Health sector development's effect on life expectancy in pakistan

Chapter 1
Introduction

Health is an imperative aspect of human life. It is a fundamental requirement, and necessary for the endurance of all human beings. Health plays an significant role in determining the human capital. Better health improves the competence and efficiency of the labor force; it ultimately contributes to economics growth and leads to human welfare. Improving health around the world to day is important social objective in all the societies, health sector is a major source of employment and also affects the lives of all citizens. In every developed and industrialized country, it consumed significant a proportion (6-12%) of their Gross National Product as well as places increasing stress on government allocation budgets. In developing countries, health care is estimated to consume two percent or less of GNP. As in the profile of the developing countries, Pakistan has in the past given a low priority to the development in the social sector which is reflected in the low human indicator of the country. The health sector of Pakistan is riddle with numerous problems, contradiction. As concerned the health facilities one can analyze from own point of view. Health care facilities in Pakistan are concentrated mostly in urban areas in low risk of death from infections and diahorea diseases but the rural area of Pakistan suffer from insufficient health facilities i.e. shortage of trained medical persons, inability of medical graduates to work in simple rural settings and their dependence on “sophisticated” technology of pharmaceutical companies enriching themselves at the expense of common man, and adequate sewerage in slums and rural areas.


Objectives:

The core objective of this thesis is to analyze health sector development’s affect on life expectancy in Pakistan. Further more we want to test a hypothesis that health sector development in Pakistan remained satisfactory over the last 48 years or shows a different situation.

Arrangement of the Thesis


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Chapter no. 2
Review of literature

2.1 Introduction
In this chapter, we have presented a comprehensive review of literature about health sector development’s effect on life expectancy.
2.2 Review of literature
Ali and Rizwan-ul-haq (2003) examined the relationship of water and environmental sanitation interventions with that if the incidence of diarrhea among children under age 10. Access to clean drinking water and sanitation facilities have a direct positive impact on health through prevention of water-borne diseases, especially dirarrhea morbidity of children. This study also finds that about 30 percent of total deaths among children are attributed to diarrhoel, and 4.1 years in life expectancy can be added if water borne diseases are eliminate. The data for this study has been taken from WES survey. It is clear from the above study that the ability of WES facilities greatly reduces the incidence of diarrhea. The incidence is 13 times higher in the non-model village as compared to the model village. By providing WES facilities and promoting hygiene practices through media campaign particularly in the rural areas, greater control over the incidence of diarrheas can be achieved.

Durr-e-Nayab (2005) examined the behavioral factors effecting women’s health seeking process. The study was conducted in the city of Rawalpindi, a major urban area of Pakistan with sufficient medical facilities thus removing the reason of not seeking help in case of illness, a sample of 500 households was drown based on economic statutes of households. The findings of the study showed that the proportion seeking help for women reporting the symptom of dyspareunia (21%) and sores on genitals (25%). The study also showed that motivation to consult a health provider for a symptom and kind of help sough depends on the women health belief about that symptom. The study suggested that for health awareness public campaigns should use local vocabulary and idioms instead if any foreign symbols. According to this study television is the best medium for conveying health message. The study also suggested that of improvement in health. Services trained health professionals are needed.
Sitar and Eatzaaz (2007) examined and estimate and analyzes the magnitude of awareness for safe drinking water among households in Hyderabad district, Sindh, Pakistan. The study is based on a survey of 514 households that consists of 3796 household members of Hyderabad City. The estimated results shows that the newspaper habit of decision makers and household heads has most significant effect in determining home purification at their homes, while education of female decision maker compared to male decision maker has most significant effect by using any method of purification. They used binary dependent variable which takes the value equal to on if a household uses some water purification method and zero if household does not use any water purification method. The explanatory variable include media exposure variables likes radio, television and newspaper habits, educational attainment by household members and number of educate members in a hues. Probity model is used for estimation. This study also finds that measures of of awareness such as different levels schooling of decision-makers and house holds and their exposures to mass media have statistically significant effects on home purification methods for drinking water.
K. Gangadharan (2006) examined the extent of maternal and child health services utilization by Urban mothers. If also identifies the factors affecting the deteriorating heath of mother and children in urban areas of karallas in India. The stud is based on survey data. The study finds our that the factors affecting the heath status of mother and children are veried & include inadequate utilization of antenatal postnatal health services in adequate services provided by the government health centers during pregnancy and delivery and post delivery stages. If also finds out that maternal mortality rate in karala is estimate 87 which is higher then average of 26 for the high human development index nations. This study suggested that setting up of urban primary health centers with maternal and child health services and improvement of government health centers and hospitals with more facilities and services for poor are the measures needed to check deterioration health of mothers and children in Urban Kerala.
Framuz (1992) discussed that maternal and child health care are considered important factors behind the mortality changes the are occurring in devolving countries. In Pakistan the data source suggest that the prevailing infant mortality rate may still be around 100 per thousand births. This study also examines that presently only 2.9percent of the total government expenditure and 0.7percetn of GNP is allocated to the health which is one of the lowest among most Asin countries. The study also shows that mothers who have had hospital care a the time of delivery are likely to dependence a smaller rash of child mortality. It also shows that the majority of deaths are concentrated in families where the parents are both illiterate. Due to illiteracy, parents are unaware of the modern facilities preferring to use traditional methods for child health care. This study also analyzed that the child mortality differentials by rural-urban and educated mother who had immunized their children. A grad contrast in the health facilities available in urban and drual areas, because in rural areas modern health services are hardly available and therefore moths are unable to take independent decisions about their infant’s and their own health care. The main course of data being used for this study in the Pakistan Contraceptive Prevalence Survey (PCPS) the findings of this study indicates that the working mother has lower child mortality rate risks than mother engaged in family business or working as housewives. This study also concluded that in case of maternal and child health care, mother’s education emerged as an important variable. In case of child immunization, father’s education emerged as a strong factor.
Afzal (1992) examines that in less developed countries where most of the world population lives, the rapid decline in mortality with little reductions in fertility, under the conditions of under developments, nutritional deficiencies, insufficient converge of health, inadequate sanitation and safe water facilities, has been contributing to the increasing number of disable persons. This is because the availability of modern medicines, even to an inadequate extent, has contributed to the reduction to the mortality, but many of those who survive become permanently disable. The data collected from the census or surveys in Pakistan provide the number of disabled persons according to the concepts used in each source, classified by their age-sex characteristics. The present study found that demography of disability is a relatively new field of interest in the world. The primary reason for this interest is the increasing number of disable especially among the growing proportion of elderly population in developing countries and the increasing prevalence of disabilities resulting from wars and human conflict.
The relationship between health an economic development of a country can’t be over emphasized. Governments is aware of the fact that economic growth and development of the country require sound and sustained health programmes/policies. National program on Family Planning and Primary Health care was initiated in 1994, with the objective to provide basic health care package to community, specifically rural community. A bulk of LHWs is deployed through national program which is 93,208 during the year 2006-07. women health project (WHP) has provided 8000 LHWs during the years 2002 to 2005. National Aids Control Program aims to control HIV/AIDS. By the end to of 2006, the total member of HIV cases tested positive was 372. the total No. of deaths caused by HIV/AIDS is 165 up. Government has been implementing a 5 year National AIDS control Programe since 2003. this program was approved at the cost of Rs. 2,858 million. Tyhie estimated annual cases of all type of TB is 177/100,000 population, hence, 250,000 are added to the tell of TB patients in the country by the year 2006 the absolute member TB patients was 76,668 as compared to 97,668 in year 2004. the TB control program was revived in the year 200. in a medium term plan (2005-2010) TB Control program has been approved at the cost of 1.180 billion, main achievement of the program during 2006-07 is development of National Reference Laboratory. In Pakistan Malaria has been a major public heath problem threatening the heath of the people due to prevailing socio-economic conditions. A program Roll Back Malaria (RBM) was launched in 2001 to control malaria. National Program for preventions and control of blindness (2005-2010) has been launched at a total cost of Rs. 2.77 Billions. The Program was approved in August 2005. another program for the prevention and control of Hepatitis was launched in 2005. it the year 2006-07 Rs.450 millions has been allocated for the program. For year 2006-07 vaccination of 120,000 high rish segments of population have been planned with the cost of Rs, 30 million. During 2006-07 another hospital have been identified for provision of requester facilities with a cost of 150 million. (Pakistan Economic Survey 2006-07)

Zaida (1987) presented the theme “Health for All” which will effect not only the 130 million people of Pakistan in year (2000), but their Generations come given the social and economic conditions, ant the pattern of diseases in Pakistan, the primary health care approach is the viable one to reach the goal of health for all. The PHC approach is a radical approach, which attempts the change the exiting inequitable health system and brings it is line with the requirements of the majority of the 130million. Zaba A sitar (economist) agreed with zaidis’ conclusion that Pakistan will not achieve health for all by the year 2000 but not with has premise that, not with standing, radical socio-economic changes, this goal is impossible.

Ali and Mahmood (2002) examined that prevalence and incidence of disease among different sub groups of population and see what type of disease are common among children, adults and older population. The study also an examination of health seeking behavior person. Cost of treatments and income level of house hold. The analysis in this study is based on the data of Pakistan socio-economic survey. The total size of the house holds was 3564. the method is use to access the disease prevalence, its pattern and services facilities. These proportions give useful insights into the variation and differential of each issue. Health care facilities in Pakistan are largely confined to urban areas and services delivery is of varying quality and curative in nature. With the expansion in physical infrastructure in health sector, the number sieves provider’s staff has also increased significantly. Precise estimates of the number of health personal in each care are difficult to obtain because of their varied distribution in the public and private sector and adequate registration of health manpower. The utilization of health services and preferences of people to sue certain facilities are not only determine by easy accessibility and good duality if services, there economic level of household and costs of treatment appear to be equally important factor. The conclusion of shay study was that about 23 percent of those reported ill do not seek any health services with the two major reasons cities as “ no money” and “no need” to visit a facility. It is also concluded that is tis not merely the access or variability of services that effect people’s health seeking behavior, it is more due to priority and apathy or causal attitude towards heath atha restrain them from visiting and healthy facility.

Siddiqui and Mahoom (1994) stated that analysis of health status is important aspect f human resource development improvements in health do not only improve the productivity of the labor force the also help ot improve the impact order forms of human capital formation e.g. educations. In most developing countries health stutus in difficult to determine as a question arises as to what measures should be used as indicators of heath status. In case of health status micro and macro measures may not be perfectly correlated. In most cross-country studies life respecting at birth or the infant mortality rate are taken as indicator of heath status. Other measures are age and disease specific mortality or morbidity and if expectancy. The comparison of health indicators showed substantial improvement in the health status of people living in the developed and developing countries. A manifestation of this improvement in the health status in the rise in the level of life expectancy at birth declines in infant mortality. In this study the objective is to explore the determinants of health status in the developed and developing countries during 1960, 1970 and 1990. He examined the existing levels and trends in life expectancy at birth infant mortality rates and other socio-economic variables. Results shoed that during recent years GDP per capita has become and important factor in improving health status in low income countries and high income countries. The affect of health expenditure in negligible and it has not changed over time. Urbanization affects life expectancy positively in earlier years but the effect in not statistically significant variable, affecting health statures during 1960 and 1990. the results also showed that the effect of changes is GDP is higher in LICs implying a stronger impact of changes in GDP in the LIC as compared to the HICs. The predicted values of life expectancy are 52.43 years and 64.73 years for LICs and HICs respectively, similarly predicted values of the infant mortality rates are 129.60 and 38.34 in LICs and HICs respectively.

Zafar (1998) finding that health are closely liked to literacy, knowledge of hygiene, access to clean water, good sanitation and the family planning information. Improving women’s education will held to reduce the country’s high under five and infant mortality rates, since improved care by mothers could assist in earlier detection and treatment of health problems. Heath education is an important component of primary training to their graduates to address the key public heath issues. There is a dire need to introduce such training in all medical school. It also fined that NGOs are very active in the heath sector.

Numberous NGOs work in the area of mother and Child care are especially experienced in assisting with basic heath care, breast feeding preparation of weaning food, and identification childhood diseases.

Zahid (1996) examine that child mortality rate in Pakistan is the highest amongy children of mothers ages less than 20 years. Similarly, infant and child mortality rate is higher among first and higher-order births than among births second or third order. It also long that reduction in neonatal, infant and child mortality is the education of mother. Other important factors include and ten natal care, place of delivery, assistance at delivery and immunization.

Muhbub-ul=haq Human Development Center Report (2004) repotted that the lady heath worker programme of Pakistan, with its success in creating a large organization of female community health workers the programmed, stated in 1994 with aim of improving the access, especially a rural poor, the primary health care services by delivering primitive , preventive and curative services at the doorsteps of people the services provided by LHWs include the provision of health education and health promotion informing and motivating the clients on family planning, and educating them as how to improve their health and hygiene. By 2003-04, the total number of LHWs rose to 70,000 with 2,300 supervisors serving almost 63 million people the study finds that in LHWP area health statutes of mother and children was better than other areas. It also finds that LHWP ahs also played and important role in women’s empowerment by creating jobs opportunities for rural women.

Dran and Simam (2006) examined the effect of life expectancy on economic growth. This study obtains estimate of mortality by disease before 1940s from the league of Nations and national public health sources. By using this data, they constract and instrument for change in life expectancy, referred to as predicted mortality, which is based on the priervenation distribution of mortality from various diseases around the world and dates of global interventions. This study predicted that mortality has a large aren robust effect on the changes in life expectancy staring in 1940, but no effect on changes in life expectancy before the intervention. This study investigates the effect of life expectancy at birth as a general measure of the heath of population on economic growth. The result of this study indicates that the increases in life expectancy led to significant increase in population; birth rates did not decline sufficiently to compensate for increase in life expectancy. The study find that a small initial positive effect on life expectancy on total GDP, and this effect grows somewhat over the next 40 years, but not en enough to compensate for the increases in population.
Siddiqi, Usman and Rashda (1995), discussed the determinants of expenditure on health in Pakistan. In this study they examine the determinants of health resources for a single country i.e Pakistan. They analyzed the effect of soci-economic factors on health resources which ultimately affect the health status. The socio-economic factor include Gross national product, Per capita, education and urbanization. Health resources included physicians, nurses, hospital beds and public health expenditure per capita. In Pakistn although the health status has improved significantly over time, yet it is far below the international standards. On the basis of life expectancy, Pakistan is ranked 9th in the group. The main objective of the study is to test the hypothesis that change in socio-economic factor alone are sufficient to formulate policies regarding the provision of health requirement of Pakistan growing population. Time series data is used for the analysis.

Arif (2004), examines the health status of Pakistan children by using two important indicators, morbidity and malnutrition measured by weight-for-age and height for age children malnutrition is multi faceted problem in the nutritional status of children depends large on food, health and medical care. The main data sources used in the study is the 2000-01 Pakistan social economic survey (PSES), which provide sufficient information on children health and poverty. The findings of this study reconfirmed the positive role of mothers education with respect to children health. This study also found that the role of mother’s education is improving child health is more pronounced in poor families than in non poor families. This study also finds that the present health system in Pakistan has not provided services to adequately meet the requirement of the population, particularly the children. At present health and nutrition sector is getting only 0.7% of the GNP.


Akram and Khan (2007), carried out to measure the incidence of government spendings on health in Pakistan at provincial, both rural and urban level. The used the primary data of the Pakistan social standard living measure survey (PSLM), 2004-05, and used the three step benefit incidence approach (BIA) methodology. It also examined the nation policy emphasizing the health services as well as the trend in access to public sector spending on health care facilities in Pakistan. The study explore the inequalities in resource distribution and service provision against government health expenditure. The study find that the rural area of Pakistan are the more disadvantaged in the provision of the health facilities and expenditures in health sectors are overall regressive in rural Pakistan as well as provisional and regional levels. Mother and child subhead is regressive in Punjab and general hospitals and clinics are regressing in all provinces. The study also finds that only the preventing measures and health facilities sub sector is progressive in Pakistan. Public health sector are pro-rich in Pakistan

Chapter 3
Methodology and Data
31. Introduction
This chapter explains the methodology and data, which is used to detect the role of health sector development in life expectancy for the analyzing the methodological concentration is focused on the health sector. The below 3.2 section gives us information about the framework of analysis and model used to get the regression results.

3.2 frame work analysis
We have used a simple linear regression model by using ordinary least square technique to show role of health sector development in life expectancy through some important factors and their impact on overall Pakistan economy. To achieves this objectives, we have formulated following model.



3.3 explanatory variables
Ht = Physical development in health sector. It includeds number of hospitals.
RDt = services development in health sector. It includes number of registered doctors
IMRt = Infant mortality rate
EXPHt = Expenditure on health sector as a percentage on GNP
PQLIt = Physical qulity of life index
Estimated model

LE = f( H, RD, IMR, EXPH, PQLI )

Econometric form of model

Let = α0+ α1Ht+ α2RDt+ α3IMRt+ α4EXPHt+ α5PQLIt+Ut

Data Explanation
In this study we have used secondary data. the time period this study is extended for 1960-2008. The data for this study has been taken from economic survey of Pakistan, Fifty years of Pakistan statistics, annual report of social policy and development center, health indicator of Pakistan Gateway paper 2 by saima nishter, united nation reports and other national and international publications, physical quality of life index paper by Dr. Sardar Javed Iqbal khan.

Chapter 4
Results and discussion
Health is an important aspect of human life. It is a basic requirement, and essential for the survival of all human beings. Health plays an important role in determining the human capital. Better health improves the efficiency and productivity of the labor force; it ultimately contributes to economics growth and leads to human welfare. Improving health around the world to day is important social objective in all the societies, health sector is a major source of employment and also affects the lives of all citizens. In every developed and industrialized country, it consumed significant a proportion (6-12%) of their Gross National Product as well as places increasing stress on government allocation budgets. In developing countries, health care is estimated to consume two percent or less of GNP. As in the profile of the developing countries, Pakistan has in the past given a low priority to the development in the social sector which is reflected in the low human indicator of the country. The health sector of Pakistan is riddle with numerous problems, contradiction. As concerned the health facilities one can analyze from own point of view. Health care facilities in Pakistan are concentrated mostly in urban areas in low risk of death from infections and diahorea diseases but the rural area of Pakistan suffer from insufficient health facilities i.e. shortage of trained medical persons, inability of medical graduates to work in simple rural settings and their dependence on “sophisticated” technology of pharmaceutical companies enriching themselves at the expense of common man, and adequate sewerage in slums and rural areas.
LE = f( H, RD, IMR, EXPH, PQLI )
Let = α0+ α1Ht+ α2RDt+ α3IMRt+ α4EXPHt+ α5PQLIt+Ut
Variable
C0-efficient
Std-error
t-statics
Prob.
αo
23.60
6.0417
3.9074
0.0003
Ht
0.026
0.0042
6.2356
1.66E-07
RDt
-7.3 E -06
6.38E-06
-1.425
0.2595
IMRt
0.10298
0.0316
3.2541
0.0022
EXPHt
4.4669
2.1724
2.0562
0.0458
PQLIt
4.908312
1.1028
4.4506
5.98E-05


R-Square = 0.9538
Adjusted R-Square = 0.948

















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