Pakistan's health system: performance and prospects after the 18th Constitutional Amendment
Pakistan's health system: performance and prospects after the 18th Constitutional Amendment
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DOI：
10.1016/s0140-6736(13)60019-7
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发表时间：
2013-06-22
期刊：
影响因子：
168.9
通讯作者：
Mirza, Yasir A.
中科院分区：
文献类型：
--
作者：
Nishtar, Sania;Boerma, Ties;Mirza, Yasir A.
根据第18条宪法修正案，巴基斯坦的联邦结构发生了巨大变化。为了深入了解改革计划，我们评估了巴基斯坦卫生系统绩效的几个方面。在过去65年中，卫生系统的业绩有所改善，但主要卫生指标落后于同行国家。78.08%的人口在医疗保健方面自掏腰包。私营部门提供了四分之三的保健服务，医生与护士和助产士的比例约为2：1。复杂的治理挑战和卫生投资不足阻碍了进展。随着卫生任务的下放，出现了改革卫生的机会。联邦政府负有卫生信息、省际协调、全球卫生和卫生监管的宪法责任。所有其他保健责任都是省级授权。在卫生系统内外采取适当的政策、体制和立法行动，现有的挑战是可以克服的。
Pakistan has undergone massive changes in its federal structure under the 18th Constitutional Amendment. To gain insights that will inform reform plans, we assessed several aspects of health-systems performance in Pakistan. Some improvements were noted in health-systems performance during the past 65 years but key health indicators lag behind those in peer countries. 78.08% of the population pay out of pocket at the point of health care. The private sector provides three-quarters of the health services, and physicians outnumber nurses and midwives by a ratio of about 2:1. Complex governance challenges and underinvestment in health have hampered progress. With devolution of the health mandate, an opportunity has arisen to reform health. The federal government has constitutional responsibility of health information, interprovincial coordination, global health, and health regulation. All other health responsibilities are a provincial mandate. With appropriate policy, institutional, and legislative action within and outside the health system, the existing challenges could be overcome.