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REPORT

1. The population of Punjab doubled during the period 1981-2011 and it is expected to be
doubled by 2050 if the current growth rate is not checked. Though Punjab is showing
better progress in healthcare facilities as compared to other provinces, yet its
performance against regional countries (India, Bangladesh, Nepal and Sri Lanka) is
lagging. This is particularly informative as these countries share similar levels of socio-
economic conditions as that of Punjab but have been performing better than the
province, indicating that the province can also fare better with the right policies and
strategies.

2. Development of infrastructure is a precondition for the economic growth of a country.


Increasing demand for quality infrastructure can only be met with robust investment,
proficient project management and technological advancement. To meet these
requirements, governments are utilizing the capabilities of the private sector in a big
way. Publicprivate partnerships (PPP) have become the preferred mode for the
construction and operation of infrastructure projects, both in developed and in
developing countries. As most governments in emerging economies are facing fiscal and
capacity constraints, PPP provides a way for them to bridge the gap in infrastructure
investment. PPP not only brings in additional capital but also enables both public and
private sectors to bring to the table their own experiences and strengths, resulting in
efficient development of infrastructure and service delivery.

3. The concept of co-operation between public and private provision of health care was
instituted in Pakistan in national health policy in 1960 and started as a model of
corporate social responsibility to serve the nations health needs. The 1973 Constitution
of Pakistan, Article 38(d), guarantees that the State shall provide the basic necessities of
life, including the provision of health care. Yet, the apparent priority given to security
needs over human development means that the government seems unable to fulfill its
constitutional promise to bring reforms to the health sector of Pakistan. The provision of
basic health services in Pakistan is inadequate and is a major obstacle to human
development. In addition to the obligations imposed as aforesaid, the honorable
Supreme Court of Pakistan in its various decisions have declared the right to health as
a Fundamental Right and directed the provincial governments to provide better health
facilities to the citizens. Further, under international treaties, the Government of
Pakistan is bound to provide to its citizens a minimum of health facilities.

4. The parameters of Punjab Health Sector Plan 2018 have been defined by two key
documents; Pakistan Vision 2025 and Punjab Growth Strategy 2018. Pakistan Vision
2025 envisions the investments in social sector including Health and nutrition as key to
enhance human capabilities. Pillar 1 of the Framework for Growth and Development of
the Vision 2025 acknowledges the necessity to scale up the investments in social sector
including health. These investments in turn would ensure social inclusion and equal
access to opportunities particularly by the marginalized and disadvantaged sections of
the society. The Vision views this as mandatory condition for the inclusive growth which
is one of the pillars of the long term strategy, as the healthy and educated population is
more likely to have access to the economic opportunities.

5. There have been some examples of successful public private collaborations in health
care provision in the past:

the national programmes for malaria, tuberculosis and HIV/AIDS control


implemented through a collaboration of government and private health care
providers, including the Ministry of Health and the GreenStar Network, the
Asia Foundation and HealthNet International; the World Health Organization
(WHO), United Nations Development Programme and World Bank support all
providers in the services; the Ministry of Finance, Government of Pakistan,
subsidizes the insecticide-treated bednets.

a public sector mother and child hospital in Shikarpur district in Sindh


province whose management is handed over to a private practitioner;

the Health and Nutrition Development Society (HANDS), an NGO in


partnership with Sindh government to provide primary health care services at
basic health units in Karachi;

the Aga Khan University Karachi, Pakistan, a private sector partnership with
Sindh Government to provide primary health care services in rural and urban
slum communities for disease surveillance, vaccines and drug trials; Heartfile,
an NGO in partnership with government, the International Vaccine Institute
(South Korea), WHO, Save the Children and UNICEF, is the supporting agency
in a policy development initiative to control noncommunicable diseases;

a Ministry of Population Welfare and United States Agency for International


Development partnership established a social marketing programme from
the GreenStar Network in Pakistan to enhance contraceptive use;

6. The key challenges to an efficient quality service delivery are well documented. There is
a general consensus among the provincial government and key donors on these
challenges. The important challenges and issues in the primary and secondary health
delivery inter alia include:

A. Stock out of medicines especially at Basic Health Units (BHUs) and Rural Health
Centres (RHCs) level is a critical issue. Multiple reasons contribute to this situation.
Essential Drugs List exists but is not updated regularly to take into account the
changing circumstance. A mismatch is at times found between the Essential Health
Services Package and required drugs at health facilities. The procurement of drugs
often takes time due to issues related to poor understanding of procurement rules,
centralized purchases, and budget releases.
B. Immunization coverage across districts varies and generally has not attained the
required level. The main reasons for this discrepancy are involvement of
immunisation staff in other activities and their weak monitoring. Record is difficult to
maintain in a systematic manner as targets given to immunization staff are based on
the projections on the population census of 1998, which in many cases differ greatly
from the ground conditions. Parents are usually not aware of the touring program of
the vaccinator or availability of vaccination at BHU.

C. The primary and secondary health care is the responsibility of the district level health
managers but the district level health sector does not enjoy the essential authorities
in terms of human resource management especially related to contract recruitments,
transfers and discipline; and financial management in terms of budget formulation,
releases and execution. There is also a need to integrate the different vertical
programs at district level. The absence of robust Monitoring & Evaluation system is
affecting planning and decision making.

7. Punjab Government, esp the health department lack key organizational and financial
resources to achieve the provincial, national and international benchmarks even in the
remote future. Key organizational restructuring activities include restructuring of
management tier to strengthen the monitoring and for this purpose divisional
directorates need to be established and district offices restructured. The critical areas of
communications, procurement, logistics, training and research need to be supported
through restructuring of Directorate General Office and by establishing Directorates of
Information, Education and Communication (IEC); Procurement and Logistics; and
Research & Training. The restructuring will help in effective monitoring and evaluation
and lessons learning, leading to course correction where necessary.

8. That in view of above submissions, the Government of Punjab took a policy decision to
enter into the Agreement dated ___________ strictly in accordance with the applicable
legal provisions and without prejudicing the rights of its employees or other concerned
person. The Agreement was entered into in the public interest, according to prevailing
national and international norms and in order to achieve the benchmarks according to
the provincial and national policies and Constitutional and International obligations.