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Heartfile—a focus on health systems


In the past few decades, policy makers have recognized that for any significant improvement in the health profile of a country, the focus must be on health systems as a whole. Particular diseases and epidemics are simply symptoms of a larger problem, namely the affliction of the whole system. Heartfile’s significant achievements in this area are summarized below:

Health systems performance assessment

Establishing a framework for health systems performance assessment (initiated in 2009). This was part of a WHO-led platform to ‘Strengthen Monitoring and Analysis of Country Health Systems.’ This assessment will be reported in the Pakistan Lancet Series, published in 2013.

Heartfile Health Financing

Developing an IT-supported demand side health financing tool that can enable efficient, timely and well-targeted cash transfers in order to protect the poor against catastrophic spending on health, and to establish a seed Health Equity Fund (initiated in 2008). This is being done under the name of ‘Heartfile Health Financing.’ Funding: Rockefeller Foundation.

Choked Pipes

The publication of the book, ‘Choked Pipes: Reforming Pakistan’s Mixed Health System‘. The book charts a roadmap for health reform in Pakistan.

18th constitutional amendment in Pakistan

Analysis of the impact of the 18th constitutional amendment in Pakistan passed in April 2010, and advocacy in support of giving prominence to health.

The Gateway Paper: Health Systems in Pakistan – a Way Forward

The Gateway series of papers, which aims to strengthen the evidence base of health reform. The first in the series, Gateway Paper I was the first consolidated review of health systems in Pakistan. Its strategy was recognized as a blueprint for formulation of a new national health policy for Pakistan. Pro bono time contribution: Dr. Sania Nishtar.

Health Indicators of Pakistan – Gateway Paper II

‘Health Indicators of Pakistan – Gateway Paper II‘ was authored by Dr. Sania Nishtar, who contributed time pro bono. This paper was developed under a MOU with Pakistan’s Federal Bureau of Statistics and it aimed to build their capacity for developing a system of reporting on health indicators.

The post-gateway roundtables

Conducting a series of national meetings—the post-gateway roundtables developed consensus on the strategy proposed by the Gateway Paper (2005-07). Funding support for these meetings was provided by the Department for International Development UK and the World Bank.

Memoranda of understanding with the government on health policy development

Developing drafts of the national and provincial (Khyber Pakhtunkwa) health policies of Pakistan under MoU with the Federal Ministry of Health and with the provincial government of Khyber Pakhtunkhwa, both of whom expressed a desire to develop a health policy based on the Gateway Paper’s approach to health systems.

Assessment of corruption in health service delivery

Conducting an assessment of corruption in health service delivery. Funding: Asian Development Bank-supported Partnership for Transparency Fund (PTF)

Health systems research

Research in the area of priority setting for health systems research. The study aimed at the development of a locally suited priority-setting model. Funding: Global Forum for Health Research, Geneva.

Health communication

Research in the domain of health communication. The intervention capitalizing on the strengths of social marketing. Funding: Canadian International Development Agency. Details of the campaigns can be accessed here and publication can be accessed here.

National Action Plan on NCDs

Developing an integrated population-based surveillance system for the ‘National Action Plan for Prevention and Control of Non-Communicable Diseases and Health Promotion in Pakistan.‘ Funding: WHO, Geneva.

Health information system

Supporting the development of a health information system in the aftermath of the October 8, 2005 earthquake. This database system generated regular reports to facilitate the Ministry of Health in its strategic planning with regard to relief efforts.

Health population institutional disconnect in Pakistan

Analysis of the health population institutional disconnect in Pakistan, which was published in a special supplement of the Journal of the Pakistan Medical Association.