HUMAN RESOURCES FOR HEALTH PROFILE SINDH Human Resource for Health Profile – Punjab, Pakistan i ACKNOWLEDGMENT Human Resource for Health Profile – Sindh i ACRONYMS ACR Annual Confidential Report AACRONYMSFP Acute Flaccid Paralysis AHWs Allied Health Workers AIDS Acquire Immune Deficiency Syndrome ARI Acute Respiratory Infection BCG Bacille Calmette Guerin BHU Basic Health Unit BMS Basic Medical Sciences BPS Basic Pay Scale BScN Bachelor of Science in Nursing CDC Communicable Disease Control CEO Chief Executive Officer CIDA Canadian International Development Agency CME Continuing Medical Education CMW Community Midwives CPD Continuous Professional Development CPR Contraceptive Prevalence Rate CPSP College of Physicians and Surgeons DCO District Coordination Officer DEWS Disease Early Warning System DFID Department for International Development DGHS Director General Health Services DHDC District Health Development Centre DHQ District Head Quarter DHQH District Head Quarters Hospital DoH Department of Health EDOH Executive District Officer Health EMRO Eastern Mediterranean Regional Office ENT Ear Nose Throat EOC Essential Obstetric Care EPI Expanded Program on Immunization FAO Food and Agriculture Organization FBS Federal Bureau of Statistics FCPS Fellow of College of Physicians and Surgeons FHT Female Health Technician FLCF First Level Care Facility FP Family Planning Human Resource for Health Profile – Sindh ii FWC Family Welfare Center GAVI Global Alliance for Vaccination & Immunization GDP Gross Domestic Product GFATM Global Fund for AIDS, TB & Malaria GHWA Global Health Workforce Alliance GIZ German Agency for International Cooperation GoP Government of Pakistan HCPs Health Care Providers HDI Human Development Index HEC Higher Education Commission Hep B Hepatitis B HI&ES Household Income and Expenditure Surve y HIV Human Immunodeficiency Virus HMIS Health Management Information System HMPs Health Management Professionals HRD Human Resource Development HRH Human Resource for Health HRM Human Resource Management HRMIS Human Resource Management Information System HSA Health Services Academy HSRU Health Sector Reforms Unit HWs Health Workers IMNCI Integrated Management of Neonatal & Childhood Illnesses IMR Infant Mortality Rate IUCD Intra Uterine Contraceptive Device JICA Japanese International Cooperation Agency KPK Khyber Pakhtunkhwa LHS Lady Health Supervisor LHV Lady Health Visitor LHW Lady Health Worker MCH Maternal and Child Health MCPS Member of College of Physicians & Surgeons MDG Millennium Development Goal MDR Multi-Drug Resistance MHUs Mobile Health Units MICS Multiple Indicator Cluster Survey MIS Management Information System MMR Maternal Mortality Ratio MO Medical Officer MoH Ministry of Health Human Resource for Health Profile – Sindh iii MPH Master in Public Health MScN Master of Science in Nursing MTDF Mid Term Development Framework NCDs Non Communicable Diseases NGO Non-Governmental Organization NHIRC National Health Resource Information Center NHSP National Health Survey of Pakistan NPPI Norway - Pakistan Partnership Initiative OEC Overseas Employment Corporation OOP Out of Pocket Expenditure OPD Out Patient Department OPV Oral Polio Vaccine P&D Planning and Development PCSIR Pakistan Council for Scientific and Industrial Research PDHS Pakistan Demographic and Health Survey PG Post-Graduate PH Public Health PHC Primary Health Care PHDC Provincial Health Development Centre PIHS Pakistan Integrated Household Survey PMDC Pakistan Medical & Dental Council PMRC Pakistan Medical Research Council PNC Pakistan Nursing Council PPHI People's Primary Healthcare Initiative PPP Public Private Partnerships PR Pakistan Railways PRSP Poverty Reduction Strategy Paper P SLMS Pakistan’s Social and Living Standards Measurement Survey PSM Pakistan Steel Mills PWD Population Welfare Department RHC Rural Health Centre RHS Reproductive Health Services RHS Reproductive Health Services RHSCs Reproductive Health Services Centers RMPs Registered Medical Practitioners RN Registered Nurse RTIs Reproductive Tract Infections SESSI Sindh Employees' Social Security Institution SHC Secondary Health Care SLGO Sindh Local Government Ordinance Human Resource for Health Profile – Sindh iv SON School of Nursing SOP Standard Operating Procedures STDs Sexually Transmitted Diseases THC Tertiary Health Care UC Union Council UHCs Urban Health Centers UHUs Urban Health Units UK United Kingdom UKAID United Kingdom’s Aid for International Development UN United Nations UNDP United Nations Development Program UNFPA United Nations Fund for Population Activities UNICEF United National Children’s Fund UNICEF United Nations International Children’s Fund USAID United States Agency for International Development WAPDA Water And Power Development Authority WHO World Health Organization WMO Woman Medical Officer Human Resource for Health Profile – Sindh v TABLE OF CONTENTS Acknowledgement -------------------------------------------------------------------------------------------- i Acronyms ------------------------------------------------------------------------------- ii List of Tables ------------------------------------------------------------------------ viii List of Figures ------------------------------------------------------------------------- x Preface -------------------------------------------------------------------------------------------------------- xi Foreword ---------------------------------------------------------------------------------------------------- xii Executive Summary ------------------------------------------------------------------------------------- xiii SECTION 1. Introduction -------------------------------------------------------------------------------- 1 1.1 Initiatives undertaken to Improve Pakistan’s HRH Profile -------------------------------------- 2 1.2 HRH Profiling in Sindh ------------------------------------------------------------------------------- 4 1.2.1 Purpose & Objectives of the Study --------------------------------------------------------------- 4 1.2.2 Methodology ---------------------------------------------------------------------------------------- 5 1.2.3 Source of Information ------------------------------------------------------------------------------ 6 SECTION 2. Sindh Provincial Context ---------------------------------------------------------------- 8 2.1 Geography ---------------------------------------------------------------------------------------------- 8 2.2 Demography -------------------------------------------------------------------------------------------- 9 2.3 political Context -------------------------------------------------------------------------------------- 12 2.4 Economic Context ------------------------------------------------------------------------------------ 13 SECTION 3. Health System Pakistan ---------------------------------------------------------------- 14 3.1 Governance -------------------------------------------------------------------------------------------- 15 3.2 Health Status Sindh ---------------------------------------------------------------------------------- 16 3.3 Health Systems Sindh -------------------------------------------------------------------------------- 18 3.3.1 Private Health Care System --------------------------------------------------------------------- 18 3.3.2 Public Private Partnerships ----------------------------------------------------------------------- 19 3.3.3 Pharmaceutical Sector ---------------------------------------------------------------------------- 19 3.4 Department of Health Sindh ------------------------------------------------------------------------ 20 3.4.1 Human Resources Policy ------------------------------------------------------------------------- 22 3.4.2 Administration ------------------------------------------------------------------------------------- 22 3.4.3 Governance ----------------------------------------------------------------------------------------- 23 3.5 Karachi Metropolitan Corporation ----------------------------------------------------------------- 24 3.6 Vertical Health Programs --------------------------------------------------------------------------- 24 3.7 Para-Statal Health Care Providers in Sindh ------------------------------------------------------- 28 3.7.1 Population Welfare Department Sindh --------------------------------------------------------- 28 3.7.2, 3, 4 & 5 SESSI, WAPDA, PR & PSM -------------------------------------------------------- 30 3.8 Health Financing ------------------------------------------------------------------------------------- 30 3.9 Health Information System ------------------------------------------------------------------------- 32 SECTION 4. Health Workers’ Situation ------------------------------------------------------------- 34 4.1 Health Facilities and Health Workers in DoH, Sindh ------------------------------------------- 34 4.1.1 Health Facilities ----------------------------------------------------------------------------------- 34 4.1.2 Doctors in Health Department Sindh ----------------------------------------------------------- 37 4.1.3 Nurses Working in DoH, Sindh ----------------------------------------------------------------- 42 Human Resource for Health Profile – Sindh vi 4.1.4 Paramedics Working in DoH, Sindh ------------------------------------------------------------ 43 4.1.5 LHWs & LHSs of NP-FP & PHC Sindh ------------------------------------------------------- 45 4.1.6 Supporting Staff Working in DoH, Sindh ------------------------------------------------------