The government should establish a Federal health division after devolution of health ministry to the federating units, this was the gist of legislative forum 'Health and the 18th Constitutional Amendment' organised by Pakistan Institute of Legislative Development and Transparency (Pildat) in collaboration with Heartfile, a Non-governmental organisation (NGO) here on Tuesday.
Dr Nadeem Ehsan, MNA, Chairman National Assembly Standing Committee on Health, Dr Sania Nishter, President of Heartfile, Bilal Mandokhel, Secretary Health Balochistan, Shaheen Afiridi, Director Health, Khyber-Pakhtunkhwa (KPK), Aftab Shaban Mirani, MNA, Wazir Ahmed Jogezai, former deputy Speaker, National Assembly and Ahmed Bilal Mehboob, Executive Director of Pildat were among the participants of the forum.
Speaking on the occasion Dr Nadeem Ehsan said that the Implementation Commission is still working on the issues regarding 18th amendment, adding that National Assembly Standing Committee on Health has held several meetings with different stakeholders regarding future role of federal health ministry and invited participants to submit their suggestions to the committee as well, which will be shared with the Chairman Implementation Commission Senator Raza Rabbani. He stressed that provinces also need fiscal autonomy to effectively run the functions transferred to the provinces under the 18th Constitutional Amendment.
Dr Sania Nishter in her presentation appreciated the 18th Constitutional Amendment, which strengthened provincial autonomy. However, she believed that certain important issues such as health could only be dealt at national level and, therefore, national role of health should be retained. She presented in detail the functions, which should be under a federal health unit. She believed that the immediate steps be taken to create health division and definition of its appropriate mandate so it can serve national functions in health. Secondly regulatory prerogatives to the federal level by the provinces under article 144 of the Constitution should be granted.
Dr Sania said that there are four national subjects in health: i) health information, inclusive of research in health; ii) health regulation; iii) international commitments; iv) national health policy, with respect to federal mandates in health, overarching norms, norms of care, inter-sectoral action, trade in health, health technology and disaster response. It is also a national responsibility to ensure policy co-ordination, and support provinces with weak capacity. There are strong justifications for retaining the national role in health.
Dr Sania was of the opinion that the proposition of abolishing the Ministry of Health is not a matter defined in the 18th Amendment, but interpretation of the same Amendment. A federal institutional structure to serve national health responsibilities, reform of the Ministry of Health to make it compatible with devolution is an imperative. The new federal structure should have adequate capacity. Ministry of Health was never structured properly for national functions and as a consequence never had the full range of capacities.
"There should be a plan for incrementally devolving all except those functions within the national health programmes where inter-provincial policy coordination is needed or where a specific advantage is gained through collaborative action. To achieve the purpose, a unified interim federal structure should be made responsible for devolving functions", Dr Sania said. She added that this structure should be maintained till such time that provincial capacity is fully developed. Over the long term, a lean and minimal federal structure should be maintained for programmatic functions, which need to be served nationally.
Ahmed Bilal Mehboob said that with the passage of the 18th Constitutional Amendment, Health has become a provincial subject and, according to the Constitutional requirements, all the departments under the Federal Health Ministry are to be absorbed gradually in the Provincial Health administrations. He said that this devolution has raised several questions among stakeholders regarding the requirement of smooth delivery of Health services and may need to be addressed before complete devolution of Health Department to the Provinces.
Jalal Mandokhel in his presentation briefed about the programmes running under federal government. He believed that federal government always funded the provincial government for health programme, but kept funds under its own control. He said that instead of creating new programmes, provincial government would use the funds to strengthen its current health facilities. While giving example, he said that federal government wants to get rid of Lady Health Workers (LHWs) programme and wants to shift its burden to the provinces, which will become a liability on provinces. He briefed that total cost of the eight national programmes is Rs 11865 million. He said that federal government should continue the MNCH and LHW programmes and the remaining six programmes should be shifted to provinces with the shift of donors support to provinces as well.
Shaheen Afiridi was of the view that provinces have the capacity to handle federal projects on its own. She said the major concern is financial implications for provinces. She said that after 18th amendment, provinces have more defined and clear role. She proposed a federal license authority, which could handle the federal issues regarding health.
Aftab Shaban Mirani was of the opinion that affects every citizen, so it is very important subject to discuss in detail. He believed that in rules there is always room for amendments. He said that 2, 50,000 federal employees are to be sent to provinces, which is a huge task and will take time.