PESHAWAR, May 25: The World Bank has expressed dissatisfaction over the poor performance of Health Sector Reforms Unit (HSRU), established by the military-led government to act as a think-tank for reforms in the health sector.

According to the World Bank’s report recently compiled after the third review of Structural Adjustment Credit (SAC) programme, and submitted to the health department, the plans to strengthen HSRU have been affected adversely due to frequent transfers of staff and unwillingness of the department to retain the skilled staff.

Besides, the report has also pointed out that there is no institutional mechanism to track expenditures to identify bottlenecks and take corrective measures in the provincial health sector.

The bank in its report pointed at a number of issues limiting progress, which include: ambitious reform agenda which is being expanded without taking into consideration the working capacity; lack of adequate monitoring arrangements and coordination with the district governments to assess progress of implementation and track results at the district level.

Despite a number of initiatives for public-private partnerships, reforms continue to focus on strengthening the government health services. There is a need for a more balanced approach that encompasses reforms for improving private health services and to influence household behaviour and demand side factors, the report adds.

PC1 of HRSU has been approved, however, expenditures are very low — Rs 0.095 million as compared to the approved fund of Rs3 million.

The report says that HSRU, which was envisaged to conceptualise and provide technical leadership for designing reforms, has got involved in the implementation phase of projects.

Due to lack of adequate incentive for the staff, the department continues to lose trained staff, weakening its capacity to perform.

It may be mentioned here that the HSRU was established last year with the initial funding of Asian Development Bank (ADP). However, in the current financial year 2002-2003, the provincial government has allocated funds for the unit.

It was the plan of the government that full-time separate staff would be posted at the unit by July 1, 2002. However, the unit is still being run on an ad-hoc basis when the end of the current financial year is just one and half month away.

Standardization of Health Care Facilities (SHCF) is another project on which the progress is very slow. About the programme, the report says it is being extended to 12 districts, and 17 out of 26 schemes have been approved and initial funding released. However, implementation progress is slow and it is unlikely to make any significant progress during the financial year 2003.

The slow progress is due to delay in the approval of schemes and limited capacity at the district level to implement projects. To address critical shortage of nurses to improve quality of health-care at the district and sub-district hospitals, 255 posts are to be created as part of rationalisation programme. The recruitment process is being initiated and likely to be completed by end of this financial year, the report said.

Standardization of Health Facilities was also a brainchild of the previous government. Through this project, it was decided that all the existing health facilities of the province, including District Headquarters Hospital (DHQ), Basic Health Unit (BHU), Rural Health Centre (RHC) and teaching hospitals of the province would be divided into various categories in order to upgrade the capacity of the health delivery system. However, the idea also could not materialize.

The report said the reform initiatives were in various stages of implementation and appeared to have slowed down since the second review mission.