Reform of primary health care in Pakistan

Abstract

With a neonatal mortality rate exceeding 45 per 1000 livebirths, a UNICEF report ranked Pakistan as the riskiest place to be born on earth. 1 UNICEFEvery child alive: the urgent need to end newborn deaths. United Nations Children Fund, New York2018 Google Scholar Although the recent Demographic and Health Survey indicates that the situation has improved, the neonatal mortality rate in Pakistan is among the highest in the world. 2 National Institute of Pakistan StudiesPakistan Demographic and Health Survey: key indicators report, 2017–18. National Institute of Pakistan Studies, Islamabad2017 Google Scholar Other health indicators, particularly those pertaining to maternal and child health and nutrition, are worse than other countries in the region with comparable or lower socioeconomic indicators. 3 Akseer N Kamali M Arifeen SE et al. Progress in maternal and child health: how has South Asia fared?. BMJ. 2017; 357: j1608 Crossref PubMed Scopus (39) Google Scholar Pakistan is one of only two countries in the world where polio remains endemic and the country had little success in achieving the Millennium Development Goals (MDGs), especially those related to maternal and child health outcomes. 4 Government of PakistanPakistan Millennium Development Goals report 2013. Planning Commission, Government of Pakistan, Islamabad2013 Google Scholar The Astana Declaration: the future of primary health care?Primary health care is in crisis. It is underdeveloped in many countries, underfunded in others, and facing a severe workforce recruitment and retention challenge. Half the world's population has no access to the most essential health services. Yet 80–90% of people's health needs across their lifetime can be provided within a primary health-care framework—from maternity care and disease prevention through vaccination, to management of chronic conditions and palliative care. As populations age, and multimorbidity becomes the norm, the role of primary health-care workers becomes ever more important. Full-Text PDF Alma-Ata at 40 years: reflections from the Lancet Commission on Investing in HealthIn 2013, the Lancet Commission on Investing in Health published its report, “Global health 2035: a world converging within a generation” (GH2035). The report concluded that a grand convergence in health—a reduction in infectious, child, and maternal mortality to rates seen in the best-performing middle-income countries—is technically and financially feasible for all but the poorest countries by 2035. Mortality from non-communicable diseases could be reduced through inexpensive population-based and clinical interventions, especially fiscal policies such as heavy tobacco taxation. Full-Text PDF Effectiveness and sustainability of a diagonal investment approach to strengthen the primary health-care system in EthiopiaWeakness of primary health-care (PHC) systems has represented a challenge to the achievement of the targets of disease control programmes (DCPs) despite the availability of substantial development assistance for health, in resource-poor settings. Since 2005, Ethiopia has embraced a diagonal investment approach to strengthen its PHC systems and concurrently scale up DCPs. This approach has led to a substantial improvement in PHC-system capacity that has contributed to increased coverage of DCPs and improved health status, although gaps in equity and quality in health services remain to be addressed. Full-Text PDF