Health Department (2010-13)
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Version II DraftDraft for forDiscussion Discussion MEDIUM TERM BUDGETARY FRAMEWORK (MTBF) (2010-13) Volume - II Medium Term Budgetary Framework (MTBF) – Health Department (2010-13) Government of the Punjab Health Department 27th July 2010 i Draft for Discussion Table of Contents MESSAGE FROM SECRETARY HEALTH DEPARTMENT 1 ACRONYMS 2 SECTION I 4 1. Introduction and Background to the Department 4 1.1. Particulars of the Department 4 1.2. Vision Statement 4 1.3. Policy Objectives 4 1.4. Overview of Health Sector in Pakistan 5 1.5. Overview of Health Sector in Punjab 6 1.6. Organizational Structure and Functions of the Department 7 1.6.1. About the Department 7 1.6.2. Key Functions of the Department: 8 1.6.3. Planning & Budgeting Process in the Department 9 1.7. Share of Health Budget in Provincial Budget Outlay 11 2. Priorities in the medium term (2010-13) 12 3. Medium Term Budget Estimates (2010-13) 13 3.1 Summary of MTBF Estimates (2010-13) 13 3.2 MTBF Allocations by Policy Objectives 16 3.3 MTBF Allocations – by Object Classification 18 3.4 MTBF Allocations – by Functional Classification 21 3.5 MTBF Allocations – by Cross Classification 23 3.6 Key Inputs and Outputs – Current Budget 29 3.7 Selective Outputs for Large Development Schemes 36 3.8 Recurrent Impact of Development Projects 40 APPENDIX – B: EXPLANATORY NOTES TO MTBF ESTIMATES (2010-13) 42 APPENDIX – C: MTBF AT HEALTH DEPARTMENT 46 GLOSSARY OF TERMS 50 SECTION II 53 PART – A: DETAILS OF CURRENT BUDGET ESTIMATES 2010-13 53 i Draft for Discussion PART – B: DETAILS OF DEVELOPMENT BUDGET ESTIMATES 2010-13 221 ii Draft for Discussion MESSAGE FROM SECRETARY HEALTH DEPARTMENT This was second year of MTBF reforms in the Health Department. As in the first year, the Medium Term Budgetary Framework (MTBF) Statement 2010-13 of the Department was finalized a fter a meticulous exercise spread over several months . The MTBF statement 2010-13 was an upshot of hard work put together by officials of the Department, spending units and the consultants engaged for this initiative. The format of the statement is as it was in the last year i.e. it has two sections: Section 1 deals with basic information about the Department along with analysis and summaries of MTBF estimates 2010-13 & past trends in budget allocations. It also gives a summary on cost of health policies besides a summary of a set of key ‘outputs’ that the spending units would aim to deliver in 2010-13 along with key resources (Inputs) required. Section 2 of the Statement gives MTBF estimates for non-devolved spending units of the Department separately for current and development budgets for 2010-13. Health Department delivers more complex and sensitive services than any other Department of the Government. It controls (directly or indirectly) a number of diverse entities that provide specialized services to the people in the Province and manages a large portfolio of development schemes in various sub-sectors. Role of the Department keeps evolving with the passage of time in relation to both delivery of health services and formulation and implementation of health policies. A key policy change happened during FY 2008-09 aimed at the provision of free treatment, strengthening of infrastructure and provision of other support facilities in tertiary care hospitals under Chief Minister’s initiative. This policy change resulted in a bigger resource envelope for the Department and its tertiary care hospitals. The Health Department has decided to begin to coordinate the work of the development wing and the budget and accounts wing into a FMC tasked in FY 2008-09 to drive financial management reforms in Health Department and spending agencies, and for collecting budget and expenditure information from districts. The FMC is responsible for coordinating the budget preparation and execution process and ensuring adherence to the budget preparation principles. The FMC is central to financial reporting in health sector, with the goal of generating management accounting information to facilitate budgetary control and achievement against policy goals. The pilot implementation of MTBF in coordination with the FMC seems to have laid a foundation for costing the health strategies and correlating operational targets of the spending units with their financial requirements. This essentially entails a paradigm shift in its own right and obviously requires a high degree of diligence and commitment. Let me express my unequivocal support for this major initiative and reiterate Department’s total support and ownership for this. Fawad Hasan Fawad 1 Draft for Discussion Acronyms ADP Annual Development Plan AMI Autonomous Medical Institutions BHU Basic Health Unit BCC Budget Call Circular BPS Basic Pay Scale DDO Drawing and Disbursing Officer DGHS Director General Health Services DHQH District Headquarter Hospital FD Finance Department FMC Financial Management Cell FSW Female Sex Worker FY Fiscal Year GDP Gross Domestic Product IDU Intravenous Drug User LGO Local Government Ordinance LHW Lady Health Worker MDG Millennium Development Goal MO Medical Officer MSW Male Sex Worker MTBF Medium Term Budgetary Framework MTDF Medium Term Development Framework No. Number P&DD Planning & Development Department PACP Punjab Aids Control Program PHSRP Punjab Health Sector Reforms Program PMU Program Management Unit PO Planning Officer RHC Rural Health Center SPO Senior Planning Officer SU Spending Unit THQH Tehsil Headquarter Hospital UOM Unit of Measurement WMO Woman Medical Officer 2 Draft for Discussion Medium Term Budgetary Framework 2010-13 Section I 3 Draft for Discussion Section I 1. Introduction and Background to the Department 1.1. Particulars of the Department Name of the Department Health Department, Punjab Name of the Principal Accounting Officer Mr. Fawad Hasan Fawad Number of current budgets (2010-11) 48 No. of development schemes (2010-11) 167 Number of DDO’s 215 Staff strength (2010-11)1 14,964 1.2. Vision Statement 2 “Healthy population with a sound health care system practicing healthy life style, in partnership with private sector including civil society, which is effective, efficient and responsive to the needs of the low socio-economic groups especially women in the reproductive age.” 1.3. Policy Objectives Policy Objective Policy Objective Description Number Reducing widespread prevalence of communicable diseases and 1 strengthening preventive health care Addressing inadequacies in primary and secondary health care and 2 increased pro-poor health expenditure Creation of Health Care Commission quality management, 3 standardization and accreditation 4 Improving patient care facilities at tertiary care level 5 Provision of quality medical education 6 Providing and strengthening of allied health services 1 Does not include staff of Autonomous Medical Institutions (AMI’s) 2 Source: Medium Term Development Framework 2010-11, Government of the Punjab 4 Draft for Discussion Policy Objective Policy Objective Description Number 7 Strengthening of restructured Director General Health Services 8 Private sector involvement and mainstreaming Improving governance at all levels and addressing systemic issues at 9 macro level 1.4. Overview of Health Sector in Pakistan 3 In Pakistan, investments in the Health sector are viewed as an integral part of the government’s poverty alleviation endeavor. An improvement in the overall health sector indicators of a country has important ramifications not just for the quality of life of its citizens, but for economic development generally, through the channels of productivity enhancement and poverty alleviation. While there has been noticeable improvement in some health indicators over the years, on the whole, Pakistan ranks poorly on this count. Overall, life expectancy in Pakistan remains lower than many in its peer group, while infant as well as maternal mortality rates are amongst the highest. The National Health Policy of Pakistan of 2009 seeks to improve the health indicators of the country. It aims to do so by delivering a set of basic health services for all by improving health manpower, gathering and using reliable health information to guide program effectiveness and design, and strategic use of emerging technology. It also aims to improve health status of the population by achieving policy objectives of enhancing coverage and access of essential health services, measurable reduction in the burden of diseases and protecting the poor and under privileged population subgroups against risk factors. Several programs are under way with major thrust to improve health care, coverage and to help in achieving Millennium Development Goals (MDGs) pertaining to health indicators. Special attention is being given to the training of nurses and several training centers are already in operation. The achievement of MDGs is a priority area for Pakistan, especially in the health sector. Pakistan is committed to meeting these goals by 2015 by launching new policy initiatives. Through a major health intervention program and strategies, it is aimed to reduce the less than five years old children mortality rate to 52 per 1000, infant mortality rate to 40 per 1000, and maternal mortality ratio to 140 by 2015. Whereas the proportion of 1 year-old children immunized against measles is 3 Source: Economic Survey 2009-10, Government of Pakistan 5 Draft for Discussion targeted to be increased to 85% and the proportion of births attended by skilled health personnel to 90% by 2015. In addition, plans have been formulated to combat TB, Malaria,