Primary Healthcare In Pakistan Health And Social Care Essay

Pakistan is a state which is affected by about every know crisis in the universe. More and more work has to be carried out in the alleviation and constitution sectors in order to advance factors which can be critical in stableness of the state. Many private NGO ‘S and organisations are working to better many affected sectors in Pakistan like instruction, wellness, nutrient etc. In old five old ages Khyber Pukhtun Khwa has been the most affected state of Pakistan. Terrorism, inundations, low criterions of instruction, wellness, ongoing military operations and the adjustment and alleviation disbursals on people that have been migrated from the no go countries are the chief jobs. PPHI ( Peoples primary wellness attention enterprise ) is a authorities based plan which promotes constitution of wellness criterions and alleviation oriented plans which are associated with wellness of the people. Health is a large issue in KPK every bit good as the FATA which are no go countries or the tribal countries linked with KPK. Every catastrophe that came to Pakistan has violently affected the KPK. Floods, Terrorism and non-availability of instruction have ruined the wellness criterions of KPK. Hundreds of authorities infirmaries became the victims of terrorist onslaughts therefore about completing the lone means of wellness stableness from the hapless and rural people of KPK and FATA.

In the above Bar chart a study was conducted in order to entree the wellness jobs of inundation affected people that migrated to different territories of KPK. More than three quarters of respondents said they or person in their household had needed health care services since they were displaced. Many of the respondents ( 73 % ) said their household needed intervention for acute unwellness such as diarrhoea or acute respiratory infection. A one-fourth of respondents expressed a demand for intervention for injury or hurts, while 58 % said their kids needed healthcare The bulk ( 62.5 % ) of respondents have concerns about their ability to entree wellness services while in supplanting. A 3rd was worried about the deficiency of medical specialty and supplies ; another tierce was concerned about the inaccessibility of wellness installations. Other grounds were the deficiency of female wellness workers ( 12.75 % ) and the trouble accessing wellness services due to hapless roads/distance ( 15.75 % ) .

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Admiting the interruption down of Management Services as the basic issue in the proviso of Primary Healthcare in Pakistan, the Federal Government, through the Special Initiatives Division, launched a state broad Program to be known as the President ‘s Primary Healthcare Initiative ( PPHI ) . In the Khyber Pakhtunkhwa and FATA, the Program was, practically, initiated in 2007 when the several territory authoritiess and DoH, FATA transferred financess to PPHI.

The basic aim of the PPHI is to better wellness service bringing at the primary degree through betterment of direction of the wellness establishments. For this intent, Agency/ District Support Units ( A/DSUs ) have been established in each selected District/ Agency to take over the direction of Basic Health Units ( BHUs ) .Agency/ District Support Manager ( A/DSM ) , who is caput of the A/DSU. District and Agency Support Units, with devolved administrative and fiscal authorization, are responsible to guarantee effectual and efficient Primary Health attention service bringing to the rural population, specially the marginalized groups. As a affair of policy, the Government considers it as an indispensable enterprise for the relief of poorness. PPHI enterprises to accomplish this nonsubjective through betterment in the basic substructure of the wellness installations, guaranting handiness of medical specialties and staff and by organizing assorted activities associating to the health care service bringing at primary degree including promotive, preventative and healing health care. The Program is to the full owned, and funded by, the Federal and Provincial Governments. Table: 1

S. No.


No. of BHUs

















Upper Dir
























FR Pesh/Kt



418In Khyber Pakhtunkhwa and FATA, the plan was initiated in July, 2007 when PPHI was entrusted with the direction of 7 Districts, 2 Agencies and 2 FRs ( Peshawar and Kohat ) . Budgetary allotments were, nevertheless, transferred in November, 2007 by the several District Governments and Directorate of Health ( FATA ) . In August 2008 PPHI extended its services to four more territories in Khyber Pukhtunkhwa viz. ; Mardan, Haripur, Charsadda and Malakand. The Program is to the full owned and funded by the Federal and Provincial Governments and its administrative control rests with the Prime Minister ‘s Secretariat.


To convey the PHC substructure to an optimal degree of public presentation in footings of all the eight components of the PHC, and, to help in re-engineering the ( territory ) wellness direction and to manus over vibrant and extremely incorporate RHFs to a Reformed direction.


The focal point of the PPHI is to supply quality health care services through efficient and effectual service bringing system that is accessible, just, acceptable, low-cost and sustainable. PPHI strives to better the wellness installations in the rural countries, chiefly concentrating on healing attention, alongwith the system of outreach activities for proviso of preventative and promotive services maintaining in position the following guiding rules ;

aˆ?A Efficient Human Resource Management,

aˆ?A Enhanced Community Participation,

aˆ?A Local Resource Mobilization,

aˆ?A Promoting Communication Channels.


The PPHI plan has the undermentioned aims ;

Significantly strengthen the Primary Healthcare ( PHC ) system in the districts/ bureaus so as to guarantee the bringing of a standard bundle of preventative, healing, and promotive services that will assist Khyber Pakhtunkhwa achieve the Health Millennium Development Goals ( MDG ) .

Significantly better the:

Coverage and use of services,

Quality of attention, and

Equity of entree to the services by geographical countries, by income degree, and by adult females and kids.

Ensure that patients and communities are progressively involved and satisfied with the publically financed wellness services and ease the community ‘s engagement in the design, bringing, and rating of wellness services.

Construct the capacity of wellness workers so that they can supply better services to the community within an available budget.


Medicines and Equipment Procurement

Regular supply of medical specialties is an of import undertaking in guaranting primary health care services in rural countries. After taking over the BHUs, PPHI received some medical specialties from DG and DoH, FATA. Medicines worth Rs. 88 million, during 2008-09, were distributed to respective BHUs. Similarly PPHI has procured medical equipments deserving Rs 7.01 million and furniture deserving Rs.1.8 million. To guarantee quality of medical specialties, PPHI avails the services of Resource Group, comprising of doctors and druggist. Requirements are worked out in audience with the District Managers and BHU physicians.

As per proviso of “ Manual of Operation ” PPHI has the discretion to buy Medicines out of sanctioned lists of other states and reputed Institutions in add-on to list of MCC. This in-built flexibleness is of great aid to guarantee quality of medical specialties.

3.7 Restoration of Community Confidence

Mobilization of Community and engagement in determination devising has greatly improved the state of affairs. Posting and presence of qualified medical officers, proviso of medical specialties and equipments, fixs of BHU and uninterrupted visits of territory staff has resulted in Restoration of assurance of community in the PHC system. Substantial addition in OPD is one major index of community trust in the PHC. As indicated in table 3 there is an overall addition of 61 % over the base line twelvemonth.

Table: 4 Mother and Child Healthcare



Immunization ( TT Vaccine )


Children Vaccinated


Pre-natal attention


Deliveries ( BHU+Home )


Post-natal attention

19,854Mother and Child Preventive Healthcare

PPHI has given cardinal attending to female parent and kid preventative attention. For this intent PPHI non merely ensures the handiness of trained medical staff but besides provides medical specialties and equipment ‘s. So far, PPHI has administered TT vaccinum to 280,343 pregnant and kid bearing age adult females. Similarly 2,101,100 kids have been vaccinated in the mark countries, 12,201 bringings have been handled in the BHUs and 24,750 at places, 23,154 adult females were provided pre-natal and 19,854 adult females with post- natal attention.

3.9 Provision of Ultrasonography

Females and kids constitute more than 80 % of the OPD in BHUs, who suffer from assorted diseases, notably those associated with gestation and prenatal attention. Due to non-availability of professional staff and the needed medical specialties and equipment ‘s in BHUs, this most ignored and vulnerable section of rural community has no entree to diagnostic and ANC services. As one of several stairss for the proviso of better diagnostic and ANC services, PPHI is in the procedure of supplying Ultrasonography for ANC. This will assist in hiking the ANC services, bettering the Cardinal Performance Indicators and in incorporating unneeded visits to large infirmaries. This, in bend, will assist in cut downing the tendency of hapless patients sing urban infirmaries for minor complaints, salvaging them from incurring heavy outgo for such visits.

3.10 Construction of Labour Rooms In BHUs

The absence of well-equipped and decently furnished labor suites at primary health care centres / BHUs, notably in the rural countries, deprives female patients from availing prenatal attention services, therefore coercing them to see territory degree infirmaries or private clinics where they suffer economically, besides incommodiousness for junior-grade jobs. PPHI Khyber Pukhtunkhwa/FATA is, hence, working out the inside informations to build labor suites in BHUs located in the dumbly populated and distant countries, for which financess will be made available from within the available budget. The cost of one such labour suite designed by the Provincial Government is about Rs.2.4 Million. PPHI plans to build labour suite with much lesser cost with proviso for future enlargement.

Participants of MRMs at DSU/ ASU

Medical Officers ( MOs )

Support Group Members ( as may be considered by the DSM ) .

A representative from the PSU.

All DSU/ASU professional staff. Community Participation

The Role of community engagement, inter alia, includes instilling a sense of ownership of BHU, feedback, entree to preventative plans, organisation of community wellness Sessionss, organisation of school wellness Sessionss, focal point on hygiene, nutrition and EPI etc.

Community Health Session ( Table: 7 )

No of Sessions


No. of Participants in CHS

69,863Community Health Sessions

In community wellness Sessionss, talks are given to the participants on a assortment of subjects associating to wellness and hygiene. So far PPHI has arranged 1435 Sessionss in which 69,863 participants have taken portion.

School/Madrassa Health Sessions ( S/MHS )

PPHI on a regular basis arranges school wellness Sessionss in schools to do the pupils cognizant of assorted diseases. Health Sessionss are besides being on a regular basis conducted in Madrassah. The intent is that the pupils of these establishments could every bit be informed of the catching diseases and precautional steps against these diseases. During the session, pupils are given of import tips about wellness, medically examined and, if required, provided intervention. So far 1,642 school wellness Sessionss have been arranged in which 88,127 pupils have participated, 27,620 pupils have been medically examined while 30,782 provided with proper intervention.

Free Medical Camps

Under PPHI outreach plan, to better wellness bringing service, free Medical Camps are arranged. PPHI arranges free medical cantonments to cover distant countries. In fact this is the extension of the first degree wellness installations. So far PPHI-Khyber Pukhtunkhwa/FATA has organized 40 free medical cantonments with 3312 patients were treated. In these free medical cantonments, medical specialties of WHO was delivered.

PPHI Mass Awareness Program

Approximately 83 % of the entire population of the Province resides in rural countries where installations in societal sectors are either scarce or even non existent. Consequently, the occupants have to avail these installations, per force, in the urban countries affecting incommodiousness every bit good as outgo which the hapless communities can non afford. The MDGs require that the proportion of parents able to call the danger marks of some diseases should be less than 10 % by 2015. This so is a mark which will non be achieved without serious attempts made at the grass root degree through instruction.

Empirical analysis of wellness related information would uncover that about 80 % of the diseases in rural countries can be prevented if the communities are good informed about the causes of such diseases and steps are taken for their bar. Unfortunately, the population at big, peculiarly in rural countries, remains nescient of this really of import facet of primary health care. Resultantly, immense amount of money is spent by the rural hapless on diseases which can be merely prevented through more wellness instruction. This will non merely assist in the relief of poorness but besides lessen the load on bigger infirmaries.

PPHI has endeavored to distribute this message every bit far as possible. Health consciousness stuffs, including brochures, postings, which are being distributed in Schools / Madrassa and in community wellness Sessionss. All these activities are directed towards mass consciousness of the population. Free medical cantonments, School Sessionss and Support Group meetings are built-in portion of mass consciousness plan.

( Chapter # 3 )

Organizational Apparatus

Main aims of PPHI is to supply an effectual and professional managerial leading at territory and provincial degree with policy over sight, both, at the degree of state and federation.

National Steering Committee

Federal Support Unit ( FSU )

Provincial Support Unit ( PSU )

Provincial Steering Committee/ Health Department

Sarhad Rural Support Program

Regional Program Director

District Support Unit/ Agency Support unit



Medical Military officers Table: -2


No of BHUs


Entire MOs/ FMOs Currently working


MOs/FMOs hired by the Govt.


MOs/ FMOs hired by PPHI

151Currently 257 MOs are working in BHUs out of which 134 have been hired by PPHI, including 17 Female Medical Officers.

PPHI has given importance to the enlisting of trained paramedical staff at BHU degree. Paramedical staff non merely assists MOs in everyday undertakings of BHUs but besides perform extra responsibilities like infantile paralysis obliteration etc. PPHI has recruited 296 paramedics including medical technicians and LHVs.

PPHI sections

There are four chief sections in PPHI:


Human resource




The finance section is one of the most of import sections in the organisation, as it helps supply the funding and accounting information necessary to do assorted determinations. However, this section has a function that encompasses a figure of responsibilities.

The finance section is responsible for maintaining path of all the disbursals that are necessary in Providence of wellness installations etc.

Another duty of the finance section is to supply direction with a profit-and-loss statement that will demo the overall strengths or failings of the organisation. It besides provides a layout for future financess to be applied from the authorities for PPHI.

Directors need the most current information to do the best determinations for their sections. The finance section has a responsibility to supply them with the most accurate and timely information possible. This would include information such as disbursals on operations.

The finance section plays an built-in function in assisting the concern receive the necessary funding it needs.


HR section is responsible for ciphering work force projections, finding handiness of appliers and measuring the suitableness of campaigners for arrangement throughout the Public and PPHI. Recruiters besides contact newspapers and other media mercantile establishments to publicize vacancies.

The employee dealingss and labour dealingss countries of HR are jointly responsible for beef uping the employer-employee relationship. Employee dealingss representatives resolve employee struggles, design public presentation direction systems, create employee acknowledgment plans and assess degrees of employee satisfaction.

Depending on the organisation, the workplace safety responsibilities of an HR section may change greatly. Often moving in more of a preparation than oversight capacity, the workplace safety and hazard direction subdivision is finally responsible for keeping a safe workplace. PPHI specially work in KPK and FATA which are largely affected by terrorist act therefore HR plays an of import responsibility. Many safety professionals coordinate their attempts with employee dealingss representatives and benefits specializers to set up guidelines refering to issues such as on-the-job hurts and conformity with employment Torahs and ordinances.

HR preparation and development is the country responsible for encouraging professional and personal development in the workplace through the bringing of organized acquisition chances. Training and development professionals are well-versed in affairs refering to necessitate appraisal, course of study design and developmental scheme. They work to antagonize abrasion and attach toing diminutions in workplace accomplishments.


Keep abreast of research consequences in the capable affair country of selling ; co-ordinate work with local, province, and national planning groups and other interested parties in assisting them place major job countries and demands in selling. It develop and transport out appropriate action plans that will ensue in important betterments being made by those people concerned with jobs of selling. It coordinates attempts with representatives of other bureaus or organisations or individuals who are concerned with related plans.


By and large talking disposal includes general co-ordination of assorted things, care of office and other bhu ‘s, HR section, vehicle motion ‘s etc.


I did my internship in PPHI Peshawar. PPHI Peshawar is a territory subdivision and co-ordinates and facilitates territory Peshawar and tribal belt of Kohat. PPHI Peshawar ‘s basic aim was to develop and supply wellness installations and counter the jobs that damage a healthy environment.

I was an intern in the HR section and got preparation in Fieldss like enlisting and choice procedure.

Training plan:

In HR section of PPHI chiefly these activities were done:

Recruitment and choice




Description of undertakings assigned to me:

As an intern my responsibilities were to supply coordination and communicating between sections and external environment. The coordination undertaking included the applications to travel at appropriate topographic points. Writing applications for financess and ordination of files and certification. Another basic duty was to see that miscommunication between sections does n’t happen.

HR section construction:

In every HR section ( every territory ) there are 3 employees supplying these services.

As three employees are working in the HR section of territory Peshawar therefore the section organisation construction is really simple.

Recruitment and Posters:

For enlisting of contract staff, stations are foremost advertised in taking Newspapers of the part. The short listed campaigners appear for an interview before a Selection Committee consisting of representative from EDO ( Health ) /Agency Surgeon ‘s office, Provincial Support Unit ( PSU ) , and the several DSUs/ASUs. Beginnings of campaigners are external because the seats are contractual and advertizements are given in the intelligence documents.

Training and development:

Employee developing demand appraisal is done through public presentation analysis of employees. To measure the public presentation of BHUs, regular meetings are held every month with staff of BHUs at DSUs/ASUs degree. A outstanding characteristic of these meetings is that different functionaries from Health section are invited. Decisions are made and assorted activities are coordinated in audience with EDOs ( H ) and Agency Surgeons ( in instance of FATA ) . Coordinators of assorted National Vertical Programs like EPI, T.B DOTS, Polio Eradication, Malaria Roll Back Program, Lady Health Workers Programs etc are besides invited for these meetings and activities at BHUs under these Programs are evaluated. In add-on to this, these meetings provide an chance for capacity edifice of BHU staff. For this intent Professors/Assistant Professors from Government Hospitals are invited to present talks on assorted Health issues. Training plans are held at every Wednesday to see the competence of employees. Apart from sharing monthly advancement studies from BHUs with HMIS cell, quarterly studies sing PPHI ‘s public presentation are sent on a regular footing to DG ( H ) , Secretary Health, FSU, SRSP, EDO ( H ) , DCOs, APAs, and Secretary Administration, FATA.

Employee compensation and Benefits:

PPHI has initiated a particular Compensation for BHUs ‘ staff ( MOs and paramedic staff ) working in difficult countries to promote them to be given to their responsibilities at BHUs. An sum of Rs.40.30 million were allocated. Based on class of difficult country Medical Officers and paramedics are paid particular allowance up to Rs.7000 and Rs.5000 per month, severally overall staff of 159 BHUs is profiting.

Organizational calling direction:


Promotions of employees depend upon their public presentation. Under the rigorous observation of senior direction employees are evaluated and so promoted to upper classs.


Like publicity the transportation besides depends upon the public presentation degree of the employees. Underachieving employees are screened and so transferred to rural territories.


If an employee wants to vacate from the PPHI the procedure is that the employee submits the surrender along with the ground to the deputy undertaking manager which is farther send to project manager.

SWOT Analysis of PPHI:

Without the appraisal of PPHI we can non make the SWOT analysis.

Since sign language of understanding with District Government Malakand in March, 2008 and existent financess transferred in April, 2008, PPHI has got considerable success in territory Malakand where it has started work. Noteworthy addition in OPD, care and rehabilitation ( M & A ; R ) of BHUs, medical staff enlisting and guaranting their attending, proviso of medical specialty and covering some of the BHUs by constellating & A ; some by individual MO in the territory, are the few singular activities of PPHI plan. The plan has built-in system for set uping support groups in order to instill sense of ownership in the beneficiary community, set uping community wellness Sessionss ( CHS ) and School/ Madrassa wellness Sessionss ( S/MHS ) for consciousness against the common diseases besides supplying stuff for wellness instruction ( consciousness of school kids and community ) .

Addition in OPD after the launching of the plan in 2008 is more than 100 % . To get the better of the lack of staff, PPHI hired medical officers ( 11 ) in its mark countries. Each of the BHUs has been covered by individual MO apart from six bunchs made so far. Health instruction and awareness plan is traveling on side by side and School Health Sessions, Community Health Sessions & A ; Madrassa Health Sessions are on a regular basis being held. During wellness Sessionss, pupils are given a talk on wellness and hygiene, so pupils are medically examined, and those who need intervention, are provided with medical specialty. To instill the sense of ownership, PPHI on a regular basis organizes support group meetings of the beneficiary communities and so far PPHI has established 20 support groups. M & A ; R in 16 BHUs has been completed chiefly in the service units while it is to be started in the staying 04 BHUs shortly. The plants are identified by the support groups and MOs taking into consideration the demand of MOs/ Paramedic staff and the patients peculiarly.

Regular affair is kept with Provincial Govt/ Health Department and District Government, Malakand. After successful execution of healing facet of wellness, attending is now being diverted to the promotive & A ; preventative sides of wellness through lasting partnerships with perpendicular plans.

PPHI has done a batch to better the PHC services at BHUs since its start of existent activities in July, 2008. But there is ever room for betterment. Some sensible clip would still be required to resuscitate the decades-long ignored BHUs/ PHC services. Besides, the betterment in physical substructure of BHUs, the behavior/ attitude of “ non working in rural countries ” will necessitate clip to alter and to alter this tendency PPHI has introduced difficult country allowances for the MOs and Paramedic staff w.e.f. 1st July 2009. Similarly, testing trials ( Hepatitis B & A ; C, Sugar & A ; Pregnancy ) have been started and disposable baseball mitts, syringe-cutters, etc. have been provided to the BHUs w.e.f. December, 09. Apart from it, wooden shelves have been provided to the BHUs for the safe storage of medical specialty.


Year 2008

Year 2009

Constitution of the District Support Unit

Constitution of Liaison with local interest holders

Base line study of all the BHUs

Transportation of financess ( Salary & A ; Non-Salary )

Covering with the General Duty Staff

Recruitment of Staff ( MOs/Paramedics )

Preparation of Plan for M & A ; R Work

Formation of Support Groups and engagement of community

Issue of the General Duty Staff resolved ( 50 % )

M & A ; R carried out in 15 BHUs ( Maximum cost Rs. 1.5 Million )

Recruited 11 MOs and 07 Paramedics

More than 100 % addition in monthly OPD

Re-formation of Support Groups ( 20 SG )

Provision of Furniture / Shelves for shops

Procurement of Medicine even beyond the scope of MCC

Provision of Healthcare to IDPs

Feasible Monitoring Regime installed

Hard country allowances for the BHU staff

Survey on KPIs conducted

External Influences:

1. Resistance by the vested involvement groups

2. Label of NGO

3. Lack of Cooperation by the DoH

4. Volatile security state of affairs & A ; unfavorable environment

5.Political intervention

6. Hindrance in transportation of financess from DG

External Influences:

1. Obstructed medical specialty supplies due to security state of affairs

2. Changeless curfew and prostration of the monitoring government

3. Restoration of the public assurance and high outlooks

4. Transfer / Posters by the EDO ( Health ) Office

5. Hindrance in transportation of financess from DG

6. Political Intervention


SWOT Analysis



Qualified & A ; Committed Staff

Role of Community in the form of SG

Handiness of Monitoring government

Flexibility in use of Budget

Competition with DoH

Periodic reappraisal of public presentation

Budget being non-lapsable

Proper certification and analysis of informations

Animosity with EDO ( H )

Fiscal Dependence on DG

Uns due hold in release of fund

Lack of lucidity on disposal legal power

Restriction of purchase from MCC

Over politicized Community



PHC being a neglected sphere

Development of partnership

Authorization of community

Timely use of nest eggs

Use of HMIS Data for future

Planing & A ; Policy doing

Political Intervention

Law and order state of affairs

Vested involvement

Future Sustainability

Decision to SWOT ANALYSIS:

Lack of cooperation from EDO ( Health ) Office particularly in affairs of staff

Lack of lucidity w/r to PPHI manner of operations particularly one line transportation

Dependence on the District Government in fiscal affairs particularly timely release of budget

Engagement of the community and high outlooks

Restraint of working in the same ball of budget & A ; accomplishing an ambitious docket

Vertical plans non on the same grid with PPHI as they work under a separate administrative umbrella

Non handiness of a coordination commission at territory degree to quickly cover with differences


PPHI should concentrate on the undermentioned points.

Strengthening the PHC through public private partnership

Enhanced Co-ordination and coaction with perpendicular Plans

Engagement of the community in the affairs of the HFs through Support Groups

Imparting sense of ownership to the community to guarantee sustainability of the revamped PHC

Efficient Utilization of homo and fiscal resource

Focus on issues of equality & A ; equity within the sphere of PHC



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