The Health System of Azad Jammu & Kashmir (AJK)
1.
Introduction: Health as a Foundation for AJK's Future
Welcome
to this overview of the health system in Azad Jammu & Kashmir (AJK), a
self-governing state. The health of a population is the bedrock of its
progress. As noted in the AJK Health Policy, the development and prosperity of
any country are intrinsically linked to the well-being of its people. The
recent COVID-19 pandemic exposed significant gaps in the region's health
system, making a clear, modern health strategy more critical than ever. For
those new to the topic, this document provides a foundational guide to the
structure, goals, and key challenges of the AJK health system, breaking down
how it serves its communities.
To understand this system, it is
essential to first look at the high-level global commitments that guide its
strategy and direction.
2. The Big Picture: AJK's Core Health Commitments
The
AJK health system does not operate in a vacuum. It aligns its goals with two
major international frameworks that aim to improve health outcomes and access
to care for people everywhere.
2.1
The Sustainable Development Goals (SDGs)
AJK's health strategy is aligned with
the United Nations' Sustainable Development Goals (SDGs), a global agenda
adopted in 2015 to guide development efforts until 2030. While all 17 SDGs are
interconnected, Goal 3 is to "ensure healthy lives and promote
well-being for all at all ages." Many other goals, such as those related
to poverty, clean water, and education, are also indirectly crucial for public
health.
AJK has shown progress on several key health indicators in line with these goals:
- Births Attended by Skilled Health Personnel: The percentage of births attended by skilled
professionals increased from 63% in 2018-19 to 68% in
2020-21.
- Immunization Coverage: The rate for fully immunized children rose from 77%
in 2018-19 to 81% in 2020-21.
- Population Per Doctor: The ratio of population to each doctor worsened
slightly, increasing from 3,839 in 2018-19 to 3,954 in
2020-21, indicating a growing gap between the number of available doctors
and the needs of the population.
2.2
The Goal of Universal Health Coverage (UHC)
Universal
Health Coverage (UHC) is a central objective for AJK's health policy. It
represents the ideal that everyone, everywhere, should be able to get the
quality health services they need without suffering financial hardship. The
World Health Organization (WHO) defines UHC as:
"ensuring
that all people can use the promotive, preventive, curative, rehabilitative and
palliative health services they need, of sufficient quantity to be effective,
while also ensuring that the use of these services does not expose the user to
financial hardship."
The pursuit of UHC in AJK is built on three core principles:
1.
Population
Coverage: This focuses on who is covered
by the health system, aiming to include everyone, especially the most
vulnerable.
2.
Range
of Health Services: This addresses what services
are provided, from preventive care and health promotion to treatment and
rehabilitation.
3.
Out-of-Pocket
Expenditure: This aims to ensure that using health
services does not lead to financial ruin for individuals and families.
National
initiatives like the "Sehat Sahulat Program" are key strategies
designed to help AJK move closer to achieving this goal.
Now
that we have reviewed the guiding principles, let's explore the practical,
on-the-ground structure of how healthcare is organized and delivered across the
region.
3. The Building Blocks: How Healthcare is Delivered in AJK
Healthcare
services in AJK are organized into a tiered system, with patients moving
between primary, secondary, and tertiary levels of care based on their needs.
3.1 Primary Healthcare: The First Point of Contact
Primary
healthcare is the frontline of the health system. It focuses on essential
preventive, promotive, and basic curative services, acting as the first point
of contact for individuals and families. This level is particularly vital for
women and children in remote and rural communities. The main components
include:
- Basic Health Units (BHUs)
- Rural Healthcare Centers (RHCs)
- Dispensaries and Maternal and
Child Healthcare Centers (MCHs)
- The National Program for Family
Planning and Primary Health Care: This critical program is delivered at the community level by Lady
Health Workers (LHWs). The LHW program provides essential services at
the doorstep and currently covers 69% of the AJK population.
However, the program's effectiveness is hampered by significant funding
challenges for supplies and operations.
3.2 Secondary Healthcare: More Specialized Care
Secondary
healthcare facilities serve as the next level of the system, providing more
specialized services than primary centers. Patients are often referred to these
hospitals from BHUs and RHCs for more advanced diagnosis and treatment. The two
main types of secondary facilities are:
- Tehsil Headquarters Hospitals
(THQs)
- District Headquarters Hospitals
(DHQs)
3.3 Tertiary Healthcare: The Highest Level of Care
Tertiary
care represents the most specialized level of the healthcare system, handling
complex cases and receiving referrals from secondary hospitals. While Teaching
Hospitals are the primary providers of tertiary care in AJK, some District
Headquarters (DHQ) hospitals are also equipped to offer these advanced
services. For instance, the DHQ Hospital in Kotli is the only facility
providing tertiary-level care in its district, serving as a crucial referral
center for the surrounding region.
While
this tiered structure provides a framework for care, it is constantly tested by
the specific health challenges facing the population of AJK.
4. Key Health Challenges in AJK
Like
many developing regions, AJK confronts a complex mix of health challenges that
its system must manage simultaneously.
4.1 The "Double Burden" of Disease
The
AJK Health Policy notes that the region faces a "double burden" of
disease. This means the health system must battle both traditional infectious
diseases and a rising tide of chronic, non-communicable diseases at the same
time.
|
Disease Category |
Description & AJK Examples |
|
Communicable Diseases |
Diseases that can spread from person to person. Examples in AJK include
Tuberculosis, Diarrheal diseases, and Lower respiratory infections. |
|
Non-Communicable Diseases (NCDs) |
Chronic, long-term diseases that are not infectious. The burden of NCDs
is increasing in AJK. Key examples include Ischemic heart disease, Stroke,
Diabetes, and Cancers. |
4.2 Trends in the Top Health Concerns
An
analysis of disease burden data from 2009 to 2019 reveals several significant
shifts in the leading health issues in AJK:
- Rise of Heart Disease: Ischemic heart disease became the top cause of
death, showing a 28% increase over the decade.
- Progress in Newborn Health: While still a major concern, Neonatal disorders
saw a significant decrease of -24.8%, moving from the top cause of
death to the second.
- Emergence of Cancer: Breast cancer demonstrated the highest increase
among the top causes of death, rising by 45.9% and moving into the
top ten.
These
challenges highlight the need for a clear and forward-looking strategy, which
is encapsulated in the official vision for the region's health sector.
5. The Path Forward: A Vision for Health in AJK
To
conclude this overview, the AJK Health Policy outlines a clear and ambitious
vision for the future of healthcare in the state. This vision serves as the
guiding star for all future policies, programs, and reforms.
“To
achieve complete physical and mental well-being for the people of AJ&K by
2030 through the employment of international best practices that ensure easy,
sustainable, and affordable access to health service for all.”
A Guide to the 2022 Health Policy
1.
Introduction: Setting the Scene for a Healthier AJK
The
health of a nation's people is the foundation upon which its prosperity and
development are built. As the preface to the Azad Jammu & Kashmir (AJK)
Health Policy notes, "Only healthy people can bring sustainable
development and progress." Recognizing this, the government of Azad Jammu
& Kashmir is undertaking a significant reform of its healthcare system to
meet modern challenges and the future needs of its population.
This document serves as a guide to this transformation. We will explore the primary health issues AJK is currently facing and break down the key goals and strategies outlined in the AJK Health Policy 2022, the region's new blueprint for a healthier future.
To
build a better system, it's essential first to understand the specific problems
that need solving. The AJK Health Policy 2022 is designed as a direct response
to a complex set of health challenges facing the region.
2. The Core Challenge: AJK's Key Health Issues
To
create an effective plan, one must first understand the problems. AJK faces two
major types of challenges: the kinds of diseases affecting its population and
the structural weaknesses within the healthcare system itself.
2.1. The "Double Burden" of Disease
AJK
is grappling with a "double burden" of disease. This public health
term describes a situation where a region must simultaneously fight two very
different health battles:
- Communicable Diseases: These are infectious diseases that can spread
from person to person, such as tuberculosis or the flu.
- Non-Communicable Diseases (NCDs): These are chronic conditions often linked to
lifestyle, genetics, and environment, such as heart disease and diabetes.
The
table below, based on Global Burden of Diseases data and a study from Kotli
District Hospital, illustrates this dual challenge.
|
Communicable Diseases (Infectious) |
Non-Communicable Diseases (Chronic) |
|
Tuberculosis (TB): Remains a
significant public health problem. |
Ischemic Heart Disease: Now the #1 cause of death in AJK, rising by 28% in a decade. |
|
Diarrheal Diseases & Pneumonia: Major causes of illness, especially in children. |
Stroke: The third leading cause of death,
with an 18.7% increase in burden. |
|
Lower Respiratory Infections: A persistent issue requiring medical attention. |
Chronic Obstructive Pulmonary Disease (COPD): A major respiratory illness, remaining a top cause
of death. |
|
Hepatitis: Viral hepatitis is a surveillance
priority. |
Hypertension: A common condition requiring
increased attention at the primary care level. |
|
Neonatal Disorders: While decreasing,
these remain a top cause of death and disability. |
Diabetes & Chronic Kidney Disease: A growing challenge for the healthcare system. |
|
Breast Cancer: Showed the
highest increase (45.9%) among the top ten causes of death. |
2.2. A System Under Strain
Beyond
the types of diseases, the healthcare system itself faces significant
structural challenges that limit its effectiveness.
- Healthcare Worker Shortage AJK has a population-per-doctor ratio of 3,954 to
1, which is far from the World Health Organization (WHO) standard of one
doctor for every 1,000 people.
- Service Inequities Access to quality healthcare is unequal across
the region, with significant gaps between districts, particularly in
remote areas where female doctors are often reluctant to work.
- Limited Community-Level Care The Lady Health Worker (LHW) program, which
delivers essential primary care directly to communities, only covers 69%
of the population and struggles with inadequate funding.
- Fragmented Health Information Health data is not well-integrated. This
fragmentation is so significant that even basic identifiers like a
patient's national ID card number (CNIC) are often not captured, making it
impossible to link records between different health facilities or government
departments.
The AJK Health Policy 2022 is the government's comprehensive strategy to confront these deep-seated issues head-on.
3. The Blueprint for Change: The AJK Health Policy 2022
The
AJK Health Policy 2022 is the official strategy designed to address the
challenges of disease and systemic weakness. It lays out a clear vision for the
future of health in the region.
The
policy's official vision is:
“To achieve complete physical and mental well-being for the people of AJ&K by 2030 through the employment of international best practices that ensure easy, sustainable, and affordable access to health service for all.”
To
achieve this ambitious vision, the policy is built on several guiding
principles. For a student of public health, two are especially important:
- Universal Health Coverage (UHC): This core principle means ensuring that all
people can get the quality health services they need—from prevention to
treatment—without suffering financial hardship when paying for them.
- A Human Rights-Based Approach: This principle treats health as a fundamental
human right. It requires that health policies prioritize the needs of the
most vulnerable populations first, including persons with disabilities,
the elderly, and those in hard-to-reach areas.
This
vision and these principles guide the specific, actionable recommendations that
form the heart of the policy.
4. The Action Plan: Key Policy Recommendations
The
policy outlines a multi-faceted plan to build a stronger, more responsive, and
more equitable health system for all citizens of AJK.
4.1. Strengthening the Workforce and Governance
A system is only as good as its people and its structure. The policy prioritizes two major reforms:
- Decentralized Governance: The plan is to delegate more administrative and
financial power to three Divisional Directorates in Muzaffarabad, Mirpur,
and Rawalakot. This will improve local supervision, make the system more
responsive to local needs, and increase accountability.
- Investing in People: The policy calls for better, regular training for all health professionals. This includes mandatory certification in Basic Life Support (BLS) for doctors and creating clear career paths (service structures) to improve job satisfaction and performance.
4.2. A New Focus on Prevention
A
core theme of the policy is a strategic shift from merely treating sickness to
actively preventing it. This preventive strategy is built on three pillars:
1.
Primary
Prevention This means stopping a disease before
it ever starts. The policy recommends strengthening programs like childhood
vaccination, health education in schools and communities (on topics like
healthy diet and exercise), and improving dental hygiene.
2.
Secondary
Prevention This focuses on detecting diseases at
their earliest, most treatable stages. Key initiatives include establishing
population-wide screening programs and improving maternal and child health
services to catch potential issues early.
3.
Controlling
Communicable Diseases The goal is to build a
well-functioning disease surveillance system. This will help public health
officials detect and respond to outbreaks of infectious diseases like
Tuberculosis, malaria, HIV/AIDS, cholera, and dengue before they can spread
widely.
4.3. Empowering Health with Technology
The
policy recognizes the power of modern technology to revolutionize healthcare
delivery. It recommends two key technological upgrades:
- Integrated Health Information
System: The plan is to create a
connected digital system where a patient's health data can flow seamlessly
from a local primary care clinic (Basic Health Unit) to a District
Hospital and up to the state level. This ensures better continuity of care
and provides valuable data for public health planning.
- Digital Health: The policy aims to use digital tools to promote
public health messages, ensure patient data is secure and private, and
improve overall access to health services for the population.
4.4. Reaching Every Community
A
central priority is ensuring that high-quality healthcare reaches everyone, not
just those living in major towns and cities. The policy focuses on three
community-level actions:
- Expand the LHW Program: There is a clear and direct goal to increase the
coverage of the vital Lady Health Worker program from its current 69% to
100% of the population.
- Improve Community Nutrition: The plan calls for strengthening community-based
nutrition programs to combat childhood stunting and wasting, with a
special focus on pregnant women, children, and adolescent girls.
- Build Community Resilience: Given AJK's geography, the policy emphasizes the
importance of community engagement and training for disaster response.
This includes creating community-based first aid training programs to help
citizens respond effectively in an emergency.
This
forward-looking plan is designed to be comprehensive, addressing the health
system's challenges from multiple angles.
5. Conclusion: Charting the Course to a Healthier AJK
The
AJK Health Policy 2022 represents a clear and strategic roadmap for the future.
It is a direct response to the region's most pressing health needs—from the
double burden of infectious and chronic diseases to deep-rooted systemic
weaknesses. By strengthening its workforce, shifting its focus to prevention,
embracing technology, and ensuring no community is left behind, the policy aims
to build a resilient and equitable system. Ultimately, these efforts are all
directed toward achieving the inspiring vision of complete health and
well-being for every citizen of AJK by 2030.
Policy Briefing:
Strategic Analysis of the Azad Jammu & Kashmir
Health Policy 2022
1.0
Introduction: A New Health Mandate for Azad Jammu & Kashmir
The
Azad Jammu & Kashmir (AJK) Health Policy 2022 marks a pivotal moment for
the region's public health sector. As the first comprehensive update since
1996, it has been formulated in an era of greater administrative autonomy
following the 18th Constitutional Amendment, granting the AJK government a
strategic opportunity to fundamentally reform its health system. The policy's development
was driven by a pressing need to address a rapidly changing health landscape,
significant inter-district inequities in service delivery, and critical
systemic weaknesses starkly exposed by the COVID-19 pandemic. This briefing
synthesizes the policy's guiding principles, key strategic recommendations, and
proposed governance reforms to provide a clear and concise overview for health
officials, policymakers, and system stakeholders.
2.0 Core Vision and Guiding Principles
A
policy's effectiveness is rooted in a clear vision and its alignment with
established ethical and operational frameworks. The AJK Health Policy 2022
anchors its recommendations in widely recognized national and global health
mandates, establishing a robust foundation for systemic reform. These guiding
principles are not merely aspirational; they define the ethical compass and
operational standards for all proposed changes, ensuring that subsequent
actions are coherent, equitable, and directed toward a unified goal.
2.1 Proposed Vision for 2030
The
policy sets forth a clear and ambitious objective for the health and well-being
of the population by the end of the decade:
“To
achieve complete physical and mental well-being for the people of AJ&K by
2030 through the employment of international best practices that ensure easy,
sustainable, and affordable access to health service for all.”
2.2 Alignment with National and Global Frameworks
The
policy strategically positions its goals within broader national and
international health agendas to ensure coherence and leverage established best
practices.
- Pakistan National Health Vision: The policy aligns with the national vision, using
it as an overarching guide for strategic direction and ensuring that AJK's
health system development is harmonized with federal objectives.
- Sustainable Development Goals
(SDGs): The policy explicitly commits to
achieving the health-related SDG targets. It recognizes that ensuring
healthy lives and promoting well-being (Goal 3) is essential to
sustainable development and notes that 16 of the 17 SDGs are directly or
indirectly related to health.
2.3 Foundational Tenets of the Policy
The
policy's strategic recommendations are built upon a set of core tenets that
prioritize equity, access, and quality.
1.
Human
Rights-Based Approach: The policy frames
health as a fundamental human right. This requires that all health programs and
policies are designed to uphold human dignity, are non-discriminatory, and give
special consideration to the needs of vulnerable populations, including persons
with disabilities, the elderly, and transgender individuals.
2.
Universal
Health Coverage (UHC): A central
commitment of the policy is to achieve UHC, defined as ensuring all people can
access the promotive, preventive, curative, and rehabilitative services they
need without facing financial hardship. To support this, the policy recommends
expanding the coverage of the Lady Health Worker (LHW) program from the current
69% to 100% to strengthen primary healthcare at the community level.
3.
Quality
of Care Standards: The policy emphasizes a commitment to
improving the quality of health services by adhering to established benchmarks
and standards, moving beyond mere access to ensure that care is effective,
safe, and people-centered.
These
principles collectively form the strategic bedrock of the policy, guiding the
structural reforms designed to bring its vision to life.
3.0 Strategic Recommendations for Health System
Transformation
The
policy outlines a series of integrated recommendations aimed at systemic
transformation. These reforms are designed to address critical and
long-standing gaps in governance, human resources, service delivery, and
information management. By targeting these core components, the policy seeks to
build a health system that is not only more effective but also more resilient,
accountable, and responsive to the needs of the population.
3.1 Governance and Stewardship Reform
A
central recommendation is the shift from a highly centralized governance model
to a decentralized structure. This reform is intended to delegate
administrative and financial authority to the divisional level, a critical move
designed to dismantle decision-making bottlenecks. The strategic intent is to
empower local leadership, thereby strengthening supervision, enhancing
accountability, and fostering a system more responsive to district-specific
health challenges.
The
proposed governance structure is as follows:
- Minister in Charge Health
- Secretary Health
- Director General Health
- Director Muzaffarabad Division
-> Districts
- Director Mirpur Division ->
Districts
- Director Rawalakot Division
-> Districts
- AJ&K Healthcare Commission
- AJ&K Drug Regulatory
Authority
3.2 Human Resource Management and Development
Recognizing
that a skilled and motivated workforce is the backbone of any health system,
the policy proposes several key initiatives to strengthen human resources.
- Performance Evaluation: Implement new performance evaluation mechanisms
to ensure accountability and promote quality within the health workforce.
- Regular Training: Make training in Basic Life Support (BLS),
Advanced Cardiac Life Support (ACLS), and Advanced Trauma Life Support
(ATLS) mandatory for all doctors and allied health professionals.
- Service Structure and Promotions: Establish a clear service and promotion structure
for all cadres to improve job satisfaction, reduce absenteeism, and
enhance overall performance.
- Adequate Staffing and Task
Shifting: Develop strategies to address
workforce shortages, improve the distribution of health workers to
underserved areas, and implement task-shifting to optimize the use of
existing personnel.
3.3 Modernizing Service Delivery
The policy strategically reorients service delivery by prioritizing preventive and primary care. This represents a fundamental shift from a historically curative-focused model to one that proactively manages population health, aiming to reduce the long-term burden on tertiary facilities and lower catastrophic health expenditures for families.
1.
Reforming
Preventive Healthcare: Place a high
priority on primary prevention measures, such as vaccination and health
education, and secondary prevention through population-based screening programs
for early disease detection.
2.
Reforming
Primary Healthcare (PHC): Strengthen the PHC
system as the foundation for achieving UHC. A robust PHC network will serve as
the first point of contact for communities and the front line of response for
controlling communicable diseases.
3.
Improving
Tertiary Level Hospitals: Enhance the
capacity and capabilities of tertiary care hospitals to manage complex cases
and reduce the need for out-of-state referrals.
3.4 Digital Transformation and Health Information Systems
The
policy envisions leveraging technology to create a more efficient and
data-driven health system. It recommends creating a fully integrated health
information system and institutionalizing digital health initiatives. A
significant challenge identified is that current birth and death records kept
at health facilities consist of aggregated numbers and lack essential data,
such as the Computerized National Identity Card (CNIC), which prevents linkage
with national ID authorities and impedes data flow to higher administrative
levels for planning and analysis.
3.5 Ensuring Financial Sustainability
To
secure the long-term viability of the health sector, the policy proposes five
key financing strategies:
- Improve the efficiency of revenue
collection.
- Reprioritize health within
government budgets.
- Explore innovative financing
mechanisms.
- Secure development assistance for
health from partners.
- Strategically purchase services
from the private sector where appropriate.
These
systemic reforms are specifically designed to address the unique and pressing
health challenges confronting the population of AJK.
4.0 Addressing AJK's Core Health Challenges
The
policy’s recommendations are not theoretical; they are an evidence-based
response to the most significant health issues facing the people of AJK. The
strategies for system reform are directly targeted at confronting the region's
distinct disease burden and building the resilience needed to manage future
health crises.
4.1 Confronting the Double Burden of Disease
Analysis
of health data reveals that AJK faces a challenging "double burden"
of disease, grappling with a rising tide of non-communicable diseases (NCDs)
while simultaneously managing persistent communicable diseases. The disease
landscape has shifted significantly over the past decade, as illustrated below.
|
Disease/Condition |
Rank in 2009 |
Rank in 2019 |
% Change (2009-2019) |
|
Ischemic heart disease |
2 |
1 |
+28.0% |
|
Neonatal disorders |
1 |
2 |
-24.8% |
|
Stroke |
3 |
3 |
+18.7% |
|
Breast cancer |
11 |
10 |
+45.9% |
|
Tuberculosis |
6 |
9 |
-21.5% |
|
Diarrheal diseases |
5 |
7 |
-18.7% |
In
response, the policy proposes a strategic approach focused on investing in
community-level prevention programs, introducing early screening for NCDs, and
ensuring the timely management of cases to reduce complications and
catastrophic health expenditures. This will be complemented by robust programs
to control communicable diseases like Tuberculosis and Hepatitis.
4.2 Building a Resilient Health System
The
experience of the COVID-19 pandemic heavily informed the policy's strong
emphasis on building a resilient health system capable of withstanding future
shocks. The strategy is built on several key pillars:
- Strengthened Disease
Surveillance: The policy calls for a robust
surveillance system defined by the ongoing, systematic identification,
collection, analysis, and interpretation of disease data to enable timely
and effective public health action.
- Disaster and Pandemic
Preparedness: Moving beyond what the policy
terms "paper exercises," it recommends active preparedness
measures, including stockpiling essential medical supplies and building
reserve health service capacity to manage surges during emergencies.
- Biosafety and Biosecurity: The policy distinguishes between biosafety
(preventing unintentional exposure to or release of biological agents) and
biosecurity (protecting against the misuse, theft, or deliberate
release of such agents). It calls for comprehensive measures to minimize
risks from natural, accidental, and intentional disease threats.
- Community Engagement: To improve pre-hospital outcomes during
disasters, the policy recommends developing community-based first aid
training programs. This aims to empower local communities to act as first
responders, mitigating the impact of emergencies before professional help
arrives.
These
targeted interventions are essential for achieving the policy's overarching
goals for a healthier future.
5.0 Conclusion: Charting the Course for a Healthier AJK
The
Azad Jammu & Kashmir Health Policy 2022 represents a transformative and
comprehensive roadmap for public health reform. By focusing on decentralized
governance, a strengthened health workforce, modernized service delivery, and
the strategic integration of digital technology, the policy provides a clear
framework for building a more equitable, efficient, and resilient health
system. The successful implementation of these strategic reforms is critical
for overcoming existing challenges and realizing the vision of improved health
and well-being for all citizens of AJK by 2030.
----------------------------------------------------------------------------------------------------
Source: Department of Health, Azad Government of the State of
Jammu and Kashmir. (2022). Health Policy, Azad Jammu & Kashmir.
Strategic Health Reform Plan for Azad Jammu & Kashmir
(2024-2030):
An Action Plan for
the AJK Health Policy 2022
1.0 Introduction: Charting a Course for a Healthier AJK
This
strategic plan establishes the operational roadmap to realize the vision
articulated in the Azad Jammu & Kashmir (AJK) Health Policy 2022. Decades
after the state's first health policy in 1996, shifting public health dynamics
and the stark lessons of the COVID-19 pandemic have created an undeniable
urgency for reform. This plan confronts systemic gaps head-on and builds a
modern, resilient, and equitable health system capable of meeting the evolving
needs of the people of Azad Jammu & Kashmir.
Its
core purpose is to translate the recommendations of the AJK Health Policy 2022
into a coherent and actionable set of strategic initiatives for the 2024-2030
period. This plan drives reform across the health system's most critical
domains: it overhauls governance for greater accountability, strengthens the
health workforce to address critical shortages, reorients the model of care
toward prevention, ensures financial sustainability, and leverages digital
technology to create a data-driven ecosystem. To achieve these goals, this
document first reaffirms the foundational vision and principles that steer this
transformative journey.
2.0 Our Vision and Guiding Principles
A
successful long-term reform must be anchored by a clear vision of the future
and a set of unwavering principles. These elements serve as the north star for
all strategic efforts, ensuring that as tactics evolve, the ultimate
destination and the values guiding the journey remain constant. This section
defines the ultimate goal for the AJK health sector by 2030 and the
foundational values that will guide every subsequent action and decision.
The
official vision for the AJK health sector, as articulated in the AJK Health
Policy 2022, is:
“To
achieve complete physical and mental well-being for the people of AJ&K by
2030 through the employment of international best practices that ensure easy,
sustainable, and affordable access to health service for all.”
Our Guiding Principles
All
initiatives within this strategic plan will be designed and implemented in
alignment with the following core principles, synthesized from the AJK Health
Policy 2022.
- Universal Health Coverage (UHC): We will ensure all people have access to the
promotive, preventive, curative, and rehabilitative health services they
need without facing financial hardship.
- Alignment with Sustainable
Development Goals (SDGs): Our efforts are dedicated to achieving the global agenda for health
and well-being (Goal 3) while recognizing the crucial interplay between
health and the 16 other SDGs.
- A Human Rights-Based Approach: We will treat health as a fundamental human
right, focusing on equity, non-discrimination, and prioritizing the needs
of the most vulnerable and marginalized populations.
- Efficiency and Sustainability: We will ensure the optimal use of available
human, financial, and physical resources to create a resilient and
self-sustaining health system for future generations.
These
principles form the ethical and operational foundation for reform. To build
upon this foundation, an evidence-based understanding of the current health
landscape is essential.
3.0 Situational Analysis: The Case for Transformation
An
honest appraisal of Azad Jammu & Kashmir's health system reveals a
foundation of valuable assets undermined by critical systemic weaknesses. This
section provides a comprehensive analysis of the system's strengths,
weaknesses, opportunities, and threats, drawing on evidence from the AJK Health
Policy 2022 and recent public health research. This analysis forms the evidence
base for the strategic pillars and initiatives that follow.
3.1 Current Strengths and Foundational Assets
The
AJK health system is built upon a number of assets that provide a solid base
for reform.
- Existing Health Infrastructure: AJK has an established network of public health
facilities, including Basic Health Units (BHUs), Rural Healthcare Centers
(RHCs), Tehsil and District Headquarters (DHQ) hospitals, and specialized
centers, with a total of approximately 3,810 beds.
- Community Health Outreach: The National Program for family planning and
primary healthcare provides a crucial link to communities, covering 69% of
the population with a dedicated workforce of 3,300 Lady Health Workers
(LHWs).
- Disease Control Programs: The state has dedicated vertical programs for
managing specific communicable diseases, including a Dengue Control
Program, a Hepatitis Control Program, and the National TB Program, which
provide a framework for disease surveillance and response.
3.2 Systemic Weaknesses and Gaps
Despite
its strengths, the system faces deep-seated challenges that impede progress and
necessitate fundamental reform.
- Human Resource Crisis: There is a critical shortage of health workers.
The 2019 population-per-doctor ratio stood at 3,954, far from the World
Health Organization (WHO) standard of 1:1,000. This is compounded by the
reluctance of female doctors and specialists to serve in hard-to-reach
areas, creating significant service gaps.
- Double Disease Burden: AJK is grappling with a dual challenge: the
persistent threat of communicable diseases like Tuberculosis (TB) and a
rapidly rising tide of Non-Communicable Diseases (NCDs). By 2019, the NCD
burden had increased to 43.7% of the total disease burden, with ischemic
heart disease becoming the leading cause of death.
- Fragmented Data Systems: The health information system is weak and lacks
integration. An evaluation of the District Health Information System
(DHIS) in Kotli revealed inconsistencies in manual data entry, such as
missing indoor patient details for an entire month. Critically, there is
no mechanism to capture national identity card (CNIC) numbers or to ensure
health data flows from primary care facilities to the state level for
planning.
- Inefficient Financial Allocation: The health budget is overwhelmingly consumed by
recurrent costs. In the 2021-22 fiscal year, 88% of the budget was
allocated to salaries and utilities, leaving a mere 5% for essential
expenditures like treatment, medicines, and equipment.
- Service Delivery Inequities: Significant inter-district inequities in service
provision persist. A weak and inadequate referral system places an
unsustainable burden on DHQ and tertiary hospitals, while the private
health sector remains largely unregulated, leading to variable quality and
pricing.
3.3 Strategic Opportunities
The
current environment also presents unique opportunities to catalyze
transformation.
- Governmental Autonomy: The 18th Constitutional Amendment has granted the
Government of AJK greater autonomy in managing its health system, creating
a policy window for bold and tailored reforms.
- Digital Transformation: The ongoing trial phase of the DHIS and the
policy's call for an integrated digital ecosystem present a significant
opportunity to leapfrog legacy systems and build a modern, data-driven
health infrastructure.
- Economic Development through
Health: By improving the quality of its
health services and leveraging its natural beauty, AJK has the potential
to develop medical tourism, creating a new engine for economic growth.
The
profound human resource crisis and fragmented data systems detailed above
necessitate the reforms outlined in Pillar II and Pillar V, while the rising
NCD burden and service inequities demand the reoriented model of care and
fortified primary health services proposed in Pillar III. The identified
strengths provide a foundation to build upon, and the strategic opportunities
offer a clear path forward for the targeted, high-impact reforms organized
under the following strategic pillars.
4.0 Strategic Pillars for Health System Reform
To
address the systemic challenges identified in the situational analysis and
realize the vision of the AJK Health Policy 2022, this plan organizes all
reform efforts under five interconnected pillars. Each pillar represents a
critical area for transformation, and together they form a holistic framework
for building a health system that is responsive, resilient, and equitable.
1.
Pillar
I: Reforming Health Governance and Leadership
– To establish a decentralized, accountable, and transparent governance
structure that improves stewardship and regulatory oversight.
2.
Pillar
II: Strengthening the Health Workforce
– To build a sufficient, skilled, and motivated health workforce capable of
delivering quality care across AJK.
3.
Pillar
III: Reorienting the Model of Care
– To shift the focus from curative treatment to an integrated model emphasizing
preventive, primary, and community-based healthcare.
4.
Pillar
IV: Ensuring Financial Sustainability
– To optimize the use of existing funds and explore innovative financing
mechanisms to ensure the long-term viability of the health system.
5.
Pillar
V: Building a Data-Driven, Digitally-Enabled Health Ecosystem – To harness the power of data and digital technology to
improve decision-making, efficiency, and patient outcomes.
The
following section operationalizes these pillars through specific, time-bound
initiatives and actions.
5.0 Strategic Initiatives and Action Plan
This
section translates the high-level strategic pillars into a concrete action plan
for implementation between 2024 and 2030. Each strategic initiative listed
below is directly derived from the evidence-based recommendations of the AJK
Health Policy 2022 and is designed to produce tangible improvements in the
health and well-being of the population.
5.1 Pillar I: Reforming Health Governance and Leadership
- Strategic Initiative 1.1:
Implement Decentralized Governance.
- Action: Formulate and execute a plan to delegate
administrative and financial authority by creating three Divisional
Directorates for Health in Muzaffarabad, Mirpur, and Rawalakot, as
proposed in the AJK Health Policy governance structure. This will
strengthen supervision and ensure accountability at lower levels.
- Strategic Initiative 1.2:
Strengthen Regulatory Oversight.
- Action: Develop the legal and operational framework for
the AJK Healthcare Commission and a dedicated AJK Drug Regulatory
Authority. Introduce regulations for the private health sector to address
gaps in service quality and pricing.
5.2 Pillar II: Strengthening the Health Workforce
- Strategic Initiative 2.1:
Implement a Modern HR Management Framework.
- Action: Design and roll out new systems for performance
evaluation, work-life balance, and a clear service structure with
transparent promotion criteria for all cadres, including doctors, nurses,
and allied health professionals.
- Strategic Initiative 2.2: Achieve
WHO-Recommended Staffing Densities.
- Action: Create a phased recruitment and deployment plan
to achieve the 2030 targets for population density of physicians,
dentists, and nurses as outlined in the AJK Health Policy 2022.
- Strategic Initiative 2.3: Enhance
Workforce Capacity.
- Action: Mandate regular training in Basic Life Support,
Advanced Cardiac Life Support, and Advanced Trauma Life Support. Initiate
the process for establishing a dedicated Medical University in AJK to
ensure a sustainable supply of qualified health professionals.
5.3 Pillar III: Reorienting the Model of Care
- Strategic Initiative 3.1: Fortify
Preventive and Primary Healthcare (PHC).
- Action: Expand the LHW program coverage from 69% to 100%
to ensure universal access to community-level PHC. Implement
population-based screening programs for early disease detection and
strengthen school health and community nutrition programs.
- Strategic Initiative 3.2: Address
the Double Disease Burden.
- Action: Launch targeted programs to reduce the burden of
NCDs, focusing on early screening and management for leading causes of
death like ischemic heart disease, stroke, and breast cancer.
Simultaneously, strengthen surveillance and response systems for communicable
diseases like TB, leveraging data from the National TB program.
- Strategic Initiative 3.3:
Strengthen the Referral System and Tertiary Care.
- Action: Design and implement a formal, two-way referral
system from PHC facilities to DHQs and tertiary hospitals. Invest in
upgrading the capacity of tertiary level hospitals to reduce the need for
out-of-state referrals and associated out-of-pocket expenditures.
5.4 Pillar IV: Ensuring Financial Sustainability
- Strategic Initiative 4.1:
Diversify Health Financing.
- Action: Explore and implement innovative financing
models, including public-private partnerships and mechanisms to increase
development assistance for health, to reduce reliance on the government's
recurrent budget.
- Strategic Initiative 4.2: Improve
Budgetary Efficiency.
- Action: Conduct a comprehensive review of health
expenditures to identify inefficiencies. Develop a plan to reprioritize
government budgets, gradually increasing the allocation for treatment,
medicines, and equipment beyond the current 5%.
5.5 Pillar V: Building a Data-Driven, Digitally-Enabled
Health Ecosystem
- Strategic Initiative 5.1:
Establish an Integrated Health Information System (HIS).
- Action: Implement the proposed framework for an
integrated HIS from the AJK Health Policy. Scale up the DHIS across all
districts, ensuring standardization of data collection (including
mandatory CNIC capture) and creating protocols for data to flow from
health facilities to divisional and state levels.
- Strategic Initiative 5.2:
Institutionalize Digital Health.
- Action: Develop policies and infrastructure to support
digital health initiatives such as telemedicine, mobile health
applications, and precision public health, ensuring they are integrated,
secure, and patient-centered.
- Strategic Initiative 5.3: Promote
Data as a Public Good.
- Action: Establish clear data-sharing protocols between
government departments (e.g., Health and Local Government) to ensure that
health data is used effectively for planning, resource allocation, and
public benefit.
To
ensure these initiatives translate into measurable results, a robust monitoring
framework is essential.
6.0 Implementation and Monitoring Framework
To
ensure these reforms translate into tangible outcomes, a robust implementation
and monitoring framework is essential. This final section outlines the
structure for governance, accountability, and performance measurement that will
guide the plan's execution and ensure its objectives are met by 2030.
6.1 Governance and Accountability
The
new decentralized governance structure, with empowered Divisional Directorates
for Health in Muzaffarabad, Mirpur, and Rawalakot, will serve as the primary
mechanism for overseeing the implementation of this plan at the operational
level. The State Health Directorate will retain the overall stewardship role,
providing strategic direction, setting standards, and ensuring alignment with
the national vision.
6.2 Key Performance Indicators (KPIs)
Progress
will be tracked against core health indicators from the Annual Development
Programme, which directly reflect the intended outcomes of our strategic
initiatives, particularly those under Pillar III aimed at reorienting the model
of care. The following table outlines these key performance indicators and
their initial targets for the 2023-24 fiscal year.
|
Indicator |
2023-24 Target (as per ADP) |
|
Population with access to public health facility (%) |
85 |
|
Infant Mortality Rate (IMR) per 1000 live births |
45 |
|
Children < 1 year fully immunized (%) |
95 |
|
Maternal Mortality Rate (MMR) per 100000 LB |
95 |
|
Trained personnel’s attending pregnancies (%) |
70 |
|
Contraceptive Prevalence Rate (CPR) % |
40 |
6.3 Evaluation and Review Cycle
Progress
against this strategic plan will be reviewed annually. This review will be guided
by the systematic evaluation cycle proposed in the AJK Health Policy 2022. This
continuous cycle involves measuring performance against KPIs, analyzing results
to understand successes and challenges, planning adaptive changes based on
evidence, and implementing those changes to ensure continuous improvement and
responsiveness.
This
strategic plan represents a steadfast commitment to the health and well-being
of every citizen. Its dedicated implementation will not only build a stronger,
more equitable, and resilient health system but will also serve as a
cornerstone for the broader prosperity and sustainable development of Azad
Jammu & Kashmir, paving the way for a healthier and more secure future for
all.