EDITORIAL: The Punjab government’s decision to outsource 150 underutilised basic health units (BHUs) across the province – with the objective of making these facilities fully functional to provide better healthcare to patients, especially in rural areas – is a step in the right direction.
It acknowledges long-standing inefficiencies in the whole country’s public healthcare system. Yet while outsourcing to private operators can address some operational inefficiencies, it is not a cure-all. Without a robust accountability framework, this initiative risks perpetuating the very issues it seeks to solve.
The systemic failures of BHUs are well-documented. Chronic absenteeism among staff, shortages of essential medicines, and inadequate infrastructure have rendered these facilities all but ineffective. Outsourcing management to the private sector is premised on the assumption that private operators will bring efficiency and professionalism. However, efficiency alone cannot ensure that these facilities meet their mandate of delivering equitable and quality healthcare.
Therefore, for this initiative to succeed, it must be anchored in measurable outcomes. Key Performance Indicators (KPIs) must be established to evaluate the performance of outsourced BHUs. Metrics such as patient satisfaction, staff attendance, availability of medicines, and treatment outcomes should serve as benchmarks. These indicators should not only be defined clearly but also be regularly and rigorously monitored. It’s also important to note that public disclosure of performance metrics will enhance transparency.
Another critical element often overlooked in such reforms is community feedback. BHUs serve some of the country’s most underserved populations, whose voices are rarely heard. Mechanisms to gather and incorporate feedback from patients and local communities must be integral to the reform process.
Surveys, helplines, and community forums can provide actionable insights into the real-world performance of these facilities. Such feedback would not only help in identifying service gaps but also ensure that private operators remain responsive to the needs of those they serve.
Privatisation; by itself, while definitely more efficient than the country’s public sector, is still not a silver bullet. The root causes of BHU underperformance require systemic solutions. While outsourcing can improve operational aspects in the short term, it does not absolve the state of its responsibility to strengthen the overall healthcare framework. Public investment in infrastructure, training for healthcare workers, and better oversight mechanisms are essential to ensuring long-term sustainability.
It is also crucial to address the issue of equity. One of the greatest shortcomings of the private sector, especially in such areas, is that it often prioritises cost efficiency, which may not always align with the needs of the poorest segments of society. Safeguards must be in place to ensure that healthcare services remain accessible and affordable for all. Without such protections, privatisation risks exacerbating existing disparities in healthcare access.
The outsourcing of BHUs is a good step, but its success depends on proper implementation. Enforcing accountability through audits and penalties, and incorporating consumer feedback mechanisms are not optional; they are prerequisites for meaningful reform.
Anything less risks turning this initiative into yet another missed opportunity to address Pakistan’s chronic healthcare challenges. Policymakers must seize this chance to set a new standard for public-private partnerships in healthcare, one that prioritises accountability, inclusivity, and the well-being of the communities these facilities are meant to serve.
Copyright Business Recorder, 2025
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