Health System Of Pakistan Research Articles

What does it take to make a wrong decision? A qualitative study from Pakistan's health sector.

Pakistan's health system over the past three decades has experienced social, economic, geopolitical instability, and notwithstanding man-made and natural catastrophes. Since 2001, the health system in Pakistan has undergone three phases of organizational and management reforms and does not have a unified national health policy since then. The aim of this research was to assess the factors behind the decision-making by policy planners in the health system of Pakistan. An exploratory qualitative study based on grounded theory was designed where in-depth interviews conducted with 20 representatives of the political constituencies, civil bureaucracy, health planners and managers, research and educational institutions, NGOs providing technical support in the health sector, development partners and media. There leading reason cited was the dearth of leadership in health sector, which is compounded by a range of factors such as "institutional monopoly", "contextual deterrents", "power for turf"; "inadequate knowledge", and "design faults". Such factors were perceived to have a serious effect on the competencies, roles and responsibilities, use of knowledge for decision making. The behavioral aspects of decision makers include the "mindset," and "conflicting interests". The multitude of factors and complexities within the health sector of Pakistan continue to widen the vacuum in the leadership echelons. Hence, there is a high probability of taking wrong decisions not based on evidence, and resulting in a grossly under-performing health system.

Quality provision in Pakistani health care system: insights into a major obstacle and the way forward.

Madam, Safety, cost-effectiveness, efficiency and equity are all components of quality healthcare. Key factors determining quality are’ and their families’ satisfactions and better disease outcomes.1 Doctors, paramedics, pharmacists, laboratory technicians, administrative staff, pharmaceutical companies, government agencies and policymakers are the caregivers who have an essential direct or indirect role in providing, sustaining and improving health care.1 A population's health is crucial to a state's stability and growth. Quality in healthcare has been a subject of discussion across the globe for decades, with developed nations contributing the majority of its measures and recommendations6. In contrast it is still battling to fully establish and function in emerging nations like Pakistan. The health system in Pakistan comprises primary, secondary and tertiary health centres. The latter are found in a few urban cities and are run by both the public and private sectors. Private bodies include profit as well as welfare-based organizations.2,3 According to the WHO, on average, there are 6.3 hospital beds per 10,000 population in Pakistan, which is below its recommendation and much less compared to other developing nations.2 Majority of the population reside in rural areas and thus their option in various illnesses is primary or secondary health unit.3 The major drawback in such centres is lack of attendance by doctors and paramedical staff, lack of competent clinician or general practitioner along with absence of equipment, state-of-the-art laboratory and latest treatment options, all contributing to delays in diagnosis and management.4,5 There is also a lack of patient registry, long-term follow-ups, appropriate and timely referrals to higher health care centre and disease discussion between clinicians.3 Due to such weakened basic units, many patients directly visit an urbanized tertiary health center, which is a major cause of overcrowding of our hospitals. Some break-through policies which could address this dilemma is giving incentives to the assigned staff, providing commute in case of long travels, improving the infrastructure and facilities within the centers, installation of biometrics and having regular audit of attendance, number of patients treated and medications provided. Conducting education seminars regarding work ethics would also contribute towards a professional working environment leading to better patient outcomes.3,4 Creating awareness regarding the responsibility and crucial role of general practitioners in primary and secondary health units along with recognition of their importance, would also help in diverting medical community towards opting for such roles.6 ---Continue

Knowledge, Attitudes, Perceptions, and Acceptance of COVID-19 Vaccination among Pharmacy and Non-Pharmacy Students

University students are a sub-group of the population at high risk of COVID-19 infection, and their judgments on vaccination affect the public attitudes towards vaccination. Thus, the present study aimed to assess the knowledge, attitudes, perceptions, and acceptance of the COVID-19 vaccine among pharmacy and non-pharmacy students. A cross-sectional study was conducted by enrolling pharmacy (375) and non-pharmacy (225) students from the universities in Lahore. Chi-square analysis was used for significant frequency distributions and a 5-point Likert scale was used to score attitude, perception, and acceptance. The majority of the students were aged between 19-24 years, hailing from urban and middle-class families with good self-reported health. The preferred vaccine was Pfizer, followed by Sinopharm and Sinovac. The major source of information was social media, followed by government campaigns and family members. The pharmacy students demonstrated better knowledge and positive attitudes toward COVID-19 vaccination. The non-pharmacy students scored higher for the questions based on scientific leads, myths, and baffling conspiracies. The non-pharmacy students showed higher hesitancy/barrier total scores related to their trust in the health system, COVID-19 vaccine storage, and efficacy. Data suggested that pharmacy students exhibited better knowledge, positive attitudes, and perceptions about COVID-19 vaccination. Overall, vaccine efficacy and safety were mutual concerns. Nonetheless, non-pharmacy students were hesitant due to mistrust in the health system of Pakistan.

Universal health coverage in Pakistan: is the health system geared up to take on the challenge?

BackgroundThere is a strong and wide consensus that Pakistan must pursue universal health coverage (UHC) attainment as the driving force for achieving sustainable development goals by 2030. Nevertheless, several institutional and socioeconomic challenges may hinder the progress toward UHC.Main bodyIt is important that the health system of Pakistan must be transformed to strengthen all three dimensions of UHC i.e. maximizing the population covered, increasing the range of services offered, and reducing the cost-sharing. To make UHC dream a reality in Pakistan, there are some pre-requisites to meet upfront: a) budgetary allocation for health as percentage of GDP must be increased; b) health system’s readiness especially in the public sector ought to improve in terms of human resource and availability of essential services; c) safety nets for health must continue regardless of the change in the political regimes; d) decrease the reliance on donors’ funding; and e) accountability to be ensured across the board for service providers, managers, administrators and policymakers in the health system.ConclusionCOVID-19 pandemic has revealed some major gaps in the health system’s capacity to deliver equitable healthcare, which is a cornerstone to achieving the UHC agenda. The priority-setting process will need to be aligned with the SDGs to ensure that the agenda for action towards 2030 is comprehensively addressed and successfully accomplished preferably before, but hopefully not beyond the targeted dates.

Prevalence of PTSD symptoms in children: The cost of the inadequate mental health system in Pakistan

Post-Traumatic Stress Disorder (PTSD) is a disorder that affects not only military veterans but also the general public specifically children. They may replay the event and its aftermath, avoid talking about it, have low self-esteem, and be unable to develop meaningful connections. Mentally sick individuals in Pakistan frequently face an obstacle, as discussing mental health is taboo. Mentally ill people are publicly humiliated in Pakistan, and sufferers are occasionally referred to as “pagal.” Even parents ignore the symptoms of their children.

Nursing Faculty Development in Pakistan; Teaching and Learning Competencies

Human health resource is the core component of any health system. Pakistan’s health system faces a critical shortage of qualified healthcare professionals such as physicians, dentists, nurses, pharmacists and allied healthcare workers1. Pakistan has one of the fastest growing populations and is ranked as the fifth largest population in the globe2. The health system of Pakistan is confronted with the challenge to cater to the unmet healthcare needs of this rapidly growing human population. The health system of Pakistan is facing multiple challenges and among these, one of the key challenges is the production of quality human resource for health. Pakistan has recently focused much on uplifting the standards of medical schools; to produce competent physicians, however, uplifting and streamlining nursing education still remains a big challenge. Currently, there are approximately 90,000 nurses registered with Pakistan nursing council3. In 2018, the Ministry of National Health Services, Regulation and Coordination made a thorough assessment of the existing human health resource and as per the report published Pakistan needs 0.8 million nurses by the year 20304. There is also an imbalance in the current workforce with more physicians onboard as compared to nurses in the system. Pakistan is thus confronted to upscale the production of nurses to meet Universal Health Coverage goal by year 2030 as well as to maintain the minimum standards of nursing workforce development. To uplift the standards of nursing education, Pakistan has embarked on graduate nursing education as entry into practice qualification from the year 2018 and onwards. This has shifted nursing education pre-dominantly from associate diploma regulated by nursing examination boards to baccalaureate degree program run by the universities. Maintaining standards in the production of quality nursing workforce is a big challenge for Ministry of National Health Services, Regulation and Coordination and Pakistan Nursing Council. Pakistan has though shifted onto a baccalaureate degree program in nursing its faculty is not fully prepared in modern day educational pedagogies, assessment methods, curriculum development and evaluation, educational psychology and educational leadership and management5. There is an acute need to train nursing faculty in basic teaching competencies for effectively teaching at BS nursing level. Such trainings shall be mandatory for everyone who aspires to teach in nursing colleges. The Pakistan nursing council shall make such trainings mandatory for all nursing faculty who is involved in teaching to nursing students.

Health Policies Formulation in Pakistan: An Analysis

Objective: A reviewing study of the health policy planning and formulation was initiated which explored the procedure of formulation of health policy and its implementation in Pakistan. The purpose of the study is to learn the procedure of health policy formulation and its implementation and to observe the issues in health system in Pakistan.
 Methodology: This study on health policy formulation was exploratory in nature. The research design was qualitative. The data was collected through secondary sources which includes research articles published in various journals and available on online sites. Moreover, data was also collected through books written on public policy by some foreign and local authors.
 Findings: The findings indicates that the planning and policy formation of the health sector in Pakistan is capable at the preparation level but not at the execution level.
 Implications: This paper recommends overcoming the health-related problems in Pakistan through formulation and implementation of sound, assertive and credible policies.

Strengthening health system building blocks: configuring post-COVID-19 scenario in Pakistan.

To gauge the level of preparedness of health system of Pakistan in the wake of Corona Virus Disease 2019 (COVID-19) pandemic. The global COVID-19 outbreak and its subsequent repercussions and implications, after being declared as a pandemic by the World Health Organization (WHO), exposed all the inherent, lingering, and acute shortcomings of the health systems in many developing countries and Pakistan was no exception. A detailed literature review was done which included peer-reviewed articles on COVID-19 and health system, published in local and international journals, WHO and World Bank's publications, and the documents and official reports of the government. Focus was to glean and cite strategies adopted by the developing countries in response to COVID-19 and to see the applicability of those which are feasible for Pakistan. Level of preparedness was minimal and the response to manage the outbreak was weak. Based on toll of the cases and number of deaths, this public health threat turned out to be a catastrophe beyond the controlling authority and capacity of the health system, and hence other sectors and agencies had to be engaged for devising a concerted and integrated response to deal with the emergency. Governance was disorderly, financing was inadequate, human resources were not trained, supplies and logistic were not stocked, information system was patchy, and research capacity was limited, and most of all the service delivery was in a biggest chaos of times. COVID-19 demanded to re-configure the health system of Pakistan. Improving the emergency preparedness of the hospitals is the foremost and an urgent need. A strong national public health system in Pakistan is needed to rapidly investigate and analyze the reports, assess the magnitude of the public health risk, share real-time information, and implement public health control measures in a concerted and systematic demeanor.

COVID-19 and fiscal space for health system in Pakistan: It is time for a policy decision.

SummaryMost developing countries with weak economies and low GDPs strive to invest an optimal amount of budget to health sector. Compounding on this state of affairs is their inherent inefficiency to spend even that meager amount on the welfare of the patients, improving service delivery, motivating their workforce and making their health systems responsive to the needs of the people they serve. With weak fiscal base and inelasticity in budget spending, when these countries face a catastrophe like COVID‐19, there is a whole situation of havoc and lack of finances emerges as the biggest issue in such crises. Pakistan has been no exception to this kind of situation. Government funds allocated to other public sector development schemes are diverted to deal with the health emergency. Hence, the result is an overall socioeconomic shock that a country has to face. Amid such crises, other international commitments also face a state of uncertainty. With the changing disease patterns all over the world, the public financial management system for health sector needs to be revisited to devise a more sustainable and resilient mechanism not only to absorb shocks like COVID‐19 but also to meet the international health commitments.

Mental healthcare in Pakistan

Background: According to the latest report, over 15 million people in Pakistan are suffering from some form of mental illness. But for a population of 220 million, only 400 trained psychiatrists exist with few state-run psychiatric hospitals and a small number of psychiatric units in teaching and general hospitals. In a traditionalist society, there is frequently a social disgrace together with discussing dysfunctional or abnormal behaviors as mental health problems and is generally described as a “shortcoming of character.” Methods: We carried out comprehensive literature review to collect data on the current mental health picture in Pakistan, and we also compared and formulated the recommendations from the literature of the related countries in the region and developed countries whenever possible. Results: Mental healthcare is still not a priority in the health system in Pakistan. A dire need still exists for a recognition from both public and private sectors for improving mental health planning and services in the country. Government must actualize social strategies that should be simple, equitable, and practical, as well as being able to address the issues of the regular needs. Asset allotment for emotional wellness is horrifyingly low and wasted away by defilement and fumble. A requirement exists for expanded spending on mental healthcare and psychological and emotional well-being just as appropriate usage of accessible assets. Conclusion: In this review, we suggest that a progressive change is required in the current state of psychiatry in Pakistan and that a need exists for a continuing review about existing strategies with a focus on setting sustainable priorities in the field of mental health, especially in policymaking, capacity building, awareness among public, and the use of media to minimize stigma.

Knowledge Attitude and Practices of shepherds regarding Crimean Congo Hemorrhagic Fever, Balochistan, Pakistan

Background :Crimean-Congo Hemorrhagic Fever (CCHF) is an infectious disease and a growing public health issue in Pakistan. Thus, more research on awareness assessment vital for developing a planned inquiry form to initiate an activity of interrogating.Methodology: The current survey was initiated in Balochistan where disease is endemic. A cross sectional survey was plotted through April 2016 to June 2016, in district Loralai, Balochistan and a total of 420 subjects were part of this survey. The questioning was led in Makhtar; the beneficiary group was comprised of shepherds. Information was gathered through a structured data collecting tool regarding Crimean-Congo Hemorrhagic fever.Results :The implication of Statistical analysis of the accumulated information unveiled that (279) 66% of shepherds had low level of knowledge while only (141) 38.6% had good preventive practices. A notable amount (261) 62% had negative attitude. Status of education (P= 0.018), monthly income (P= 0.173) and age (P= 0.000) of the respondents had significant association with their practices about prevention of CCHF. Most shepherds had varying levels of knowledge about ticks and tick-borne diseases, while 46.2% knew any preventive practice regarding CCHF. There was a strongly associated relationship between knowledge and practices of shepherds related to CCHF prevention measures (P<0.000).Conclusion :Raising community awareness regarding CCHF and route of its dispatch is suggested through various broadcasting and radio medium; despite that the role of health workers in the health system of Pakistan is important, they can be utilized in training of rural population. Activities to raise awareness among shepherds are important to be integrated.

Potential for task-sharing to Lady Health Workers for identification and emergency management of pre-eclampsia at community level in Pakistan.

BackgroundAn estimated 276 Pakistani women die for every 100,000 live births; with eclampsia accounting for about 10 % of these deaths. Community health workers contribute to the existing health system in Pakistan under the banner of the Lady Health Worker (LHW) Programme and are responsible to provide a comprehensive package of antenatal services. However, there is a need to increase focus on early identification and prompt diagnosis of pre-eclampsia in community settings, since women with mild pre-eclampsia often present without symptoms. This study aims to explore the potential for task-sharing to LHWs for the community-level management of pre-eclampsia and eclampsia in Pakistan.MethodsA qualitative exploratory study was undertaken February-July 2012 in two districts, Hyderabad and Matiari, in the southern province of Sindh, Pakistan. Altogether 33 focus group discussions (FGDs) were conducted and the LHW curriculum and training materials were also reviewed. The data was audio-recorded, then transcribed verbatim for thematic analysis using QSR NVivo-version10.ResultsFindings from the review of the LHW curriculum and training program describe that in the existing community delivery system, LHWs are responsible for identification of pregnant women, screening women for danger signs and referrals for antenatal care. They are the first point of contact for women in pregnancy and provide nutritional counselling along with distribution of iron and folic acid supplements. Findings from FGDs suggest that LHWs do not carry a blood pressure device or antihypertensive medications; they refer to the nearest public facility in the event of a pregnancy complication. Currently, they provide tetanus toxoid in pregnancy. The health advice provided by lady health workers is highly valued and accepted by pregnant women and their families. Many Supervisors of LHWs recognized the need for increased training regarding pre-eclampsia and eclampsia, with a focus on identifying women at high risk. The entire budget of the existing lady health worker Programme is provided by the Government of Pakistan, indicating a strong support by policy makers and the government for the tasks undertaken by these providers.ConclusionThere is a potential for training and task-sharing to LHWs for providing comprehensive antenatal care; specifically for the identification and management of pre-eclampsia in Pakistan. However, the implementation needs to be combined with appropriate training, equipment availability and supervision.Trial registrationClinicalTrial.gov, NCT01911494 Electronic supplementary materialThe online version of this article (doi:10.1186/s12978-016-0214-0) contains supplementary material, which is available to authorized users.

Primary oral health care: a missing link in public health in Pakistan

In Pakistan, the limited availability of oral health care and the high level of unmet oral health care needs are well documented. The recorded prevalence of dental caries is 50-70% and that of oral cancer is among the highest in the world. Although oral health care has been declared to be part of the primary health care system, oral health disparities between rich and poor, and emerging problems of access to and use of appropriate care have never been addressed, reflecting a lack of awareness among both patients and health system decisionmakers. Oral cancer screening and atraumatic restorative treatment for tooth decay could be included in a basic package of oral care that does not require qualified dental surgeons. This article develops an argument, based on literature review and an analysis of the health system in Pakistan, for how a basic oral health programme could be an accessible, affordable and acceptable component of the primary health care system.

E-health: effect on health system efficiency of Pakistan

BACKGROUND AND OBJECTIVESThe health system in Pakistan is spraining because of increasing cost and demand gravities. The shortage of skilled health care workers is one of the main factors of health issues. There is a need to move away from the dependency of tools such as pen, paper, and human memory to a milieu where patients and health care providers can reliably access and share health information in real time across geographic and health sector boundaries.DESIGN AND SETTINGSThe purpose of this research is to observe the effect of e-health on the physician–patient relationship and to analyze the capacity of health professionals by noting information and communication technologies usage as indicators.METHODSStructured questionnaire was used to gather data from physicians to judge the success and effect of existing e-health policy. Both categorical and Likert scale variables were used. The analysis of data was performed using chi-square test and binary logistic regression.RESULTSSpecialist doctors comprised the major proportion of health care professionals in both male and female categories with good knowledge about Internet usage. E-health–based communication does not seem to be gender specific. Logistic regression revealed that busy doctors whose patients are more than 100 per week believe that e-health would significantly strengthen their communication with patients (OR=3.06; 95% CI=1.05–8.87). Among other significant impacts of e-health include reduced consultation period and time of diagnosis.CONCLUSIONE-health technology can play a crucial role in controlling many epidemic diseases through effective surveillance. E-health implementation will result in improving the efficiency, better access of general public to the health care system, and eradication of diseases in Pakistan.

Emerging Challenges and Health System Capacity: The Case of Non- Communicable Diseases in Pakistan; a Review

Background: Pakistan is facing double burden of disease and the contribution of mortality by non-communicable diseases has over numbered the communicable diseases. The focus of health system of Pakistan is inclined more towards communicable disease and maternal & child health. Therefore, there is a need to review health policy, health sector budgeting and health setup in order to meet the needs of healthcare in context of non-communicable disease. Objective: To review the health system capacity to manage the emerging challenge of non-communicable diseases in Pakistan. Methodology: A thorough literature search on PubMed and Google Scholar was done. Reports from W.H.O, other national and international organizations and government & non-government policy papers were also reviewed. We used following search terms; Non Communicable Disease, Health system capacity, Pakistan. Results: Several health system issues emerged through the review of the health system capacity for NCDs. These included lack of political commitment, services more focused on communicable disease and MNCH, inadequate human resources, lack of inter-sectoral approach, insufficient funding opportunities and fragmented health system. These issues can be addressed through government support for combating burden of NCDs, provision of services for NCD at PHC level, human resource training regarding NCDs and integrated care system. Finance should be allocated for NCDs and existing HMIS should also be used for utilizing information regarding NCDs. Conclusion: Health systems framework to NCD means in summary re-examining the planning and organization of the entire health system, from service provision to financing, from information generation to ensuring adequate supply of pharmaceuticals/technologies or human resources, from improving facility management to performance monitoring.

Pakistan human resources for health assessment, 2009

Pakistan faces a human resources for health (HRH) crisis. A cross-sectional survey was conducted to overview frontline health workers. A total of 750 health facilities were surveyed across Pakistan. The median estimate of public sector health care workers in the district health system in Pakistan is 417 288, including 46 153 estimate of public sector health care workers in the district health system in Pakistan is 417 288, including 46 153 doctors and 41 032 nurses. Another estimated 20 000 doctors work in public sector tertiary care hospitals across the country. A total of 3549 health care workers were interviewed regarding job satisfaction and work environment. The private sector had better work environment scores compared with the public sector. Policy dimensions showed an absence of robust policies in practice. The public sector is inadequately staffed and job satisfaction and work environment need improvement. HRH crisis countries should share experiences, and developmental partners should support them in overcoming the HRH crisis.

A mixed methods field based assessment to design a mental health intervention after the 2005 earthquake in Mansehra, North-West Frontier Province, Pakistan

The capacity of the pre disastermental health system in Pakistan was weak, and the earthquake aiected areas in the North-West Frontier Province (NWFP) of Pakistan were among the most underserved areas in the country in terms ofadequate mental health services. The natural disaster exposed the weaknesses in the mental health delivery system in most of these areas.This paper describes a mixed methods ¢eld based assessment to design a mental health intervention in the earthquake aiected district of Mansehra of NWFP.The assessment had two objectives:1) to get a more complete and comprehensive understanding of mental health issues and priorities in this earthquake-aiected district; and 2) to help in selecting and designing mental health intervention for the earthquake aiected population. Both qualitative and quantitative data were collected. Qualitative data collection methods included open-ended semi structured key informant interviews, structured focus groups, and unstructured participant observation. Quantitative data collection methods included a community survey and a multiple choice mental health knowledge test. Equal priority was given to quantitative and qualitative data collection and analysis. Both types ofdata were analysed separately and integrated in the ¢nal results of the assessment.The results showed that a mental health training for both primary health care stai and community volunteers was a feasible and high priority intervention to improve the mental health of the earthquake aiected population in the Mansehra District. The assessment helped in selection of topics for training interventions.

Pathways to Care: Duration of Untreated Psychosis from Karachi, Pakistan

BackgroundSubstantial amount of time is lost before initiation of treatment in Schizophrenia. The delay in treatment is labelled as Duration of Untreated Psychosis (DUP). Most of these estimates come from western countries, where health systems are relatively better developed. There is dearth of information on pathway to care from developing countries.Methods and ResultsPatients with ICD-10 based diagnosis of Schizophrenia were enrolled by convenient method of sampling. The pathway to care was explored through a semi-structured questionnaire. Onset, course and symptoms of psychosis were assessed using Interview for the Retrospective Assessment of the Onset of Schizophrenia (IRAOS). Ethical approval of the project was taken from The Aga Khan University, Ethics Review Committee. Of the enrolled 93 subjects, 55 (59%) were males and 38 (41%) were females. In our sample, 1.56 mean (median, 2) attempts were made prior to successful help seeking. The duration of untreated psychosis was 14.8 months (St. Deviation; 29.4). DUP was 16.8 months (St. Deviation; 34.9) for males and 11.8 months (St. Deviation; 18.9) for females. In the pathway to care, psychiatrists featured prominently as initial care providers. In the first attempt at help-seeking, 43% patients were initially taken to psychiatrists. After the initial consultation, 45% were prescribed psychotropic medication while 7% were hospitalized. Only 9% subjects were given the diagnosis of schizophrenia initially. When participants were inquired about the reasons for delay, 29% reported financial difficulties as the barrier to care. Positive symptoms of psychosis were present in 57% subjects while negative symptoms were present in 30% subjects. There was a statistically significant difference (Chi-square; 7.928, df: 1, Sig 0.005) between DUP and the positive and negative symptoms category.ConclusionIn the absence of well developed primary care health system in Pakistan, majority of patients present to psychiatrists as a first contact. DUP, as a measurement of help seeking behaviour, tends to be shorter with positive symptoms of Schizophrenia. Substantial amount of time is lost due to non recognition of disease and subsequently, inadequate treatment. Secondary prevention strategies should focus on families, which play an important role in the treatment-seeking process of psychotic patients.

Health-seeking Behaviour of Women Reporting Symptoms of Reproductive Tract Infections

A woman’s access to health care, in physical, social, and psychological contexts, depends on her health beliefs and her socio-economic and demographic background. As in most developing countries, the health system in Pakistan is a combination of modern and traditional medicine, and the nature of care sought again depends on the individual’s health beliefs and background characteristics. This paper thus not only focuses on whether women seek help or not when sick, but also on the differentials that exist in the health-seeking behaviour among women with different backgrounds. It finds that less than half the women reporting any symptom related to reproductive tract infections seek help, while for some symptoms the proportion seeking help goes down to a mere one-fifth. The decision to seek help depends on a woman’s educational and economic status, the extent to which she is worried about the symptom, duration of experiencing the symptom, and inter-spousal communication about the symptom. Lack of finances to access any health service and considering the symptom as something common not needing attention are the two main reasons for not seeking help. The choice of the healthprovider consulted for a symptom is linked to the perceived cause of the symptom, but allopathic doctors are preferred by the majority of women seeking health care.

Can Cost-effective Reallocation of Inputs Increase the Efficiency of the Public Health System in Pakistan?

Heavy investment in many developing countries in the social sector including health is based on the premise that human capital is vital to the growth and development of a nation. However, Pakistan's spending on this sector has been one of the lowest in the region. In the present environment of high budget deficits, one does not expect substantial public funds to be forthcoming and diverted towards the social sector in the intermediate- or medium-term future. The critical issue facing the public sector should then be to design health policies which must be cost-effective and efficient. This study examines these health policy issues within the context of an optimisation framework for public health system, forecasts future upto (2002-03) and discusses an efficient optimal mix of health inputs, outputs, expenditures, and wage policies under alternative scenarios. The study recommends that, first, growth of health infrastructure building in the urban areas be slowed down in the short-term (two to three years), and some of the resources reallocated towards the rural sector either in terms of building new Basic Health Units or upgrading the existing Rural Health Centres. Second, not only attractive wage policies be formulated for health personnel, but the status of nurses in the public health system be also elevated by giving them higher grades. Third, for every rupee of development expenditure incurred, Public Health Department must plan or keep provisions for recurring outlays. All this reallocation of resources is feasible within the projected actual budget and it will lead to efficiency gains in the order of 8 to 10 percent for the entire public health system.