Status of health sector reforms in Khyber Pakhtunkhwa: a post-devolution analysis

Abstract

Introduction

Decentralization brings power and authority closer to people. Experts believe that decentralization and devolution of power lead to an improved health sector. The essence of democracy lies in devolution which promotes social and economic transformation of an economy. A centralized system of government looks at the picture holistically and a decentralized government sets its own set of priorities in the region. Devolving power to the lower tier helps the system gets diversity in a way that more people are involved in the decision making processes. Political representatives become more accountable and thus the service delivery gets better. Many experts of devolution are in favor of including local representatives over important services like Health (Shah, 2004; World Bank, 2006; Yilmaz & Serrano- Berthet, 2008). However, developing countries tend to have a centralized form of government which therefore needs the decentralization of power and its promising prospects to keeps the region driving ahead.

In Pakistan, the 18th constitutional amendment transfers some powers to the provinces. This was successfully implemented as the devolution of power to the lowest tier; the essence of the 1973 constitution of Pakistan. This amendment empowered provinces to legislate and implement policies related to the devolved ministries on their own. This amendment devolved the power of 17 central ministries24 to the second tier of provincial governments in 2010. Among them the powers of the Ministry of Health were also defined as provincial subjects. The provincial health sector, after taking charge, has started formulating policies with the goals of obtaining fruitful results for their respective provinces. However, Pakistan has failed to still achieve real progress in the devolution of power, and provincial governments are not in a position to exercise the devolved power in a true and manner since the 18th constitutional amendment passed in 2010. While the devolution of power to lower tiers is considered to expedite economic growth and sustainable development, research in this area is lagging.