AS of July 1 Pakistan has no institutional structure responsible for the health sector at the federal level. The ministry of health was devolved on June 30 under a constitutional amendment leading to the devolution of powers to provincial governments.

The 18th Amendment was passed on April 8, 2010, and involves the devolution of about 22 federal ministries to the four federating units.

While the idea of moving power bases nearer the people is generally welcomed by most, provincial governments at the moment are still at an early stage of preparation to assume the new responsibilities.

A sense of confusion and uncertainty prevails in the provincial capitals today. This is happening at a time when Pakistan faces dire need to increase the capacity of the health system to tackle the myriad health problems in the country.

The Drug Act of 1976, the law regulating pharmaceutical sector in the country, and the regulatory structures formed under it for registration, manufacturing, quality assurance of medicines and adjudication of contraventions, etc, also do not exist anymore under the 18th Amendment. There is no provincial legislation at the moment to fill the gap.

A concern has been raised on the devolution of drug regulation at a time when elsewhere in the world countries are moving towards regionalisation models of drug regulation.

Taking such international trends into account, one may argue that there aught to be further strengthening of the capacity at the federal level rather than fragmenting it further.

A ray of hope is in the eminent formation of a national drug regulatory authority, approved by the federal cabinet in 2002, and since languishing for lack of follow-up, under the auspices of the Implementation Commission formed under the 18th Amendment.

While these hugely important policy decisions are under way, there is little consolation for the discerning citizens in the knowledge that none of this is based on hard evidence and sound research.

AYYAZ KIANI Islamabad