Transforming Visions Into Impactful Results.

In developing countries such as Pakistan, program and policies underperform in providing public good as weak institutions lead to decisions that are unresponsive to citizens and are driven by personal motivations of the incumbents. We describe the decision-making processes in the health sector through the framework of “Public Choice” theory which posits how individual motives shape institutional performance and direction.

In developing countries such as Pakistan, program and policies underperform in providing public good as weak institutions lead to decisions that are unresponsive to citizens and are driven by personal motivations of the incumbents. We describe the decision-making processes in the health sector through the framework of “Public Choice” theory which posits how individual motives shape institutional performance and direction.

The COVID-19 pandemic highlighted the importance of evidence-based decision-making. However, evidence-guided policy is not the norm in many low and middle-income countries (LMICs), either because the data is not available , or considered unreliable by policymakers who may also not be able to interpret them. Policies created without evidence lead to ineffective programs, wasted resources, and persistently poor health outcomes.

COVID-19 mass vaccination is the only hopeful savior to curb the pandemic. Vaccine distribution to achieve herd immunity is hindered by hesitance and negative attitude of the public against COVID-19 vaccination. This study aims to evaluate the vaccine hesitancy and attitudes in major cities in Pakistan as well as their determinants.

The estimated cervical cancer burden in Pakistan is higher than the WHO target. Estimates are sensitive to health seeking behavior, and appropriate physician diagnostic intervention, factors that are relevant to the case of cervical cancer, a stigmatized disease in a low-lower middle income country setting. These estimates make the case for approaching cervical cancer elimination through a multi-pronged strategy.

Child immunization, though cost-beneficial, experiences varying costs influenced by individual facility-level factors. A real-time solution is to optimize resources and enhance vaccination services through proper method to measure immunization facility efficiency using existing data. Additionally, examine the impact of COVID-19 on facility efficiency, with the primary goal of comprehensively assessing child immunization facility efficiency in Pakistan.

Pakistan is the fifth most populous country in the world, with a population that is growing at 2.4% annually. Despite considerable political will, including a national commitment that was endorsed by the president to raise the contraceptive prevalence rate (CPR) to 50% by 2025, it has stagnated at around 30–35%. Much of the dialogue on raising CPR is hypothetical and revolves around percentage point change rather than an actual number of women that must be served.

NCDs (non-communicable diseases) have become one of the leading causes of death in Pakistan. However, the country is still grappling with infectious diseases and high neonatal and maternal mortality: a recent analysis by the Global Burden of Disease 2019 study found neonatal disorders, ischaemic heart disease, and stroke to be among the leading causes of death in Pakistan.

The COVID-19 pandemic showed distinct waves where cases ebbed and flowed. While each country had slight, nuanced differences, lessons from each wave with country-specific details provides important lessons for prevention, understanding medical outcomes and the role of vaccines. This paper compares key characteristics from the five different COVID-19 waves in Pakistan.

Pakistan’s contraceptive prevalence rate (CPR) has remained static (less than 1% annual increase since 2006) due to several demand and supply issues. The Akhter Hameed Khan Foundation implemented a community-driven, demand-generation intervention with complementary supply side family planning (FP) services in a large urban informal settlement in Rawalpindi,Pakistan. Methods. The intervention recruited local women as outreach workers called Aapis sisters), who conducted household outreach and provided counseling, contraceptives, and referrals.

Developing countries have been facing difficulties in reaching out to low-income and under-served communities for COVID 19 vaccination coverage. The rapidity of vaccine develop-ment caused a mistrust among certain subgroups of the population, and hence innovative approaches were taken to reach out to such populations. Using a sample of 1760 respondents in five low-income, informal localities of Islamabad and Rawalpindi, Pakistan, we evaluated a set of nterventions involving community engagement by addressing demand and access barriers.

Syringe reuse during therapeutic injections has contributed to the global epidemics of Hepatitis C and HIV (3–6), and is well‐documented in high income and low‐ and middle‐income countries. In Pakistan, high reuse of syringes during therapeutic injections (13) has led to a national prevalence of Hepatitis C of 4.8% (12), with some districts as high as 12%, and has contributed to at least one community outbreak of HIV (14). Therapeutic injections in Pakistan range from 4.2–4.6 injections per person annually.

Schools were closed all over Pakistan on November-26, 2020 to reduce community transmission of COVID-19 and reopened between January-18 and February-1, 2021. However, these closures were associated with significant economic and social costs, prompting a review of effectiveness of school closures to reduce the spread of COVID-19 infections in a developing country like Pakistan. A single-group interrupted time series analysis (ITSA) was used to measure the impact of school closures, as well as reopening schools, on daily new COVID-19 cases in 6 major cities across Pakistan: Lahore, Karachi, Islamabad, Quetta, Peshawar, and Muzaffarabad.

In Comparison to the traditional model of funding and implementing development work without expectations of improved outcomes, the MDGs (Millennium Development Goals) succeeded in part by setting and achieving specific measurable targets. In turn, this focus on measurement helped improve the science of valuations. Today, a number of institutions specialize in evaluating programmes or ideas, and these institutions generate considerable knowledge to guide measurements that aid evaluations.

In his seminal paper, Amartya Sen focused the world’s attention on “missing women” by highlighting that women are far fewer than expected. The phenomenon occurs predominantly in some regions such as China, South Asia or the Middle East;2-5 and may relate both to culture and economics. On the other hand, it is almost non-existent in the US or Europe, where a more “balanced family” is the norm.6,7 Subsequent work has confirmed his idea and explored causes of the discrepancy.

The public sector in Pakistan accounts for 30% of outpatient visits and 32% of healthcare spending. In family planning (FP), 44% of all current users received their current method from the public sector, although only around 35% of FP services provided within the past year were provided by the public sector (the rest of the users had received their methods in previous years).4 Within the public sector, contraceptives are provided through provincial Departments of Population Welfare and Health.

Closing schools to control COVID-19 transmission has been globally debated, with concerns about children’s education and well-being, and also because of the varied effectiveness of the intervention in studies across the world. This paper aims to determine the effect of school closure policy on the incidence of COVID-19 in Pakistan. A Difference-in-Differences (DiD) analysis compared changes in COVID-19 incidence across cities that completely (Islamabad) and partially (Peshawar) closed schools during the second wave of COVID-19 in Pakistan.

Phuping-et-al identified lack of skills, resources, knowledge as core limitations to research-productivity in Thailand. Their findings differ from Pakistan’s Ministry of Health and the WHO found in 2009, as part of national consultation to develop a National Strategy for Health Research.
We found very limited health research productivity in Pakistan – a mere 1154 non-Medline and 964 Medline publications in 2008; that increased to 1485 by 2012; or around 8 per million population. Thus, Pakistan lags all nearly its regional neighbours. Only two institutions – Aga Khan and Karachi Universities – account for 51% of all publications.

The contraceptive prevalence rate (CPR) is a widely accepted measure of maternal health and women’s empowerment1 and is used worldwide in different aspects of health policy planning and formulation. 2 However, CPR is not the best tool to measure and plan family planning (FP) services. In this paper we propose a slightly different method of estimating the quantum of FP services from the number of women being served annually to help identify the scope of and gaps in FP services at the national level.

The use of contraception remained unchanged in Pakistan in the past decade,1 resulting in a high number of closely-spaced and ill-timed pregnancies and births that contributed to some of the highest infant and maternal mortality rates in the world2,3 and limited Pakistan’s progress in attaining its millennium dev elopment goals (MDGs).4-8 While the maternal mortality ratio and the total fertility rate have been decreasing slowly,1,9 the pace implies that Pakistan may be short of reaching its targets for the MDG 4 and 5 by 2015.10 Since 1990, family planning (FP) rates in Pakistan have increased by around one percent per year.

Female-sterilization has long been the most popular method of family planning in Pakistan, and yet most public health experts feel it contributes little to controlling family size or to population w elfare. We used Pakistan Demographic Health Survey (PDHS) data to understand the role female sterilization plays in the overall context of FP in Pakistan

Community-based distribution (CBD) has been successfully applied to family planning (FP) services worldwide. It forms the basis for the large lady health worker (LHW) programme in Pakistan which serves a limited number of women with contraception services. Thus, the concept has seen limited application in Pakistan. We present the outcomes of a CBD model that was implemented in 49 districts across Pakistan by a non-government organization (NGO).

Despite six decades of government and private sector programs, CPR in Pakistan is among the lowest in the region. This article reviews published and grey literature to understand why despite sufficient time and usually sufficient funding, CPR remains low in Pakistan. This paper looks beyond the usual factors of quality of services, coverage and supplies and management issues to examine how family planning may be improved in Pakistan.

Pakistan is the sixth most populous country in the w world with a population of 174 million and one of the highest fertility rates in the world.1 In 2006-7 when the Pakistan Demographic Health Survey (PDHS) was conducted, there were 24 million married women of reproductive age (MWRA); of these, only 22% or five million used modern contraception.

Unsafe injection practices, including excessive use of therapeutic injections and reuse of syringes, are major public health hazards and have likely contributed to the high prevalence of Hepatitis B and C1-6 which now infect over 12 million people nationwide.1 A recent outbreak of HIV in Gujrat (National AIDS Control Programme, 2009) has further highlighted the concerns for iatrogenic transmission of infections among the general public.

Sexually transmitted infections (STIs) have reemerged as a new public health threat in Pakistan against the backdrop of HIV prevalence. STIs facilitate HIV-1 transmission1-4 and their sequelae contribute significantly to the morbidity and mortality in the population.5,6 STIs are more common than the attention paid to them.

Pakistan’s private sector caters to around 65% of family planning users. Private sector family planning was promoted in the Delivering Accelerated Family Planning in Pakistan (DAFPAK) program by UK’s Foreign, Commonwealth & Development Of ce (FCDO) in 2019. We use data from DAFPAK to analyze the clientele and products distributed by two major NGOs, Marie Stopes Society (MSS) and DKT Pakistan, that support private providers in Pakistan. We also examined the effect of COVID-19 on client visits and contraceptives uptake at private facilities in Pakistan.

The economic crisis that is unfolding globally is at a scale unprecedented since the period before the Second World War. World equity markets lost US$ 37 trillion in 2008 and rich and poor nations alike face a deep recession. Pakistan is doubly affected since it has not yet recovered from the large increase in oil prices of that year and now has a large fiscal deficit that limits its ability for discretionary spending.

The total health care expenditure in Pakistan is Rs 185 billion (USD 3.08 billion), of which the private sector spends Rs 121 million and public sector spends Rs 59.5 million (1). This spending which comes to around 2.2% of the GDP or around USD 19 per head annually is among the lowest in the region. The government’s share of this whole is around 0.6-0.7% of the GDP (2) and has largely remained unchanged over the years due fiscal and political constraints.

The human immunodeficiency virus (HIV) epidemic in Pakistan has become well established among injection drug users (IDUs) [1–3]. In 2008, the national AIDS control programme estimated that there were about 100 000 street-based IDUs in Pakistan, of whom nearly 21% had HIV infection.

Cervical cancer is the fourth leading cause of cancer deaths in women worldwide. In 2020 approximately 604,000 women were diagnosed with cervical cancer, and 341,000 died due to the disease [1]. It is estimated that most of these deaths occur in low-and low middle income countries (LI-LMICs) and in the coming years, these countries will bear a majority of the burden of cervical cancer [1].

Pakistan’s HIV epidemic is fully established and expanding among injection drug users (IDUs) of whom 20% are infected with HIV. Nascent epidemics are seen in some cities among Male sex workers and transgenders who form sexual contacts of IDUs. With involvement of sex workers, Pakistan appears to be following the “Asian Epidemic Model”.

Asian countries vary considerably in the scope and intensity of their HIV epidemics [1]. Despite decades of epidemiologic research on HIV transmission, it remains unclear whether a concentrated epidemic in high-risk groups, such as injection drug users (IDUs) or prostitute women, develops into a generalized epidemic affecting a significant share of the general population.

Many countries that prospered in the later half of the 20th century did so only once their populations stabilized. This is logical since limited resources can only be stretched so far and because strategizing for development and growth is difficult, particularly if the growth targets keep moving further away. Pakistan is the 6th most populous country in the world and is growing at 1.9% annually.

Most of the 340 million new infections with sexually transmitted infections (STIs) occur in developing countries. They contribute significantly to the burden of disease in these countries and some such as HIV are now considered the main developmental issue in some countries. While HIV or STI epidemics are nascent in Pakistan, global lessons suggest that this is the best time to control these epidemics.

Ever since an outbreak heralded its onset in 2003, the HIV epidemic has expanded explosively among Pakistan’s injection drug users (IDUs). The National AIDS
Control Program (2006) estimates that there are an estimated 146,000 IDUs in Pakistan[4] of which about 80,000 to 100,000 are street-based. By 2007, nearly 20% of these street-based IDUs nationwide were infected with HIV[5]. Most inject about 2–3 times a day and in groups of 4–10. Specific drugs used vary by city and include opioids (e.g. heroin, buprenorphine), benzodiazepines (e.g. diazepam), solvents (e.g. rubber glue), antihistamines (e.g. Phenirimine) etc[5-8]. Overall the experience in Pakistan has been consistent with that from other Asian countries where HIV epidemics were started among IDUs as well.

Dear Sir, In their experience, Dr. Memon et al.1 found that about 30% of all AIDS patients had active clinical tuberculosis but found no HIV among 70 patients with tuberculosis. Their description of 30% incidence of tuberculosis at presentation or within the first year after AIDS diagnosis is consistent with other national experience2 but is somewhat higher than the 7-10% annual tuberculosis incidence described elsewhere.

Ofloxacin is a DNA gyrase inhibitor and a member of the Fluoroquinolone family which are popular and effective outpatient antibiotics. It is a racemic mixture of which Levofloxacin is the active component. The more than 30 formulations available in Pakistan all contain 200 mg of Ofloaxacin (although formulations with up to 400 mg are available internationally) which is insufficient to treat many common infections.

Dr. Essa Abdulla’s letter in the March 2005 issue of JPMA rightly highlights the pitfalls of HIV test ing in a low prevalence country. While he is correct in postulating an autoimmune explanation for the false positive test, a simpler explanation would be to invoke the Bayes’ theorem. The sensitivity of HIV antibody detection by ELISA is 93-99% and the specificity 99%1, giving a likelihood ratio 2 of the positive test of 99.