Shadow Development Budget for the Health Sector Punjab Province FY 2019-20 www.cpdi-pakistan.org Shadow Development Budget for the Health Sector Punjab Province FY 2019-20 December 2018 Centre for Peace and Development Initiatives would welcome reproduction and dissemination of the contents of the report with due acknowledgments. Centre for Peace and Development Initiatives Tel: +92 (51) 831 2794-5 Fax: +92 (51) 844 3633 Email: [email protected] URL: www.cpdi-pakistan.org Disclaimer Every effort has been made to ensure the accuracy of the contents of this publication. The organisation does not accept any responsibility of any omission as it is not deliberate. Nevertheless, we will appreciate provision of accurate information to improve our work. ISBN: 978-969-9484-65-0 Ds Shadow Development Budget for Health Sector Table of Contents ABBREVIATIONS ............................................................................................................................................................ 1 FOREWORD ...................................................................................................................................................................... 2 CHAPTER 1: ...................................................................................................................................................................... 3 CONCEPT, BACKGROUND AND THE METHODOLOGY ........................................................................................ 3 1.1. CONCEPT OF SHADOW BUDGETING ........................................................................................................................... 3 1.2. BACKGROUND OF SHADOW BUDGETING ................................................................................................................... 3 1.2.1. INTERNATIONAL CONTEXT ...................................................................................................................................................... 3 1.2.2. NATIONAL CONTEXT ................................................................................................................................................................. 4 1.3. GOVERNMENT RESPONSIBILITY ................................................................................................................................. 4 1.3.1. NATIONAL COMMITMENTS ...................................................................................................................................................... 4 1.3.2. INTERNATIONAL COMMITMENTS ........................................................................................................................................... 6 1.4. GUIDING VALUES ......................................................................................................................................................... 7 1.5. METHODOLOGY ........................................................................................................................................................... 7 CHAPTER 2: ...................................................................................................................................................................... 8 HEALTH SECTOR IN THE PUNJAB PROVINCE ....................................................................................................... 8 2.1. OVERVIEW ................................................................................................................................................................... 8 2.2. STATUS OF HEALTH FACILITIES AND PROGRAMMES ................................................................................................ 9 2.3. MAJOR HEALTH SECTOR CHALLENGES ...................................................................................................................... 9 2.3.1. GAPS IN IMMUNIZATION COVERAGE ................................................................................................................................... 10 2.3.2. UNSAFE BIRTHS ...................................................................................................................................................................... 10 2.3.3. INEFFICIENT AND INACCESSIBLE PRIMARY AND SECONDARY HEALTH FACILITIES ................................................... 10 2.3.4. POOR POLICY IMPLEMENTATION CAPACITY ...................................................................................................................... 11 2.3.5. INADEQUATE PREVENTIVE MEASURES .............................................................................................................................. 11 2.3.6. INADEQUATE AND INACCESSIBLE CURATIVE INFRASTRUCTURE .................................................................................... 11 2.3.7. LOW LEVEL PUBLIC EXPENDITURES ................................................................................................................................... 11 2.3.8. HEALTH IS UNAFFORDABLE FOR THE POOR ...................................................................................................................... 12 2.3.9. ROLE OF PRIVATE SECTOR.................................................................................................................................................... 12 CHAPTER 3: ................................................................................................................................................................... 13 HEALTH SECTOR DEVELOPMENT BUDGET 2018-19 ..................................................................................... 13 3.1. OVERVIEW ................................................................................................................................................................ 13 3.2. PRIMARY AND SECONDARY HEALTHCARE.............................................................................................................. 14 3.2.1. OVERVIEW: .............................................................................................................................................................................. 14 3.2.2. GOVERNMENT STRATEGY: .................................................................................................................................................... 15 3.2.3. PROGRESS SO FAR: ................................................................................................................................................................. 16 3.2.4. SALIENT FEATURES OF ADP 2018-19: ............................................................................................................................ 16 3.3. SPECIALIZED HEALTHCARE AND MEDICAL EDUCATION ....................................................................................... 20 3.3.1. OVERVIEW ............................................................................................................................................................................... 20 3.3.2. ADP 2018-19........................................................................................................................................................................ 21 3.3.3. ADP 2018-19: KEY FINDINGS ........................................................................................................................................... 25 CHAPTER 4: ................................................................................................................................................................... 27 HEALTH SECTOR SHADOW BUDGET 2019-20 .................................................................................................. 27 4.1. OVERVIEW ................................................................................................................................................................ 27 4.2. SHADOW BUDGET 2019-20: ASSUMPTIONS AND PRIORITIES ........................................................................... 27 4.3. SHADOW BUDGET: HIGHLIGHTS ............................................................................................................................. 29 4.3.1. PRIMARY AND SECONDARY HEALTHCARE ......................................................................................................................... 29 4.3.2. SPECIALIZED HEALTHCARE AND MEDICAL EDUCATION ................................................................................................. 30 CHAPTER 5: ................................................................................................................................................................... 31 CONCLUSIONS AND RECOMMENDATIONS .......................................................................................................... 31 ANNEXES ........................................................................................................................................................................ 32 ANNEX-I: SHADOW BUDGET FOR THE PRIMARY AND SECONDARY HEALTH SECTOR .............................................. 32 ANNEX-II: SHADOW BUDGET FOR SPECIALIZED HEALTHCARE AND MEDICAL EDUCATION .................................... 38 i Ds Shadow Development Budget for Health Sector Abbreviations ADP Annual Development Programme BHU Basic Health Unit CPDI Centre for Peace and Development Initiatives DHA District Health Authority DHQ District Headquarters Hospital FY Financial Year GDP Gross Domestic Product HDI Human Development Index HDR Human Development Report