Healthcare Reforms in Pakistan

Provincial Healthcare Model

Proposed by

Saad Hashmi

MBAHospital and International Healthcare Management,MBBS.

30 Charlotte Street,Blackburn.BB1 7LE,United Kingdom.

Mob.No:+447812971864 Email:

Contents

Page NO

1.0 Introduction03

2.0 Aims and Objectives 04

3.0 Restructuring of Healthcare 05

3.1 Regional Healthcare Commission05

3.2 Health Outreach Teams06

3.3 Primary Care Centers06

3.4 District General Hospitals08

3.5 University Hospitals09

4.0 Healthcare Cost11

5.0 Employment Reforms11

6.0 Conclusion11

1.0 Introduction.

“Health is wealth”

It is evident that sustainable healthcare provision contributes into continuous economic growth of a country. Proper placement and utilization of healthcare unitsstrengthenthe delivery system on a larger scale.Demographics, culture and resources directly influence the viability of healthcare projects.There are various good examples in history of healthcare services through out the world.Today many nations aresuccessful in gettingdesired healthcare services as their healthcare systems evolved through a particular process based on excellent strategies.

Pakistan like other third world countries has challenges in healthcare sector. The growing population is an obvious factor in creating imbalance in demand and supply. It is obviously very hard for any state to strike a balance in healthcare provision in the presence of limited resources and rapid population growth.The healthcare system in our country is a blend of public and private healthcare providers. The private sector has dominance over public sector in cities. There is dissatisfaction of majority of people regarding services at public hospitals. They have plenty of choices in the form of private clinics and private hospitals depending upon their paying capacity .The non-functioning primary care structure in urban and rural areas adds upin poor image of public hospitals. It is a common experience that public hospitals are found over-crowded and this is a reflection of under-utilization and lack of coordination at primary care level. There are two types of patients attending public hospitals. One category travels from remote areas to receive treatment in the absence of required services in their local areas and unfortunately some of patients are already in terminal stage by the time they reach there. Other includes those who live in cities but can not afford high cost atprivate setups.

The current healthcare situation in Pakistan demands reforms .According to proposal comprehensive and uniform primary care structure dotted through out country disregarding urban and rural division can bring healthcare revolution in Pakistan. The medical services can be available at affordable cost to the public and may allow provincial government to achieve targets in limited budget at the same time.

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1."Health facts". Ministry of Health, Pakistan. Retrieved 7 September 2010.

2..Population Policy of Government of Pakistan.

Existing Healthcare Process.

2.0 Aims & Objectives.

  • To improve housing and sanitation in communities.
  • To createpublic access to efficient Primary Care Centers throughout Pakistan.
  • To bring operational reforms in public hospital services according to international standards such as following policies of Joint Commission International (JCI).
  • To establish regional healthcare commission to regulate public and private healthcare providers.
  • To integrate healthcare information technology.
  • To build sustainable resources to bear the cost of healthcare delivery.

3.0 Restructuring of Healthcare Services.

3.1 Regional healthcare commission.

The responsibilities may include:

  • Regular inspection and monitoring of public and private healthcare providers.
  • Allocating funds for primary care centers and district general hospitals.
  • Implementation of Public health programs such as TB Control, Malaria Control ETC.
  • Supervision of health outreach teams.
  • Recruitment and staff training of medical and non medical employee at primary care centers.
  • Central purchase for primary healthcare centers and district hospitals.
  • Provision of ambulance service (Rapid Emergency Response) for acute emergency cases.

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1.The World Health Report 2000: Health Systems: Improving Performance. Geneva, Switzerland: World Health Organization. 2000. p.154. ISBN92-4-156198-X.

2..

3.2Health Outreach Team.

The role includes:

  • Assessment of housing and sanitation.
  • Dissemination of public health messages e.g. creating awareness about personal hygiene(regular hand washing to prevent cross infection),Dengue fever, Hepatitis C, Hepatitis B, Detrimental effects of Smoking, breast cancers, healthy life style ETC.
  • Educating mothers aboutfamily planning and child care.
  • Assessment of developmental milestones in children.
  • Checking immunization records.
  • Assessment of elderly needs at home.

3.3 Primary Care Centers.

The services at primary care centers may include:

  • Registration.

Healthcare services number may play important role in opening patient account and maintaining treatment record.

  • e-Prescription writing.

The electronic prescription writing maykeep past record available for treatment and followups in future and to avoid duplication and errors.Healthcare Information Technology (HIT)linking primary care centers to district hospitals and tertiary care hospitals can easily speed up the process of care. It may help healthcare professionals to access patient record on system at hospital to know patient history in case of further treatment required.

The minimal out of pocket flat rate charges of Rupees 20 payable on each appointment is suggested here. There is fixed prescription charges of Rupees 50 in proposal.Children under age of 10 and elderly above 65 can be exempted from these payments.

  • Appointment booking services.

Staff at Primary Care Center can be responsible for appointment booking in outpatient department at DistrictHospital for further treatment.

  • Midwifery Services.

Regular checkup during pregnancy by qualified midwife may be managed at Primary Care Center to ensure proper monitoring during ante natal phase. Referral arrangements to ante natal clinic in district hospital for ultrasound scan and examination by obstetrician is part of booking service at Primary Care Centre.

  • Extended Program on Immunization.

There is provision of regular full course of vaccination for children at center. Vaccination record in a book can be made available for mothers to keep with them.

  • Pharmacy.

Patients may get medicines from pharmacy at primary care centers on prescription from doctor only.Fixed prescription charges Rs. 50 are proposed in a model.

PrimaryCareCenter.

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Health and Healthcare Systems in Southeast Asia.

3.4 District General Hospitals.

The acute emergency cases in emergency department and referred patients from primary care centers only have access according to model. Restricting direct approach to out patient departments in district hospitals may enhance resource availability to other facilities.

DistrictHospital.

The major services may include:

  • Free treatment in emergency department.
  • Out of pocket charges of rupees 20 in out patient department.
  • Free Radiology and Laboratory services.
  • Diagnose Related Grouping (DRG System) to control cost of bed days. Bed charges rupees 30 per night with provision of breakfast and all meals.
  • Service line management which delegates all responsibilities to department head including decision making, department operations and purchase.
  • Referring patients to university hospital (tertiary care)when required.

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Mills, A. et al (2002) The Challenge of Health Sector Reform: What Must Governments Do?London, Palgrave.

3.5 University Hospitals.

Like any other developed country the services by university hospitals has been incorporated into healthcare model.

Hospital Rooms Facilities.

The special services may include

  • Center of excellence for specialized treatment such as Oncology .ETC.
  • General treatment facilities like other district hospitals.
  • Graduate and post graduate training for doctors and nurses.
  • Medical Research.

Emergency Reception.

Flow Chart of Proposed Healthcare Process in a Province.

4.0 Healthcare Cost.

The healthcare cost may be covered from following sources.

  • National healthcare insurance (10% deductible from wages in public and private sector).
  • Flat rate fee payable in primary healthcare centers and hospitals.
  • Tax money.

5.0Human Resource.

The skill development and facilities may include:

  • Creating general physician positions for primary care centers and awarding specific grade to doctors attaining general physician certificate after two years training and passing exam.
  • Providing opportunities for nurses to specialize in midwifery and pediatrics.
  • Providing trainings to health visitors.
  • The salaries may be reviewed to stop brain drain to other countries.The provincial government may arrangeboarding, lodging and security of healthcare professionals working in primary care centers in remote areas.

6.0 Conclusion.

This provincial healthcare model has focus on patient centered care. This modelhas enhanced capacity to ensure continuous, efficient and effective delivery of healthcare services to the public of Pakistan and it also has potential to eliminate waste in the existing process.

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