Health System Management in Kpk, Pakistan

Research Synthesis: Health System Management in KPK, Pakistan

Dr. Syed M. Ali Shah, University of Southern Queensland

Wajahat Anwar, AAN Associates

28th July 2013, Pakistan.

Constitutional and Legal Framework

The constitutions of 1956 and 1973 envisioned a decentralized federation of provinces in Pakistan. However over the years the division of powers has kept changing with particular emphasis of centralizing power at the federal level citing various reasons under different government and regimes. Between 1955-2010 a consistent erosion of provincial powers took place particularly in their taxing and spending abilities, but also by maintenance of a concurrent list under the constitution which allowed federal government to play an active role in many subjects that had originally been intended to be provincial subjects.

Prior to the 18th Amendment, the Constitution contained two legislative lists—the Federal Legislative List (FLL) and the Concurrent Legislative List (CLL)^[1]. These lists laid out the distribution of legislative powers between the Parliament and the four provincial assemblies^[2]. The Parliament was given exclusive power to make laws with respect to any matter listed in the FLL and both the Parliament as well as the Provincial Assemblies were conferred with the power to make laws with respect to any matter contained in the CLL. Any matter not enumerated in either of the lists fell under the jurisdiction of the Provincial Assemblies^[3].

However on 20 April 2010 the parliament passed a historic and unanimous consensus based constitutional amendment restoring Pakistan’s constitution to its original intent.

18th Amendment

The 18th amendment to the constitution has furthered the devolution process in Pakistan by devolving 44 subjects, in an attempt to increase efficiency, effectiveness and accountability. It brings a major change in structures, service delivery and resource generation between federal and provincial governments. 18 ministries including health, population welfare and other social sectors were removed from the federal portfolio list^[4]. Other key provisions of the amendment include the abolishing of the concurrent legislative list and revision of the Council of Common Interests.

Moving Forward

In theory this devolution seems to be a promising initiative, but there are reservations on its adequacy, in particular on the continuing status of local government as an institution of the Provincial government. It is therefore imperative to review the provisions and amendments to the constitution affecting the critical elements of governance and specifically look at the new distribution of responsibilities under the 18th amendment with potential and opportunities for better governance.

The focus has to be on the performance of the Provincial Assemblies in progressive lawmaking and highlighting landmark legislation for better governance. They also have to identify areas for future legislation in pursuance of public policy, keeping in view the devolved subjects after the 18th amendment.