Health financing and public financial management during the Covid‐19 pandemic: Evidence from Pakistan as low‐income country

Abstract

Purpose This article aims to explore the areas of misalignment between the public financial management (PFM) and health financing during the COVID‐19 pandemic in Pakistan. Originality/Value To the best of our knowledge, it is the first study on South Asian countries to adopt a framework and bring forward the dominant themes that cause the misalignment between PFM and health financing. The timing of the research was excellent as the world was facing the biggest health challenge in the form of COVID‐19 which has put pressure on the PFM and has seriously hampered health service delivery. Therefore, the findings of the study are helpful for the ministry of health to draft policies to improve health allocations and move towards Universal Health Coverage. Design/Methodology/Approach In‐depth semi‐structured interviews of 15 participants were used to explore the areas of misalignment between PFM and health financing. Based on qualitative data, thematic content analysis has been carried out. Findings The findings of the study can be divided into five clusters and their explanations. First overall budget allocation has an impact on the health sector budget. For example, the budget for priority health interventions is not reflected in the budget allocation process. Further, the budget is classified by inputs rather than disease and finally, the budget is not released by the health priorities. The second cluster was the devolution of health to provinces which is unfinished agenda. Under this cluster fiscal decentralisation has been found to cause problems for the provinces as they have not provided fiscal autonomy to spend the money and there is a lack of coordination between the federal and provincial authorities. The third cluster was donor funding, and it was observed that it is not aligned with the government policies and priorities. Forth cluster was procurement and it was discovered that it is a lengthy process and caused delays in procuring the essential health equipment. The fifth cluster was an organisational culture that is not conducive to the health sector. Under this cluster, the attitude, knowledge, and practices of departments responsible for the health sector require complete revamping.

Concursos públicos: aquisição local de equipamentos de proteção individual no contexto de descentralização e elevada desigualdade socioeconômica

“…Em primeiro lugar, é possível fazer uma avaliação semelhante da interação entre a descentralização dos serviços de saúde e a COVID-19 no Chile, ao que foi mencionado em casos como o Reino Unido, o Paquistão ou o Quênia (Khan et al, 2023;Ochieng'-Springer, 2022;Warner et al, 2021). O Chile é também um caso em que a descentralização pode gerar respostas de saúde adequadas entre os municípios, mas também em que os recursos não são distribuídos de forma a mitigar as desigualdades socioeconômicas entre os territórios geridos pelas autoridades municipais.…”

“…A descentralização é o processo de transferência de competências e responsabilidades dos governos nacionais para os governos locais, que pode envolver administrações regionais, provinciais ou municipais. Este processo de descentralização moldou o panorama dos serviços de saúde pública em regiões tão diversas como a Europa (Diamond & Laffin, 2022;Warner, Richards, Coyle, & Smith, 2021), a Ásia (Khan, Nazir, Afzal, & Sohail, 2023), a África (Ochieng'-Springer, 2022) e a América Latina (Riquelme-Briceño et al, 2017).…”

“…No caso da Inglaterra, Warner et al (2021) descobriram que as desigualdades de saúde pré-existentes e a atribuição desigual de subsídios centrais contribuíram para os piores resultados da COVID-19 entre as entidades locais. Do mesmo modo, Khan et al (2023) constataram que a descentralização estava associada à falta de coordenação da resposta à pandemia entre os governos provinciais do Paquistão. No Quênia, Ochieng'-Springer (2022) afirma que, embora a descentralização tenha sido concebida como um mecanismo para reduzir a desigualdade, criar uma governação mais inclusiva e melhorar a prestação de serviços em todo o país, a realidade durante a resposta à pandemia foi a falta de recursos básicos para prestar serviços de saúde adequados a nível local.…”

Bidding against each other: local procurement of personal protective equipment in the context of decentralization and high socio-economic inequality

“…Devolution is the process of handing competences and responsibilities from national to local governments, which can involve regional, provincial, or municipal administrations. This devolution process has shaped the landscape of public health services is regions as diverse as Europe (Diamond & Laffin, 2022;Warner, Richards, Coyle, & Smith, 2021), Asia (Khan, Nazir, Afzal, & Sohail, 2023), Africa (Ochieng'-Springer, 2022) and Latin America (Riquelme-Briceño et al, 2017).…”

“…In the case of England, Warner et al (2021) found that pre-existing health inequalities and unequal central grant allocation contributed to worse outcomes from COVID-19 among local entities. Similarly, Khan et al (2023) found that devolution was associated with lack of coordination of the pandemic response among Pakistan's provincial governments. In Kenya, Ochieng'-Springer (2022) claims that, while devolution was intended as a mechanism to curb inequality, create more inclusive governance, as well as to enhance service delivery throughout the country, the reality during the pandemic response was one of lack of basic resources to provide adequate health services at the local level.…”