2025-01-19-世界银行-巴基斯坦UHC绩效监测系统评估及UHC预算支出分析（英）_114页_3mb

Summary of Universal Health Coverage (UHC) Performance Monitoring and Budget Expenditure Analysis in Pakistan (June 2022)

Overview

This report evaluates Pakistan's progress toward Universal Health Coverage (UHC) using data from 2016–2019, focusing on the link between financial inputs and public health outputs. It highlights gaps in health data reporting systems and proposes improvements to strengthen UHC monitoring at provincial and district levels.

Core Issues Identified

1. UHC Index Construction:

   • Uses 16 WHO-defined service clusters, tracking progress through an aggregated index based on key health indicators (e.g., family planning, immunization, maternal care, infectious disease control).
   • Key problems:
     • DHIS Data lacks reliability (e.g., missing NCD indicators, inconsistent provincial reporting, lack of standardization for financial protection).
     • FABS Data has issues with inconsistent Chart of Accounts coding across provinces, hindering meaningful financial–output linkage.

2. System gaps in Reporting:

   • Health and finance systems (DHIS for outputs, FABS for inputs) are misaligned, preventing comprehensive analysis.
   • Missing data for non-communicable diseases and tertiary care limits monitoring.

Proposed UHC Index and UHC Template

• UHC Index is designed to track progress across provincial and district levels using routine data.
• Integrated Reporting Template includes:
  • Linking service outputs (e.g., immunization, antenatal care) with budget and expenditure data.
  • Using FABS for financial data but addressing coding inconsistencies via restructured CoA functional codes.

Budget Expenditure Analysis (by Province)

• Overall Trends:

  • Increases in budgets and expenditures were seen across provinces (e.g., Punjab, Sindh), but not all provinces achieved proportional improvements in UHC indicators.
  • PCI variation between districts remains high but may reflect population differences and systemic issues.

• Provincial Highlights:

  • Punjab: Mixed results, with tertiary care underfunded and budget utilization uneven.
  • Sindh: Political changes amid high budget, no clear correlation between expenditure and visits.
  • KP: Shift toward primary care in recent years, but EPI coding issues persist.
  • Baluchistan: Minimal budget growth but declining service delivery.

Key Recommendations

1. Performance Monitoring:

   • Define clear UHC goals nation-wide and operationalize them through standardized provincial templates.
   • Integrate financial and output data to enable performance-based budgeting.
   • Prioritize costing studies for key services to develop district-level budgets.

IMproved Coordination and Governance: Invest in training public financial management systems (e.g., FABS) and institutional capacity for monitoring

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accountability, including for financial oversight.

3. Data and Transparency:
   Standardize data reporting (DHIS and FABS), audit mechanisms, and methodologies to ensure credible UHC performance monitoring.

Designated

The analysis underscores the need for collaborative efforts between policymakers, health systems, and donor agencies — revising current systems will support UHC- goal realization in Pakistan.