Presentation on Health Sector - World...

Ministry of Health

Government of PakistanMinistry of Health

Presentation on Health Sector

May 2003

2Ministry of Health

Social Indicators of IPRSP - Health(Baseline, Target and Current Position)

21 in 13 districts

0199 (Year 2000)

Polio cases reported in one year

58(LHW-MIS)

8532Target Population covered by LHWs (%)

37(HMIS)

4023Utilization rate of FLCF (%)

35(PIHS-IV 2001-02)

5031Coverage of prenatal care (%)

53(PIHS-IV 2001-02)

8549Routine Immunization coverage of children (%)

24(PIHS-IV 2001-02)

2519Births attended by Skilled personnel (%)

105(PRHFPS 2000-01)

82111Under 5 Mortality Rate (per 1000 lb)

82(PIHS-IV 2001-02)

6589Infant Mortality Rate (per 1000 lb)

Current Position

Target (2003-04)

Baseline (1998-99)

PIHS-III

Core Health Indicators in IPRSP

3Ministry of Health

National Health Programs(Health is a Provincial subject but National Health Programs involving Federal/ Provincial

partnership are being implemented in priority health areas)

Rs. 302 million for 5 years11. National Nutrition Programme

Rs. 273 million for 5 years10. National Malaria Control Programme (RBM initiative)

Rs. 188 million for 5 years9. National TB Control Programme

Rs. 774 million Rs. 2.85 billion for 5 yr

8. National AIDS Control Programme • Enhanced HIV/AIDS Control Programme (2003-08)

Rs. 788 million for 6 years7. Women Health Project (Federal Component)

Rs. 9104 million for 9 years6. The Lady Health Workers’ Programme

Rs. 857 million for 2 years5. Elimination of MNT in high risk districts

$ 44 million for 5 years4. Strengthen routine EPI with GAVI grant

$ 28 million for 5 years3. Introduction of Hepatitis-B vaccine in EPI with GAVI grant

$ 8 million /year2. Polio Eradication Initiative

Rs. 5366 million for 5 years1. National EPI Programme

CostNational Health Programs

4Ministry of Health

Total Government Expenditure on Health(Federal plus Provincial)

(Rs. in billion)Public Sector Health Expenditure

(Federal plus Provincial) Fiscal Year

Development Expenditure

Current Expenditure Total Expenditure

As % of GNP

1996-97 1997-98 1998-99 1999-00 2000-01 2001-02

6,485 6,077 5,492 5,887 5,944 6,688

11,857 13,587 15,316 16,190 18,337 18,717

18,342 19,664 20,808 22,077 24,281 25,406

0.75 0.70 0.71 0.70 0.70 0.74

2002-03 Allocation 6,609 22,205 28,814 0.78

Source: Planning and Development Division; Economic Survey 2001-02.

5Ministry of Health

Allocation of Fed. Health PSDP

Rs. in million

Fiscal Year Allocation for Federal Health PSDP % of Federal PSDP

1999-00 2000-01 2001-02 2002-03

2464.781 2742.974 4213.892 3309.247

2.12% 2.28% 3.24% 3.67%

Source: Budget book

6Ministry of Health

Federal Health PSDPAllocation and Expenditure (2001-03)

Rs. in million

2001-02 2002-03 Programme/ Project Budget

Request Actual

Allocation Expenditure Budget Request

Actual Allocation

National Program for FP & PHC 2232 2256 1770 2466 1791 National EPI Programme 912 696 250 1200 500 Rollback Malaria Initiative 105 146 97 156 31 TB Control Program 20 131 2.6 90 25 HIV/AIDS Control Program 94 184 177 100 100 Enhanced HIV/AIDS Control Programme

- - - 550 150

Nutrition Project - 50 14 50 50 Women Health Project 233 100 89 237 237 Reproductive Health Project - - - 20 20 Others: 2309 650 269 4734 405

Grand Total MOH-PSDP: 5905 4213 2669 9,603 3309

7Ministry of Health

Federal Health PSDP Expenditures (1995-2002)

(Million Rs.)

Fiscal Year Federal Health PSDP Expenditures

1995-96 1996-97 1997-98 1998-99 1999-00 2000-01 2001-02

1852 1802 1581 2024 2193 1790 2669

Source: Economic Survey

8Ministry of Health

Expenditure on Health –Comparison with Other Countries of the Region

Country THE as % of GDP - 2000

GHE as % of THE - 2001

Per capita THE in US $ - 2000

Per capita GHE in US $ - 2000

Bangladesh 3.8 36.4 14 5 Egypt 3.8 46.1 51 24 India 4.9 17.8 23 4 Indonesia 2.7 23.7 19 5 Iran 5.5 46.3 258 119 Pakistan 4.1 22.9 18 4 Sri Lanka 3.6 49 31 15 Thailand 3.7 57.4 71 41

Source: World Health Report 2002, World Development Report 2002 THE – Total Health Expenditure GHE –Government Health Expenditure OOP - Out of Pocket Expenditure

9Ministry of Health

Health Care Delivery Infrastructure

HUMAN RESOURSE FOR HEALTH:Doctors: 96,248 (1,506 persons / Doctor)Dentist: 4,622 (31,371 persons / Dentist)Nurses: 40,019 (3,623 persons / Nurse)LHVs: 5,669 Lady Health Workers: 70,000

Hospitals : 106Small Hospital : 520General Practitioners: 20,000Maternity Homes : 300Dispensaries : 340Laboratories : 450Health Care NGOs : 254

Hospitals : 906Dispensaries : 4,590RHCs : 550BHUs : 5,308MCH Centers : 862TB Clinics : 285 Total Hospital Beds : 98,264

(1,443 persons / bed)

PRIVATE SECTORPUBLIC SECTOR

10Ministry of Health

National EPI Programme

To immunize children against six communicable diseases to reduce child morbidity and mortality.

• GAVI support of $72 million over five years.• Hepatitis-B included in routine EPI schedule.

• Fully immunized (12-23 months ) - based on recall and recordsTotal Urban Rural

Pakistan 53% 70% 46%Punjab 57% 76% 51%Sindh 45% 64% 33%NWFP 57% 70% 55%Balochistan 24% 36% 22%

Source : (PIHS- 2001-02)


Polio Eradication InitiativeEradication of Polio by end 2003• In 2000, new strategies were adopted

–Increased government involvement from outside the MoH at the urging of the National and Provincial leadership.–Door to door strategy.–Extra rounds added.

• In 2001, further intensification–High-risk areas identified through AFP surveillance network.–Additional personnel and resources–Additional rounds in high-risk areas.

• Year Cases1999 5582000 1992001 1192002 852003 (till May) 21


High prevalence rate of the Hepatitis-B in Pakistan (5 to 7 % of the population).

• All children <1 year being immunized against hepatitis-B.• Hepatitis -B vaccination included in routine EPI in all

Districts.• Ultimately will lead to reduction of prevalence of

Hepatitis-B, Cirrhosis, malignancies and other complications.

Introduction of Hepatitis - B Vaccination


Vaccination against Maternal and Neonatal Tetanus

To reduce high neonatal and maternal mortality because of Maternal and Neonatal Tetanus.

• Three rounds have been completed in 55 districts.• 3.9 million Child Bearing Age (CBAs) were immunized

against MNT. • Vaccination in 65 high risk districts is being carried out in

phase III.• Request for Phase IV has been made to JICA


The Lady Health Workers’ Programme (National Programme for F P & PHC)

Major Programme launched to reduce high Infant Mortality, Maternal Mortality and Fertility Rate in the country.

Provision of Promotive, Preventive and Curative services at the doorstep of the community through 100,000 LHWs.

• 70,000 LHWs working in 123 districts of the country. (Selection of 20,000 LHWs started in 2002-03).

• Merger of VBFPWs of Population Division and Lady Health Workers Cadre of Ministry of Health completed.

• The Programme is having a significant impact on a range of health outcomes. A result that is very rarely found in community health programs of this size.

• New PC-1 of the Programme for the period 2003-08, costing Rs.22.4 billion submitted for approval of ECNEC.


Women Health Project

To reduce high Maternal Mortality through• Developing 20 women friendly districts and strengthening of

District Health Management..• Provision of Comprehensive Emergency Obstetric Care

Services in 20 districts.• Recruitment of 8000 LHWs in 20 districts.• Developing midwifery cadre at community level.• Strengthening advocacy, social mobilization and health

education for women health.• Strengthening of Schools/ Colleges of Nursing.


National HIV/AIDS Control Programme

Pakistan is a low prevalence but a high risk country for an HIV/AIDS epidemic. Programme launched to

– control HIV/AIDS cases;– promote blood safety by strengthening safe blood transfusion.

• Extensive Information, education and communication campaign.• Support to 47 HIV surveillance centers throughout the country (About

3.25 million tests performed). • 3.652 million blood screening tests conducted• 1765 HIV cases and 233 AIDS cases have been reported• Enhanced HIV/AIDS Control Programme with the World Bank assistance

has been approved at a cost USD $ 47.00 million.• Safe blood ordinance in place.


TB Control Programme

Pakistan has the sixth largest burden of tuberculosis in the world. The TB incidence @ 177 per 100,000 population.

Programme launched– to control TB through DOTS strategy, international best practice.– to achieve 85% cure rate and 70% case detection rate.

• 69 districts covered under DOTS. • Strengthening of referral laboratories, provision of drugs,

surveillance system and training. • All districts and 100% coverage will be achieved by 2005.


Malaria Control Programme

About half a million malaria cases occur annually.Malaria is a re-emerging disease with high endemicity in

Sindh and Balochistan. Falciparum malaria has registered an increase in Sindh (57%), with overall burden 33%.

Rollback Malaria (RBM) initiative launchedto control malaria morbidity and mortality by reducing annual parasite rate to 50% by 2010.

• 40 high risk districts identified• Implementation started in 19 districts• Expansion of RBM intervention in all districts by 2006• Pilot projects for Impregnated bed nets initiated


50% of CBA women, 45% of mothers and 29% of children are anemic. 37% of children are underweight for age.

PC-1 on Nutrition Project (2001-06) approved at the cost of Rs. 302 million, which includes:

• Nutrition through PHC; Micro-nutrient Supplementation; IEC; Nutrition Research.

• Vitamin A and Iron /Folic acid supplementation to mothers through LHWs.

• Promotion of use of iodized salt.• Training of LHWs on micronutrients supplementation, Lactation

management and Nutritional Education.

National Nutrition Programme


• National Programme on Perinatal and Newborn Care;• National Programme of Community Midwives;• Non-Communicable Diseases Control Project;• Health Management Information System;• Policy Analysis and Research Unit;• National Health Facility (NHF) – DFID;• Early Childhood Development (ECD) Project – ADB;• Global Fund to Fight AIDS, TB and Malaria.

New Initiatives in Health – In Process

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