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How health care system in Pakistan can learn from standard formed by Punjab

health care in punjabPrimary healthcare remains an essential component and game shifter in the future provision of healthcare. The Millennium Development Goals outlined by the World Health Organization continue to be the roadmap for primary healthcare.

A recent document by Punjab Developed Social Services Program has created minimum service delivery standards for primary and secondary health care in Punjab. This document is an extension of previous attempts made to standardize systems of care delivery. However, there is much more needed here. Based on the Health for All Declaration, this document is worth reviewing to understand the overall progress in the primary healthcare system and how it has evolved.

So what is this particular document referring to? It is interesting to note the of the eight millennial development goals, three pertain to health directly. Furthermore, eight of the 18 targets, while 18 of the 48 indicators also directly link to health and health care delivery.

Primary health care concept picked up its pace in the 1970s after the alma mater declaration indicating primary health care as the exclusive medium to provide health for all. Here the burden of disease can be the most important indicator directing strategizing resources and access to all. The standards which will govern the use of these resources for many years had remained ambiguous. The creation of MSDS or minimum service delivery standards can be the missing component in ensuring provision of quality care, and will help unify the different efforts by various stakeholders working in the health care sector.

Unfortunately, the very standard that can help channel these directives is outdated. The last statistics of Burden of Disease date back to 1996, where 40% of the total BOD was linked to communicable diseases in poverty stricken areas. Among these causes were included tuberculosis, malaria, vaccine preventable conditions including polio, reproductive health problems. Non-communicable diseases hold a major share of nutritional deficiencies.

It is very difficult to assume how much the BOD has changed during the years. With over two decades old information to guide us, we are pretty much lost and blind in creating any healthcare strategy without risking a miss.

This perhaps is the biggest flaw in the theoretical framework, which limits the strategic fortitude of the implementations suggested in the document.

  • What is encouraging is that the researchers tried to bridge this gap by involving more health care professionals in creating the MSDS. This strategy has helped highlight many of the current challenges faced by primary healthcare systems in the region, which in turn have influenced the modification of MSDS, since these have been developed by considering many of the international health standards.

The research has helped identify the key primary health care setups, including

  1. outreach and community based activities

  2. Basic Health Units (BHUs) and Rural Health Centres (RHC)

  3. Secondary Health Care services of Tehsil Headquarters Hospital and District Headquarters Hospitals

  4. Tertiary Care hospitals

The document has listed down suggested in terms of allocation, infrastructure and building of new primary health care centers in non-access areas. It has also suggested the introduction and expansion of the healthcare workforce and integration of health management information systems.

The document is a must read for every health care professional to understand and appreciate the efforts carried out to improve the quality of healthcare service delivery. Similar attempts and actions should be taken by other provincial governments ensure attainment of millennial development goals.

January 8, 2014

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