World Bank2025-01-082025-01-082025-01-08https://hdl.handle.net/10986/42633This 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.en-USCC BY-NC 3.0 IGOGOOD HEALTHHEALTH CARE DELIVERYHEALTH CARE FINANCINGHEALTH SERVICE DELIVERY MARKETSPUBLIC FINANCE MANAGEMENTReportWorld Bank10.1596/42633https://doi.org/10.1596/42633