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7.4 Private health care facilities The private health care facilities are quite diverse and have generally grown unregulated. There are no standardized or classified health facilities in the private sector. The private sector gener- ally exists in the form of: • Major hospitals with specialized health facilities; • Other hospitals with variable quality/level of services; • Individually run clinics/general practitioners including dental and eye care. These clinics are either owned by a single person who is the sole proprietor of the facility or they are run on partnership basis; • Homeopaths, hakeems, tabibs and other traditional health providers; • Health care facilities from NGOs including the philanthropic organizations; • Ambulatory health services; • Pharmacies and • Opticians. Considering that 83% of the population access healthcare from the private sector and 17% from public sector, it is vital to estimate health expenditures in private sector. In principle, this can be done using demand-sided (patients or households) or supply-sided (health care providers) approaches or both. In first round of NHA Pakistan the demand-sided approach was applied on household data. In this round of NHA Pakistan, the same approach has been adopted by getting data from the specialized OOP Health Expendi- ture Survey conducted by PBS. For the results see Chapter 4. 7.5 Private health insurance Health insurance is covered under the non-life insurance. In 2021-22 there were 39 insurance com- panies in Pakistan offering group health insurance or individual health insurance. The insurance companies are funded by premiums of their clients. They are not financing source but are agents as well as providers of (administrative) health services. Since the Securities and Exchange Commission of Pakistan (SECP) is the formal regulator of the insurance industry under the Insurance Ordinance 2000, the data on private health insurance has been taken from SECP. 7.6 Philanthropic / Non-Government Organizations Philanthropy has been defined as “activities of voluntary giving and serving, primarily for the benefit of others beyond family31”. The philanthropy is dedicated to health care, but not exclusively. It has broadly two components • Services: in which the non-profit organizations are primarily involved • Giving: individual or corporate Philanthropy is very commonly institutionalized as non-government organizations (NGOs), also of- ten referred to as non-profit institutions (NPIs). NGOs are an important part of civil society and are quite distinct from private enterprises. Known variously as the ‘non-governmental’, ‘voluntary’, ‘community-based‘ charitable’, and ‘welfare societies’, this set of institutions includes within it a variety of entities such as
31 Pakistan Centre for Philanthropy, Available at: http://www.pcp.org.pk/. Accessed on 20 Jan 2009
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schools, hospitals, dispensaries, human rights organizations etc. Many definitions of NGOs have been put
forward which add to the confusion. However, despite their diversity the NGOs share certain common fea-
tures32:
• They have an institutional presence and structure;
• They are institutionally separate from the state;
• They do not return profits to their members, managers or directors
• They control their own affairs;
• They attract some level of voluntary contribution of time or money an d also membership
in them is not legally required.
Pakistan Centre for Philanthropy (PCP) has been working on the regulation of the philanthropy in
Pakistan with a mission to increase the volume and effectiveness of the philanthropy for social develop-
ment. The PCP database includes only certified institutions.
The practices of giving can broadly be divided into Individual and corporate giving. The individual
giving can further be classified as zakat and non -zakat giving. As being predominantly a Muslim cou ntry,
much of Pakistan's individual giving is probably in response to the teachings of Islam. The individual giving
includes the obligatory (by religion) festival charity (Zakat -ul-fitr) and charitable wealth tax (Zakat -ul-mal).
The zakat deducted at sourc e by the government mentioned in the Zakat section only includes the Zakat -
ul-mal. Also, it is not obligatory on the citizens to give the Zakat at the Government source. They have the
option of paying zakat privately on their own.
The corporate giving is also an important part of philanthropy. About 37% of the corporate sector
is involved in philanthropic support to the health sector 33.
It is pertinent to mention here that the health expenditures incurred by local or national NGOs in-
volved in providing health services has been accounted for in this report while the individual philanthropies
whether in cash ( except for Zakat & Bait -ul-Mal) or in kind are not accounted for in this re port as there is
lack of national level research/data on it.
32“Dimensions of the Non-Profit Sector in Pakistan”, Social Policy and Development Centre, Working Paper No.1 (2002). 33Pakistan Centre for Philanthropy. Available at: http://www.pcp.org.pk/fact_sheet.html. Accessed on 20 Jan 2009 Pakistan Bureau of Statistics National Health Accounts
86
Annexure
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Annexure 1: Data sources
Data Type
Source
Publication or official correspondence available
Out of pocket expenditure
PBS
HIES 2018-19
Federal government
AGPR
Appropriation Accounts (Civil) Volume-1 2021-22
Provincial government
AG Office Punjab
Appropriation Accounts for the Year 2021-22
District data
AG-Office Punjab
District. Appropriation Accounts 2021-22
Provincial government
AG Office Sindh
Appropriation Accounts for the Year 2021-22
District data
AG-Office Sindh
District Appropriation Accounts 2021-22
Provincial government
AG Office KP
Appropriation Accounts for the Year 2021-22
District data
AG-Office KP
District Appropriation Accounts 2021-22
Provincial government
AG Office Baluchistan
Appropriation Accounts for the Year 2021-22
District data
AG-Office Baluchistan
District Appropriation Accounts 2021-22
Health Insurance data
FIS section, PBS
Non-Life Insurance Companies reports
Donors
EAD
Data collected officially
Social Security
Punjab ESSI
Data collected officially
Social Security
Sindh ESSI
Data collected officially
Social Security
KP ESSI
Data collected officially
Social Security
Baluchistan ESSI
Data collected officially
Military
Military Accountant General
Data collected officially
Zakat
Ministry of Religious Affairs
Data collected officially
Autonomous bodies/Corporations
PBS
Census of Autonomous Bodies 2011-12
Sehat Sahulat Programme
Ministry of Health, Federal Government
Data collected officially
Sehat Sahulat Programme
Health Department, KP Government.
Data collected officially
Reimbursement of medical
charges
FABS, CGA, Islamabad
Data collected officially
• FABS stands for Financial Accounting & Budgeting System • CGA stands for Controller General of Accounts
Note
Pakistan Bureau of Statistics National Health Accounts
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Annexure 2: Literature
Asian Development Bank TA 4155-Pak, Social protection strategy development study, Vol: II, Health
Insurance, 2004.
Asian Development Bank, Social Protection Strategy Development Study, Social Protection, Final Re-
port Vol. 1: Social Protection.
Asian Development Bank. Technical assistance to the Islamic Republic of Pakistan for developing a
social health insurance project (TAR; PAK 37359). Asian Development Bank, 2005.
Pakistan Bureau of Statistics, Health, Pakistan Statistical Year Book 2011.
Ministry of Finance, Health and Nutrition, Pakistan Economic Survey 2011-12
Fouzia Rahman, “Building upon successful Philanthropic Models in Health Sector of Pakistan”, World
Bank Study. 2008.
Ministry of Health: http://www.health.gov.pk/. Accessed on 14 March 2009.
Ministry of Health, Drug Control Organization. Link: http://www.dcomoh.gov.pk/about/overview.php.
OECD, A System of Health Accounts, 2011, Paris, www.oecd.org/health/sha
Pakistan Public Administration Research Centre, Management Services Wing, Establishment Divi-
sion, Annual Statistical Bulletin of Employees of Autonomous/Semi-Autonomous Bodies/Corpora-
tion under the Federal Government 2007-2008, Islamabad.
Social Policy and Development Centre “Dimensions of the Non -Profit Sector in Pakistan”, Working
Paper No.1 (2002).
World Health Organization - National Health Accounts Series, Pakistan: National Expendi ture on
Health, 2010. Link: http://apps.who.int/nha/database/Standard.
WHO, Guide to Producing National Health Accounts: with special application for low income and mid-
dle-income countries, 2003.
Zakat & Ushr Ordinance, 1980 (NO. VIII of 1980).
Department: System.
Pakistan Bureau of Statistics National Health Accounts
90
Annexure 3: Structure of Provincial Health Care
Adapted from: S Siddiqi et al. The effectiveness of patient referral in Pakistan.
Health Policy and Planning; 16 (2) 93–198.
Primary health care is implemented through Basic Health Units (BHUs), Rural Health Centers (RHCs),
Maternal and Child Health Centers (MCHCs) and Dispensaries.
A Basic Health Unit (BHU) covers 10000 to 15000 populations and 5-10 BHUs are attached to a Rural
Health Centre (RHC)34. It mainly provides health preventive and health primitive services such as
maternal and child health services, immunization, diarrheal disease control, malaria control, child
spacing, mental health, school health services, prevention & control of locally endemic diseases, and
provision of essential drugs.
A Rural Health Center (RHC) covers 25,000 to 50,000 populations. It mainly provides preventive and
health primitive services, also curative services for common illnesses.
Maternal and Child Health Centers (MCHCs) are part of the integrated health system focusing on the
maternal and child health.
Secondary health care includes first and second level referral facilities providing acute, ambulatory
and inpatient care provided through Tehsil Headquarter Hospitals (THQs), and District Headquarter
Hospitals (DHQs). The primary and secondary health care constitutes the District Health System.
Tehsil Headquarter Hospitals (THQs), and District Headquarter Hospitals (DHQs) covers 100,000 to
300,000 and 1-2 million persons respectively35.
Tertiary health care is provided through major hospitals with specialized facilities which are under the
administrative jurisdiction of provinces.
34 Health System Profile – Pakistan, Regional Health System Observatory-EMRO, World Health Organization, 2007. 35 Health System Profile – Pakistan, as cited above
Pakistan Bureau of Statistics National Health Accounts
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Annexure 4: Schematic overview of Health Care System
Public Sector
Federal Government
Ministry of
Health
Vertical
Programs
Institutions/
Hospitals
with MoH
Research
Institutions
Ministry of
Defence
Military
Health Care
System
Cantonment
Board of
Pakistan
Other
Ministries
Autonomous
bodies
Provincial Government
Private Sector
Other hospitals
with various kind
/level of health
care
Major hospitals
with specialized
health facilities
Individually run
clinics/GPs
including dental
and eye care
Homeopaths,
Hakeems &
other traditional
health care
providers
Provincial
Health
Department
District Health
System
THQs, DHQs
Secondary Care
Primary Care
Health care
facilities from
NGOs including
Philanthropic Or-
ganizations.
RHCs
Tertiary care
BHUs, MCHCs,
Dispen
Other
Provincial
Departments
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Annexure 5: Military Health Care System
Secondary health care in military
Health facility
Number
Beds per facility
Function
Population
Class “A”
CMHs*
10
500 & above
Primarily
curative
All of the Armed Forces, their dependents
and the general public
Class “B”
CMHs*
9
300-400
Class “C”
CMHs*
11
51-200
Class “D”
CMHs*
14
50 & below
Military Hospital
1
1000
Primarily
curative
Pakistan Army, their dependents and the
general public
Note:
CMH = Combined Military Hospital
Primary Health Care Centres consist of …
Military
Reception
Centres
Garrison
Medical
Centres
Combined
Military Hos-
pitals
(CMHs)
Preventive
and
Curative
Services
Class
“A”
Class
“B”
Class “C”
Class
“D”
CMH---
Equal
to
Secondary
level health
care facility
Preventive
services
mainly
Provide services
exclusively to the Military
Personnel and their
dependents
Provide health services to all
of the Armed Forces, their
dependents and to the gen-
eral public
Military Hospitals Curative services mainly Provide health ser- vices to Pakistan Army, their de- pendents and to the general public
Tertiary Care AFIRM, AFIU, AFBMTC, AFID, AFIT, AFIP, AFIC
Medical Battalion Provide Services to Military personnel in field
Curative Services mainly
Secondary Care Tertiary Care Curative services mainly
Primary Care
Pakistan Bureau of Statistics National Health Accounts
93
Medical Battalion
They collect, treat, and evacuate casualties from Regimental Aid Post (RAP) to Advance Dress-
ing Stations (ADS)/Forward Treatment Centre (FTC) for the provision of essential life-saving sur-
gical and dental treatment.
Field Medical Units
These units include Medical Inspections Rooms/Medical Reception Centres & Garrison Medical
Centres. These units are responsible for:
■ Medical support to deployed elements of formations
■ Preventive health measures in formations
■ Medical support for all training activities
■ Participation in collective training exercises
■ Unit level training cycles
■ National commitments including vaccination campaigns and medical relief in aid to dis-
asters / calamities
■ International commitments including Hajj and UN missions
Both the Medical Battalion & the Field Medical Units deliver the health services exclusively to the
military personnel.
Secondary Health Care Centres
The secondary health care facilities include the Combined Military Hospitals (CMHs) which are
further categorized as Class “A”, Class “B”, Class “C” as well as Class “D” hospitals depending upon
the number of beds and facilities available. At Rawalpindi there is also a military hospital (MH).
The CMHs provide health services to all of the Armed Forces, their dependents, retired sol-
diers, civilians paid from defence estimates and to the non-entitled civilians. The Military Hospital pro-
vides services only to the Pakistan Army, their dependents and to the non-entitled civilians.
Tertiary Health Care Centres
The tertiary health care is constituted of some state-of-the-art institutes with modern health
care facilities which include
•
Armed Forces Institute of Cardiology (AFIC)
•
Armed Forces Institute of Pathology (AFIP)
•
Armed Forces Institute of Transfusion (AFIT)
•
Armed Forces Institute of Dentistry (AFID)
•
Armed Forces Bone Marrow Transplant Centre (AFBMTC)
•
Armed Forces Institute of Urology (AFIU)
•
Armed Forces Institute of Rehabilitation Medicine (AFIRM)
The Army Medical Corps also has international commitments, as they participate in the UN
medical missions and relief missions to foreign countries.