PUBLIC HEALTH REFORMS

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➢ A term describing the major health policy creation or
governmental policy that affect health care facilities to a
specific population in a given place

Key Objectives:
➢ To broaden the health care coverage of the population
through public or private sector
➢ To improve health care quality
➢ To ensure access to the health care specialist
➢ Public health reforms aims at:
Prevent, Promote and Protect.

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Public Health Services
Public health reforms delivers the health care services with
the following salient features:
➢ Monitor the health status of the community
➢ Investigate and diagnose health problems and hazards
➢ Inform and educate people regarding health issues
➢ Mobilize partnerships to resolve the community problems
➢ Support policies and plans to achieve health goals
➢ Enforce laws and regulations to protect health and safety
➢ Link people for needed personal health services
➢ Establish a skilled, competent and public health workforce
➢ Evaluate effectiveness, accessibility and quality of health
services
➢ Research and apply innovate solution
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Public health and Epidemiology
➢ Epidemiology is the integral part of public health
practices.
➢ It aims for preventing disease and promoting health of
population.
➢ Professional epidemiology includes epidemiological
assessment of public health data , health situation and
trend analysis with in the particular community.
➢ The rise of modern epidemiology has been mixed
blessing as well as has major shortcomings both in public
health and in scientific terms due to changing in basic
concepts and method of data analysis etc.

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Worldwide Public health Organizations
World Health Organization
➢ World Health Organization is a specialized agency of the United
Nations which is concerned with international public health
➢ It was established on 7 April 1948, headquartered in Geneva.
Aims and Goals
➢ It improves equity in health
➢ Reduce health risks
➢ Promote healthy lifestyles and settings
➢ Respond to the underlying determinants of health
AREAS of Interest
➢ Health system delivery in the population.
➢ Non-communicable diseases (surgery, trauma, emergency care)
➢ Promoting health through life course
➢ Communicable diseases (AIDS, malaria, T.B, Swine flue)
➢ Preparedness surveillance and response
➢ Environmental health
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RSPH-LONDON
➢ Royal society for public health is an independent multi-disciplinary
charity organization dedicated to improve the public health and
abbreviated as RSPH
➢ Established in October 2008 with the association of royal society of
health and royal institute of public health
REFORMS
➢ It delivers the policies and practices associated with public health
care.
➢ It works to educate communities
➢ It empowers and support populations to live healthily
PROJECTS
➢ Centre for Citizenship and Community
➢ Developing Professional Standards for Health Promotion Capacity
Building in Europe (2009-2012)
➢ Public Health Reforms and operating Principles for Health and
Wellbeing Boards
➢ Shaping the Future of Health Promotion
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CURRENT REFORMS
➢ Access to nutritious meal for children, older adults and patients.
➢ Food for Life Partnership
➢ Health trainer governance
➢ Well London and RSPH Training Communities program
UNICEF
United Nations international children’s emergency fund provides
long-term humanitarian and developmental assistance to children and
mothers in developing countries.
PRIORITY AREAS:
➢ Child survival and development
➢ Basic education and gender equality
➢ HIV/AIDS and children
➢ Children protection
Good Will Celebrity Ambassadors:
Shakira (2003), Jackie Chan (2004), A. Bachan (2005), Queen Rania
(2007), L. Messi (2010), S. Williams (2011), N. Djokovic (2015),
P.Chopra (2016).
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➢ IARC (International Agency for Research on Cancer)
➢ It is an intergovernmental agency forming part of the World Health Organization of
the United Nations. Its main offices are in Lyon, France. Its role is to conduct and
coordinate research into the causes of cancer. It also collects and
publishes surveillance data regarding the occurrence of cancer worldwide. It
maintains a series of monographs on the carcinogenic risks to humans posed by a
variety of agents, mixtures and exposures.
➢ The IARC categorizes agents, mixtures and exposures into five categories.
➢ Group 1: carcinogenic to humans: There is enough evidence to conclude that it can
cause cancer in humans. e.g. Alcoholic beverages, Aflatoxins, HCV, HBV, UV
rays, tobacco, industrial smoke etc.
➢ Group 2A: probably carcinogenic to humans: There is strong evidence that it can
cause cancer in humans, but at present it is not conclusive. e.g. red meat,
Acrylamide,, bitumen, petroleum refining etc.
➢ Group 2B: possibly carcinogenic to humans: There is some evidence that it can
cause cancer in humans but at present it is far from conclusive. e.g. Carrageenan,
BHA, Gasoline, printing ink, lead etc.
➢ Group 3: not classifiable as to carcinogenicity in humans: There is no evidence at
present that it causes cancer in humans. e.g. Caffeine, sulpher dioxide, calcium
carbide etc.
➢ Group 4: probably not carcinogenic to humans: There is strong evidence that it
does
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Education, Inc. cancer in humans. e.g. Caprolactum (air pollutant)
Millennium Development Goals/ Sustainable Development goals
➢ The Millennium Development Goals (MDGs) were the eight international
development goals for the year 2015 that had been established following
the Millennium Summit of the United Nations in 2000, following the adoption of
the United Nations Millennium Declaration. All 189 United Nations member
states at that time, and at least 22 international organizations, committed to help
achieve the following goals. Each goal is set with their respective targets and
funding from different donor agencies like IMF, world Bank, G8 members. They
have now been changed to sustainable development goals (SGDs) in 2016
➢ To eradicate extreme poverty and hunger
(Poverty gap ratio, Employment Rate, Proportion of employed population below
$1.25 per day, Prevalence of underweight children under five years of age,
Proportion of population below minimum level of dietary energy consumption).
➢ To achieve universal primary education.
(Enrollment in primary education, completion of primary education).
➢ To promote gender equality and empower women
(Ratios of girls to boys in primary, secondary and tertiary education, Share of
women in wage employment in the non-agricultural sector, proportion of seats held
by women in national parliament)
➢ To reduce child mortality
(Under-five mortality rate ,Infant (under 1) mortality rate, proportion of 1-year-old
children immunization).
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➢ To improve maternal health
(Maternal mortality ratio, proportion of births attended by
skilled health personnel, contraceptive prevalence rate,
adolescent birth rate, antenatal care coverage)
➢ To combat HIV/AIDS, malaria, and other diseases
(HIV prevalence among population aged 15–24 years, condom
use at last high-risk sex, proportion of population aged 15–24
years with comprehensive correct knowledge of HIV/AIDS,
proportion of population with advanced HIV infection with
access to antiretroviral drugs, prevalence and death rates
associated with malaria, proportion of children under 5
sleeping under insecticide-treated bed nets, proportion of
children under 5 with fever who are treated with appropriate
anti-malarial drugs, Incidence, prevalence and death rates
associated with tuberculosis, proportion of tuberculosis cases
detected and cured under DOTS (Directly Observed Treatment
Short Course)
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➢ To ensure environmental sustainability
(Proportion of land area covered by forest, CO2 emissions,
consumption of ozone-depleting substances, proportion of total
water resources used, proportion of terrestrial and marine
areas protected, proportion of species threatened with
extinction, proportion of population with sustainable access to
an improved water source, urban and rural Proportion of
urban population with access to improved sanitation)
➢ To develop a global partnership for development
(Includes a commitment to good governance, development,
and poverty reduction– both nationally and internationally,
tariff and quota free access, generous ODA (Official
Development Assistance) for countries committed to poverty
reduction, market access, debt sustainability, proportion of
population with access to affordable essential drugs on a
sustainable basis
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Public health reforms in Pakistan
➢ Pakistan is in the middle of epidemiological transition
where almost 40 percent of total burden of disease is
accounted for infectious diseases.
➢ These include diarrheal diseases , malaria , T.B , hepatitis
B,C, acute respiratory infections.
➢ Nutritional deficiencies such as iron deficiency, iodine
deficiency and vitamin D deficiency accounts for 6% of
total burden of diseases.
➢ Non communicable diseases caused by sedentary
lifestyles, environmental pollution, unhealthy diet habits
and smoking include CVD’s, cancer and diabetes which
account for 10% of total burden of diseases.

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Health care delivery
➢ Health care system is a three-tried health care delivery system:
▪ Primary care mechanism: Health care provided in the community for
people making an initial approach to a medical practitioner or clinic
for advice or treatment. In our country this is being offered in the
community through lady health workers connected to basic health
units.
▪ Secondary care mechanism: Healthcare is provided by the medical
specialists with an upward referral pathway to rural health
centres, tehsil hospitals and district hospitals.
▪ Tertiary care mechanism: This type of healthcare is known as
specialized consultative healthcare usually for inpatients and on
referral from primary and secondary healthcare for advanced medical
investigation and treatment. following examples of tertiary care
services are plastic surgery, burn treatment, cardiac surgery, cancer
management, neurosurgery, complex medical and surgical
interventions etc. Includes national hospitals, teaching hospitals etc.
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Public health projects
➢ Pakistan joined the world health organization(WHO) ever
since its establishment. According to the WHO guidelines,
Pakistan launched multiple programs that includes
Malaria control program
➢ Epidemiologically, Pakistan is classified as a moderate
malaria endemic country and accounts for 43.2% of the
population at high risk of malaria
➢ Malaria strategic plan 2015-20
➢ It will reduce the malaria burden by 75% in high and
moderate endemic districts and eliminate malaria in low
endemic districts of Pakistan, aligned with The Global
Technical Strategy (GTS) and Global Malaria Plan of
Action (GMAP) 2015-2020

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Expended programme immunization
➢ The Expanded Programme on Immunization (EPI) was launched in
Pakistan in 1978 . The main objective is to reduce mortality and
morbidity by immunizing children aged from 0 to 11 months and
pregnant women.
➢ Initially protects children by immunizing them against childhood
tuberculosis, poliomyelitis, diphtheria, pertussis, tetanus and measles.
➢ The program has been upgraded by introducing new vaccines in EPI
for influenza, chicken pox, typhoid, HAV, HBV, MMR (measles,
mumps and rubella), OPV (Oral Polio vaccine), DTP (Diptheria,
tetanus, pertusis), HiB ( Haemophilus influenza type B: causing
meningitis)
➢ There are multiple other programs in the health sector of Pakistan to
enhance health awareness among common people. They includes
community oriented medical education (COME) and continuing
medical education (CME) started under the guidelines of Pakistan
Medical and Dental Council (PMDC).
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Pakistan vision 2025
Pillar I: Putting People First, Developing Human and Social Capital
➢ 1. Increase Primary school enrolment and completion rate to 100% &
literacy rate to 90%.
➢ 2. Increase Higher Education coverage from 7% to 12%, and increase
number of PhD’s from 7,000 to 15,000.
➢ 3. Improve Primary and Secondary Gender Parity Index to 1, and
increase female workforce participation rate from 24% to 45%.
➢ 4. Increase proportion of population with access to improved
sanitation from 48% to 90%.
➢ 5. Reduce infant mortality rate from 74 to less than 40 (per 1000
births) and reduce maternal mortality rate from 276 to less than 140
(per 1000 births).
➢ 6. Reduce the incidence/prevalence of Hepatitis, Diahorrea, Diabetes
and Heart Disease by 50%.
➢ 7. Pakistan will be World Champions in 2 sports and win at least 25
medals in the Asian games.
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Pillar II: Achieving Sustained, Indigenous and Inclusive Growth
➢ 8. Become one of the largest 25 economies in the World, leading to
Upper Middle Income country status.
➢ 9. Reduce poverty level by half.
➢ 10. Increase annual Foreign Direct Investment from USD 600 million
to over USD 15 billion.
➢ 11. Increase tax to GDP ratio from 9.8% to 18%.
Pillar III: Democratic Governance, Institutional Reform &
Modernization of the Public Sector
➢ 12. Place in the top 50th percentile for Political Stability (from
bottom 1 percentile), No Violence/Terrorism (from bottom 1
percentile), and Control of Corruption (from bottom 13th percentile)
as measured by the World Bank’s Worldwide Governance Indicators.
Pillar IV: Energy, Water & Food Security
➢ 13. Energy: double power generation to over 45,000 MW to increase
electricity access from 67% to over 90% of the population

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➢ 14. Energy: (a) reduce average cost per unit by over 25% by
improving generation mix (15%) and reducing distribution losses
(10%); (b) increase percentage of indigenous sources of power
generation to over 50%;
➢ 15. Water: increase storage capacity to 90 days, improve efficiency
of usage in agriculture by 20%, and ensure access to clean drinking
water for all Pakistanis
➢ 16. Food: Reduce food insecure population from 60% to 30% with
the provision of safe, nutritious and wholesome food.
Pillar V: Private Sector and Entrepreneurship Led Growth
➢ 17. Rank in the top 50 countries on the World Bank’s Ease of Doing
Business Rankings
➢ 18. Increase Diaspora investment (via remittances) in private sector
from USD 14 billion to USD 40 billion.
➢ 19. Create at least 5 global Pakistani brands (having more than 50%
sales coming from consumers outside Pakistan), and make ‘Made in
Pakistan’ a symbol of quality
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Pillar VI: Developing a Competitive Knowledge Economy through
Value Addition
➢ 20. Join the ranks of the top 75 countries as measured by the World
Economic Forum’s Global Competitiveness Report
➢ 21. Triple labour and capital productivity in services, food
,agriculture and live stock.
➢ 22. Improve Pakistan’s score on the World Bank Institute’s
Knowledge Economy Index from 2.2 to 4.0, and increase internet
penetration to over 50%
➢ 23. Increase the number of tourist arrivals to 2 million
Pillar VII: Modernizing Transportation Infrastructure & Greater
Regional Connectivity
➢ 24. Increase road density from 32 km/100 km2 to 64 km/ 100 km2,
and share of rail in transport from 4% to 20%
➢ 25. Increase annual exports from US$ 25 billion to US$ 150 billon

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