The document summarizes Pakistan's National Health Policy of 2001. It analyzes the policy according to nine "Benchmarks of Fairness" across various aspects of healthcare provision and financing. The analysis finds that the policy fails to score impressively and falls below the status quo line on many benchmarks. It is deficient in addressing issues like communicable diseases, road accidents, and sensitive topics. While it claims to follow the goal of "Health for All," its main focus remains on curative care rather than prevention. Four years after implementation, Pakistan continued to face widespread issues in its health sector that were not adequately addressed by the policy.

1. HealthPolicyofPakistan
MUHAMMAD IRFAN
MPH 2ND SEMESTER

2. HealthPolicy
Policy is defined as Governmental and organizational guidelines about allocation of resources
and principles of desired behavior.
A policy maker is a person or organization who make policies at an international, national,
regional, or local level.
Policy makers in Pakistan are provincial secretary health, provincial secretary planning and
development, chief of health planning commission, provincial minister health, and director
general health.
Head/executives of medical institute and tertiary care hospitals and deans of faculties and
principals of medical colleges in the province are also involved in the policy planning process.

3. Issue
Identification
Setting
Objectives
Priority Settings
Defining
Options
Option
Appraisal
Implementation
Evaluation

4. HealthPolicyofPakistan
In Pakistan, the delivery of health care is based on the Beveridge model.
The Beveridge Model is a health care system in which the government provides health care for
all its citizens through income tax payments. This model was first established by William
Beveridge in UK in 1948.
Health care system in Pakistan is centralized and the Government is responsible for provision of
free medical treatment to all citizens in need for health care services.

5. HealthFacilitiesinPakistan
Pakistan has four provinces (Baluchistan, NWFP, Punjab, and Sindh) and every district is further
divided into smaller administrative units called Districts. Every province has a provincial health
ministry with an exclusive directorate of health having several directors and deputy directors.
Policy process steps are top to bottom hierarchy i.e.
Federal to Provincial to Districts and the health agenda and policy decisions are made at the
Federal Ministry level.

6. HealthFacilitiesinPakistan
Health professionals, civil servants and administrators at the federal, provincial and district
levels play their roles according to their capacities in implementing health policies and
programs.
The implementation part is highly influenced by the political, economic and socio-cultural
context in Pakistan.
Lastly the monitoring and evaluation stage is the weakest amongst all in Pakistan, and there are
very few evidences on practical evaluation in government health sector

7. StatisticsofHealthFacilitiesofPakistan
In year 2000 and 2001, 32.1 percent of Pakistani population lived below the poverty line and
government expenditure on health was only 0.45% of its GDP (17.5 Billion PKR) out of which
more than 70% was spent on general hospitals and clinics
GDP growth declined from 5.6 percent in 1990-91 to 2.2 percent in 2000-01 and there was only
one doctor for 1,516, one dentist for 31,579 and a Nurse for 3639 population hence rendering
Doctor Nurse Ration as 3:1 instead of 1:3 . Infant Mortality Rate was 73 per 1000 live births and
under-5 mortality was over 100 per 1000 live births.

8. BenchmarkofFairnessforhealthcarereform
“Benchmark of fairness” were developed for assessment of comprehensive medical insurance
reform proposed in United States.
Teams from four countries (Columbia, Mexico, Pakistan and Thailand) in collaboration through
two week-long workshops came together to adopt the benchmarks for health systems use in
developing world.
There are nine benchmarks of fairness.
Every benchmark in itself contains further different criteria for evaluation of particular features
of the fairness of a policy.

9. NationalHealthPolicy2001
National Health Policy of Pakistan 2001 focuses on 10 key areas
1. Reducing prevalence of communicable diseases
2. Addressing inadequacies in primary/ secondary health services
3. Removing professional/managerial deficiencies in DHS
4. Promoting greater gender equity
5. Bridging basic nutrition gaps in the target population
6. Correcting urban bias in health sector
7. Introducing required regulations in the private medical sector
8. Creating mass awareness on public health issues
9. Effecting improvements in the essential drugs sector
10. Capacity building for health policy monitoring

10. Benchmark1: Intersectoral Public Health
Basic Population Needs
1. Basic Nutrition
2. Housing
3. Environment
4. Education and Health
5. Public safety and Violence Reduction
Develop Infrastructure for Health Status inequalities
1. Appropriate Indicators
2. Research Intervention
Improvement of social determinants of Health at Local, Regional or National
Level
If we assign one mark to each point in every criteria of benchmark 1, then
NHP 2001 scores for benchmark 1 would be -3 as NHP has not even
maintained status quo on some criteria

11. Benchmark2: Financial barriers to Equitable Access
Informal Sector Coverage
1. Universal Access to Basic Services
2. Examples of packages of varying Scope
A. Drug Coverage
B. Medical Transportation Costs
C. Primary Care package
D. Catastrophic Coverage
Insurance for Formal sector
1. Reduction of different obstacles to enrolling people in Formal sector
2. Family Coverage for Enrolled workers
3. Drug Coverage
4. Medical Transportation Costs
5. Producing Uniform benefits for All
6. Integrating various Schemes Involving Workers
Thus NHP 2001 scores -1 for second benchmark

12. Benchmark 3: Nonfinancial Barriers to Access
1. Reduction in Geographical Distribution
A. Facilities and Services
B. Training of Persons
C. Supplies & Drugs
D. Clinic Hours
E. Transportation for Medical Purpose
2. Gender
A. Decision making status in Family
B. Mobility & Access to resources
C. Reproductive autonomy
D. Gender sensitive provision of Services
3. Cultural
A. Language
B. Attitude and Practice relevant to disease and Health
C. Uniform Reliance on Untrained Practitioners
D. Perception of Public Sector Quality
4. Discrimination by Race, Religion, Class, Sexual Orientation, diseases,
Public Care
Second and third criteria of benchmark III are related to culture and
discrimination by race, religion, sexual orientation and disease status in
health. These criteria are not being touched upon by NHP 2001.Thus NHP
2001 scores 4 in benchmark III

13. Benchmark 4: Comprehensiveness of benefits and Tiering
Mainly Two Criteria's
Uniformity in standards of treatment and affordability of all tiers of health care
provisions either private or public.
NHP 2001 does not address the issue of affordability or any reforms to 29
address the benchmark 4 in any manner. Thus in this area NHP 2001 fail to
score any point.
Benchmark 5: Equitable Financing
If Financing by Ability to Pay
A. If Tax- based Scheme
B. If Premium Based
C. Out of pocket Payments
NHP 2001 fails to address any of the health care financing issues which are
mentioned under this benchmark and thus fails to score in this benchmark.

14. Benchmark VI: Efficacy, efficiency, and equality of health
care
1. Primary Health care PHC
A. Training and Incentives
B. Allocation of Resources
C. Community Participation
D. Referral Mechanism
2. Implementation of Evidence based practice
A. Health Policies
B. Public Health and clinical prevention
C. Therapeutic interventions
D. Information infrastructure and Database
3. Measure to Improve Quality
A. Regular assessment of Quality
B. Accreditation of Hospitals
C. Professional trainings
NHP 2001 also does not address the implementation of evidence based
practice and utilization of research in policy making. Thus in this benchmark,
NHP collectively scores only -1.

15. Benchmark 7: Administrative efficacy
1. Minimize administration overloads
2. Cost Reducing Purchasing
3. Minimize Cost Shifting
4. Minimize abuse and frauds and inappropriate incentives
None of other components mentioned under benchmark 7 had been
addressed in NHP 2001. There is a separate key area for addressing
professional and managerial deficiencies in District health system under key
area 3 but even that does not have any point on administrative efficiency.

16. Benchmark 8: Democratic Accountability and Empowerment
Three criteria mentioned under benchmark 8 are deficient in NHP 2001 and there
is no mentioning of democratic accountability or accountability of any sort. This
renders NHP a score of 1 in strengthening civil society role and in other areas the
score is well below zero mark according to the scoring criteria given by article.
Benchmark 9: Patient and Provider Autonomy
1. Degree of Consumer Choice
2. Degree of Practitioner Autonomy
This area has not been touched upon by NHP 2001 and hence the NHP has moved
regressively of the status quo and hence scored well below zero into minus.

17. Conclusion
National Health Policy 2001 when analyzed according to Benchmarks of Fairness, failed to score
impressively rather the collective score falls the document well below the status quo line.
The content of the policy does not address communicable disease, road traffic accidents,
violence, abuse and sensitive issues like organ transplant and abortion etc.
The policy claims to be following the Health for All agenda but its major focus is not on
environment, disease prevention and health promotion rather it focuses more on curative side.

18. ProblemsFacingbyPakistanAfterNHP2001
Pakistan was facing following prevailing problems in health sector four years after NHP 2001
Widespread prevalence of communicable disease
Inadequacies of primary/secondary health care services
Urban-rural imbalances
Professional and managerial deficiencies in the district health system
Nutritional gaps in the target population
A deficient system for health education
Mental health and substance abuse
A vastly unregulated private sector

19. ThankYouSoMuchEveryone
ANY QUESTION?