Khan Mohsin Saeed, Shaikh Babar Tasneem
Health Systems & Policy Department, Health Services Academy, Islamabad, Pakistan.
Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
Dialogues Health. 2023 Mar 24;2:100127. doi: 10.1016/j.dialog.2023.100127. eCollection 2023 Dec.
Pakistan's health system over the past three decades has experienced social, economic, geopolitical instability, and notwithstanding man-made and natural catastrophes. Since 2001, the health system in Pakistan has undergone three phases of organizational and management reforms and does not have a unified national health policy since then. The aim of this research was to assess the factors behind the decision-making by policy planners in the health system of Pakistan.
An exploratory qualitative study based on grounded theory was designed where in-depth interviews conducted with 20 representatives of the political constituencies, civil bureaucracy, health planners and managers, research and educational institutions, NGOs providing technical support in the health sector, development partners and media.
There leading reason cited was the dearth of leadership in health sector, which is compounded by a range of factors such as "institutional monopoly", "contextual deterrents", "power for turf"; "inadequate knowledge", and "design faults". Such factors were perceived to have a serious effect on the competencies, roles and responsibilities, use of knowledge for decision making. The behavioral aspects of decision makers include the "mindset," and "conflicting interests".
The multitude of factors and complexities within the health sector of Pakistan continue to widen the vacuum in the leadership echelons. Hence, there is a high probability of taking wrong decisions not based on evidence, and resulting in a grossly under-performing health system.
在过去三十年中，巴基斯坦的卫生系统经历了社会、经济、地缘政治的不稳定，且屡遭人为和自然灾害。自2001年以来，巴基斯坦的卫生系统经历了三个阶段的组织和管理改革，此后一直没有统一的国家卫生政策。本研究的目的是评估巴基斯坦卫生系统中政策规划者决策背后的因素。
设计了一项基于扎根理论的探索性定性研究，对20名来自政治选区、文职官僚机构、卫生规划者和管理者、研究和教育机构、在卫生部门提供技术支持的非政府组织、发展伙伴和媒体的代表进行了深入访谈。
被提及的主要原因是卫生部门缺乏领导力，一系列因素如“机构垄断”“背景阻碍”“地盘权力”“知识不足”和“设计缺陷”使情况更加复杂。这些因素被认为对能力、角色和职责以及决策中知识的运用产生了严重影响。决策者的行为方面包括“思维定式”和“利益冲突”。
巴基斯坦卫生部门内众多的因素和复杂性继续扩大了领导层的真空。因此，极有可能做出不基于证据的错误决策，导致卫生系统表现极差。
