ISLAMABAD: World Bank’s assistance has been sought for implementation of the proposed National Health Support Programme (NHSP) that will tackle a number of systematic issues, including an insufficient, underutilised and underperforming health workforce, and the shortage of essential medicines, family planning commodities and supplies at the primary healthcare provider level.

The expected cost of the NHSP, to be implemented at the community, primary and secondary care levels, amounts to about $5,900 million for all provinces, over five years. This includes the provincial governments’ budget for primary and secondary level care, a World Bank document says.

The proposed NHSP will utilise a Programme for Results (PforR) instrument, the first in the health sector in Pakistan. The PforR is the most suitable lending instrument given the government’s universal healthcare programme and associated reforms, the recurrent nature of the expected health expenditures, and improvements in the government’s capacity, as witnessed through the National Immunisation Support Project (NISP).

Expected cost of five-year NHSP for four provinces is $5.9bn

The NISP, which has been under implementation since 2016, is an Investment Project Financing (IPF) with Disbursement-Linked Indica­tors (DLIs). Pakistan has demonstrated effective use of the PforR instrument in other sectors such as education and public financial management.

The result-based financing would be complemented by an investment financing component, estimated at less than 20 per cent of the total financing under this operation. This component would also be managed by health departments in the four provinces and the national health services ministry, regulations and coordination to mobilise technical assistance and pilot innovation in a timely manner.

The proposed NHSP would be national in scope, benefiting Balochistan, Khyber Pakhtunkhwa, Punjab and Sindh.

It aims to support the government’s Universal Healthcare Programme.

As health is a devolved subject, the proposed NHSP would support the provincial governments to improve the equitable delivery and quality of essential health services at the PHC level. While the government’s programme comprises a set of services to be delivered at the primary and secondary care levels, the NHSP’s programme boundary is confined to the PHC, defined in the Pakistan’s context as those services being delivered at rural health centres and below, including at the community level.

Published in Dawn, March 9th, 2022