dispensing and compounding

1. Chapter # 2

2. PUBLIC HEALTH
 Art & science of preventing diseases, prolonging life
and promoting health & efficacy through organized
community measures;
 Such as control of infections, sanitation, health
education, health services & legislation.

3. EPIDEMIOLOGY
 Epidemiology
 Study of distribution of disease or physiological
condition in human populations & of factors that
influence this distribution.
 Study of the role of agent, host & environment in natural
history of diseases.
 Study of distribution & determinants of health related
events in population.
 Health related events include disease, disability,
physiological conditions & different states of health.

4. Cont...
 Population is used in statistical sense & means a
group of individuals sharing one or more specified
characteristics.
 Distribution refers to distribution of event in relation
to time, place & person.
 Determinants refer to etiological or risk factors
related to particular disease or health state.

5. Epidemiological triad
 Occurrence & manifestation of any disease are
determined by interactions b/w agent, host &
environment.
 These three together constitute the epidemiological
triad.
1. THE AGENT
 An organism, a substance or a force, the presence or
absence of which may initiate a disease process or may
cause it to continue.
 May be single or multiple agents for a disease.

6. Cont...
 Agents – classified as;
a. Living or biological agents
b. Non-living or intimate agents
a. Living or biological agents
 Includes;
 Arthropods, helminths, protozoa, fungi, bacteria & viruses.
 e.g., Mycobacterium tuberculosis cause tuberculosis,
 lice cause pediculosis,
 mites cause scabies etc.

7. Cont...
b. Non-living agents
 Include;
i. Nutrient agents
ii. Chemical agents
iii. Physical agents
i. Nutrient agents
 Protein, carbohydrates, fats, vitamins, minerals, energy, water
& fibre etc.
ii. Chemical agents
 2 types

8. Cont...
 External agents – lead, arsenic, alcohol, dust, stone particles &
carbon.
 Internal agents – produced in body as result of metabolic
disorders or dysfunction of endocrine glands.
 e.g., uremia in renal failure & ketoacidosis in diabetes mellitus.
iii. Physical agents – pressure, temperature, humidity,
friction, light, electricity, sound & vibration.

9. Cont...
2. THE HOST
 A person or an animal that afford subsistence to an
infectious agent under natural conditions.
 Host factors – the characteristics that determine how he
reacts to agents in environment.
 Host factors are;
 Genetic endowment
 Genetic composition either increases susceptibility to disease
or may protect against it.

10. Cont...
 e.g., haemophilia, diabetes, colour blindness, sickle disease,
G-6-P deficiency etc.
 Age
 Strong determinant of health.
 Diseases such as whooping cough, measles & diarrhoea are
common in children;
 Due to lack of protective immunity.
 Diseases like cataract, parkinsonism etc – seen at older ages;
 Due to degenerative changes.

11. Cont...
 Gender
 Sexual differences – may be due to metabolic or
structural differences, differences in exposure or even to
genetic background.
 e.g., haemophilia & gout – in males, while
 Carcinoma of cervix & RA – in females.
 Race
 For example – sickle cell anaemia is common among
Negros.

12. Cont...
 Marital status
 Pattern of disease differ in married & unmarried people.
 STDs – common in unmarried adults.
 Nutritional status
 Poor nutrition results in diseased condition.
 Examples;
 Osteomalacia due to Vit-D deficiency
 Encephalopathy in alcoholics due to thiamine deficiency
 Goitre due to iodine deficiency

13. Cont...
3. ENVIRONMENT
 Source or reservoir for agent of disease.
 Helps in transmission of agent to host of disease.
 Environment – maybe favourable to host or unfavourable to
agent & vice versa.
 Constant attempt for adjustment & readjustment b/w man
& agent.
 If adjustment achieved – there is health, harmony &
symbiosis.
 If no adjustment – then disharmony, disease or death.

14. Cont...
 Environment of man – 2 types;
 Internal environment
 External environment
 Internal environment
 Consists of cells, tissues, organs & systems within human
body.
 Fault in functioning of one or more component parts result in
disease.
 e.g., dysfunction of liver effects not only digestion, but physical &
mental function also effected.

15. Cont...
 External environment
 Any thing which is outside to the environment.
 If there is imbalance b/w host & ext. Environment –
then disease may occur e.g.,
 Heat stroke is result of interaction b/w high temperature
(agent) & body (host), characterized by hot, humid & still air.
 If environment favourable – no heat stroke.

16. Cont...
 Environment may be living or non living.
 Physical environment – space around man containing
air, water & food -
 Biological environment – universe of all living things
that surround man except human beings.
 Social environment – human beings around host & their
activities & interactions.

17. Aim & objectives of epidemiology
 Aim – to minimize or eradicate disease or health problems
& its consequences.
 Objectives
 To define magnitude & occurrence of disease conditions in
man.
 To identify etiological factors responsible for above
conditions.
 To provide data necessary for planning, implementation &
evaluation of programs aimed at preventing, controlling &
treating disease.

18. ROLE OF PHARMACIST IN DISEASE
PREVENTION
PREVENTIVE HEALTH
 Also known as preventative health.
 “warding of disease”
 Process of making small regular decision & taking positive
action on health, diet, relationship, exercise & life style.
 These actions – provide best chance of remaining free
from disease.

19. Cont...
 Since epidemiology deals with determinants & occurrence
of disease in define population;
 so epidemiology is medical ecology.
 Health care programs must be designed to meet the
needs of community.
 For epidemiological study, diseases are classified as;
 Communicable diseases
 Non-communicable diseases

20. Cont...
1) Communicable diseases
 which are transmitted from person to person.
 Examples;
 Measles, Tuberculosis, Mumps, Aids, Common cold
 Transmitted, either by food contact, direct contact or
air.
2) Non-communicable diseases
 Not transmitted from person to person.
 Examples
 Cancer, Heart disease, Ulcer, Diabetes mellitus

21. Cont...
ROLE OF COMMUNITY PHARMACIST
 Pharmacist – can apply basic principals of epidemiology in
his community &
 will become an important member of health care team.
 Pharmacist role – not only referring patient to physician.
 also can collaborate with local health departments & health
planning agencies in epidemiology.

22. Cont...
So role of pharmacist can be summarized as;
A. Control of epidemic diseases
 Pharmacist – can quickly become aware of epidemic
infectious diseases in community.
 For example;
 Arrival of unusual number of people with diarrheal disease for OTC
products may be result of an outbreak of food born disease.

23. Cont...
 Sometime epidemic of venereal disease may occur due to
heterosexual or homosexual contact.
 So, pharmacist should tell patients about these possibilities.
 An active distribution of pamphlets with a few well chosen
words to the customer is very beneficial.
 Best time to educate patient – when patient wait for
prescription filling & do nothing.

24. Cont...
B. Immunization programs
 Immunization procedures (vaccination) – helps to control
children diseases.
 For example;
 Poliomyelitis
 Measles
 Mumps etc.
 Pharmacist should obtain immunization schedule from the
health department.
 Should tell patient of importance of adhering to this
program.
 Also supply vaccine for immediate use.

25. Cont...
C. Prevention guideline database
 Centre for disease control & prevention (CDC) offers
prevention guideline database (PGDB);
 that serve as guide for prevention & control of;
 AIDS, hepatitis, TB, vaccine preventable diseases, cancer & birth
defects.
 Pharmacist – should obtain database & should tell patients
about prevention of above mentioned diseases.

26. Cont...
D. Control of infectious diseases
 Made possible by environmental control of food, milk, water
& sewage.
 Pharmacist provide necessary information.
E. Control of heart disease & stroke
 Depends upon;
 Stopping tobacco use
 Controlling high blood pressure
 Lowering cholesterol intake
 Increasing physical activity
 Having a good overall health consciousness

27. FAMILY PLANNING
 The way of thinking & living that is adopted voluntarily
upon the basis of knowledge, attitude & responsible
decisions by individuals & couples;
 in order to promote health & welfare of family groups & thus
contribute effectively to the social development of country.
 OR
 Planning of when to have children & use of birth control &
other techniques to implement such planes.

28. Cont...
 Family planning in its literal sense is a unit consisting of
husband, wife & children.
 well known permanent unit of society;
 members are dependent on each other for all round health &
welfare.
 Most parents have limited physical, social & economic
resources;
 sufficient only for a limited number of children.
 Too many children – deprived of adequate care & tend to
be ill nourished & unhealthy.

29. Cont...
 Family planning thus mean planning size of family in a
manner compatible with;
 physical & socioeconomic resources of parents &
 conducive to health & welfare of all members of the family.
Objectives of family planning
 To avoid unwanted births.
 To bring about wanted births.
 To regulate interval b/w pregnancies.
 To control the birth time in relation to ages of parents.
 To determine number of children in family.

30. Cont...
Characteristics of ideal contraceptive
 Contraceptive is a substance or drug which prevents the
fusion of gametes during & after sexual activity.
 Ideal contraceptive contains following desirable qualities.
 Reliability
 Should be 100% effective in order to prevent fusion of
gametes.
 Safety
 Should be free from associated side effects & complications.

31. Cont...
 Reversibility
 Complete return to fertility when the method is discontinued.
 Low cost
 Poor people may also be benefited.
 Conveniences
 Should be convenient to use.
 Long acting methods are generally convenient.
 Cultural acceptability
 Should be acceptable in culture.

32. Methods of family planning or birth control
 There is no best method of birth control.
 Every method has its own positive & negative aspects.
 Necessary for couples to learn about birth control methods.
 Before choosing birth control method, think about;
 Your overall health
 Possible side effects
 How well each method works to prevent pregnancy
 Comfort level with using method

33. Cont...
 These methods – classified in 6 groups;
1. Terminal methods
2. Non-terminal methods
3. Intrauterine devices (IUD)
4. Hormonal methods
5. Post-conceptional methods
6. Miscellaneous methods

34. 1. Terminal methods
 Permanent methods i.e.
 provide permanent contraception
 Appropriate procedures for those who have attained their
desired family size.
 Include;
A. Vasectomy
B. Tubectomy

35. Cont...
A. VASECTOMY
 Safe permanent method of contraception.
 In which tubes through which sperms travel from testes to the penis
are cut & blocked, so that spermatozoa can no longer enter semen
that is ejaculated.
B. TUBECTOMY
 Fallopian tubes are closed so that egg cannot travel through them to
meet the sperm.
 Tubes are surgically closed with bands & clips or by cutting & tying.

36. 2. Non-terminal methods
 Not permanent methods i.e.,
 Produce temporary infertility.
 Include;
A. Periodic abstinence
B. Barrier methods
A. PERIODIC ABSTINENCE
 Abstinence means – to refrain from sexual intercourse.
 Also known as safe period method.
 Requires couples to refrain from sexual intercourse during
estimated time of fertility.

37. Cont...
 To determine approx; time of ovulation & fertile
period, following methods are used.
i. Calendar method
 Length of menstrual cycle is recorded for at least 8
cycles & time of fertility is calculated by subtracting 18
days from length of shortest cycle, which indicate 1st day
of fertile period &
 Subtracting 11 days from length of longest cycle which
indicate last day of fertile period.

38. Cont...
 The day of start of menstruation is counted as 1st day of
cycle.
 Calendar method is not used if all cycles are shorter
than 27 days.
ii. Basal body temperature
 Based on fact that during ovulation, there is rise in body
temperature.

39. Cont...
iii. Cervical mucous method
 This shows that mucous becomes thin & profuse (abundant &
excessive) during ovulation & thick & scanty after ovulation.
B. BARRIER METHODS
 Include;
i. Physical methods
ii. Chemical methods
iii. Combined methods

40. Cont...
i. Physical methods
a. Condom
 Sheath of thin rubber or latex which is used before
intercourse to collect the semen.
 Most widely used contraceptive.
 Also prevent venereal diseases.
 OTC barrier method of birth control.
 Different types like;
 Ordinary type – thick & non-lubricated.
 Deluxe type – thick & lubricated.
 Super deluxe type – thin & lubricated.

41. Cont...
b. Diaphragm
 Soft rubber cup with a stiff but flexible rim around the edge.
 Contraceptive creams or jellies – applied on surface facing the
cervix.
 Diaphragm is inserted into vagina before intercourse.
ii. Chemical methods
a. Foam tablets
 Tablet has to be inserted into vagina before intercourse
 Foam is formed locally – which kills the sperms when
discharged.

42. Cont...
b. Jelly
 Supplied along with vaginal applicator.
 Spermicidal in action.
iii. Combined methods
a. Vaginal sponge
 Small polyurethane foam sponge – which is saturated
with a spermicide.
 Less effective than diaphragm.

43. 3. Intrauterine devices
 Foreign bodies – introduced into uterus & retain as
long as sterility is desired.
 IUD – inserted in 6 weeks after delivery & after 1st
menstrual cycle, following abortion.
 IUD – labelled as 1st, 2nd & 3rd generation devices.
 1st gen; IUDs – were non-medicated,
 Made of polyethylene alone.

44. Cont...
 2nd gen; IUDs – contains copper.
 Copper – has infertility effect.
 For example copper T-200 – destroys mobility of sperm.
 To be replaced after every 2 years.
 Newer devices are – multi-loaded 250 & multi-loaded 375.
 Contain higher amount of copper.
 Effective life of 5 years.
 More recent devices;
 T Cu-380 Ag & Nova-T
 Contain copper and silver & more effective.

45. Cont...
 3rd gen; IUDs - contain a hormone which is slowly
released.
 Commonly used device – Progestasert;
 which is T-shaped device containing progesterone.
 Another device – contains levonorgestrel
 Also called pregestogen
 Both these act as hormonal contraceptive.

46. Cont...
 Exact mechanism of action is unknown;
 However they cause cellular & biochemical changes in
endometrium & uterine fluids;
 Due to which viability of ovum is reduced.

47. 4. Hormonal methods
 Anti-fertility effect is produced by using hormone.
 Types
A. Oral pills
B. Depot formulation
A. ORAL PILLS
 2 types
i. Combined pills
ii. Mini pills or progestin only pills

48. Cont...
i. Combined pills
 Combination of estrogens & progesterone (released slowly).
 stop the ovaries from releasing an egg each month (ovulation).
 thickens cervical mucous.
 makes lining of uterus thinner – less likely to accept fertilised egg.
 Oral pill – used daily for 21 days, starting on 5th day of
menstrual cycle.
ii. Mini pills or POP
 Contain synthetic progestin – that makes cervical mucous
thick & impenetrable to sperm & induces a thin atrophic
endometrium.

49. Cont...
B. DEPOT FORMULATION
 Two preparation available;
 DPMA (depot medroxyprogesterone acetate)
 NETE (Norethisterone enanthate)
 Both of these contain synthetic progestin hormones;
 that are injected into muscles from where they are slowly
released.
 have same mechanism of action as oral pills.

50. 5. Post conceptional methods
 Conception means fertilization i.e., fusion of sperm
and ovum to form zygote.
 3 methods of post conception
A. menstrual regulation
B. menstrual induction
C. abortion

51. Cont...
A. MENSTRUAL REGULATION
 Evacuation of uterus in a woman who has missed her
menstrual period by 6-14 days, who previously had
regular period and who has been at the risk of
conception.
 It may be performed before proof of pregnancy. It is
done by a small flexible plastic cannula in association
with a hand held gynaecological syringe.

52. Cont...
B. MENSTRUAL INDUCTION
 Based upon intrauterine application of prostaglandin
under sedation.
 This results in sustained contraction for 7 minutes and
cyclic contraction for next 3-4 hours.
 Bleeding continues for about a week.

53. Cont...
C. ABORTION
 It is the termination of pregnancy before the foetus
becomes viable.
 It may be spontaneous or induced.

54. 6. Miscellaneous methods
 Includes:
A. Anti-fertility vaccines
B. Female condoms
A. ANTI-FERTILITY VACCINES
 Contraceptive vaccines use the immune system to
induce antibodies against hormones or other
molecules involved in human reproduction.

55. Cont...
 Currently different vaccines are under the process of
development.
 It is generally assumed that the final product will be an
anti-fertility vaccine administered by injection or orally
and lasting for one or two years.

56. Cont...
B. FEMALE CONDOM
 Made of thin plastic called poly urethane.
 The condom is placed in vagina and is opened at one
end and close at other end. (similar to diaphragm)
 Both ends have a flexible ring used to keep the condom
in place.

57. NATIONAL DRUG POLICY
 A national drug policy is a document which covers all
the areas and issues related to drugs.
 Pakistan is committed to the goal of Health for all.

58. Cont...
 To achieve this, the Government is taking all possible
measures in the field of health services at large and
drugs in particular.
 Formulation of the national drug policy thus forms an
integral component of its national health policy,
 purpose of which is to ensure regular availability of
essential drugs of acceptable efficacy, safety and
quality at affordable prices to all irrespective of their
socio-economic status or place of living.

59. Cont...
 Essential Drugs are those which meet the health care
needs of the majority of the population.
 They should therefore be available at all times in
adequate amounts and in appropriate dosage forms, at
a price the community can afford.
 Hence they will help in combating disease and
maintaining and improving the health of population.

60. GOAL OF NATIONAL DRUG POLICY
 The goal is to develop country potential within the
resources through the availability of drugs, to
control common diseases and to alleviate pain and
suffering.

61. OBJECTIVES
 to develop and promote the concept of essential drugs
and to ensure regular, uninterrupted and adequate
availability of such drugs of acceptable quality and at
reasonable prices.
 to encourage in all related sectors and personnel the
concept of rational use of drugs with a view to
safeguard public health from over-use, misuse or
inappropriate use of drugs.
 to encourage the availability and accessibility of drugs
in all parts of the country with emphasis on those
which are included in the National Essential Drugs List.

62. Cont...
 to attain self sufficiency in formulation of finished
drugs and to encourage production of pharmaceutical
raw materials by way of basic manufacture of active
ingredients.
 to protect the public from hazards of substandard,
counterfeit and unsafe drugs.
 to develop adequately trained manpower in all fields
related to drugs management.

63. Cont...
 to develop a research base particularly for operational
and applied research with a view to achieving the
above mentioned objectives.
 to develop the pharmaceutical industry in Pakistan
with a view to meeting the requirement of drugs within
the country and with a view to promoting their exports
to other countries.

64. LEGISLATION
 Towards achieving this goal, Pakistan has a drug
legislation, a quality control system, and certain
other elements of a drug policy in fragmented form, but
to meet the challenges of the day, a more
comprehensive drug policy is necessary.
 Pakistan has a fairly modern legislation namely the
Drug Act, 1976.
 Under this law comprehensive rule have also been
framed on various aspects of drug control.

65. Cont...
 The law provides a system of licensing of each
manufacturing company and registration of all
finished drugs with a view to ensure efficacy, safety ad
quality of the drugs sold in the market.
 For licensing and registration Central Licensing and
Registration Board comprising of experts from the
field of medicines and pharmacy are established.
 Quality Control is ensured through inspection and
laboratory services.

66. Cont...
 The law also provides compliance of Good
Manufacturing Practice by the manufacturers, for
fixing drug prices and for regulation of imports, export,
and sale of drugs.
 Under this Act, the manufacturing, registering and
import/export are regulated by the Federal
Government where as the sale is regulated by the
Provincial Governments.

67. NATIONAL ESSENTIAL DRUGS LIST
(NEDL)
 The Federal Government and each provincial
government until 1993 had their own lists of drugs for
purchases for the government institutions and thus
there was lack of uniformity in these lists.
 There was, therefore, an urgent need to prepare a
National list of Essential Drugs of Pakistan to be
implemented uniformly both at the Federal and
Provincial levels.

68. Cont...
 A National Essential Drugs List of Pakistan was thus
prepared in 1994 in view of the health needs of the
country with the help of specialists in the field of
medicines and pharmacy from all over the country.
 This has already been published and circulated widely
throughout the country.

69. DRUG PRODUCTION
 Consequently whereas there was virtually no
pharmaceutical manufacturing in Pakistan at the time
of its independence in 1947, today about 80% of the
drugs market is from local production by some 285
companies including 25 multinationals.
 However the industry still depends largely on imported
raw materials and that there is no assessment of the
actual requirement of drugs according to the health
needs of the country.

70. NATIONAL INDUSTRY AND EXPORT
 To encourage exports of drugs, incentive similar to
those available to other value added export industries
shall be made available.
 An institutional mechanism shall be developed so that
the national units are brought at equivalence with the
international standards.
 Transfer of technology shall be encouraged by allowing
contract manufacture by a multinational with
national companies.

71. REGISTRATION OF DRUGS
 Under the Drug Act, 1976, all finished drugs ready for
use are required to be registered through the Drugs
Registration Board.
 Presently some 13000 products are registered including
some 10000 locally produced and 3000 imported
products.
 The registration shall be granted and reviewed on the
basis of established criteria of acceptable safety,
efficacy, quality and keeping in view real health
needs of the country and the public interest.

72. Cont...
 Drugs which are banned for safety reasons either in
USA, Canada, European Union, Japan, Australia,
China, Switzerland or in the country of origin shall not
be allowed sale in Pakistan.
 In the labeling of drugs the use of generic names
with at least the same prominence as brand names
and necessary information in national language shall
be made as a mandatory requirement.

73. DRUG PRICING
 Efforts will be made to make availability of much
needed drugs at reasonable prices.
 The grant of patent protection for drugs shall be only
of process and not for the product. Further after the
expiry of initial period provided in the law, no
extension shall be granted in case of drugs.
 A system for monitoring and evaluation of drug
prices shall be developed.

74. DRUG SUPPLY SYSTEM:
 Hospital Pharmacy.
 Scientific hospital pharmacy shall be introduced in the
country both under the Federal and Provincial
Governments.
 Hospital pharmacists shall be appointed in all the hospitals
of the country at the rate of one pharmacist for each fifty
beds.
 They will be assigned with specific duties to provide an
efficient drug supply system and where possible a limited
production of pharmaceuticals.
 The system will ensure the availability of essential drugs in
health facilities

75. Cont...
 Community Pharmacy (Retail Pharmacy)
 In the Private Sector, a system of scientific retail
pharmacy service shall be introduced by taking
following steps.
 As recommended by the WHO, pharmacists shall be
made to play their role in drugs management, supply and
distribution.
 The sale of all potent drugs shall be restricted only on
prescription of registered medical practitioner.
 To begin with, all psychoactive drugs, hormonal and
steroidal preparations and antibiotics shall be so
restricted.

76. QUALITY ASSURANCE.
 Quality assurance include both inspection and
laboratory services.
 Inspection services
 At the Federal level 8 inspectors are working to monitor
compliance of Good Manufacturing Practices at the
manufacturing level whereas, at the Provincial level 81
regular inspectors of drugs in various grades as district,
divisional and chief inspectors have been appointed

77. Cont...
 Laboratory services
 Presently there are five drug testing laboratories in
the country.
 Four are for routine analysis out of which one is under
the Federal Government at Karachi as Central Drugs
Laboratory (CDL) and one each under the Provincial
Governments of Punjab, Sindh and NWFP at Lahore,
Karachi and Peshawar respectively.
 The law provides that any one who is not satisfied with
the results of the these laboratories can appeal
requesting for retesting of the sample by an Appellate
Laboratory.

78. RESEARCH AND DEVELOPMENT
 In the field of research, Drugs Act, 1976 requires the
manufacturers to contribute a certain percentage of
their profit (1 %) towards a Drug Research Fund.
 These funds will be spent for conducting researches on
the development of new drugs and encouraging
rational drug therapy.
 A comprehensive national drug research program will
be jointly developed by the universities and research
institutes active in this field according to national
health priorities.

79. National Health Policy
 A national health policy is a document which covers all
the areas related to health of human beings.
 The term health has been defined by WHO as “a state of
complete physical, mental and social well being and not
merely the absence of disease or infirmity”.

80. Need for Health Policy
 It is not sufficient for a doctor working in a community to
be able to treat patients or even to be able to take
specific preventive measures and advise about how to
promote health.
 As a health administrator, he should be able to
understand and even formulate health policies, to make
plans and even to implement them.

81. Cont...
 Policy formulation, planning, administration and
management are the areas with which every public
health man must be thoroughly familiar.
 So as a matter of fact proper planning and management
are essential for achieving high standard of public health.

82. Need for a New Health Policy
 The National Health Policy 2009 states that there should
be proper efforts to ensure progress towards a healthy
Pakistan in which all citizens benefit from a better
working health care delivery system, particularly the
poorest.
 The Policy builds upon the National Health Policy 2001,
under which modest progress was made.

83. Cont…
 There was a need to reset policy due to:
 slow progress in improving health outcomes.
 inadequate performance in improving access to
essential health care services especially for the poor.
 lack of management of various policy documents.
 The Ministry of Health initiated the process to develop
a new health policy in 2006 but the process remained
slow.
 In 2009 the Government decided to set a new agenda
to improve health care.

84. The State of Pakistan’s Health
 The links between ill health and poverty are well
known. Ill health contributes to poverty.
 It is, therefore, critical to move towards a system
which is able to address the challenges and prevents
families from falling into poverty.
 The health of the people of Pakistan has improved
since 1990; however the rate of improvement in
health outcomes has been slow compared to its
neighboring countries.

85. Cont...
 Pakistan continues to spend less on health than most
other countries at the same level of Gross domestic
product (GDP).
 Pakistan’s under-five mortality remains the highest
among the South Asian countries.
 High maternal mortality (deaths) combined with high
fertility, results in one out of every 89 women dying
from pregnancy related causes.
 Malnutrition remains widespread and unaddressed.

86. Cont...
 Pakistan’s population growth rate has declined from
3% in the late 1980’s to the present estimated level of
1.9% per annum, but it remains unacceptably high.
 The burden of diseases is heavily dominated by
communicable diseases and malnutrition issues,
accounting for 50% of the total burden of diseases.

87. Cont...
 Pakistan is also facing an increasing burden of non
communicable diseases, such as cardiovascular diseases,
diabetes, injuries and neuro-psychological diseases.
 The harm that tobacco use does to health is
unquestionable. In Pakistan about 100,000 people die
annually from diseases caused by use of tobacco.

88. Key Challenges in the Health Sector
 Making progress in current health sector and tackling
effectively newly emerging and re-emerging health
issues including non-communicable diseases and
disasters.
 Improving access of essential and cost effective health
services especially for the poor and vulnerable.
 Emphasizing more on quality of care and services at
all levels.
 Protecting poor from terrible health expenditures.

89. Cont...
 Improving the availability and motivation of health
workforce.
 Aligning outputs of the academic institutes in line with
the needs of health system and improving the quality
of education and training.
 Effectively engaging private health sector and civil
society organizations to improve health outcomes.
 Developing pharmaceutical sector and ensuring access
to quality medicines.

90. Cont...
 Making health system more responsive and
accountable.
 Ensuring effective research, monitoring & observation
system to measure results and evidence based
decision making at all levels.
 Government must also interlink ministry of health and
other related government departments, international
organizations like World bank, WHO and leading
NGO’s.

91. Goal of National health policy
 The overall goal of the policy is to improve health status
of the people of Pakistan.

92. Policy Objectives
National Health policy aims to improve health status of
people of Pakistan by achieving the policy objectives
mentioned below .
 Enhancing coverage and access of essential health
services especially for the poor;
 Measurable reduction in the burden of diseases especially
among vulnerable segments of population;

93. Cont...
 Protecting to the poor and under privileged
population subgroups against terrible health
expenditures and risk factors;
 Strengthening health system with focus on
resources;
 Strengthening management functions in the sector to
ensure service provision, reasonable financing and
promoting accountability;
 Improving evidence based policy making and strategic
planning in the health sector.

94. Factors affecting health policy
The failure to develop any compact and
comprehensive health policy is due to various factors
such as:
 Successive national government in Pakistan.
 Fragmented urban health services.
 Problems related to public expenditure.
 Issues related to development projects like
overlapping, gaps in planning and implementation,
dependency of provinces on federal government for
funding which delays projects.
 Problems and imbalance in human resources.