“Health, the greatest of all we count as blessings.” -- Ariphron

“Health, the greatest of all we count as blessings.” 

--Ariphron

The saying may be true but in Pakistan this blessing still needs to be worked upon in order to increase the efficiency of the system. One of the key reason as to why the western countries are ahead of the Pakistan and similar countries in the area of health is the presence of the appropriate infrastructures and policies. 

It should however be pointed out that at present much work with regards to health is being done in Pakistan at grass root level along with international NGOs and agencies also participating and funding various health projects in order to improve health in all Pakistani communities ranging from the rural to the urban and from the lower to the higher classes of Pakistan. 

Apart from the work that is already being done presently, there is a need to establish an infrastructure for health research in the provincial health departments with the collaboration of Pakistan Medical Research Council centres. Along with this, the personnel should also be trained for the purpose and deployed with special incentives. Policy- and decision-makers, planners and managers then also need to understand health research and recognize its importance. With regards to this orientation workshops are a great help to introduce health systems research and illustrate its importance to the planners, policy-makers and health managers. If properly executed then The Health Services Academy of the Ministry of Health and the Pakistan Medical Research Council could be the forum where regular interaction and coordination could be organised for policy-makers and health managers. 

Decision-making in the health sector takes place at the macro-level whereas implementation takes place in the regions, going down to the village level through different stages. Health policy is the responsibility of the Federal Ministry of Health with the assistance of the attached health departments. 

The main objective of health systems research is to bring about improvement in the health of the people by increasing the effectiveness and efficiency of the health care system. In Pakistan, the research can be initiated on the basis of the available data on the financial and physical position of the health sector. In Pakistan, health systems research has the potential to play an important role in the achievement of health for all.

Decline in the incidence and impact of infectious diseases and awareness of chronic diseases have raised the public's expectations of the health system. However, only a small portion of the gross national product is spent on health in the public sector. Low economic and high population growth and demand for resources by other sectors have left little prospect of increasing the budget for the health sector. In this situation, the improvement can only be achieved through greater efficiency, which includes data collection on the inputs and outputs of the health sector, which will provide feedback for planning, implementation, monitoring, evaluation and strengthening of concerned management and administration. 

In the recent years, Pakistan has been following a plan of action to achieve the goals of health for all through the establishment and improvement of the primary health care network. This includes providing medical equipment, staff and medicine to the primary health care facilities through enhanced allocation, skill development of staff in the outlets and employment of lady health workers in the country. Assessment of the present progress of the primary health care facilities for the sake of improvement in the future is of considerable importance. Some of the most important indicators for measuring the progress of health for all are as follows. 

• Health policy indicators: These include resource allocation, degree of equity of distribution of resources, community involvement, degree of decentralisation in decision-making and organizational framework, and the managerial process. 

• Indicators of the provision of health care. These include progress in availability, accessibility and use of the health care services and the quality of care. They should be related to the specific types of services that the national health strategy aims at providing. 

• Health status indicators: These include changes and trends in the health status of the population. 

• Social and economic indicators: These include demographic and economic trends, income distribution, education, housing and food availability. 

It should be noted here that, in all the plans, health targets and indicators have been set at the levels of other regional countries without comparing resources. The absence of a research-based approach to allocating resources in line with the targets ultimately creates problems. As a result, the decision-makers are provided with incomplete feedback which results in a gap between targets and achievements. An example from a five-year plan illustrates the problem. The infant mortality rate for 1993 was taken as 86 per 1000 live births. In the Eighth Five-year Plan, the target was to reduce this rate to 65 per 1000 live births by 1998. The infant mortality rate in the country was reported to be 95 per 1000 live births. There is an open question of how to bring down the infant mortality rate by 21 points during the five years of the plan. Were there sufficient resources, i.e. funds, personnel, and other infrastructure available to achieve this target? What was the basis for calculating all these variables? Were these variables based on past trends, and do they provide consolidated ground for the policy-makers to approve the same targets? Were there adequate data available to support the targets and achievements? Most of the questions have no answer because of the absence of health systems research in the country. 

Health systems research aims to discover new ideas for the benefit of the people. It is time to introduce and implement the strategy of national objectives of health through a well established system of health research. Only such an approach will lead to truly achieving the goal of health for all.