Simulation Exercise on Public Health in Pakistan: (National School of Public Policy)

8/8/2019 Simulation Exercise on Public Health in Pakistan: (National School of Public Policy)

http://slidepdf.com/reader/full/simulation-exercise-on-public-health-in-pakistan-national-school-of-public 1/27

SMULATION EXERCISE III-PUBLIC HEALTHCONFIDENTIAL

1

TO BE RETURNED AT THE END OF THE EXERCISE

Copy Number:

NATIONAL INSTITUTE OF MANAGEMENT, LAHORE

10TH MID CAREER MANAGEMENT COURSE

(MONDAY, 20TH SEPTEMBER, 2010 TO FRIDAY, 24TH DECEMBER, 2010)

SIMULATION EXERCISE – III

ON

PUBLIC HEALTH

(Tuesday, 7th December, 2010 to Wednesday, 15th December, 2010)

Sponsor DS: Salman Choudhry




2

Confidentiality of Document

Participants and Faculty Members of National Institute of Management, Lahore are

authorized to use this document. Use of this document-in original or copy of it-by any

person, other than the authorized persons, inside or outside National Institute of

Management is STRICTLY PROHIBITED. Please DO NOT make PHOTOCOPY of this

document.

Disclaimer

This document contains training material designed exclusively to promote discussion

amongst the participants of 10th MCMC at NIM Lahore. It is not a prediction of the

future, nor does it necessarily reflect the views of the institution.

NATIONAL INSTITUTE OF MANAGEMENT LAHORE




3

(MID CAREER MANAGEMENT WING)

10TH Mid Career Management Course

SIMULATION EXERCISE

1. One of the knowledge, learning and application tools used at NIM is Simulation

Exercise. This is, by far, the most important training activity of the course. The fundamentaldifference between a Simulation Exercise and a Case Study is that while the latter dissects a by-gone event, issue or policy, the former analyzes a live event, issue or policy, whileharnessing hindsight from the past and insight into the present, and helps derive guiding principles to formulate strategic options and operational plans for the future. An Exercise ismeant to provide an opportunity to the participants to demonstrate their ability to apply their skills and knowledge (accumulated in-service, as well as learnt during the course), to near real-life situations. A single option to achieve ends of policy is poor planning. Multipleoptions are the hallmark of good planning and the important requirement of decision-making.

2. There are three Exercises in the course, spread over several days. These exercises are

designed to simulate the process of strategizing implementable plans to achieve aims andobjectives of a national policy in line with clearly defined aims, or ends. While policydetermines the ends, strategy provides the means to achieve those ends. Strategy isformulated by first looking at the magnitude and the nature of challenge or challenges andthen taking stock of the resources and the time-frame in which to deal with them. Resourcesinclude tangible and intangible resources, structure, infrastructure; concrete human andfinancial assets are tangible, while commitment, devotion and professional capacity,leadership, quality of human resources are intangibles. The duration of time-frame will differ in accordance with the span of the challenge at each level.3. As you must have noticed and experienced already, Simulation Exercise is aneffective method of learning as the philosophy of training is centered on “learning by

doing”. This is, by far, the most important training activity of the Course. Theexercise “Public Health” focuses on the process of studying, analyzing andsynthesizing health policy, systems, issues in provision of health and the present stateof health in Pakistan. The participants will then be applying this analysis andsynthesis to the formulation of effective policy and its implementation strategies for national development and overall wellbeing of the masses. For the purposes of thisExercise, the group shall be divided into smaller Syndicates and Research andAnalysis Groups (RAGs). Participants will be assigned formal roles of people in positions of executive authority in the state, and of academic quality and experientialexcellence in the society. While playing these roles Syndicates and RAGs will berequired to develop policy implementation solutions that can take into account prospective eventualities demanding change while simultaneously ensuring continuityin policy, where the existing policy warrants extension. Participants will be requiredto interview either in person or, at least, on phone, those persons, whose roles they play during the Exercise. Knowledge of socio-political, socio-cultural and socio-economic environment is essential as they are inter-related with the present state of education and development in Pakistan. Also knowledge of the stated policies andtheir implementation mechanisms in the Federal and Provincial Government structures




4

along with resource allocation is essential for this Exercise. Participants’ knowledgeabout departmental capacity, the role of vested interests, impact of inter-intradepartmental factors and the role of donor agencies, whether or not impinging on theeducation are necessary for policy formulation and implementation strategies which

should lead to the desired development.Aim OF Simulation Exercise:

4. To offer an opportunity to participants to apply knowledge and skills to understandthe process of policy formulation so as to work out Implementation Strategies anddevelop operational plans for policy execution.

Training Objectives of Simulation Exercise:

(1) To sift the essential from the trivial in a given scenario.(2) To prioritize issues according to the degree of importance in a given

environment.(3) To develop leadership skills among the participants.

(4) To develop the skills of working as a team and building consensus througheffective negotiation techniques.(5) To employ research methodology to harness primary and secondary resources.(6) To hone presentation skills for effective communication.(7) In doing all above, TO THINK OUT OF THE BOX - INNOVATE.(8)Main emphasis would be on “HOW TO THINK” and not “WHAT TO

THINK”.5. While doing so the Syndicates and Research and Analysis Groups (RAGs) are

required to foresee at least one International, National and one Provincial, Local eventor a development which could have the potential to destabilize the operational planand the process of its implementation. Generally, governmental approach towards

such issues lacks an operational flexibility, with the result that when confronted withunforeseen hazards, mid-course corrections are not possible. In such an eventuality,the Syndicates RAGs are required to prepare a contingency plan (Plan B), which willenable the Government to make mid-course corrections and ensure sustainability of the proposed operational plan. All such plans must contain an elastic approachtowards various issues. Elasticity and ability to prepare for a probable event in futureis the hallmark of a strategic manager. It is essential for working out a solution or solutions, which can cater for unforeseen upsets, which can become “foresee-able”, toa large extent, by playing out a simulated scenario. This is what essentiallydistinguishes a Simulation Exercise from other training methods.




5

SIMULATION EXERCISE

PUBLIC HEALTH

6. Pakistan has a high fertility rate with 4.2 million new births annually. This rapid population growth will further strain an already overstretched and underperforming health

care services delivery system, including deliveries by skilled birth attendants. Efforts madeover the years to improve health standards have been partially neutralized by the rapidgrowth of the population. In addition, gender bias and limited access to health servicesfurther compromise health of Pakistanis. In spite of some improvement since 1990, thehealth of the people of Pakistan lags much of South Asia and the improvements have notkept up with the increasing GDP. For example, a GDP of USD 870 per capita in 2007 would predict about 27 excess infant deaths per thousand, 19 excess child deaths per thousand, 36 percent lower births attended by trained personnel, 11 percentage points higher babies bornwith low birth weight. This profile suggests that these lags make Pakistan a model case for economic “growth without development” indicating an underperforming health care deliverysystem1.

7. Sub-optimal performance of the health sector in Pakistan is primarily because of lowlevel of health spending. Total expenditure on health as percent of GDP is only about 2 percent of GDP, which is much lower than other countries with similar income levels. Thegovernment contributes about a third of this and the remaining 70 percent is paid out-of- pocket by citizens at the points of service delivery.8. A number of non-financial constraints have played an equally important role in theunderperformance of health systems. Health workers are unmotivated and distracted fromtheir work by conflicting interests. Weak governance, imbalance of human resource, lack of equitable service delivery, absence of social safety nets, lack of effective implementation of regulations particularly in a large unregulated private sector are some of these factors havingan adverse impact on the performance of the health sector.9. It is also important to note that Pakistan has made concrete commitments to theMillennium Development Goals (MDGs)2. Through its major health intervention programs,the Ministry of Health has pursued practical strategies aimed at:

A) reducing:• The under-five mortality rate from an estimated 140 in 1990 to a target of

52 by 2015.• The infant mortality rate from an estimated 110 in 1990 to a target of 40 by

2015.• The maternal mortality ratio from an estimated 530 in 1990 to a target of

140 by 2015.

B) increasing:• The proportion of 1 year-old children immunized against measles from an

estimated 50% in 1990 to a target of 85% by 2015.

1 National Health Policy 2009; July 2009 Ministry of Health Government of Pakistan.2 Pakistan: Poverty Reduction Strategy Paper June 2010 IMF Country Report No. 10/183.




6

• The proportion of births attended by skilled health personnel from anestimated 20% in 1990 to a target of > 90% by 2015.

C) combating:

• TB, Malaria, HIV/AIDS and other communicable diseases.

10. The 2008 report of the MDG Gap Taskforce revealed that while there has been much progress during the last decade, the delivery on commitments particularly in MDG 4 & 5 haslagged behind schedule. Pakistan has3:

A) reduced the under-five mortality rate by 25 during the 1990s but has achieved nofurther reductions in the past decade;

B) but also:• maintained the same infant mortality rate of around 75 in the past decade;• slightly increased the proportion of 1 year-old children immunized against

measles to 60%;• significantly reduced the maternal mortality ratio to 280; and• doubled the proportion of births attended by skilled health personnel to

40% .However, these results would still fall short of the targets identified for the remainder

of the current timeframe due to the reasons above mentioned.11. In this Simulation Exercise while the participants are required to focus on the

problems and issues facing the health sector, it is very essential that they should beinquisitive and curious about the aims and objectives of this Exercise. Unfortunately,in this sector of vital importance the government has not made any significant stridesother than on paper and the population at large are still devoid of health facilities. It isimperative that economic leap forward is not possible without healthy nation. There is

a National Health Policy 2001 and 2009 which has set ambitious goals to be met

4

. Thesyndicates and RAGs are required to strategize with a view to scrutinise these policiesand should be able to pin point with clarity as to what is doable, what is not and whyit cannot be implemented.12. The participants are well advised to study in detail all relevant aspects of education for suggesting policy options and implementation strategies.

SETTING, LEARNING OBJECTIVES,

SCOPE, CONDUCT AND METHODOLOGY

Setting:

13. You have by now entered into the 13th week of your training at the Mid Career

Management Course and, being a potential BS-19 officer, the focus of training at your levelis centered at the tactical and operational levels. As part of service delivery paradigm, mostof you will play the roles of operational managers under a given policy, working outactionable plans for policy implementation by yourself and officers one or two levels junior to you.

3 National Health Policy 2009. Government of Pakistan.4 Ministry of Health, Government of Pakistan.




7

14. As a participant of Mid Career Management Course, you are assigned roles of operational executives, and accordingly you are expected to interact with other elementswithin the Federal, Provincial and District Government, prioritizing your objectives, andtaking into consideration all the available resources (including the human resource), while

also making the best use of such resources.15. During these past weeks, you have interacted with some prominent policy makers and policy implementers and men of opinion in different walks of life. You have been introducedto the essentials of research methodology, communication and presentation skills and havealso been familiarized with the process of project planning and evaluation. You have beenshown how policy is formulated at various levels, what are its various sources, and what isrequired for its effective implementation. The course contents have also exposed you to theanalysis of social, economic, strategic management and governance issues, and domestic andsome regional and global contexts in which policy making and implementation take place.You have also been exposed to Pakistan’s socio-economic, socio-cultural, socio-political andadministrative dimensions and how they differ from province to province.

16. During the Exercise, keeping in view public interests, taking into consideration theopportunities and resource constraints you will analyze various challenges and threats toyour action plans to actualize projects. Your analysis should lead you to determine optionsthat address issues and to achieve the ends at the grassroots level. You will also be requiredto look at the different government departments from the perspective of the individual rolesassigned to you in your respective groups.17. During the exercise, as members of various Syndicates and RAGS, you will beassigned different roles. These roles have been assigned for facilitating focused research in ashort time span; it does not mean that at the time of making presentations these roles will beactually played at stage . You will provide concrete recommendations on which projects tostart first and how best to orchestrate operational level management tools. You will thrashout management solutions in a dynamic and demanding policy implementation environment.How well you analyze the issues, comprehend the contest between vested interests, anddeliberate both within your own domain and with others in policy implementation arena, willdetermine the overall effectiveness of your management potential in dealing with thechallenge that you may face.Learning Objectives:

1. To develop an in-depth understanding of the participants about theimportance of education, education policy, systems, and issues in provisionof education to all and their relationship with national development with aview to recommend changes for better service delivery at grass-roots level.

2. To undertake a strategic appraisal of the prevailing environment, scarceresources, limited governmental capacity, and competing demands onresources.

3. Ability to comprehend the process and methodology of evolving effective,hands-on “Implementation Mechanism” which will ensure service deliveryto the public under a near-realistic environment.

4. To develop and propose an organizational structure with an in-built reviewand monitoring mechanism.




8

5. To come up with specific and concrete set of action plans for sustainedexecution of the Operational Strategy; ensuring sustainable public good inthe short-term (1–2 years) and medium term (3–5 years). ‘Wish-list’ type of recommendations needs to be avoided.

6. To develop presentation skills for effective communication.Scope:

1. To study various aspects of public health and their impact on the life of citizens and development of society.

2. To understand the constitutional responsibilities and role of Federal,Provincial and District Governments in providing helath facilities to all.

3. To make specific rather than stereo type general recommendations withinnovative capacity.

4. To study the impact of public health on the economic dynamics of Pakistan.5. To analyse the role of different levels of Public Health in national

development as spelled out in the Poverty Reduction Strategy Paper II 5

(PRSP II) and also meet the commitment of achieving MillenniumDevelopment Goals (MDGs).

6. To be able to think of real issues in the field of health at the operationallevel which can then be translated in formulating an effective operationalmechanism.

7. To strike a balance between implementation and limited, scarce resources.8. To understand various stages in the health system and lapses inherent it like

corruption and inefficiency.9. The development of health system has been at various places without focus

which also needs evaluation as large numbers of Basic Health Units(BHUs) are lying vacant.

10. To understand the reasons behind flight of trained doctors from the healthsystem.

11. To understand the weaknesses of various vaccination schemes in Pakistan.12. To evolve an effective implementation plan in the light of the policy

already made.Conduct:

18. The Exercise will be conducted in following phases: Phase- I

1. Briefing on Exercise by DS2. Issue of General Instructions

Phase -2Planning and Consideration(Including scheduled and un-scheduled visits by the faculty)

Phase 3 – Final Presentations:1. Presentations by Syndicates and RAGs2. Exercise Debrief 5 PRSP II, Ministry of Finance, Government of Pakistan.




9

Note: Presentation schedule will be issued separately.Methodology:

19. During the Simulation Exercise, you will be divided into 5 Syndicates and 7 Researchand Analysis Groups. While playing operational management roles in various departments,

ministries and members of think tanks, you are expected to come up with implementablesolutions in the backdrop of global, regional as well as domestic environment. These

solutions will reflect the collective wisdom of each group and not individual views.20. In the light of the foregoing, the Simulation Exercise-III is designed to focus on alimited but focused area of research.21. Participants will be required to interview either in person or, at least, on phone, those persons, whose roles they play during the Exercise. As a minimum, participants must read performance audit reports, national strategic papers, or major strategic statements by the realincumbents of those roles/appointments.

FORMATION OF TOPICS FOR THE SYNDICATES & RAGS:

Syndicate 1: CHIEF MINISTER PUNJAB’S SPECIAL COMMITTEE TOREVIEW PROVISIONS OF HEALTH SERVICES IN LAHOREAND RAWALPINDI DISTRICTS.

Syndicate 2: ADVISOR TO CHIEF MINISTER KP’S WORKING GROUP ONCURBING CORRUPTION IN HEALTH SECTOR IN KP.

Syndicate 3: FEDERAL SECRETARY HEALTH’S TASK FORCE ONIMPLEMENTATION OF POLIO VACCINATION CAMPAIGNIN PAKISTAN.

Syndicate 4: FEDERAL MINISTER HEALTH’S STUDY GROUP ON

COMMUNITY HEALTH PROMOTION IN PAKISTAN.

Syndicate 5: CHIEF MINISTER PUNJAB’S TASK FORCE FOR PRESENTING A PLAN TO CONTROL MEDICAL NEGLIGENCE IN PUNJAB.

Rag 1: CHIEF SECRETARY PUNJAB’s WORKING GROUP ON IMPROVINGSTANDARDS OF NURSING & PARAMEDICS.

Rag 2: SECRETARY HEALTH PUNJAB’s STUDY GROUP ON IMPROVING CHILDHEALTH IN FAISALABAD.

Rag 3: ADVISOR TO CHIEF MINSITER PUNJAB ON HELATH’sSTUDY GROUPSP ON HARNESSING COMPLIMENTARYAND ALTERNATE MEDICINE IN MULTAN.

Rag 4: CHIEG MINSITER SINDH’s SPECIAL COMMITTEE FOR IMPROVING THEMECHANISM OF CHECKING SPURIOUS ANDCOUNTERFIET DRUGS IN SINDH.






11

1. Identification of specifics of the requirement i.e. Terms of Reference (TOR).

2. Aims to be determined and tasks to be assigned.

3. Analysis of the tasks assigned.

4. What other tasks can be assigned to other stakeholders.

5. Ascertaining the funding requirements, resources mobilization and resourceallocations.

6. Technical and technological resources, if any and how to obtain andharness them.

7. Other tangibles and intangible resources available.

8. Institutional preparedness in terms of structures, rules and procedures. Also

job requirements, motivation levels of the personnel and their level of commitment and professional competence. (Capacity; Individual &Institutional)

9. Infrastructural needs and how to meet them.

10. The required political will as well as administrative will (or absence of it).

11. Our international commitments, obligations under international laws, treatyobligations whichever is relevant.

12.Time frame in which the options and recommendations are to be implemented.

Short term: 1-2 years; medium term: 3-4 years; and long term: 5-7 years.SECIFIC REQUIREMENTS

Syndicate 1: CHIEF MINISTER PUNJAB’S SPECIAL COMMITTEE TO

REVIEW PROVISIONS OF HEALTH SERVICES IN

LAHORE AND RAWALPINDI DISTRICTS.

27. By infrastructure standards, Pakistan has one of the largest health service deliverynetworks at a basic healthcare level. This comprises of 5301 BHUs, each with a catchment population of 10,000 to 20,000 and 552 Rural Health Centers (RHC0s – a step above theBHUs6. However in reality only 70% of the BHUs are currently operating7; their infrastructure is used by other sectors in many cases and a vast majority is underutilized witha recently reported average daily turnover of 20 to 30 patients a day. The low turn-over observed at these sites is attributable to low-quality inputs as is evidenced by staff absenteeism, infrequent availability of essential medicines, poor attitude of staff and other issues such as geographic access and out of pocket payment for supposed free services. As aresult, the average cost per- admission and outdoor-contact incurred does not justify the present level of investment in infrastructure, staff and equipment in these sites. Given these

6 Ministry of Health, Government of Pakistan 2010.7 Pakistan Demographic and Health Survey: Tracking the Millennium Development Goals. USAID 2009.




12

considerations, a strategy which aims to restructure BHUs is, in principle, desirable giventhat BHUs in their present form are – put simply – underutilized and unsustainable.However, this strategy should pay careful attention to a number of steps that need to be takenin tandem in order to ensure its success and long term viability.

28. Keeping in mind these facts the syndicate is required to analyse the issue at inthreadbare manner. Is the regulatory framework within which the system of BHUs and RHCsis set is adequate? What are the recruitment criteria for selection and what are the monitoringstandards for the staff. The syndicate must pay attention to absenteeism in the lower staff also. Accessing the health services at these levels are also a point to study, the syndicateshould also analyse the system in place and how does the Social Safety Nets systems ensurethat there is no discrimination. BHUs and RHCs serve as community hubs for the delivery of preventive and promote services such as vaccination and control of infectious diseases; thesehave to be delivered by the State as public goods. In addition, BHUs also serve as traininghubs for Lady Health Workers; the syndicate needs to study this important issue. Thesyndicate should also discuss community participation in delivery system at the BHU8.

While working out your solutions, you are required to strictly adhere to the General Requirements in paras 22-26.Syndicate 2: ADVISOR TO CHIEF MINISTER KP’S WORKING GROUP

ON CURBING CORRUPTION IN HEALTH SECTOR IN KP.

29. Pakistan needs to pay special attention to corruption in the health sector in particular for a number of reasons. To contextualize the rationale, it should be recognized thatPakistan’s focus on the health sector is largely propelled by commitments to meet ‘programtargets’ as articulated in the Millennium Declaration, and others embodied within indigenous policy instruments such as the Medium Term Development Framework 9, in addition to anumber of processes and outputs targets in the health policy of 200110. However evidenceshows that these priorities cannot be met if institutions do not function and if there is wastageof scarce resource, which leads to poor quality of care, compromised safety and efficiencyand de-motivation of the staff. Discussions relating to the health sector are never completewithout references to malpractices which fall within the preview of fiscal and ethicalcorruption; even if half this anecdotal evidence is grounded in reality, the fiscal costsincurred to the state and the cost of accessing care – which remain undocumented 11 – appear to be significant.29. In recent years public sector allocations for financing health have significantlyincreased; however, corruption stands as a key impediment to the impact of well-intentionedspending on health. Without addressing this issue, the commitment to meet goals articulatedin the Millennium Declaration as well as others embodied within indigenous policy

instruments such as the MTDF simply cannot be met. It is for this reason that the governmentshould accord high priority to the issue because of the potential it has to compromise publicinvestments in a highly constrained environment. What should therefore be done in this

8 Restructuring Basic Health Units – Mandatory Safeguards Dr. Sania Nishtar, 2010.9 Government of Pakistan. Medium Term Development Framework 2005-10. Islamabad, Pakistan: Planning

Commission; 2005.10 Government of Pakistan. Health Policy 2001. Islamabad, Pakistan: Ministry of Health; 2001.11 The NEWS International: Sunday, August 5, 2007.




13

regard? As a starting point, there is a need to understand and prioritize corruption risks bycorruption mapping and analyzing incentives and disincentives. This must be done at severaldomains.30. The syndicate must focus and discuss the issue of corruption at the governance and

regulatory level. What are the reasons for that and why it is happening in this vital publicsector and then work ahead with the next items on the agenda. The syndicate should discussthe drug registration system and discuss the contracting process for the purchase of drugswhich offers a lucrative source of returns for corrupt officials and suppliers throughkickbacks, over-invoicing, and outright graft. This also includes procurement, supply andquality of the drugs at the government hospitals. The service delivery at the hospitals fromcorruption; the syndicate should study this aspect closely. The other aspect is the private public interface which needs attention from the syndicate. Even though there is an elaborateregulatory process in place but the quality control is missing this aspect needs attention fromthe syndicate.While working out your solutions, you are required to strictly adhere to the General

Requirements in paras 22-26.Syndicate 3: FEDERAL SECRETARY HEALTH’S TASK FORCE ON

IMPLEMENTATION OF POLIO IMMUNIZATION

CAMPAIGN IN PAKISTAN.

31. The Polio Eradication Initiative was launched in Pakistan in 1994, 15 years after thelaunch of the Expanded Programme for Immunization; the latter is mandated to undertakeroutine immunization activities. Since 2000, the Polio Eradication Initiative has beenfollowing the successful approach in developed countries supplementing routine polioimmunization with huge country-wide campaigns several times a year to deliver drops of oral polio vaccine to every child under the age of five years. Over the past 9 years, 88 roundsof Supplementary Immunization Activities have been conducted with nationwide coveragefunded by the Global Polio Eradication Initiative – a global partnership of the World HealthOrganization, United Nations Children’s Fund, the Centers for Disease Control andPrevention, Rotary International and other major donors.32. Initial success of the Polio Eradication Initiative in Pakistan was remarkable. Thenumber of confirmed cases of poliomyelitis based on acute flaccid paralysis surveillance datafrom across the country declined from 1155 cases in 1997 to 28 in 2005 – the lowest ever recorded in one year. A very sensitive nationwide reporting system was built up to assure thedetection of all remaining polio cases. The system captures all children aged less than 15years with acute onset flaccid paralysis, and includes subsequent laboratory testing of stoolspecimens12. However, since 2008, there has been a marked resurgence of polio cases, both

in aggregate terms and in relation to geographical spread; in 2008, eight cases were reportedin Punjab the largest province in Pakistan, home to more than 60% of the country’s population compared to zero cases reported in 2007.33. Failure to achieve polio eradication demonstrates the importance of determinantsoutside the health sector influencing health status. Pakistan has witnessed the resurgence of polio cases in areas far from the western border, such as in Punjab province, indicates that12 AFP Surveillance in Pakistan: National Surveillance Cell, Pakistan Polio Eradication Initiative. Islamabad:

Ministry of Health; 2006.




14

weaknesses in the delivery of services. Broader issues of health system governance are alsomajor factors in the failure to achieve eradication.34. The syndicate should look at this issue and try to answer the weakness of thecampaign. Was the quality of operations satisfactory in all respects. Could it have been

inaccessibility to reach the affected areas. What impact refusals have on the campaign andhow can they be reversed. The issue of mobile populations; which has been due to earthquake and floods, also need attention. While working out your solutions, you are required to strictly adhere to the General Requirements in paras 22-26.

Syndicate 4: FEDERAL MINISTER HEALTH’S STUDY GROUP ON

COMMUNITY HEALTH PROMOTION IN PAKISTAN.

35. In 1978, Pakistan became one of the initial signatories to the World HealthOrganization’s (WHO) Alma-Ata Declaration, which laid the foundation and target for Health for All by the Year 2000 (WHO, 1978). One of the five principles to emerge fromAlma-Ata focuses on disease prevention, health promotion, and curative and rehabilitative

services. Policies to address this principle in Pakistan did not appear until 1990 when thePakistan Government launched its first National Health Policy (Ministry of Health,Government of Pakistan, 1990). From a public health and health promotion perspective this policy focused on school health services; family planning; nutrition programs; malariacontrol programs; control of communicable diseases (e.g. tuberculosis and infectivehepatitis); sanitation and safe drinking water.36. In 1997, the second National Health Policy (Ministry of Health, Government of Pakistan, 1997) was launched and health promotion and health education received a prominent place under priority health programs and non-communicable diseases, such as,cardiovascular disease, cancer and diabetes were highlighted for prevention and controlmeasures. The focus for health promotion was “health education” and the five principles of the Ottawa Charter for Health Promotion (WHO, 1986) as a guiding framework per se werenot alluded to. The most recent National Health Policy (Ministry of Health, Government of Pakistan, 2009) is in continuation of the earlier Policy of 2001 and omits the prevention andcontrol aspect of non-communicable diseases; it does not specifically refer to health promotion and, in relation to public health13, the main goal is to create mass awareness in public health matters with a major focus on the use of multimedia to disseminateinformation.37. The syndicate should analyse the concept of community health and the governmentcommitment towards it. The policy is there but there is systemic bottlenecks which hamper its effectiveness and the syndicate should address this issue in detail. Many curable diseases

can be prevented through community health services the syndicate should look at the cost benefit analysis also. Service delivery in case of family planning, vaccination and mother-

13 In 2004, the National Action Plan for Prevention and Control of Non-communicable Diseases and Health

Promotion in Pakistan (NAP-NCD) was launched and the first planning phase for implementation was initiated.This public health/health promotion policy is both a policy and an implementation document and is Pakistan’s firstnational policy devoted specifically to the prevention and control of non-communicable diseases and health promotion and therefore is a milestone in public health/ health promotion policy development.




15

child health to name a few sectors, can be improved through community participation; thesyndicate should also explore this concept. What can be the role of the NGOs, media andschools in promoting community health, the syndicate should also discuss in detail thisaspect.

While working out your solutions, you are required to strictly adhere to the General Requirements in paras 22-26.

Syndicate 5: CHIEF MINISTER PUNJAB’S TASK FORCE FOR

PRESENTING A PLAN TO CONTROL MEDICAL

NEGLIGENCE IN PUNJAB.

38. Presently, the status of regulation of the medical profession in Pakistan is inchoate. Alarge part of the medical sector, including the private sector, remains either under-regulatedor completely unregulated. As part of its health policy, the government has undertaken stepsto rectify the situation. A key area of reform included in the government’s 2001 Agenda for Health Sector Reform was: “To introduce required regulation in the private medical sector with a view to ensuring proper standards of equipment and services in hospitals, clinics and

laboratories as well as private medical colleges and tibb, homoeopathic teachinginstitutions.” But to date, little seems to have been done in this regard.39 This situation has been viewed with concern by the Supreme Court in its judgment in Pakistan Medical and Dental Council v Ziauddin Medical University 14 ,Justice TassaduqJillani, noting the mushroom growth of medical and dental institutions in the private sector over the last few decades, emphasised: “The need for regulatory mechanism in the realm of general education and in the domain of professional courses has never been greater.” Hesuggested that there is a dire need to enforce the provisions of the existing laws. However,what may be needed even more than the enforcement of existing laws is the rationalisationand expanded application of these laws and the promulgation of new laws in areas notcovered by existing legislations.40. Every now and then there are reports of medical negligence by doctors and other health related personnel resulting in fatal injuries or deaths, this is a cause for alarm. Thesyndicate should devote much time in highlighting this issue and analyse the existingregulatory framework present and what could be the possible reasons for its failure. The presence of untrained and unqualified personnel poses another aspect and the syndicateshould go deep in this area as well. The syndicate should also discuss the existence of the presence of alternative medical practice and its impact on the overall picture. The discussionshould also explore the possible weaknesses of PMDC and other regulatory bodies. There arenumber of laboratories in the private sector providing various services what are the qualitycontrols and standards.

While working out your solutions, you are required to strictly adhere to the General Requirements in paras 22-26.Rag 1:CHIEF SECRETARY PUNJAB’s WORKING GROUP ON IMPROVING

STANDARDS OF NURSING & PARAMEDICS.

41. Pakistan urgently needs more than 3000 nurses and paramedics and at least 1000competent midwives to improve the country's healthcare system15. According to an article published in the latest edition of Pakistan Journal of Medical Education, owing to lack of 14 PLD 2007 Supreme Court 323.




16

understanding among the policy makers as well as even among the doctors' community littleattention has been paid towards the quality of education and training of these allied professionals. Although there are 119 schools of nursing and 144 schools of midwifery thestandard of education in these institutions are depressingly low16. A few years ago a survey

conducted by UNICEF on midwifery training showed that 90% of the nurses pass their examination without performing even a single delivery in a labour room environment.During their training they are poorly paid and are not allowed any exposure to antenatalclinics. The scene is not much different in nursing schools where life is marked by a chronicshortage of tutors, text books, teaching aids and resource material etc. As a result at the timeof passing out from the public sector entities the nurses are neither well trained nor do theyhave sound theoretical knowledge. They are also not well versed in basic professional ethicsand this explains the alarming number of medical accidents in the hospital.

42. The rag is required to discuss the current situation of Nursing and paramedics inPunjab. How many teaching institutions are there and what are the quality controls enforced

there. Is the financial constraint the only reason in the abysmal low standard of the nursesand paramedics. What is the incentive motive in this field. How can this vital link in the public health related with the field units. What is their role in family planning , immunizationand community health systems. What is the mechanism for ensuring quality and safe practicefor them and its efficacy.While working out your solutions, you are required to strictly adhere to the General Requirements in paras 22-26.Rag 2:SECRETARY HEALTH PUNJAB’s STUDY GROUP ON IMPROVING

CHILD HEALTH IN FAISALABAD DIVISION.

43. Although child mortality is declining, it still remains high by all standards comparedwith an average of South Asian as well as low income countries 17. Malnutrition, diarrhea,

respiratory illnesses, and other communicable and vaccine-preventable diseases account for two-thirds of the child mortality. Moreover, prevalence of bad practices due to ignorance andilliteracy of mothers have hampered achieving a significant reduction in child mortality18.Over the past twenty years there has been little overall change in the prevalence of childmalnutrition. Public expenditures on health remained constant in the 1990s, 0.7 percent of GDP. In short, the rise in poverty in the 1990s and 2000s is likely to have adversely affectedthe child health, particularly their nutritional status.44. The Rag should study this important issue in what is the current position. What arethe conditions at pre birth and post birth. What affect nutrition can have and what are thesteps initiated in this regard. What can be the underlying reason for ineffective vaccinationstatus and what measures should be initiated in this effort. What steps have been taken toempower women and educate women about these issues what are the impediments like socialor religious. The role of mid wife must also be considered; where do they get their training

15 The News International 11th October 2010.16 Health Systems Profile- Pakistan Regional Health Systems Observatory- EMRO.17 World Bank 2009.18 Child Health and Poverty in Pakistan G. M. Arif *The Pakistan Development Review 43 : 3 (Autumn 2004) pp.

211–238.




17

and how are they regulated it at all. What operational weaknesses have allowed this sector toremain ineffectual . Care must be taken as all these issues are inter woven with a larger public health.While working out your solutions, you are required to strictly adhere to the General

Requirements in paras 22-26.Rag 3: ADVISOR TO CHIEF MINSITER PUNJAB ON HELATH’s

STUDY GROUPS ON HARNESSING COMPLIMENTARY

AND ALTERNATE MEDICINE IN MULTAN DIVSION.

45. The herbal or ‘Unani’ or Greco–arab system of medicine is a growing industryworldwide. Global sales of herbal products now exceed a staggering US$40 billion a year 19.Pakistan has a very rich tradition in the use of medicinal plants for the treatment of variousailments, based predominantly on the Unani system of medicine, which dates back to theIndus valley civilization20. This traditional medicine sector has become an important sourceof health care, especially in rural and tribal areas of the country. Most of the medicinal plantsare found in the temperate climates and subtropical forests of northern Pakistan. Around 70–

80% of the population, particularly in rural areas, uses Complementary and AlternativeMedicines (CAM). In addition to other CAM systems such as Ayurvedic and homeopathic,the Unani system has been accepted and integrated into the national health system. Pakistanis the only country in the eastern Mediterranean region where formal Unani teachinginstitutions are recognized21.46. There has been significant movement at the policy level in terms of CAM regulation.The government of Pakistan has in place a number of organizations and initiatives aimed atstrengthening and coordinating various aspects of the sector, supplemented by non-government and private sector initiatives. However, stronger coordination of the sector at thenational level under a strategic plan is imperative, which will produce offshoots into researchand development. There are 45 000 traditional healers, of whom about three-quarters are practicing in rural areas22. The presence of these practitioners in rural areas may be regardedas a source of health care delivery for the rural majority of Pakistan. Approximately 52 600registered Unani medical practitioners are practicing both in the public and private sector inurban and rural areas. About 360 tibb dispensaries and clinics provide free medication to the public under the control of the health departments of provincial governments. As for herbalmedicine, Pakistan is among the eight leading exporters of medicinal plants23.47. The Rag must appreciate these facts and discuss what are the training courses adoptedin these fields and is there is a need to design training and capacity-building programs for theCAM practitioners. What are the mechanism in place for bringing them into the mainstreamand elevating their status in society and are they effective. The rag must consider is there any

19 Gilani A. Prospects of Traditional Medicine in Pakistan. In: Proceedings of the International Seminar onIntegration of Traditional Medicine (Complementary/Alternative) and Modern Medicine, Cairo, 2002.

20 World Health Organization. Legal Status of Traditional Medicine and Complementary and Alternative

Medicine: A World Review. Geneva: WHO, 2001.21 Rahman AU. Bioprospecting of Medicinal and Food Plants: Pakistan. UNDP, New York: Special Unit for

South–South Cooperation, 2003.22 Gilani A. Phytotherapy—the role of natural products in modern medicine. J Pharm Med 1992;2:111–8.23 Hussain. SA, Saeed. A, Ahmed. M, Qazi. A. Contemporary role and future prospects of medicinal plants in the

health care system and pharmaceutical industries of Pakistan. URL http://www.telmedpak.com/doctorsarticles.

http://www.telmedpak.com/doctorsarticles






18

scope for private public partnership, community participation and the role of NGOs in thisfield. How can the they be integrated in the BHUs or even higher. How can the exportopurtunities in this sector be enhanced. The Rag should also consider the possibility of forging collaboration among all stakeholders including allopathic practitioners, traditional

medicine practitioners, ethnobotanists, phytochemists, pharmacologists, agricultural expertsand other related disciplines. While working out your solutions, you are required to strictly

adhere to the General Requirements in paras 22-26.Rag 4:CHIEG MINSITER SINDH’s SPECIAL COMMITTEE FOR IMPROVING

THE MECHANISM OF CHECKING SPURIOUS AND

COUNTERFIET DRUGS IN SINDH.

48. The issue of spurious drugs has been in the spotlight for some time now beginningwith the suo moto action by the Supreme Court in 2007 and the subsequent regulatoryactions by the then government to the more recent creation of a sub-committee of theSenate’s Standing Committee on Interior. The problem has elicited strong reactions byseveral governments—severe but fleeting and short-lived. The idea here is neither to analyze

individual decisions nor to delve into their motivation but to explain that the presence of spurious drugs in the market is a manifestation of erosion of capacity to regulate and govern.49. Analysis of the issue of spurious drugs highlights challenges at several levels most of which have emerged over time due to under-resourcing of regulatory institutions andweaknesses in mechanisms of accountability. The field forces of inspectors who are meant toensure that there is no mushrooming of backstreet manufacturing facilities and are mandatedto exercise oversight to ensure quality at the retail level and in the distribution chain have noincentives to perform. Systems of compensation are inadequate for sustaining appropriatelivelihood as a result of which institutionalized collusion has become a way of working andis almost regarded as a norm. As a result, harmful spurious products get manufactured andfind their way into markets; these are detrimental in many ways. Sick and poor patientssuffer further because they don’t get better despite out-of-pocket costs of treatment. Theofficial economy gets hurt because spurious drugs contribute to the growth of the black economy and bonafide businesses get affected because of infringements on their legitimate profit-making prerogatives.50. Rag 4 is required to identify the reasons for this lack of separation between policy-making and regulation which has created an environment for collusion. The vital link is theDrug Inspector which needs careful analysis. The drug testing laboratories are there and theRag should analyse their performance as to what is their level of penetration and reliability.The marketing techniques adopted by the pharmaceutical companies also need analysis. Themechanism of getting medicine over the counter deserves careful consideration. The issue of

spurious drugs is not only in allopathic but in ayuvedic and unani medicines which also needconsideration. Another important is smuggling of drugs with the collusion of other departments. It seems that corruption is not the only consideration here but lack of qualitycontrols, checks and balance in this sector.While working out your solutions, you are required to strictly adhere to the General Requirements in paras 22-26.




19

Rag 5:CHIEF MINISTER PUNJAB’s TASK FORCE ON HARMONISING THE

PRIVATE HEALTH SECTOR WITH PUBLIC SECTOR IN

PUNJAB.

51. From the very start Pakistan had two parallel health care systems, public and private.

The private sector’s share in health care was very small. Most of it consisted of the private practice of doctors in their communities. Initially this private practice was part-time and notvery expensive. However the bulk of health care existed in the Public sector. As a result of these developments we saw a mushrooming of private medical hospitals throughoutPakistan. Some of them look like European Plazas with lavish rooms similar to those of fivestar hotels, having huge LCD screens to watch television. Contrary to all myths there wasneither improvement in professional training nor professional standards. The standard of careactually deteriorated, medical malpractice reached new heights and the media filled up withreports of terrifying tales of corruption and exploitation in the private sector hospitals. Thecost of health care increased thousand folds or so. On the top of it there are constant reportsin the media on the development of illegal and unethical trade of “transplant organs” within

the private sector hospitals. Exploiting the poverty of the people, these hospitals buy kidneysand other organs from the patients sometimes even without their consent. Cases have beenreported where both kidneys of a patient were removed on pretext of doing an operation for appendicitis; pushing the person towards a certain death.52. There are horrifying stories regarding the Cosmetic surgery clinics and fertility clinics(which have mushroomed in the past decade). Their practice is totally unregulated and highlyunethical in most situations. A similar unregulated medical business exists in form of controversial laser treatment and surgery to improve the eye sight. In most cases these businesses are not in the hands of doctors and there are reports that procedures are done bynon medical technical staff (It’s not a mainstream medical practice).53. Rag 5 is required to discuss the growth of private medical sector and its contributiontowards providing medical services in Punjab. It is also required to look into the malpracticesof the private sector which are giving a bad name to the medical profession. Has theregulators turned a blind eye even to the provision of standardized medical practices. Insteadof ensuring affordable medical facilities the cost has risen manifold the Rag is required todiscuss the reasons. Private sector is also entering in specialized medical care what is thelevel of their interface with the public sector. Who determines the quality of the medicalequipments present in the private sector. Has the private sector become a dumping ground of second hand medical equipments from EU, Japan and USA. The rag must highlight theseissues.While working out your solutions, you are required to strictly adhere to the General

Requirements in paras 22-26.

Rag 6: CHIEF MINISTER PUNJAB SPECIAL TASK FORCE ON

CARDIO VASCULAR DISEASES (CVD) ALSO ANALYSING




20

PUNJAB INSTITUTE OF CARDIOLOGY & ARMED

FORCES INSTITUTE OF CARDIOLOGY.

54. Cardiovascular diseases (CVDs) are an important medical and public health issuethroughout the world24. This is an even bigger a problem for developing countries like

Pakistan which face the dual menace of still prevalent communicable diseases as well as anincreasing burden of non-communicable diseases like cardiovascular illnesses25. The rise in prevalence of cardiovascular diseases in developing countries is mostly related todemographic changes, urbanization, lifestyle modifications and higher risk factor levels suchas obesity, dyslipidemia, diabetes and hypertension26. From 1990 to 2020, the rise inmortality due to ischemic heart disease (IHD) in developing countries (137% in men and120% in women) is predicted to be much higher than that in the developed countries (48% inmen and 29% in women)27. Even these figures are underestimates because they take intoaccount only the changes in population dynamics and do not include the potential increasesin risk factor levels. It is expected that in the next fifteen years, cardiovascular diseases will become the leading cause of death in developing countries28.

55. Exact population based data on the burden and patterns of CVDs in Pakistan islacking. According to National Health Survey of Pakistan29, CVDs result in more than onehundred thousand deaths per year in the country, which is 12% of all- cause mortality. Thismortality data alone does not tell the true state of affairs because many more are living withCVD related disabilities30. Rheumatic heart disease which has largely been eradicated fromthe developed world is still prevalent in Pakistan. Despite the high occurrence of CVDs inthe country, there is a lack of reliable data available about the exact prevalence and incidenceof various cardiovascular illnesses separately.56. The rag should focus on the awareness campaigns launched by the government toaddress this issue. PIC and AFIC are premier institutes in this field and what are their contributions in this field. The Rag must also pay some consideration towards research andanalysis in these institutions. The cost of treating CVD is still very high in Punjab whatefforts have been done by the government to address this issue and has it bore any fruits.What is coverage level of these instituts in Punjab and beyond. How has the private sector interfaced in this specialized field also need consideration from the Rag.

24 Lenfant C. Can we prevent cardiovascular diseases in low- and middle-income countries? Bull World HealthOrgan 2001;79:980-2; discussion 983-7.

25 Sen K, Bonita R. Global health status: Two steps forward, one step back. Lancet 2000;356:577-82.26 Yusuf S, Reddy S, Ôunpuu S, Anand S. Global Burden of Cardiovascular Diseases: Part I: General

Considerations, the Epidemiologic Transition, Risk Factors, and Impact of Urbanization. Circulation,2001;104:2746-53.

27 Murray CJL, Lopez AD, eds. The Global Burden of Disease: A Comprehensive Assessment of Mortality andDisability from Diseases, Injuries, and Risk Factors in 1990 and Projected to 2020. Boston, Mass: Harvard Schoolof Public Health; 1996.

28 Reddy KS, Yusuf S. Emerging epidemic of cardiovascular disease in developing countries. Circulation.1998;97:596-601.

29 Pakistan Medical Research Council: National Health Survey of Pakistan 1990-94. Islamabad, Pakistan: PakistanMedical Research Council, Network Publication Service 1998.

30 Ahmad K. Facing up to Pakistan’s cardiovascular challenge. Lancet. 2002;359(9309):859.




21

While working out your solutions, you are required to strictly adhere to the General Requirements in paras 22-26.Rag 7:CHIEF SECRETATRY PUNJAB’s SPECIAL COMMITTEE ON IMROVING

WOMEN HEALTH AND PROMOTING SAFE

MOTHERHOOD IN GUJRANWALA DISTRICT.57. The health status of women in Pakistan is directly linked to women's low socialstatus. Pakistan's poor position internationally is seen in UNDP's Gender relatedDevelopment Index (GDI) 2000, where Pakistan currently ranks 135 out of 174 countries.On the Gender Empowerment Measurement (GEM), Pakistan ranked 100 out of the 102countries measured. In terms of health status, the figures are galling. Some 30,000 womendie each year due to complications of pregnancy, and 10 times more women develop life-long, pregnancy-related disability. Rural women's health is generally poorest due to the lack of health facilities and skilled health providers. For example, the maternal mortality ratio in predominantly rural Balochistan is 800 maternal deaths to 100,000 live births, compared tothe national average of 340 per 100,000.

58. The untimely death or disability of a woman, a tragedy in itself, adversely affects thehealth of her children, household productivity and the national economy. About 25 percent of children are born with low birth weight due to maternal problems. Ten percent of children donot reach their first birthday. High fertility, with an average of six children per woman, hasresulted in high population growth of three percent per annum. Consequently, improvingwomen's reproductive health through the use of contraceptives and spacing of children willnot only improve women's health but also reduce population growth and allow women moretime to pursue economic activities.59. There are also marked differences between the health status of women and men inPakistan. For example, malnutrition is a major public health problem in Pakistan thatdisproportionately affects women and girls. More girls than boys die between the ages of 1and 4; in fact the female mortality rate here is 12 percent higher than for boys. This is adirect consequence of the lower social status accorded to women and girls, who as a resulttend to eat less and face additional barriers when accessing health care. Women, girls andinfants most often die of common communicable diseases such as tuberculosis, diarrhea, pneumonia and tetanus, which could have been easily prevented and treated. The high prevalence of communicable diseases and malnutrition is not only related to poor livingconditions, but also to the lower social status of women and girls. In addition, because of social stigma and gender norms, as many as fifty percent of women suffer from recurrentreproductive tract infections.60. Rag 7 is required to discuss the causes and reasons for poor state of health of women

in Punjab. The NHP clearly spells out priority for women health as it is linked with childhealth. What has been the role of Lady Health Worker in educating women about healthrelated issues. What has been the role of the BHU in improving women health. The provisonof lady doctors is also a source of concern and the Rag should work backward to medicalcolleges as discuss as to what happens with lady doctors after graduation.

While working out your solutions, you are required to strictly adhere to the General Requirements in paras 22-26.




22

MISCELLANEOUS INSTRUCTIONS

Submission Of Written Reports:

61. The written submission will be in the proper form of a research paper as outlined for an Individual Research Paper (IRP). The deadline for the written submission by the

Syndicates and RAGs is_______________. Eleven (11) copies of each written submissionshould be delivered to the Sponsor DS. In addition, Twelve (12) copies of each presentationshould be prepared as Handouts (Black and White), with four slides per page and submittedto the sponsor DS at 2000 hours a day prior to the day/date of presentation.Text:

62. Text and notes should be between 18-20 typed pages(Font: Times New Roman—size 12, line spacing 1.5)

Time For Presentations:

Syndicates RAGs

Presentation time - 45 minutes 40 minutes

Q&A - 30 minutes 25 minutes

Schedule And Venue Of Presentations:

63. Schedule of presentations of Syndicates and RAGs will be communicated separately.The venue shall be NIM Hall. All participants will attend all sessions. Presentations by theSyndicates and RAGs will be followed by question-answer session by the Faculty/ReviewPanelists.Security And Safe Custody Of Exercise Documents:

64. The leaders of Syndicates and RAGs will be responsible for the safe custody andsecurity of all documents issued in connection with the exercise. No Exercise paper will be

taken out of the premises. All papers, when not in use, will be kept under lock and key.Photocopying of exercise papers is not allowed without permission of Sponsor DS.

Exercise Debrief:

65. After the conclusion of the exercise, there will be an Exercise Debrief Session.Chairpersons of Syndicates and Leaders of RAGs will provide inputs on their respectivegroups to help the faculty in their efforts in the future development of the exercise. ExerciseDebrief is an after-action review (AAR) which will discuss from various perspectives thefollowing:

1. What happened, what was successful, what went wrong, and why?2. What important management related lessons were learnt?

3. What important methodology related lessons were learnt?

4. How did the Review Panelist input help you in refining your approach, andenhancing your knowledge?




23

5. Were the aims and objectives of the Exercise achieved?

6. Comments regarding support services, including typing, reproduction, mess,etc.

7. Any suggestions?Time Allocated For Debrief:

66. Five minutes for each Syndicate Chairperson and 4 minutes for each RAG leader.




24

SYNDICATE 1: CHIEF MINISTER PUNJAB’S SPECIAL COMMITTEE TO REVIEW

PROVISION OF HEALTH SERVICES IN LAHORE & RAWALPINDI.

Faculty Advisor:

1 Secretary (Health), Punjab Chairman

2 Secretary (Finance), Punjab Member

3 DG (Health Services), Punjab Member

4 President (Pakistan Medical Society) Member

SYNDICATE 2: ADVISOR TO CHIEF MINSINTER KP’s WORKING GROUP ON HEALTH

ON CURBING CORRUPTION IN HEALTH SECTOR IN KHYBER PUKHTOONKHWA.

Faculty Advisor:

1 Advisor to CM KP Chairman

2 Chief Secretary KP Member

3 Health Secretary KP Member

4 DG Member

SYNDICATE 3:FEDERAL SECRETARY HEALTH’s TASK FORCE ON

IMPLEMENTATION OF POLIO IMMUNIZATION CAMPAIGN IN PAKISTAN

Faculty Advisor:

1 Chairman

2 Member

3 Member

4 Member

SYNDICATE 4: FEDERAL MINISTER HEALTH’s TASK FORCE ON COMMUNITY

HEALTH PROMOTION IN PAKISTAN

Faculty Advisor:

1 Chairman

2 Member




25

3 Member

4 Member

SYNDICATE 5: CHIEF MINISTER PUNJAB TASK FORCE FOR PRESENTING A PLAN TOCONTROL MEDICAL NEGLIGENCE IN PUNJAB.

Faculty Advisor:

1 Chairman

2 Member

3 Member

4 Member

5 Member

RAG 1: CHIEF SECRETARY PUNJAB’s WORKING GROUP ON IMPROVING

STANDARDS OF NURSING & PARAMEDICS.

Faculty Advisor:

1 Leader

2 Member

3 Member

RAG 2: SECRETARY HEALTH PUNJAB’s STUDY GROUP ON IMROVING CHILDHEALTH IN FAISALABAD DIVISION.

Faculty Advisor:

1 Leader

2 Member

3 Member

RAG 3: ADVISOR TO CHIEF MNISTER PUNJAB ON HEALTH’s STUDY GROUP ON

HARNESSING COMPLEMENTARY AND ALTERNATIVE MEDICINE IN MULTANDIVISION.

Faculty Advisor:

1 Leader

2 Member

3 Member




26

RAG 4: CHIEG MINSITER SINDH’s SPECIAL COMMITTEE FOR IMPROVING THE

MECHANISM OF CHECKING SPURIOUS AND COUNTERFIET DRUGS IN SINDH.

Faculty Advisor:

1 Leader

2 Member

3 Member

RAG 5: CHIEF MINISTER PUNJAB’s TASK FORCE ON HARMONISING THE PRIVATE

HEALTH SECTOR WITH PUBLIC SECTOR IN PUNJAB.

Faculty Advisor:

1 Leader

2 Member

3 Member

RAG 6: CHIEF MINISTER PUNJAB SPECIAL TASK FORCE ON CARDIO VASCULAR

DISEASES (CVD) ALSO ANALYSING PUNJAB INSTITUTE OF CARDIOLOGY & ARMED

FORCES INSTITUTE OF CARDIOLOGY. Faculty Advisor

1 Leader

2 Member 3 Member

RAG 7: CHIEF SECRETATRY PUNJAB’s SPECIAL COMMITTEE ON IMROVING

WOMEN HEALTH AND PROMOTING SAFE MOTHERHOOD IN GUJRANWALA

DIVISION.

Faculty Advisor:

1 Leader

2 Member

3 Member




27

SUGGESTED READINGS:

1. Year Book 2005-06 Government Of Pakistan Ministry Of Health.2. National Health Policy 2001, Ministry Of Health, Government of Pakistan.3. National Health Policy 2009 July 2009 ministry of Health, Government of Pakistan.4.

United Nations Development Assistance Framework For Pakistan 2004-2008 27March 2003.5. Restructuring Basic Health Units; Mandatory Safeguards, Dr. Sania Nishtar , 2006.6. Pakistan Demographic And Health Survey Tracking The Millennium Development

Goals US AID Pakistan, January 2009.7. Pakistan: Poverty Reduction Strategy Paper 2010, International Monetary Fund June

2010. IMF Country Report No. 10/183.8. Poverty And Ill-Health: Challenges, Initiatives And Issues In Pakistan, Inayat Thaver ,

Zulfiqar A. Bhutta, 2006.9. Pakistan Economic Survey 2009-2010.10.Pakistan’s Health Sector: Does Corruption Lurk? Dr. Sania Nishtar 2007.

11. Immunization in Pakistan; Pakistan Institute for Legislative Development andTransparency 2010.

12.Health Systems Profile; Pakistan Regional Health Systems Observatory- EMRO.13.Community Health Promotion: Creating The Necessary Conditions For Health

Through Community Empowerment And Participation. The International Union For Health Promotion And Education, Volume XIV Number 2 2007.

14. Update on Polio Eradication in Pakistan, AFP Surveillance 2009.15.Pakistan Polio Communication Review Recommendations towards Complete

Coverage Pakistan Polio Communication Review Meeting Islamabad September 17-19, 2007.

16.Health Care System in Transition III, Pakistan Part 1. An overview of health caresystem in Pakistan. Abdul Ghaffar, Birjees Mazhar Kazi, Muhammad Salman. Journalof Public Health Medicine. Vol 22 No 1 pp 38-42, United Kingdom.

17.Community health promotion in Pakistan: A Policy Development Perspective. K. A. Ronis and S. Nishtar. IUHPE–Promotion & Education VOL. XIV, No. 2, 2007.

18.Complementary and Alternative Medicine in Pakistan: Prospects and Limitations, Babar T. Shaikh and Juanita Hatcher, Advance Access Publication 20 April 2005.

19.Child Health and Poverty in Pakistan. G. M. Arif . The Pakistan Development Review43:3 (Autumn 2004) pp. 211–238.

20.Implementing the district health system in the framework of primary health care inPakistan: Can the evolving reforms enhance the pace towards the Millennium

Development Goals? F. Sabih, K. M. Bile, W. Buehler, A. Hafeez, S. Nishtar and S.Siddiqi, Eastern Medical Health Journal (EMHJ) Volume 16, September 2010.