1 / 24

Devolution, Governance & Health

Devolution, Governance & Health . Mohsin Saeed Khan Ph.D , MPH, MBBS. Total Public Sector Expenditure in Billions (Rupees) . Per Capita expenditure on Health in Pak Rupees . Health Expenditure as % of GDP. Health system assessment Approach, USAID. Devolution Road Map.

hamlin
Download Presentation

Devolution, Governance & Health

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Devolution, Governance & Health MohsinSaeed Khan Ph.D, MPH, MBBS

  2. Total Public Sector Expenditure in Billions (Rupees)

  3. Per Capita expenditure on Health in Pak Rupees

  4. Health Expenditure as % of GDP

  5. Health system assessment Approach, USAID

  6. Devolution Road Map Ministry of Health since 1970 2001 under the Local Government Ordinance; Province to Districts July 1, 2011, 18thConstitutional Amendment abolished seven federal ministries including Ministry of Health and transferred their roles to other federal ministries, divisions, and the provinces.

  7. Devolution Road Map • vacuum • as the devolved functions were not detailed out in any plan of action. • The functions that have been retained at the federal level were distributed to different ministries without setting up a coordination mechanism.

  8. The Federal Ministry of Health • Till June 30, 2011, MoH responsible for • (i) stewardship functions, including national policy and planning; • (ii) regulation and standardization including pharmaceutical; • (iii) medical Education; • (iv) research and information; • (v) central health establishment and hospitals; and • (vi) health care provision by managing preventive and infectious disease control (eleven vertical programs), curative health care through tertiary care.

  9. Fragmentation Planning and Development Division, Economic Affairs Division, Capital Authority Development Department, Ministry of Inter Provincial Coordination, Ministry of National Regulations and Services, Cabinet Division, Federal Bureau of Statistics, and Provinces.

  10. Provinces Health Strategies in Khyber Pakhtunkhwa, Sindh and Punjab Vertical Program Management without ownership

  11. Programmatic Challenges • Issues of coverage (scope & scale) • Poor accessto health services • Non-availability of adequate human resource • Population growth • Low allocations for health • Weak inter-sectoral interventions • Duplication of efforts

  12. Service & Performance Challenges • Financial instability • No accountability for poor performance • Political interference • Issues of equity • Skilled HR

  13. Confusion, Chaos & Collapse coordination, international relationships, national and cross border surveillance, national information on health, international reporting coordination with and among provinces, donor coordination, financial forecasting and resource mobilization, and quality assurance

  14. Actors Politicians – Out Focused Beurocrats – Input Focused Technocrat – Process oriented Research & Development Specialists / Institutions – Driven by TORs Donors – Guided by their own sets of priorities

  15. So where do we want to go • Vision !!!!!!!!! • Not on priority list • Burden of Disease (outcome) • Not in the planning process • Fiscal Space • Management systems and organizational structures • What is beyond MDGs

  16. IK IK Syndrome

  17. On “bottlenecks” • Remember that in bottles, the neck is always on the top!

  18. Insight from a blind woman “There is nothing more pathetic than a man with eyesight but has no vision.”

  19. Our best thinking got us here. The problems that we face cannot be solved by the same level of thinking that created them. Albert Einstein

  20. Way Forward Embrace Error Redefine Roles Deliver Services Mobilize Resources Unpack Research

  21. THE WISDOM OF TAO XVII RULERS Of the best rulers The people only know that they exist, The next best they love and praise, The next they fear; And the next they revile. When they do not command the people's faith, Some will lose faith in them, And then they resort to oaths! But of the best when their task is accomplished, their work done, The people all remark, "We have done it ourselves." Source: The Wisdom of China and India by Lin Yuntang

More Related