Publication:
Internal Control Assessment at the Primary Health Care Centers in Pakistan: Options to Improve the Flow of Funds for Front-line Health Workers

Loading...
Thumbnail Image
Files in English
English PDF (2.06 MB)
28 downloads
English Text (164.02 KB)
5 downloads
Date
2025-01-08
ISSN
Published
2025-01-08
Author(s)
Editor(s)
Abstract
This report reflects on the findings from an internal control assessment of health service delivery units for primary health care, as well as a subsequent options analysis. Together, they show significant opportunities for improved systemic efficiency, as low-value, frequent transactions (that are primarily non-salary expenditures including fuel and travel allowances) comprise over fifty percent of total health expenditure transactions in Pakistan. However, they make up only two three percent of the total health budget. Although minor in size and value, these multiple transactions go through the complete approval cycle, causing delayed payments and resulting in an increased administrative burden, with a considerable negative impact on service delivery.
Link to Data Set
Citation
World Bank. 2025. Internal Control Assessment at the Primary Health Care Centers in Pakistan: Options to Improve the Flow of Funds for Front-line Health Workers. © World Bank. http://hdl.handle.net/10986/42633 License: CC BY-NC 3.0 IGO.
Associated URLs
Associated content
Report Series
Other publications in this report series
Journal
Journal Volume
Journal Issue

Related items

Showing items related by metadata.

  • Publication
    Serbia - Baseline Survey on Cost and Efficiency in Primary Health Care Centers Before Provider Payment Reforms
    (World Bank, 2009-01-26) World Bank
    The purpose of this study is to conduct a baseline survey on the cost and efficiency in Primary Health Care (PHC) Centers in Serbia before the implementation of the payment reforms. Results can be used to inform the payment reform and to establish a baseline on health sector performance including utilization, quality, cost, and efficiency against which the impact of the reforms can be assessed in a follow-up survey. Recommendations about payment system design and capitation formula are beyond the scope of this report and have been undertaken as a separate activity. This study was conducted with the support of World Bank health sector strategy funds. The rest of this report is organized is follows. Chapter two presents the data and methodology used in this survey to evaluate the cost and efficiency performance in Dom Zdravlja (DZs). Results are presented and discussed in chapter three. Based on findings, chapter four concludes and proposes several reform measures to support the effect of the provider payment reform. The annex contains additional information including a technical annex with an overview on the literature on cost and efficiency analysis, the econometric analysis, and the model building process; a list of health facilities included in the survey, summary results, and the questionnaire used to collect information.
  • Publication
    Paying Primary Health Care Centers for Performance in Rwanda
    (World Bank, Washington, DC, 2010-01) Basinga, Paulin; Gertler, Paul J.; Soucat, Agnes L.B.; Binagwaho, Agnes; Soucat, Agnes L.B.; Sturdy, Jennifer R.; Vermeersch, Christel M.J.
    Paying for performance (P4P) provides financial incentives for providers to increase the use and quality of care. P4P can affect health care by providing incentives for providers to put more effort into specific activities, and by increasing the amount of resources available to finance the delivery of services. This paper evaluates the impact of P4P on the use and quality of prenatal, institutional delivery, and child preventive care using data produced from a prospective quasi-experimental evaluation nested into the national rollout of P4P in Rwanda. Treatment facilities were enrolled in the P4P scheme in 2006 and comparison facilities were enrolled two years later. The incentive effect is isolated from the resource effect by increasing comparison facilities' input-based budgets by the average P4P payments to the treatment facilities. The data were collected from 166 facilities and a random sample of 2158 households. P4P had a large and significant positive impact on institutional deliveries and preventive care visits by young children, and improved quality of prenatal care. The authors find no effect on the number of prenatal care visits or on immunization rates. P4P had the greatest effect on those services that had the highest payment rates and needed the lowest provider effort. P4P financial performance incentives can improve both the use of and the quality of health services. Because the analysis isolates the incentive effect from the resource effect in P4P, the results indicate that an equal amount of financial resources without the incentives would not have achieved the same gain in outcomes.
  • Publication
    Improving Primary Health Care Delivery in Nigeria : Evidence from Four States
    (World Bank, 2010-04-01) World Bank
    This study aims mainly at understanding the performance of primary health care (PHC) providers in four Nigerian states and the variables driving this performance. The study is primarily based on quantitative surveys at the level of primary health care facilities, health care personnel, and households in their vicinity. These surveys were implemented in four states: Bauchi, Cross River, Kaduna, and Lagos. This study represents the second phase of the Nigeria Health, Nutrition, and Population Country Status Report (CSR). The first phase aimed at analyzing the health situation of the poor and how the health system was performing in terms of meeting their needs. This first phase identified PHC as the weakest chain in the entire health sector and the level of care the poor use the most. This second phase of the CSR is therefore focused on the analysis of the delivery of PHC services. In contrast to the first phase, this study is mainly based on primary data, data collected through facility, health personnel, and household surveys. This study follows a similar methodology used by a facility survey implemented in Kogi and Lagos in 2002 (Das Gupta, Gauri, and Khemani, 2003). However, this study is focused in the collection of information not previously available, such as detailed roles and responsibilities of the LGA and states and community perceptions of PHC services.
  • Publication
    Nigeria—Improving Primary Health Care Delivery : Evidence from Four States
    (Washington, DC, 2008-06) World Bank
    The delivery of quality primary health care (PHC) services can have a large impact on the health of Nigerians. This study aims mainly at understanding the performance of primary health care providers and the variables driving this performance. The study is primarily based on quantitative surveys at the level of primary health care facilities, health care personnel, and households in their vicinity. These surveys were implemented in four states: Bauchi, Cross River, Kaduna, and Lagos. The purpose of this study is three fold: (i) to contribute to the evidence base of the Federal Government's health system reform efforts; (ii) to inform the Bank's and Canadian International Development Agency (CIDA) sector policy dialogue with the Government; and (iii) to inform the current and eventual health support programs of both donors at state level. This study represents the second phase of the Nigeria Health, Nutrition, and Population Country Status Report (CSR). The first phase aimed at analyzing the health situation of the poor and how the health system was performing in terms of meeting their needs. This first phase identified primary health care as the weakest chain in the entire health sector and the level of care the poor use the most. This second phase of the CSR is therefore focused on the analysis of the delivery of PHC services. In contrast to the first phase, this study is mainly based on primary data, data collected through facility, health personnel, and household surveys. This study is focused in the collection of information not previously available, such as detailed roles and responsibilities of the Local Government Area (LGA) and states and community perceptions of PHC services. This study is also to support on-going or eventual health support programs of CIDA and the World Bank at the state level.
  • Publication
    Toward Synergy and Collaboration to Expand the Supply of and Strengthen Primary Health Care in Nigeria’s Federal Context, with Special Reference to Ondo State
    (World Bank, Washington DC, 2013-01) Atim, Chris; Bhatnagar, Aarushi
    This study examines an innovative example of the expansion of supply and the strengthening of primary health care to improve key health-related Millennium Development Goal, or MDG indicators through synergy and collaboration between the federal Government of Nigeria (FGN) and state governments in an extreme federal context, and with particular reference to Ondo State. That is, the Nigerian Federal Constitution grants the federal government only very limited and indirect influence or control over the fiscal and financial affairs of state and local governments, such that 'plans, budgets, accounts and procurements are not subject to federal control and scrutiny'. Nor must the lower tiers account to the federal level for how funds transferred to them from the central level are used. The rest of case study is organized as follows. Section two describes the design of the HCP, including its interaction with the rest of the health system; section three discusses the targeting, identification, and enrolment system; section four examines the management of public funds within the HCP; section five analyses the management of the benefits package; section six reviews the information environment and monitoring systems of the HCP; section seven summarizes and analyses the evidence on the key theme of the study, which is the extent to which the HCP is expanding access to, and strengthening, primary health care within the federal system; and section eight looks at the pending agenda for action, drawing on the lessons learned and challenges for the HCP's future. The annexes present the country and health system context; a general overview of health system financing and delivery; a brief description of primary care and key supply-side efforts; and key data on Ondo State, including a description of the state's health system.

Users also downloaded

Showing related downloaded files

  • Publication
    State of Social Protection Report 2025
    (Washington, DC: World Bank, 2025-04-07) World Bank
    Social protection goes well beyond cash transfers; it includes policies and programs that bridge skill, financial, and information gaps, aiding people in securing better jobs. The three pillars of social protection—social assistance, social insurance, and labor market programs—support households and workers in handling crises, escaping poverty, facing transitions, and seizing employment opportunities. But despite a substantial expansion over the past decade, 2 billion people remain uncovered or inadequately covered across low- and middle-income countries. Drawing from administrative and household survey data from the World Bank’s Atlas of Social Protection Indicators of Resilience and Equity (ASPIRE), the "State of Social Protection Report 2025: The 2-Billion-Person Challenge" documents advances and challenges to strengthening social protection and labor systems across low- and middle-income countries, analyzing the evolution of expenditure, coverage, and adequacy of support. This report details four policy action areas governments can embrace to maximize the benefits of adequate social protection for all: extending social protection to those in need; strengthening the adequacy of social protection support; building shock-proof social protection systems; and optimizing social protection financing. The report discusses how the path of reforms will depend on country context, capacity, and fiscal space. The rising frequency of shocks and crises calls for major investments in the adaptability and preparedness of social protection and labor systems. Amid a world in transition, social protection is more important and necessary than ever.
  • Publication
    Poverty and Equity Assessment for El Salvador 2024
    (Washington, DC: World Bank, 2024-12-12) World Bank
    This report proposes an agenda for building on gains to re-accelerate poverty reduction among Salvadorans. The last World Bank Poverty Assessment for El Salvador, from 2015, proposed two key policy recommendations: (a) effective pro-poor spending and (b) reduction of crime and violence through better access to jobs and education. Nine years later, the authorities have managed to achieve a substantial reduction in crime and violence and have indicated an intent to build on such progress to establish a path toward an El Salvador where shared prosperity is achievable. In this report, we propose a three pillar structure to address poverty and inequality reduction: jobs, services, and social protection, with a cross-cutting set of primary conditions that articulates this structure.
  • Publication
    Global Economic Prospects, January 2025
    (Washington, DC: World Bank, 2025-01-16) World Bank
    Global growth is expected to hold steady at 2.7 percent in 2025-26. However, the global economy appears to be settling at a low growth rate that will be insufficient to foster sustained economic development—with the possibility of further headwinds from heightened policy uncertainty and adverse trade policy shifts, geopolitical tensions, persistent inflation, and climate-related natural disasters. Against this backdrop, emerging market and developing economies are set to enter the second quarter of the twenty-first century with per capita incomes on a trajectory that implies substantially slower catch-up toward advanced-economy living standards than they previously experienced. Without course corrections, most low-income countries are unlikely to graduate to middle-income status by the middle of the century. Policy action at both global and national levels is needed to foster a more favorable external environment, enhance macroeconomic stability, reduce structural constraints, address the effects of climate change, and thus accelerate long-term growth and development.
  • Publication
    Services Unbound
    (Washington, DC: World Bank, 2024-12-09) World Bank
    Services are a new force for innovation, trade, and growth in East Asia and Pacific. The dramatic diffusion of digital technologies and partial policy reforms in services--from finance, communication, and transport to retail, health, and education--is transforming these economies. The result is higher productivity and changing jobs in the services sector, as well as in the manufacturing sectors that use these services. A region that has thrived through openness to trade and investment in manufacturing still maintains innovation-inhibiting barriers to entry and competition in key services sectors. 'Services Unbound: Digital Technologies and Policy Reform in East Asia and Pacific' makes the case for deeper domestic reforms and greater international cooperation to unleash a virtuous cycle of increased economic opportunity and enhanced human capacity that would power development in the region.
  • Publication
    World Bank Annual Report 2024
    (Washington, DC: World Bank, 2024-10-25) World Bank
    This annual report, which covers the period from July 1, 2023, to June 30, 2024, has been prepared by the Executive Directors of both the International Bank for Reconstruction and Development (IBRD) and the International Development Association (IDA)—collectively known as the World Bank—in accordance with the respective bylaws of the two institutions. Ajay Banga, President of the World Bank Group and Chairman of the Board of Executive Directors, has submitted this report, together with the accompanying administrative budgets and audited financial statements, to the Board of Governors.