SP4PHC in Pakistan

 Strengthening primary health care (PHC) in Pakistan, the world’s fifth most populous nation, is integral to making progress toward universal health coverage (UHC) and global health goals. Despite the country’s health outcomes trailing behind regional peers, innovative provincial governments are making strides: under Pakistan’s devolved system of government, several provinces are striving to maximize the impact of limited budgets to provide free, universal PHC services. ThinkWell is working with the provincial governments of Khyber Pakhtunkhwa, Sindh, and Punjab to refine purchasing mechanisms in support of reform agendas. Our work encompasses exploring effective mechanisms for contracting out the management of public sector PHC facilities, assessing options for paying Lady Health Workers, and assessing the role of a social health insurance initiative in increasing access to PHC.  Through our technical assistance, we aim to drive impact in Pakistan’s health system, improving the availability and quality of PHC services.

Current Strategies and Activities

Strategy One: Support the provincial Department of Health in Sindh to outsource primary and secondary health care facilities and services and support governance structures towards the effective management of contracting.

  • Assist the Department of Health to outsource selected primary and secondary health care facilities.
  • Facilitate the integration and expansion of the Lady Health Workers (LHW) model, establishing linkages between facilities and community-level service provision and creating models for wider provincial coverage.
  • Analyze and map the fund flow systems of the primary care implementing agency in Sindh (PPHI), conduct a value-for-money analysis, and introduce output-based budgeting.
  • Strengthen governance related to outsourcing to improve design, procurement, contract management, and monitoring & evaluation of facilities and services being outsourced.

Strategy Two: Explore opportunities to support the government of Sindh to improve stewardship of urban private PHC.

  • Explore the work that will be required based on government priorities and which activities will build synergies, capitalizing on the previous work of the World Bank and other partners to avoid duplication of efforts.

Strategy Three: Support the provincial government of Khyber Pakhtunkhwa (KP) in strengthening the contracting and outsourcing of public sector primary health care services.

  • Develop factsheets containing key health and family planning indicators, human resources availability, and related budgets for 15 districts, and perform a budgetary analysis to enable informed decision-making.
  • Facilitate outsourcing of all primary health care services, including vertically-run programs like the Lady Health Worker program, across 15 districts.
  • Support the provincial government of KP initiate policy dialogue concerning Primary Care Management Committees (PCMCs), focusing especially on governance and financial management.

Strategy Four: Provide technical support to the Punjab government to purchase private sector family planning services.

  • Support the government in Punjab in developing a model to roll out vouchers through social franchising organizations to scale up access to family planning services under the government’s stewardship.

Strategy Five: Promote and coordinate learnings around strategic purchasing across the federal government and the focal provinces.

  • Identify opportunities for a Joint Learning Network (JLN)-style learning platform to facilitate collaboration between major development and academic partners, advocate for strategic purchasing, share lessons between provinces, and act as a think tank supporting broader health financing strategies.

Featured Learning Products

Strategic Purchasing for Primary Health Care in Pakistan: Challenges and Opportunities

Pakistan is committed to driving health sector reform toward Universal Health Coverage (UHC). Accelerating progress toward UHC in Pakistan, the world’s fifth most populous country, is crucial for meeting global goals. Weak outcomes result from low coverage of PHC services, driven by Pakistan’s low government expenditure on health. Therefore, the government aims to provide free, universal, public PHC services from this limited budget envelope, which leads to low service availability, readiness, quality, and utilization. SP4PHC aims to improve how governments purchase primary health care (PHC) services, with a focus on family planning (FP) and maternal, newborn, and child health (MNCH). ThinkWell commissioned this study to understand the current landscape for PHC, health financing, and policy reform in Pakistan through desk review and key informant interviews. This report describes our findings and sets the stage for a concept note outlining potential.

SP4PHC aims to improve how governments purchase primary health care services, with a focus on family planning and maternal, newborn, and child health. SP4PHC is supported by a grant from the Bill & Melinda Gates Foundation.