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Strengthening Health Systems through Primary Health Care Reform – A Case Study of Integrating Eye Health in Primary Healthcare in Pakistan

Author(s): H. R. Awan*1, N. Khan2, K. Gooding3, A. A. Khan4
Affiliation(s): 1Strategic Programme Development, 2Pakistan Country Office, Sightsavers International, Islamabad, Pakistan, 3Strategic Programme Development, Sightsavers International, Haywards Heath, United Kingdom, 4College of Ophthalmology and Allied Vision Sciences, Mayo Hospital, Lahore, Pakistan

Primary Health Care, Eye Health, Health Systems, Health Workforce, Health Information, Leadership and Governance


In developing countries, health programmes are usually delivered through vertical and horizontal programmes. Vertical programmes, by virtue of the acute nature of the disease and the financial resources available, tend to strengthen their respective disease specific interventions, but may not provide similar capacity development for the horizontal health services. The new health systems approach requires strengthening of all the building blocks of health systems. In addition, primary health care reform calls for reform in the four main areas of universal coverage, service delivery, public policy and leadership. This paper presents a case study of how eye health has facilitated integration of three national health programmes that address primary health care reform and health systems strengthening in Pakistan.


In 2007, a first consultation and planning meeting was held between the national coordinators of primary healthcare, eye health and health information programmes under the Ministry of Health. Up to that time, these national health programmes were operating independently of each other. A pilot study was undertaken to determine the feasibility of integrating these three programmes. The results demonstrated that not only was it feasible but that it created demand from among the primary health care staff for closer collaboration between these programmes. The case was presented to the Ministry of Health who then directed that a formal collaboration and coordination be established between these three programmes. To support this integration process, additional funds were mobilized from within the Ministry of Health, and from IrishAid and Standard Chartered Bank. The integration process called for training of 70,000 primary health care workers (known as Lady Health Workers) in eye health and basic reporting, together with the whole supervisory chain of the Lady Health Workers programme and the Health Management Information System staff. A situation analysis of eye health was conducted by the Health Information team, while baseline and follow-up information was provided by the Lady Health Workers and eye health programmes. The training curriculum of the Lady Health Workers was updated to incorporate task shifting for eye health. This case study presents a three year review of how health systems were strengthened by merging vertical and horizontal health programmes.


Three national health programmes – primary health care, eye health, and health information were being implemented independently of each other. The national eye health programme was financing for medicine and consumables separately, while also conducting training of primary health care workers in eye health as an independent exercise. This case study demonstrates that synergies between health programmes can be enhanced, task shifting between health staff attained, medicines and consumables made available through established channels of distribution, productivity of the health workforce increased and health information system strengthened through collaboration between programmes. Health financing for primary health care is now able to achieve more for the same investment and coverage of eye health through primary health care has been increased significantly.

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