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_4mb

Assessment of UHC Performance Monitoring and Budget Analysis in Pakistan

Universal Health Coverage (UHC) aims to ensure all people have access to essential health services without financial hardship. This report evaluates UHC performance and budget utilization in Pakistan using data from 2016 to 2018, addressing gaps in monitoring systems. The analysis assesses provincial and district-level data from the District Health Information System (DHIS) and Financial Accountability and Budgeting System (FABS).

The primary challenge in UHC reporting is the lack of integration between financial and health output data, which hinders accurate performance tracking and accountability under the Public Financial Management Act of 2019. This report introduces a standardized UHC Index to quantify progress, increased utilization rates show mixed trends, and regional disparities persist despite overall budget increases.

Methodology and Framework Used

The UHC Index is derived from WHO guidelines, combining health output indicators (e.g., immunization, maternal care) with financial inputs (e.g., budget allocations for primary and secondary care). Performance is assessed at provincial and district levels using DHIS and FABS data, focusing on access, service availability, and financial aspects. Limitations include inconsistent reporting across provinces and gaps in functional coding within the unified Chart of Accounts.

Main Findings

• Budget and Expenditure Trends: All provinces increased health budgets over the three-year period, but budget utilization varies significantly, often exceeding 100%, indicating inefficiencies in planning. Primary and secondary care investments show regional differences, and administrative costs contribute disproportionately.

• UHC Performance: Provincial UHC indices show minimal improvements in some areas, with declines in key indicators like antenatal care and immunization. District-level analyses reveal substantial variations in service access, financial allocation, and data reliability. The absence of integrated health sector data limits accurate performance reporting.

• Systemic Issues: DHIS data lacks completeness for non-communicable diseases and lacks internal verification mechanisms. FABS coding inconsistencies impede comparing budgets across provinces, as classification varies yearly.

Recommendations

• Data Integration: Improve UHC Index templates and standardize DHIS/FABS coding to enable reliable cross-provincial comparisons and integrate health financial data.
• Policy Actions: Strengthen performance accountability by reviewing the Chart of Accounts, conducting cost studies for priority services, and enhancing monitoring mechanisms for financial protection through initiatives like health insurance and UHC performance-linked indicators.
• Continuous Monitoring: Develop user-friendly templates and reporting tools, supported by training and robust data management systems, to improve decision-making for UHC goals.