Review Article iMedPub Journals Journal of Hospital & Medical Management 2017 http://www.imedpub.com ISSN 2471-9781 Vol. 3 No. 1: 1 DOI: 10.4172/2471-9781.100020 Comparison and Analysis of Health Care Santosh Kumar and Delivery Systems: Pakistan versus Bangladesh Suria Bano Aga Khan University School of Nursing and Midwifery, Karachi, Pakistan Abstract Corresponding author: Kumar S Health Care Delivery System (HCDS) is the arrangement that serves best to any country’s population with effective, efficient, fair distributions of resources, and funds for organized infrastructure to thrive well. Globally, HCDS becomes [email protected] a highly competitive and rapidly growing service and needs special attentions from different domains. The optimal HCDS provides hope, relief to the individual, Aga Khan University School of Nursing and community, and population. The balanced health care system delivers the Midwifery, Karachi, Pakistan quality of care, health, and facilities through efficient, effective, and fair manner. Moreover, across the world the HCDS varies from country to country and focusing Tel: +92 333-3267825 on improving access, coverage and quality of services, however, it depends on the key resources being available, organized, managed, and utilized effectively. In this paper, we will discuss HCDS of Pakistan in comparison to Bangladesh with areas of Citation: Kumar S, Bano S. Comparison and governance, service delivery, finance, information, human resources, and medical Analysis of Health Care Delivery Systems: technologies and will analyze HCDS of both countries, and ends with challenges, Pakistan versus Bangladesh. J Hosp Med recommendations to improve health care reforms and its utilization. Manage. 2017, 3:1. Keywords: Pakistan; Bangladesh; Health care delivery system; Health indicators; Health issues Received: December 22, 2016; Accepted: January 09, 2017; Published: January 14, 2017 Introduction Demographics of Pakistan and Health Care Delivery System (HCDS) is a societal response to Bangladesh the determinants of health. The concept of health care system Pakistan is a located in South Asia encircled by Afghanistan, includes the involvement of the people, organizations, agencies, India, China, Arabian Sea and Iran. It is the 36th largest country and resources that provide services to meet the health needs of in the world in terms of area with an area covering 881,913 km2 the individual, community, and population [1]. The fundamental (340,509 sq mi). Pakistan is the sixth most populous country premise of the HCDS is to value human life, promote, restore, in the world, with about 185 million people and by 2050 it will and maintain the health of the population and that is focused become the fourth largest populated country in the world [5]. and organized around the health needs and expectations of The United Nations Development Programme (UNDP) ranked people [2]. The effectiveness of health care system depends Pakistan in the Human Development Index (HDI) 146th out of upon human, materials, finance, availability and accessibility 187 countries. Presently, Pakistan has Gross Domestic Product of resources. The optimal HCDS integrates the different health (GDP) stagnant at 4.71%, Gross National Income (GNI) per capita services encompasses the management and delivery of quality is approximate US$ 1550, and is categorized as low-income and safe health services [3]. Moreover, in the balanced health country and positioned at 65th among 102 developing countries. care system people receive a continuum of health promotion, Currently, the literacy rate of the population has increased to 58% disease prevention, diagnosis, treatment, disease management, as compared to 53% in 2011-12 [6]. The state religion in Pakistan rehabilitation and palliative care services, through the different is Islam, practiced by 95-97% of the population, and remaining levels and sites of care within the health system, and according 3-5% practice Christianity, Hinduism, and other religions. to their needs throughout the life course [4]. Now, in this paper, Bangladesh is one of the most densely populated South Asian we will discuss, compare, and analyze the HCDS of Pakistan in countries. It occupies 147, 570 square kilometers. It is the ninth comparison to Bangladesh. most populated country in the world, in 2013 had a population of © Under License of Creative Commons Attribution 3.0 License | This article is available in: http://hospital-medical-management.imedpub.com/archive.php 1 Journal of Hospital &ARCHIVOS Medical Management DE MEDICINA 2017 ISSNISSN 2471-9781 1698-9465 Vol. 3 No. 1: 1 156.6 million that is expected to increase to around 218 million health services in Bangladesh is pluralistic with four key actors by 2030 [7]. Recently, Bangladesh has undergone considerable that define its structure and function: government, private, social and economic changes, economy dramatically accelerated non-governmental organizations (NGOs), and donor agencies and GNI increased from US$ 100 per capita in 1973 to US$ 700 in [13]. In the early phase, the health system of Bangladesh was 2010 [8]. The country is experiencing a high rate of urbanization primarily focused on providing curative services but at present despite such rapid urbanization, Bangladesh is still primarily a with the involvement of United Nations, private sectors, NGOs, rural country with more than seventy percent of the population and donor agencies the health system has shifted its emphasis living in rural areas [9]. The UNDP ranked Bangladesh as 146th out equally both on curative and preventive services [14]. Though, of 187 countries in terms of HDI. Islam is the faith of eighty-five HCDS has expanded its reach despite the people of rural areas percent of the population, while Hindus, Buddhist, and Christians remains with little access to facilities [8]. Moreover, the HCDS making up the most of remaining fifteen percent. of Bangladesh is challenged with governance, finances, human resources, service delivery, technology, manpower, and essential Pakistan Health Care Delivery System supplies like medicines [15]. Pakistan has a mixed health system that includes public, parastatal, private, civil society, philanthropic contributors, Key Health Issue and Indicators and donor agencies. In Pakistan, health care delivery to the In Pakistan since 2000, there has been the notable improvement consumers is systematized through four modes of preventive, in some health indicators mainly as a result of public, private promotive, curative, and rehabilitative services. The private programs and NGOs contributions [16]. Despite, health profile sector attends 70% of the population through a diverse group of Pakistan is illustrated by high population growth rate, infant of trained health team members to traditional faith healers and maternal mortality rates, and dual burden of communicable [10]. Both vertical and horizontal HCDS exists in Pakistan. The and non-communicable diseases [17]. Regardless, the country is HCDS of Pakistan is summarized in Figure 1. The major strength undergoing considerable social, environmental, and economic of HCDS of Pakistan is an outreach primary health care services changes. The basic food requirement and health are problems for delivered at the community level by Lady Health Workers the people, the paper by Nishtar [18] indicated that malnutrition (LHWs), Lady Health Visitors (LHVs), and Community Midwives is worst in the rural areas of Sindh, and Baluchistan with 20-30% (CMWs) who have earned success and trust in the communities children are being retarded, and high infant mortality is as a result [11]. In Pakistan, these LHVs, LHWs, and CMWs are attached to of malnutrition, diarrhea, and pneumonia. Furthermore, about the government facilities, from which they receive training, and 40% of deliveries are attended by skilled birth attendants, and serve the community at the doorstep in order to get desired the high maternal mortality rate is related to high fertility rate, health outcomes. Furthermore, in Pakistan under article 18th low skilled birth attendance, malnutrition and inadequate access amendment the health care services are the obligations of to emergency obstetric care services [19]. The key demographic and health indicators of both countries are summarized in provisional government except for the federal area. The public Table 1. Bangladesh despite its challenging circumstances, health delivery system functions through a three layer approach has proven to be remarkably resilient and achieved significant primary, secondary, and tertiary(Figure 1). human development gains, and impressive progress was made Bangladesh Health Care Delivery in health outcomes, especially in maternal and child health [20]. Population growth slowed considerably during the past thirty System years and falling from 2.7 percent per year in the 1980s to around Over the 45 years after independence, the HCDS of Bangladesh 1.3 percent in 2010 [21]. The contributions of the overall disease has gone through a number of reforms and established an in terms of percentages in Pakistan and Bangladesh are shown extensive health infrastructure [12]. The provision of basic in Table 2. Goals and Expectation Health Care Delivery System of Pakistan Since the time of independence, HCDS of Pakistan has undergone major reforms start its journey from National Health Policy, Public Sector Private Sector Primary Health Care services, TB control, and Immunization Program [22]. Regardless of settled