Partners’ HPSR report – 2021
Pakistan
Overview
Of the 20 HPSR-related institutions identified in Pakistan, almost 45% are independent research centres or think tanks, with the bulk of the remainder composed of government- or university-based institutions. Together, these institutions are generating a wealth of knowledge through reports, newspaper articles and articles in peer-reviewed journals, and there were more than 500 formal meetings between Ministry of Health officials and HPSR-related institutions from 2018 to 2020.
Health policy in Pakistan is, increasingly, being shaped by HPSR. It has informed the development of Pakistan’s Universal Health Coverage Benefit Package (UHC-BP), and the creation of a technical framework to facilitate fast-tracking in the event of pandemics and other health crises. The strong influence of HPSR in Pakistan is rooted in evidence-based deliberative processes involving all key stakeholders. Nevertheless, there is limited domestic funding for HPSR, and research continues to rely on funding from external sources.
Institutions by type
List of HPSR institutions
Knowledge generation
Achievements in HPSR knowledge generation in Pakistan from 2018 to 2020 included the publication of 488 national HPSR reports developed by the country’s 20 institutions. Topics included: health system strengthening, primary health care, capacity building for health care providers, essential medicines, supplies and procurement, as well as the identification of gaps in Pakistan’s health care system (e.g., maternal and child health, infectious diseases, non-communicable diseases and occupational health). In addition, more than 6600 articles related to HPSR in Pakistan have been published in peer-reviewed journals since 2000.
Major HPSR programmes established between 2018 and 2020 focus on the integration of mental health care into primary health care, universal health coverage, decentralization, health system strengthening and strategies and infectious disease surveillance. The Federal Ministry of National Health Services Regulations and Coordination (MoNHSRC) has co-organized evidence-based workshops on how to improve healthcare delivery and universal health coverage benefit packages, as well as responses to infectious diseases, such as COVID-19, and their impacts.
A number of institutions, including the Sustainable Development Policy Institute, Khyber Medical University, Aga Khan University (AKU), MoNHSRC and the National Institute of Health, have contributed to policy research on strengthening the capacities of health workers, health facilities and increasing equitable accessibility to health care. AKU and the MoNHSRC have initiated major programme development and implementation of the Universal Health Coverage Benefit Package in Pakistan (UHC-BP).
Average number of reports produced per institution each year in Pakistan and overall
Engaging policy-makers and the public
There were 507 formal meetings during 2018-2020 between Pakistan-based MOH officials and research/academic institutions to discuss health insurance, national action plans to address major public health challenges and the sustainable improvement of health systems. HPSR has informed action on a range of areas and initiatives over that time period, including the Universal Health Coverage Benefit Package (UHC-BP); public health infrastructure and the COVID-19 response; Umeed-e-Nau (New Hope programme); international health regulations; neonatal mortality; and non-communicable diseases (NCDs).
Work on the development of the UHC-BP was initiated in July 2019 through the joint efforts of Disease Control Priorities 3 (DCP3) secretariat, MoNHSRC, AKU, London School of Hygiene and Tropical Medicine, Health Services Academy, Radboud Medical Center and international experts. The package has been endorsed by the Government of Pakistan and is now being implemented in districts across every province.
Work on public health infrastructure and the COVID-19 response included a pilot by the P2Impact think tank on the ‘COVID-19 Response and other Natural Calamities Control Program’ – a technical framework to help provincial governments fast-track the development of their planning commission appraisal forms. The framework was created through consultation with national and provincial stakeholders, a review of health infrastructure and systems and the identification of gaps in the COVID-19 response to strengthen overall public health infrastructure. The Health Services Academy, MoNHSRC, National Institute of Health and the Expanded Programme on Immunization are developing an action plan for COVID-19 vaccine management, including research on health system gaps that could hamper vaccine roll-out. The Health Services Academy has developed 15 guidelines on COVID-19 management, including vaccine handling and storage, mitigation of the spread of infection and strategies for their clinical management, rapid testing and vaccination.
AKU’s Umeed-e-Nau (‘New Hope’) programme has built the capacities of frontline workers to better manage maternal, newborn and child health (MNCH), expand health services to under-served regions, and promote evidence-based health care by filling gaps in District Health Information Systems. The aim is to strengthen health service delivery and increase the coverage of MNCH services.
HPSR has further helped to ensure that the antiseptic chlorhexidine (CHX) is on the list of essential medicines to help prevent neonatal mortality, backed by local manufacturing capacity and streamlined for use by lady health workers (LHWs), community midwives (CMWs) and staff at tertiary care hospitals, following a successful pilot in Sindh.
Finally, the development of NCD action plans has been informed by provincial surveys to guide the planning and implementation of control and prevention.
In terms of engaging the public, Pakistan’s HPSR-related institutions reported generating over 1750 local news articles between 2018 and 2020, however a wider search identified more than 3300.
Average number of meetings held with policy-makers per institution each year in Pakistan and overall
Average number of media articles published per institution each year in Pakistan and overall
Academic and institutional capacity
Academic institutions have faculty that provide teaching and training on HPSR, including AKU, Dow University of Health Sciences in Karachi, Health Services Academy in Islamabad, University of Health Sciences in Lahore, Khyber Medical University in Peshawar and Bolan Medical College in Quetta.
Institutions reported an increase in HPSR faculty from 197 in 2018 to 278 in 2020. At the same time, the number of students participating in HPSR courses jumped from around 500 in 2018 and in 2019 to nearly 2000 in 2020.
This is partly down to the Continuing Education Programme on HPSR training at AKU, which built capacities on a wide range of areas, from sustainable immunization financing to strategies for the prevention of non-communicable diseases. A total of 734 national and international participants took part in these courses between 2018 and 2020. A range of faculty members at AKU are involved in HPSR, spanning activities related to research, education and public health practice. Experts from different departments have formed a HPSR group at university level to identify and share policy-relevant findings, contribute policy-relevant research to influence policy-makers, and provide a platform for the sharing of cross-disciplinary methodological skills and approaches. Several faculty members are participating in PhDs in this area both nationally and internationally, including sandwich programmes.
Total number of HPSR faculty and staff
Total number of participants in HPSR-related short courses
HPSR financing
There is limited domestic funding for HPSR and most research relies on funding from external sources. From 2018 to 2020, Pakistan’s nine main HPSR-related institutions invested a combined total of US$ 13 million in HPSR for teaching and training, HPSR research and dissemination and implementation/technical assistance and evaluation. AKU, in particular, made significant investments in HPSR, budgeting between US$ 1.04 million and US$ 1.21 million between the years of 2018 and 2020 for the salaries of faculty involved in teaching and research activities.
The main funders for HPSR in Pakistan over that period were, however, external. The Bill & Melinda Gates Foundation funded research on tools for disease surveillance and control. The World Health Organization funded projects to explore strategies and frameworks for primary health care and strengthening health systems, while the World Bank Group supported projects engaging the health private sector to improve access and quality of primary health care. At AKU, 18 grants were awarded to the Health Policy and Management section between 2018 to 2020, totalling US$ 1.16 million. These grants supported the development of HPSR related to the UHC-BP, health workers’ digitization, intersectoral interventions, primary health care, social health protection, health system strengthening, private sector engagement, migrants’ health, nutrition and disaster preparedness.
Total institutional expenditure
Credits and disclaimers
Partners’ health policy and systems research report, 2021
WHO/SCI/HSR/21.1
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