAN.
• Serious underfunding of the health sector—the public health expenditure
was 0.91% of GDP (against the target of 3% of GDP in Pakistan Vision 2025),
the government health expenditure per capita is approximately US$ 12.5,
and the share of out-of-pocket spending is almost 60%
• Access to the underprivileged areas, huge semi-urban slum affected
coverage of PHC services
• Large unregulated private health sector comprising general and specialist
clinics, pharmacies and diagnostic centres
• Shortage in some cadres of Health Workforce such as nurses and
paramedical staff and urban/rural mal-distribution of health workforce
• Mal-distribution of human resources and lack of incentives for staff serving
in remote areas.
• Dysfunctional referral system puts the patient load on secondary & tertiary
hospitals.
•Substandard/spurious/falsely-labelled/falsified/counterfeit medicines are a
major public health problem.
35. CHALLENGES
• Complex emergencies impedes delivery of priority public health programmes in certain parts of the country
• Pakistan 5th most populous country in the world with very high population growth rate and poor economic situation, leading to
negative impact on progress towards UHC
• Rapid urbanization, epidemiological transition and dual burden of diseases are among barriers that has affected health system to
respond
• Social Determinants of Health such as high level of illiteracy, unemployment, poverty, access to water and sanitation and pervasive
inequities
• Rapid change in management and leadership interrupt continuity of polices
• Health policies, regulations and laws are in abundance but their actual implementation is an issue.
• Establishment of 1 million new jobs by 2030 at health sector
• Ineffective regimes and mechanisms for regulation of the private health sector to control quality and cost of care
• Improving quality of health professionals training deployment, fair distribution, skills mix and acute shortages in some cadres
• High prevalence of HIV/AIDS, TB, Hepatitis and malaria 133,299 estimated HIV cases, with only 7% under treatment.
• Pakistan ranks 5th highest burden country for tuberculosis with 518,000 new TB cases every year, 27,000 Multi Drug Resistant (MDR)
TB Cases per year while 160,000 cases are missed.
• Pakistan is amongst the highest malaria burden-sharing countries in the EMR with estimated 1.3 million cases per year.
