Pakistan: Khyber Pakhtunkhwa Health Systems Strengthening Program

Health / Health sector development and reform

The Khyber Pakhtunkhwa Health Systems Strengthening Program results-based loan (RBL) supports the Revamping Secondary Health Care (RSHC) program,* a flagship and province-wide program of the Government of Khyber Pakhtunkhwa to improve secondary health care (SHC) services.

The RBL program aims to enhance the quality of SHC services in Khyber Pakhtunkhwa Province by (i) ensuring the availability and implementation of clinical protocols, standards, and guidelines at secondary hospitals; (ii) modernizing hospital infrastructure and medical equipment; (iii) reinforcing the planning of human resources and health services; (iv) upgrading the management of the medicine supply chain; and (v) improving the efficacy of service delivery.

The transaction technical assistance "Preparing the Khyber Pakhtunkhwa Health Systems Strengthening Program" was approved on 5 October 2021.

*The RSHC program is more commonly known in government documents as "Revamping of Non-Teaching District Head Quarter Hospitals in Khyber Pakhtunkhwa."

Khyber Pakhtunkhwa Province is facing tremendous challenges in the health sector. Its health outcomes need significant improvement to achieve the Sustainable Development Goals. The neonatal mortality rate is 41 per 1,000 live births, the infant mortality rate is 53 per 1,000 live births, and the maternal mortality ratio is 165 per 100,000 live births. The health indicators are worse in the merged districts (e.g., maternal mortality ratio of 261 per 100,000 live births in 2014). Because of the lack of access to quality primary health care (PHC) and SHC services, people tend to bypass them and seek treatment directly at tertiary care hospitals. This overburdens tertiary services and limits the resources for those who really need them, and is costly both for the government and for the patients, who usually have to travel far.

The provincial government, cognizant of the challenges , made improving the quality of PHC and SHC service delivery a central tenet of its health strategy. Quality of care concerns not only quality medical equipment and infrastructure, hygiene, maintenance, and availability of medicines, but also qualified and well-trained medical and support staff who all collaborate in an organized, conducive, accountable, evidence-based, and optimal manner. The Revamping Secondary Health Care (RSHC) program aims to transform SHC by (i) upgrading the infrastructure of the SHC facilities; (ii) providing quality new equipment; (iii) ensuring posting and availability of medical, technical, and administrative staff; (iv) efficiently outsourcing certain services to the private sector; (v) introducing and enhancing health management information systems, including electronic medical records; and (vi) introducing quality assurance regimes. The Minimum Health Services Delivery Package for Secondary Care Khyber Pakhtunkhwa will be implemented.

Accessible, equitable, and quality health care for all people of Khyber Pakhtunkhwa to advance the community's well-being, productivity, and prosperity improved

Quality of care of secondary hospital services in Khyber Pakhtunkhwa enhanced

Clinical protocols, standards, and guidelines available and implemented at secondary hospitals

Hospital infrastructure and medical equipment modernized

Planning of human resources and health services reinforced

Management of medicine supply chain upgraded

Effectiveness of service delivery improved