ISLAMABAD, Dec 29: The government has decided to allocate Rs85 billion for the development of new programmes in the health sector during 2005-10. Official sources told Dawn that for the first time such a huge funding would be made available for different health programmes for which a comprehensive plan has been developed to be implemented by the provinces and local government institutions.

The ministry of health will be playing a lead role and offering institutional and administrative support to help meet various health-related targets.

The new funding programme, sources said, has been finalized in line with the measures adopted during 2000-05 by the government to improve primary and secondary health-care services and reproductive health-care services.

However, according to an official document, the main challenge is the availability of access to skilled manpower. It is a well-established fact that public health facilities — particularly in rural areas — are inadequately staffed by female staff in general and women doctors in particular.

In recent years, the health sector has witnessed a major drive to increase the number of lady health workers but the remote and under-developed districts have not benefited from this due to non-availability of qualified women. This concern also applies to lady health visitors.

It is also said that there is a need to institutionalize management and governance reform and build better incentives through civil service reforms so as to ensure efficiency at the management level. “A system of reward and accountability within the system may be encouraged so that civil servants are motivated to perform better.”

Talking about challenge and constraints, the document said that lack of coordination between federal and district governments affects health service delivery.

Under the district devolved system, many health activities are meant to be locally implemented. However, these are being marred by the souring of relationship between the provincial and district governments. The provinces sway control over personnel and are reluctant to let go of funds.

Therefore, there is a need to devolve fiscal and administrative responsibilities in full to the districts, the document urged.

Another important barrier to achieving maternal health outcomes is fragmentation of maternal health services. Successive health policies since the 1950s have emphasized the need for an integrated maternal and child health programme.