Implementing the district health system in the framework of primary health care in Pakistan: can the evolving reforms enhance the pace towards the Millennium Development Goals?

There is growing renewed trust in primary health care as the best approach for ensuring equity in the delivery of essential health services. However, Pakistan with one of the most widely spread district health system networks in the region, has not delivered at the expected capacity. A series of health system reform agendas are now stipulated which include the promulgation of an essential health service package, public private partnerships and a people-centred focus. Nevertheless, success of these reforms will hinge on the ability of the three tiers of the government and other stakeholders to work togetherto improve the overall performance of the district health system. This paper provides an overview of thedistrict health system infrastructure and organization of primary health care services in Pakistan, the evolving governance pattern and the operational significance and merit of health system pillars for effective service implementation

Impact of wealth status on health outcomes in Pakistan

Maternal and childhood morbidity and mortality are high in Pakistan and health disparities exist. Multivariate logistic regression analysis of the Pakistan Demographic and Health Survey database 2006-07 was performed. There was an excess of 25 neonatal, 34 infant and 41 under-five deaths per 1000 live births in the poorest quintile of wealth index compared with the richest. Women in the richest quintile had a 35%, 38% and 20% higher probability of getting prenatal care, delivery by skilled provider and emergency obstetric care, respectively. Pakistan needs to enhance social equity so development benefits can accrue to the underprivileged by introducing social protection interventions so that those in the informal sector are not excluded from accessing health care, scaling-up poverty reduction strategies and promoting intersectoral action. This study assesses the independent impact of wealth status, as determined by a validated index, on health outcomes in Pakistan

Disseminated non-tuberculous mycobacterial infection in an immuno-competent host with no pre-existing lung disease: a case report

A Turkish male aged 36 years presented with pyrexia cough, weight loss and night sweats, had prosthetic aortic valve with no evidence of infective endocarditis or HIV infection. There was no radiographic evidence of lung involvement. A bone marrow trephine revealed numerous non-caseating granulomas. Mycobacterium avium intracellulare was isolated from sputum and Early Morning Urine samples

Heartfile's contribution to health systems strengthening in Pakistan

Key health indicators in Pakistan remain relatively intransigent. While there has been some improvement at intermediate outcome and process levels, several challenges remain, including an inattention to health systems strengthening. Within this context the NGO Heartfile has worked to bring about changes at a health policy and systems level through creation of a policy-level institutional mechanism for systems strengthening and a national health reform agenda based on systems strengthening and an intersectoral approach to health. By generating evidence, Heartfile has also assisted in strengthening the evidence-policy linkage, and in developing contemporary concepts for health policy and planning and service delivery

Surgical management of pericardial diseases

Tuberculosis and purulent pericarditis are the most common causes of pericardial effusion and constriction. Chronic constrictive pericarditis is a chronic inflammatory process that involves both fibrous and serous layers of the pericardium and leads to pericardial thickening and compression of the ventricles. The resultant impairment in diastolic filling reduces cardiac function. Pericardiectomy remains the treatment of choice for chronic constriction. A review of 72 cases at department of Cardiothoracic Surgery, Lady Reading Hospital is presented. There was a mortality of 12% and a morbidity of 20%. Forty seven of the 72 cases were tuberculous. The surgical excision of pericardium remains the only available curative treatment for constrictive pericarditis, while open pericardial drainage is required for cardiac tamponade resulting from pericardial effusion

Posters as a tool for disseminating health related information in a developing country: a pilot experience

To investigate the effectiveness of posters as a tool, for imparting information related to high blood pressure. The intervention involved hanging posters conveying information about blood pressure, in the waiting rooms of 339 health facilities. The impact of this intervention was assessed after 30 days of hanging the posters with the main assessment component of the survey aimed at the target audience at the facilities. 1017 people attending the facilities were interviewed. Mean age of this population was 40.4 [SD 11.06] years. There were 79% males and 21% females. 80.2% [n=816] of the respondents had noticed the posters. 84.5% of the people were of the opinion that the poster was good. 63.7% of the people understood the overall message of the poster correctly. Regarding change in behaviour, 96.7% [n=789] of the people thought that the poster was asking them to do something; 85.9% [n=501] of these got their blood pressure checked compared to 60.9% [n=14] of those who did not think the poster was asking them to do anything [p=0.004]. Of those who said that the poster was asking them to do something, there were varied responses as to what they thought the poster was asking them to do. If the response was that they should have their blood pressure checked, it was taken as a correct response. 87.3% of those who said that the poster was asking them to get their blood pressure checked, actually got their blood pressure checked compared to 83.7% of those who did not understand this message [p= 0.241]. Given the limitations of the study it is difficult to assess the effectiveness of the poster in changing people's behaviour regarding blood pressure check up. This experience will serve as a pilot for a larger prospective study to assess poster as a tool for prompting people to get their blood pressure checked