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Health systems changes after decentralisation: progress, challenges and dynamics in Pakistan.

Shehla Abbas Zaidi1, Maryam Bigdeli2, Etienne V Langlois3

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Area of Science:

  • Health Policy and Systems Research
  • Public Health
  • Political Science

Background:

  • Decentralisation is common, but its political processes and implementation challenges are under-examined.
  • Understanding devolution's impact on health systems is crucial for effective policy.
  • Pakistan's provincial devolution offers a case study for health system transformation.

Purpose of the Study:

  • To analyse how national structures leverage decentralisation for health system improvements in Pakistan.
  • To evaluate the political dynamics and challenges in implementing health devolution.
  • To identify lessons for managing decentralisation in health.

Main Methods:

  • Analysis of secondary data from the PRIMASYS study.
  • Inclusion of policy roundtable notes from Pakistan.
  • Narrative approach to examine Pakistan's provincial devolution.

Main Results:

  • Health gained priority, with increased resources and improved budgetary use.
  • Significant advancements in health planning, legislation, and governance measures.
  • Provincial ownership drove resourcing and innovation despite a challenging start.

Conclusions:

  • Effective decentralisation requires political management for coordination and stability.
  • Investment in stewardship capacity at all government levels is essential.
  • Weak institutional capacity and coordination impede effective health system transformation.