Economics & Development

Ratings of Primary Health Care (PHC) System Strengthening Project for Sri Lanka were as follows: outcome was satisfactory, Bank performance was moderately satisfactory, and monitoring and evaluation quality was substantial. Some of the lessons learned include: There are insights into designing and executing a PHC reform, even amid the dual challenges of the COVID-19 pandemic and subsequent economic distress, all within the constraints of limited institutional capacity; The Ministry of Health (MoH) commitment coupled with early technical assistance from development partners and the World Bank, and adoption of key guidelines and frameworks before implementing PSSP was pivotal; Empaneling population and engaging community in service delivery and monitoring ensured accountability of the system; Lack of a comprehensive digital framework with provision of a unique ID-based individual tracking system made it difficult and cumbersome for PMCIs to keep track of every Non-Communicable Diseases (NCD) patient and ensuring continuum of care; The PSSP missed focusing on aging population and mental health issues which could have been delivered using the service delivery platforms created for NCD services; and It is important for any project to adequately build mitigation measures in a situation where factors are out of control for both the implementing ministry and the World Bank.

Accelerated progress towards and achievement of universal health coverage (UHC) has become a central goal of the Government of Pakistan’s (GoP) policy agenda in health in recent years. Both at the center and in the provinces, Pakistan’s domestic governments have now consistently reiterated, through the National Health Vision 2016–2025 and other essential agenda setting documents, their joint commitments to making UHC and primary care access a priority across the country. The federal and provincial governments have initiated critical UHC and primary health care (PHC) related interventions. First, Pakistan has become an early adopter of the Disease Control Priority 3 (DCP3) framework and, in collaboration with the DCP3 Secretariat and the World Health Organization (WHO), has begun implementing for the first time a prioritized Essential Package of Health Services (EPHS). Another major program led by the federal government and now adopted by the provincial governments is the social health protection initiative, the Sehat Sahulat Program (SSP). The program, a tax-financed scheme, provides cash-free coverage to inpatient hospital services at empaneled public and private hospitals for eligible low-income populations (households earning less than US2 dollar per day). The EPHS and the public health insurance scheme are two promising developments that together hold the potential to expand health coverage, grow existing health finance resource pools, and improve efficiency of public health expenditures. Each would in turn help achieve broader objectives in a health financing system that has to date produced concerningly lagging health and human development outcomes. However, faced with resource needs significantly higher than current health expenditures, and a particularly turbulent near-term macro-fiscal environment, the GoP’s ability to sustainably fund crucial UHC priorities has become decidedly uncertain.