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Pakistan Country Profile
National
Health and Health Development Situation
A.
Health and Demographic Situation
Socio economic profile
Pakistan
is the most populated country in the Eastern Mediterranean Region (EMR),
accounting for 30% of the regional population. It is a Federation
comprising of four provinces namely, the Punjab, Sindh,
Balochistan and the North West Frontier
Province and three
territories including the Federally Administered Tribal Areas (FATA), Azad Jammu and Kashmir (AJK) and the Islamabad Capital
Territory (ICT). The level of socio-economic development is low; GDP per
capita is US $ 736; and 32% of the entire population estimated at 152
million lives below the poverty line. Despite variable periods of economic
growth since independence in 1947, the country has shown an impressive
growth arc over the past five years. It is important to translate economic
growth into a tangible improvement in the social indicators. Certain impediments
in the process include geo-political developments such as prolonged warfare
in neighbouring Afghanistan and the scenario
arising out of the fallout of the 9/11 crisis, which have had adverse
impacts on the social sectors of Pakistan.
Health profile
The health profile of Pakistan is characterized by
high population growth rate, high infant and child mortality rate, high
maternal mortality ratio, and a dual burden of communicable and
non-communicable diseases. Malnutrition, diarrhea, acute respiratory
illness, other communicable and vaccine preventable diseases are mainly
responsible for a high burden of infant and perinatal
mortality, while high maternal mortality is mostly attributed to a high
fertility rate, low skilled birth attendance rate, illiteracy, malnutrition
and insufficient access to emergency obstetric care services. Furthermore,
only 40% of births are attended by skilled birth attendants. During 2004,
77,780 cases of pulmonary tuberculosis and 103,416 cases of malaria were
reported, while the prevalence of hepatitis B ranges between 3-4% and
hepatitis C around 5% of the general population. Non-communicable diseases constitute
a significant proportion of the country’s burden of diseases with nearly a
third of all Pakistanis over the age of 45 years suffering from
hypertension and one in every 11 adults having diabetes mellitus. The
social indicators of the country are given in Table-1 below:
Table-1: Vital Social Indicators of Pakistan
|
Indicator
|
Value
|
Year
|
|
I- Demographic Indicators:
|
|
|
|
Midyear population estimate ('000)
|
152,530
|
2004
|
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Population growth rate
|
1.92
|
2004
|
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Total fertility rate
|
3.9
|
2004
|
|
Crude birth rate
|
27.3
|
2003
|
|
Crude death rate
|
8.0
|
2003
|
|
II- Socioeconomic Indicators:
|
|
|
|
Adult literacy rate (%): Both
sexes
|
54
|
2004
|
|
Males
|
66.25
|
2004
|
|
Females
|
41.75
|
2004
|
|
Per capita GNP (US$)
|
736
|
2004
|
|
Per capita GDP (US$)
|
480
|
1998
|
|
III- Human and Material Resources
Indicators:
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|
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Rate per 10 000 population of:
Physicians
|
7.4
|
2004
|
|
Dentists
|
0.4
|
2004
|
|
Pharmacists
|
3.40
|
1996
|
|
Nurses & Midwives
|
4.7
|
2003
|
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Hospital beds
|
6.5
|
2004
|
|
PHC units and centers
|
0.9
|
2003
|
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National health expenditure as %
of GDP
|
4.1
|
2000
|
|
International aid for health as %
of total govt health exp.
|
21%
|
2004
|
|
|
|
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IV- PHC coverage (%):
|
|
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Population with safe
drinking water
|
64
|
2003
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Population with adequate
excreta disposal facilities
|
41
|
2003
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Women attended by trained
personnel during pregnancy
|
35
|
2003
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Deliveries attended by trained
personnel
|
40
|
2003
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Infants attended by trained
personnel
|
…
|
…
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Women of childbearing age using
family planning
|
33
|
2003
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Infants fully immunized against:
Tuberculosis (BCG)
|
85
|
2004
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Polio (OPV3)
|
69
|
2004
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DPT (DPT3)
|
69
|
2004
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Measles
|
68
|
2004
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Hepatitis (HBV3)
|
65
|
2004
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Pregnant women immunized with TT2
|
43
|
2004
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V- Health Status Indicators:
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Newborns with birth weight 2500g
or more (%)
|
63
|
2002
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Children with acceptable weight
for age (%)
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63
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2002
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Infant mortality rate (per 1000
live births)
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75.9
|
2003
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Probability of dying before 5th
birthday (per 1000 live births)
|
103
|
2003
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Maternal mortality rate (per 10
000 live births)
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35
|
2003
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|
|
|
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Life expectancy at birth (years):
Both sexes
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64
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2004
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Number of reported new cases of:
Polio
|
51
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2004
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Malaria
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103 416
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2004
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Tuberculosis (all types)
|
104 842
|
2004
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Pulmonary tuberculosis
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84 057
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2004
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AIDS
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66
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2004
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Measles
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4,248
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2004
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B.
National Health Policy / Health system in Pakistan
The National Health Policy of the Government of Pakistan
formulated in 2001, for the first time described an investment in the
health sector as a cornerstone of the government’s poverty reduction
plan. Furthermore, it directed attention on primary and secondary level
health care provision, and placed a strong emphasis on sound managerial
inputs as a basis for health sector reform. The main priorities areas
identified by this policy include the control of communicable diseases,
promotion of health awareness, attention to primary health care, developing
equitable health systems able to remove professional and managerial
deficiencies in the District Health System, bridging nutritional gaps in
the target populations, regulation of the private medical sector to improve
its quality and efficiency and enhancing the performance of the
pharmaceutical sector through a Drug Policy focusing on essential drugs.
Devolution
Since August 2001, the Government of Pakistan has implemented
its plan to devolve financial and administrative authority to the district
level with an aim to upscale investment in social sector and enhance
rational utilization of services in pursuit of poverty reduction and
attainment of MDGs. As a result, currently the
federal and provincial governments are responsible for the overall policy
formulation whereas implementation is largely the responsibility of the
district level. The projected benefits of devolution in strengthening the
district health system are still in the process of consolidation. The Zila Nazim, who is elected,
is the executive head of a team of district administrators including
Executive District Officer (EDO) of Health who looks after both the
preventive and curative aspects of healthcare in the entire district. In
this context, WHO is assisting MoH in enhancing
the capacity of District Managers in public health and health economics
issues such as epidemiology, biostatistics, communicable
disease control, policy analysis tools such as burden of disease
estimation, national health accounts, and cost-effectiveness analysis.
Furthermore, recognizing the role of private sector in providing the bulk
of the healthcare, WHO is also assisting MoH in
its efforts towards enhancing its capacity
to regulate, support, and build partnerships with the private sector.
Human resource
A major challenge faced by Pakistan’s Health Sector is the
imbalance in the health workforce characterized by a lack of sufficient
number of health managers, nurses, paramedics and skilled birth attendants
as can be seen in Table-2 below. Concomitantly, the rapid increase in the
number of medical colleges, mostly in the private sector, has increased the
number of doctors leading to a much better doctor: population ratio as
compared to that of the nurses, paramedics and supporting health staff.
Problems are compounded as fresh medical graduates tend to concentrate more
in the major cities while a large number of trained health personnel
migrate to other countries, creating a vacuum in certain critical areas. MoH and WHO are emphasizing on community oriented
medical education (COME) in order to produce more primary health care
physicians in an effort to bridge the current imbalance of trained human
resource amongst the rural and urban areas. With the induction of more than
70,000 Lady Health Workers (LHWs), however, the
Government of Pakistan is in the process of providing essential health care
at the doorsteps of the community. The number of LHWs
is expected to reach 100,000 as announced by Prime Minister.
Table- 2: Position of Human
Resources in the Health Sector of Pakistan
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Category/Year
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1990
|
2000
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2004
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Registered
doctors
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52,794
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92,734
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113,206
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Registered nurses
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16,948
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37,623
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48,446
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Registered LHWs
|
---
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43,000
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71,600
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Population per
doctor
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2,082
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1,529
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1,359
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Population per
nurse
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6,374
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3,732
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3,175
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Health service infrastructure
There is an elaborate network of public sector health care
delivery outlets as shown in the Table-3 below:
Table-3: Network of Health Care Delivery Outlets in Pakistan
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Health
infrastructure
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1990
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2000
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2004
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Hospitals
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756
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876
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916
|
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BHUs
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4,213
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5,171
|
5,301
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Total beds
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72,997
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93,907
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99,908
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Population per
bed
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1,480
|
1,495
|
1,540
|
Despite this elaborate network of health facilities in the
district headquarters, tehsils, other major
towns, and union councils, the utilization of the public sector health care
delivery system is low with an estimated 24% of the population using these
services. Furthermore, a substantial proportion of the population lacks
regular access to essential medicines, laboratory or diagnostic services
particularly in the rural areas. The issue
has been outlined as a priority area in the National Health Policy of 2001
Amidst the growing realization that socio-economic
determinants of health such as poverty, illiteracy, lack of safe drinking
water and basic sanitation have a major bearing on the health status of its
population, the Government of Pakistan has embarked upon different poverty
reduction programs and is committed to the provision of safe drinking water
and sanitation facilities to the entire population by the year 2007.
Main
Issues and country initiatives
A Country Cooperation Strategy (CCS) has recently been formulated
for Pakistan
for the period 2005 – 2010, which delineates the broad framework for WHO’s collaborative work with the Government of Pakistan for the next six years. The
document articulates a coherent vision and selective priorities for WHO’s
input to the development of health sector plans of the government and its
partners. It is based on a systematic assessment of Pakistan’s development challenges and health needs, the Government of Pakistan’s policies and
expectations and the activities of other development partners. The main
issues identified by the Government of Pakistan in the Health Sector and
incorporated in the CCS include:
1.
Widespread prevalence of communicable diseases
2.
Inadequacies of primary/secondary health care services
3.
Urban-rural imbalances
4.
Professional and managerial deficiencies in the district health system
5.
Nutritional gaps in the target population
6.
A deficient system for health education
7.
Mental health and substance abuse
8.
A vastly unregulated private sector
By implementing the National Health Policy – 2001, the Government of Pakistan
is addressing the issues enunciated above by emphasizing that health sector
investment is part of the government’s poverty reduction plan and also by according
priority attention to preventive care and good governance in the Health
Sector. Apart from the Health Policy, the Pakistan Poverty Reduction
Strategy Plan, Ten Years’
Prospective Plan 2001-11, and the Medium Term Development
Framework 2005-10 are government policy initiatives aligned to achieve the
MDG targets by 2015. The overall vision for the health sector in Pakistan as
projected in Medium Term Development Framework 2005-10 (MTDF 2005-10) has
outlined the following strategies:
·
Strengthening primary health care
with necessary back up support in rural areas with all the outlets
functioning as focal points for primary health care components including
family planning;
·
Establishing centers will be
established to cover the underserved areas in the urban slums;
·
Training / re-training of medical
staff at all levels by supporting the Provincial Human Development Centers
(PHDCs) and District Human Development Centers (DHDCs);
·
Establishing a system of cost
recovery for services rendered and providing a subsidy for the poorer
segments of the target population, and regulation of private sector will be
addressed by health sector reforms;
·
Autonomy is being given to teaching
hospitals through establishment of management boards and village health
committees;
·
Effective implementation of the DOTS
/ RBM strategies will appreciably help to reduce the burden of Tuberculosis
and Malaria;
·
Creation of mass awareness through
skills development of health staff in communication techniques at all
levels; and
·
A Master plan for substance abuse
developed by the Narcotics Control Division is being vigorously
followed.
Furthermore, in an effort to address the above concerns, the GoP - WHO Joint Collaborative Programs will focus on
health system development, improving access to essential health services
and quality care, promotion of healthy lifestyles, reduction of high
maternal, infant and child mortality in the country, enhance disease
control efforts for both communicable and non-communicable and linking
health to the National Poverty Reduction Strategy. By placing health at the
center for socio-economic development, community-based initiatives such as
Basic Development Needs provide avenues to forge inter-sectoral
collaboration for health actions.
Main
Directions for 2006 Onwards
Strategic
agenda for WHO cooperation with Pakistan
The priority directions for WHO’s technical cooperation with the
Government of Pakistan during the biennium 2006-07 are based on the
strategic agenda identified in the Country Cooperation Strategy document
for the period 2005-10. These strategic directions have been framed to
assist Pakistan
in moving towards the achievement of the Millennium Development Goals. The
Strategic directions are guided by the concept and approach of the primary
health care and health for all. In addition to the MOH, the directions are
aligned to generate support through other key health partners in
government, civil society, and programmes and activities that are supported
by UN agencies and other development partners. Lastly, the strategic
directions are cognizant of WHO mandate, means and technical domain.
WHO’s strategic
direction focuses on the following seven priority areas:
·
Health policy and system development
·
Communicable disease control
·
Improving the health of women and
children
·
Non-communicable diseases
·
Addressing the social determinants of
health
·
Emergency Preparedness and Response
·
Enhancing partnerships, resource
mobilization and coordination
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Fact Book
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Area
803,940 sq km
Location
Southern Asia, bordering the Arabian Sea, between India on the east and Iran and Afghanistan
on the west and China
in the north
Administrative Divisions
(Four Provinces)
Punjab, Sindh, NWFP, Balochistan
Federally Administerd
Areas
FATA(tribal areas), FANA (northern areas), ICT (capital city)
Climate
Mostly hot, dry desert; temperate in northwest;
arctic in north
Population
152 Million
Population
growth rate
1.9% (2005 est)
Life expectancy at birth
Male: 62.04 years
Female: 64.01 years (2005 est.)
Major infectious diseases
Food or water borne diseases
Bacterial Diarrhea, Hepatitis A and E, and Typhoid
Fever
Vector borne diseases
Dengue Fever, Malaria, and Cutaneous
Leishmaniasis are high risks depending on
location.
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