1. Basic Health issues and Role of Private Health
Care System in Pakistan
DR.ABDUL.GHAFOOR SHORO
MBBS,MAS in HSA ,PGDPA,DPHC
Secretary General
Sindh Private Hospitals and Clinics welfare Association(SPHCA)

2. Structure of Modern Health Care System
Internationally Recognized Health system / Levels of health care:
An internationally recognized health care delivery system which includes four tiers.
1. Preventive care:
The specialists in preventive care plan at Governmental, institutional or community level for controlling
preventable diseases. They have special role in maintaining hygiene and sanitation of a community as
well as inculcating awareness regarding health and disease in masses.
2. Primary Care:
The Doctors working at Primary care level (Family Medicine Specialists / Qualified Specialist GPs / Simple
GPs) treat all the members of a family for most of the common illnesses. They also provide necessary
Health advice and arrange referrals to different specialists at secondary or tertiary health care levels
when required. The key element of a primary health care set up is Family Physician.
3. Secondary Care:
Doctors working in bigger hospitals including medical
specialists, surgeons, pediatricians, gynecologists, dermatologists, psychiatrists, ENT specialists
, ophthalmologists and other sub specialties provide secondary care.
4. Tertiary Care:
Special Hospitals dealing with certain subspecialties covering single organ or organ system related
diseases provide the tertiary care like Cardiac centers, Burn units, orthopedic units, Kidney centers etc.

3. Basic Health Issues in Pakistan
• Health system has been designed developed and maintained
by politicians rather than physicians/ Health professionals.
• We have a poorly organized health structure. We need to
clearly define the four tier health care system.
• Our health priorities are not properly defined.
• Lacking of experts in the field of primary health care.
• To spend more on secondary and tertiary care centers.
• Neglecting Primary and Preventive Health care system.
• High cost of Medicines and Procedures.
• Lack of Promotion of Research in Medical Field .
• Circulation of Fake Medicine.
• Lack of Health education in Community .

4. Health Issues Cont:
• Un Controlled quackery(un authorized healthcare giving) all
over the country.
• Gap between our medical training and on ground health
issues.
• difference between demand and supply of health
professionals for different services.
• We neither have insight nor physical existence of a properly
functioning preventive health care system.
• Political Interference.

5. Role of Private Health care system
• 70-80% health care providers in Pakistan.
• The Private sector specially in urban areas has become main
health provider in Pakistan.
• In Sindh private providers act on the front line and are often
the only form of healthcare available .
• Although the private sector plays an increasingly important
role in health care in Pakistan, it remains anew area of study
and innovation.
• As government fall short of providing widespread access to
care ,the private sector presents an opportunity for
sustainable scale-up of health care services along side social
and economic development.
• Included the scope of private sector agencies are both for
profit private providers and NGOs that apply market based
approaches to service delivery.
• Un fortunately Private sector’s true role was never
understood in Pakistan.

6. Cont:
• To introduce such a health care infrastructure
model where all citizens can get better health
care facilities in Sindh.
• Only access to health care, even if universal, will
have no meaning unless the larger social
determinants of health are squarely addressed
and issues of ethnicity, caste, class and gender
are engaged-with as a society.
• With regards to health, we also believe that the
private sector should play only a supplementary
and never a complementary or competitive role.

7. Private Healthcare system in Sindh
• The Private sector in Sindh is varied with no defined
structure, weak regulations exists in this sector.
Descriptive situation of the Private Health care sector in Sindh.
1. Health infrastructure 2. Types of Health facilities
3. Informal Structures 4. Allopathic Service Providers
5 . Non Allopathic Service providers 6. Traditional.

8. Health Infra structure
• The private Health Infrastructure is not well
organized .
• The wide range of disparity in health care provision
in the private sector.
• Ranging from Hi Tech regular Hospitals with all
necessary provisions to a general store providing
healthcare.

9. Types of Health Facilities
• Regular hospitals:
Fully equipped with necessary staff
,supplies, equipment, transportation, skilled
staff and can be compared to any teaching
hospital of the public sector.

10. Nursing Homes in Sindh
• Nursing homes are mostly acting as maternity
homes and generally are not well versed in
providing most of the primary health care
services and even not equipped for new born
care.

11. Clinical Set up in Sindh
• Clinics are generally owned by a single person
who is sole proprietor of this healthcare
providing structure.
• There are some very good clinics run by
specialists well equipped and providing quality
services but these are in limited number .
• Mostly situated in Metropolitan areas where
people are well aware of the quality of the health
services.
• But the Conditions of the most of the clinics is
pathetic due to weak regulatory system.

12. Informal structure
• Informal structure don’t act primarily as
health care provider and even are not legally
authorized for this ,but even then this practice
exist.
• These are general store, Karyana
merchants, and Pan wala also providing
medicines for minor diseases .

13. Allopathic Service Providers
• Allopathic service providers are divide into
three groups :
• Qualified
• Semi- qualified
• Non- qualified

14. Qualified
• Qualified Services Providers include MBBS and
Specialists.
• They are mostly providing services at private
hospitals Medical centers /nursing homes and
at their Clinics .

15. Semi Qualified
• The semi Qualified health care providers
include LHVs, LHWs etc.
• They are having some training and diploma as
recognition.
• The y are trained for specific purpose and
have their limitations with respect to health
care service provision.
• But mostly performing the functions of
qualified doctors with out enough knowledge.

16. Non-Qualified
• Non qualified ser vice providers include
dispensers, Ward boys and peon etc.
• Any other person having some experience
working with qualified health care provider for
a short time.
• The pharmacist lying in this category providing
consultancy and dispensing are also non
qualified persons.

17. Non- qualified in Action

18. ENT Specialist- Ophthalmologist and Dental surgeon

19. In the name of herbal treatment

20. Non-Allopathic Service providers
• Homeopaths, Hakims, Pehlwans and Jirhas.
• Acupuncture and Chinese Medicine treatment
Provider.

21. Traditional Health Care providers
• About 70% of the population , particularly in rural
areas use traditional and complementary
/alternate Medicine.
• The Govt: of Pakistan has issued the
Unani, Ayurvedic and Homeopathic System of
Medicine Rules of 1965.
• Under this Act courses in homeopathy provided
by recognized institutions must be four years in
duration ,culminating in a qualifying examination.

22. Governmental Responsibility
• The Private sector’s dominance in the health
sector needs to be recognized by policy makers.
• Private Provision could be financed through
Government sources to provide subsidized care
to low income groups.
• Vertical programs such as EPI , Family
Planning, TB control etc need to be expanded to
include Private Sector.
• The field of Family Medicine needs to be properly
high lighted promoted and utilized by
Government to the best of its advantage to public
• Quackery and Un- authorized health care giving
should be penalized under the law.

23. Responsibility of Private Healthcare
Sector
• Must properly analyze the ethical and Professional
Competency standards of our private healthcare sector.
• Must make a full audit of all the existing private practice
outlets.
• Must also look into the possibilities of govt: and Private
partnership.
• Should clearly define our health issues ,Health priorities
and health policy.
• Must have full Time properly functioning Public Health
Department at all levels .
• Must eliminate quackery in all forms.
• Should adopt the concept of affordable treatment for all.

24. House Hold Hakeem's