1. Donor Meeting: Health Update 14 th June, 2011

2. Health Sector Response Total Beneficiaries – estimated 25 Million Total Funds Used – US$ 156 Million Activities: ◦ Communicable Disease Surveillance and Response ◦ Essential Medicines ◦ Health Sector Partners Operations ◦ Disease Case Management - targeted 24/7 ◦ Logistics, Coordination and Information Management ◦ Laboratories ◦ Social Mobilization ◦ Special Needs (Malaria, Leishmaniasis) ◦ Vaccines (gap filling) 2

3. 18 th Amendment & Devolution MAJOR COMPONENTS All 10 vertical programs devolved ◦ Federal government will provide funds till 2014 National EPI program devolved ◦ Federal government will provide funds till 2011 Only Strategic guidelines and minimum essential standards will be maintained by federal level

4. Disrupted Health Systems No Health and Nutrition Policy and Planning Regulatory body at the federal level Planning for vertical programs continue at the federal level Disrupted health system - issues in health system at the provinces due to devolution: ◦ Policy/Strategy Formulation ◦ Financing ◦ Human Resources ◦ Pharmaceutical Areas ◦ Health Service Delivery ◦ Management Systems ◦ Equity

5. Pakistan Health Budget 2011 - 12 Budgetary allocation for health is nearly 15% less than that of the last year ◦ Not more than 0.5% of GDP for health (for most developing countries is 5%) No allocation for the prevention of disease outbreak ◦ Epidemics of malaria, dengue, hepatitis and several other communicable diseases. ◦ TB ranks at 8 in 22 “high burden” countries ◦ Top on the polio list in the region/world YearPer Capita for HealthComments 2001US$ 17/capitaTarget Achieved 2007US$ 34/capitaTarget NOT Achieved 2010US$ 18/capitaInclusive of humanitarian interventions 2015US$ 38/capitaTarget

6. Communicable Disease Surveillance and Response (CSR):  Disease Early Warning System  Biggest: Weekly reporting system: 42 weekly bulletins published 76 Surveillance Officers 95 districts / 3 agencies (67 partners) Averages 1m total consultations / week more than 3,000 health facilities 29 million consultations since the Floods Shared in Cluster Coordination One of the best response systems in the world: Integrated, Sensitive, Prepared, Responsive Integrated Communicable Disease Surveillance:  Water-borne diseases (diarrhea, AWD, dysentery, typhoid, hepatitis A&E),  Vector-borne diseases (malaria, dengue, Leishmaniasis)  Vaccinable diseases (polio, measles, pertussis, diphtheria, tetanus) Sensitive: Since Flood, detected 1783 alerts;  Now, more than 100 alerts per week Prepared: Trained >3,000 HCPs including experts for ARI, ◦ 65 DTC Rapid Response Teams  Essential Medicine, supplying diarrhea kits, ARI kits, RDT, ACT, ADS, Ribavirin, TIG Responsive:

7. 7 DEWS Response  Responded to 90% alerts within 24 hrs  738 Measles Alerts, 69 outbreaks 65 deaths were recorded out of 2108 cases (CFR 3%)  326 AWD Alerts, 110 outbreaks with confirmed V. cholera  363 Samples172 + (47%) V. cholera (47%)  Estimated 69,000 treated cases of diarrhea with some level of dehydration at DTCs (64 deaths, CFR 0.1%) Punjab Baluchistan Sindh KP

8. Environmental Health  Tested 3,500 water sources >85% contaminated  1,250,000 individuals reached - provided household treatment: ◦ Aqua tabs, Hygiene Kits, water filters, Chlorinators, rapid water testing kits, ◦ Wagtech portable water testing kits for TMAs/PHED and DOH  Trained 1,416 personnel

9. Details for Grants and Demands of Health Components Under 2011 – 2012 Federal Budget (Planning Commission) Contraceptive Requirement and Distribution (CRD) 477,035,000 National Program for Family Planning & Primary Health Care8,000,000,000 National Maternal, Neonatal and Child Health Program (MNCH)2,280,833,000 Expanded Program on Immunization (EPI), Control of Diarrheal Diseases (CDD), NIH 2,716,261,000 Enhanced HIV/AIDS Control Program246,932,000 Roll Back Malaria Program123,466,000 National TB Control Program123,466,000 National Program for Prevention and Control of Blindness246,932,000 National Program for Prevention and Control of Avian Pandemic Influenza 37,040,000 Prime Minister’s Program for Prevention and Control of Hepatitis600,000,000 Strengthening National Tuberculosis Control Program81,488,000 Grand Total (Pakistani Rupees)14,933,453,000

10. Pakistan Health Budget 2011 - 2012 Total Health Expenditure in PKR2,646,000,000Percentage Medical products, appliances and equipment00% Hospital Services2,435,000,00092% Public Health Services140,000,0005.35% Research & Development Health00% Health Administration70,000,0002.65%

11. Funding for Health USD Capacity Building and Provincial Technical Support in the Devolution Process (18 months) 42,000,000 Outbreak Response Contingency Planning (includes cholera outbreak response July 2011/ 6months) 9,500,000 Relief Funded Stock Available(3,950,000) Total Funding Gap$47,550,000