TIP BOTTOM APPROACH IN STRENGTHENING HEALTH SECTOR REFORMS

Abstract

It is my privilege to write few words for the new hallmark in publishing biannual journal of health sciences
and I fully appreciate the efforts of the editorial board. This journal will play a pivotal role in highlighting the issues
and challenges being faced by the under developed countries particularly Pakistan. I am glad to mention here that
this journal will achieve its mission in spreading the knowledge, innovative approaches, research and evidence
based technology to overcome the challenges being faced by our country.
It’s high time that we should embark on a firm policy to cover up the much needed goals enunciated at
the Alma Ata conference in 1978 but so far Pakistan has failed to attain its minimum goals and still poverty,
overpopulation, bad governance and lack of leadership in health care are the key elements for our failures.
Pakistan since its independence in 1947 and now in the 21st millennium is having an area of around 800,
000 square kilometers and a vast population of over 180 millions, could not develop a viable health system. The
planning machinery too has failed to develop defined health goals and functions to achieve the desirable health
indicators. In spite of many commissions and step- ladder 5 years health plans and policies nothing concrete
evidence could be elicited in reduction of health indicators. Morbidities and mortalities are still very high and we
are still loosing children due to malnourishment.
Poverty, illiteracy, lower status of women in large segment of population, inadequate sanitation and provision
of potable water are responsible for ill health and are still being ignored. Pakistan still continues to spend less on
health as compared to the poor neighbouring countries and its total expenditure on the health sector is stagnated
at 0.6% of GDP. Unfortunately in our country most of the health expenditure i.e 75% is out of pocket. In fact the
reality is that 80% of the budget is spent on tertiary care setup while 20% on primary health care.
The three-tiered health system needs to be revisited. The grass root health care infrastructure has not been
translated into optimal health delivery due to a number of health related issues which includes imbalances of
services in rural and urban population, least motivation of health workforce , bad governance and leadership and
lack of national human resources for health policy.
Efforts are being made to strengthen governance and practice’s in health care system in KPK. However the
health care delivery system requires revamping in the entire country. Unless and until the primary and secondary
healty care delivery system is not strengthened there is no likelyhood of achieving millennium development goals
by 2030. This must include both state and non-state, and profit and not for profit service provision.
According to UNICEF; despite significant improvement over the past two decades Pakistan ranks towards
the bottom among other countries when it comes to infant and new natal mortality. Considering the challenges
to mother and child health in Pakistan which could largely be attributed to poverty and compounded by social
exclusion and discrimination.
In order to improve health indicators, the country as a whole would need to focus on education and health
with top priority with blown up GDP in both the sectors.
Now in this new millennium its high time to reverse the budgetary allocations to reach the poorest and it is
hoped that in future a “quick look up“ tool has to be developed to face the new challenges and issues in the health
sector to give an overall approach to problem solving, to identify the needs and implementations with evidence
based specific approaches, let’s join hands together to fight against ill health and social deprivation syndrome.
I hope and pray that this publication achieve its mission and goals. I fully appreciate the efforts of the editorial
board and the management of the Institute for initiating this memorable journal.