Review of the governance of public sector hospitals in Pakistan: Lessons for the future

Governance of public sector hospitals has been a major challenge in Pakistan. A framework has been adapted to assess governance at the macro- and micro levels of decision making. At the macro-level, the experience of hospital autonomy to improve efficiency and quality of care has been inconclusive in the absence of proper rules and regulations. Following devolution in health, the provincial governments have instituted regulatory regimes for improved governance and have experimented with PPPs to improve management of district hospitals. At the micro-level, the focus has been on institutional aspects of hospital management. Most public hospitals face challenges related to human resource, financial and supply chain management; lack of information technology, poor quality of care, and lack of disaster preparedness and management capability. This paper offers three strategic priorities for policymakers to consider – first, demonstrate consistency and commitment in implementing policies related to hospital governance; second, launch a countrywide capacity development program for hospital managers; and third, establish e-governance to enhance accountability, transparency and performance of hospitals.