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Health systems changes after decentralisation: progress, challenges and dynamics in Pakistan.
Shehla Abbas Zaidi1, Maryam Bigdeli2, Etienne V Langlois3
1Department of Community Health Sciences & Women & Child Health Division, Aga Khan University, Karachi, Pakistan.
BMJ Global Health
|February 27, 2019
Summary
Pakistan
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.
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