Assessment OF UHC Performance Monitoring System and UHC Budget and Expenditure Analysis in Pakistan

In 2016, Pakistan adopted the Sustainable Development Goals (SDGs) into its national development agenda as part of its commitment to the 2030 Agenda for Universal Health Coverage (UHC). In 2018, the Government of Pakistan designed and approved a National SDGs Framework to prioritize and localize SDGs, which included an accelerated path toward UHC. To measure the global advancement toward UHC, the World Bank and the World Health Organization (WHO) have regularly issued reports concerning how countries were progressing in achieving their goals. However, there is a fundamental challenge in reporting because UHC means different things to different countries, both at the national and sub-national levels. To address this challenge in Pakistan, the Ministry of National Health Services, Regulation and Coordination (MONHSRC) released a report that derives a public health system output referred to as the UHC Index. It uniformly measures the UHC at the subnational levels. The Index is derived from the 16 clusters1 identified by the WHO to monitor the UHC. The UHC analysis brought to light the need for interventions to improve the District Health Information System (DHIS) data quality, as well as steps to improve the Financial Accounting and Budgeting System (FABS) health budget coding. The DHIS data does not provide information about noncommunicable diseases (NCDs). Thus, it needs to be supplemented with other regularly reported information at the district level to monitor the NCD cluster. In addition, the DHIS internal verification mechanisms should be reinstituted, and further effort will be required to ensure data reliability. The reported wide variation in the Expanded Program on Immunization (EPI) indicators is an example of the lack of standardization in the system that should be addressed. For budgeting and accounting, the Government of Pakistan has a unified Chart of Accounts (CoA). It is implemented at all tiers of government. For a country of its size and diversification, this represents a major feat. Accounting data is reliable, and the financial reports generated are credible. However, the use of the CoA in the health sector is not consistent across provinces, which creates difficulties in producing an aggregate view of sector allocations and spending from the FABS