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Dear Members,
Please see Dr Tasleem Akhtar’s response on the BHU restructuring comment by the Minister of Health of NWFP.
Dear Sania,
The suggestions given by Mr. Inayatullah are in line with the concept of Primary Health Care and need to be implemented. The PMRC Health Systems Research Project in village Budhni, Peshawar District has established a Primary Health Care Centre which through a collaborative strategy has been implementing the various components of PHC along with Health Systems Research to document the impact of the interventions introduced. The project has established collaboration with the community, NGOs and public sector departments working in the area. Hand pump wells and pour flush latrines have been introduced in collaboration with Public Health Engineering Department. School boundary walls and toilets have been built in collaboration with Education Department and Public Health Engineering Department. Women Literacy and Skill centre has been established in collaboration with APWA.99% immunization coverage has been achieved in collaboration with EPI and contraceptive use has been increased in collaboration with Population Welfare Department.
As suggested by Inayatullah, PHC level curative services are being provided by Paramedics and LHVs. But leadership has been provided by the Sociologist who has been incharge of the project. The projects impact has been recorded in a recently released report. Infant mortality, which was 88/100 at the start of the project in 1986 has been reduced to 44. Immunization coverage has gone up from less han 30% to over 90%. No cases of neonatal tetanus have been recorded since 1998.
The projects message is that PHC can be achieved if you have leadership at the community level. The incharge of the BHU can give such leadership. The incharge maybe a doctor or any other senior level professional who can acquire community respect and trust and who can link up with other departments and convince and facilitate them to effectively provide their services to the community. This requires a clear job description and necessary training for the BHU incharge. I am told that the Medical Officer incharge of BHU is an ex-officio member of the Union council. This provides him/her the opportunity of being an leader in the community.
Best regards,
Tasleem

Dear Members of the Health Policy Forum,
Please find enclosed herewith feedback on Viewpoint 11  (Restructuring Basic Health Units in Pakistan - posted at http://heartfile.org/viewpoint.htm ) by the Minister of Health of NWFP, Inayatullah Khan.
Comments from the Minister:
Dear Sania Nishtar,
I have gone through your reflections on RYK model and I fully agree with you that there can be more than one options and to me one such solution is as follow: 
One, abolish the post of doctor from BHU and covert it into a real PHC center for promotion of healthy life style and prevention of diseases with minimum necessary focus on curative side, using it only as first aid center with medical technician as incharge.
Two, expand the role of LHW and make it a real bridge between the community and the nearest health facility.
Three, start a structured and fully financed by the government program for effective involvement of the opinion makers including Imam-i-masjid, local elders, elected councilors, school teachers and civil society. For example sermons on different public health issues can be developed for religious leaders to be delivered on Friday prayers. Moreover, Aiam-i-masajid can also be trained for delivering different routine services including TB dots and immunization.
Similarly, local elders can be motivated for the revitalizations of the BHUs and sensitization of the community on different public health issues. Together with Imam-i-masjid a management board can be developed for the running of the BHU and in this way BHU could effectively function as PHC center.
Four, develop an essential health care package and define the minimum level of services the state is going to provide up to the secondary level. This should include all programs of preventive and promotive health along with routine diagnostic services, medication for most common medical problems and routine procedures.
Fifth, strengthening of RHC and civil hospital by making it operational for twenty four hours with round the clock EMOC services. Shifting the abolished posts of Doctors from BHU to these two facilities and linking all the BHUs with the nearest RHC for weakly outreach programs.
Sixth, developing an attractive career development and financial package for both male and female workers.
Seventh, linking essential health care package with referral system. Introduction of social health insurance system for the services which are not covered by essential care package.
Eight, for improvement of management and promotion of healthy competition within health sector the gradual selection of all administrative posts from market on open competition. 
And last but not the least a strong political will for going ahead steadfastly.
The Frontier government is working on some of the areas.
Regards
Inayatullah

Dear Members of the Health Policy Forum,
August the 23rd ‘s Executive Committee meeting of the National Economic Council (ECNEC) of the Government of Pakistan (the highest project approval authority in Pakistan) deferred four schemes which constituted all of the health projects on the agenda – incidentally all from NWFP – on the premise that the envisaged federal co-sponsors of these were not available for deliberations. A valid argument indeed! However, some have read otherwise into the situation and contrary impressions relating to how political processes impact the fate of social sector programs have been echoing in the corridors of power, ever since. The Health Policy Forum has issued and published a viewpoint on the subject in The News International on September 10, 2006. Please also note that the paper version can be accessed online  
With regards,
Sania

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