title: Community context of health system development: implications for health sector reform in Pakistan.
abstract: To describe local sociopolitical and organizational factors that influence health system development in Karachi, Pakistan, we conducted participant observation while working with health providers and communities in one urban district to reorient services towards a primary health care district health system. We found that the community characteristics, particularly the diverse socialpolitical and cultural make-up and organizational complexity that involved multiple levels of government, influenced efforts towards collaboration and shaped the development of the health system. We conclude that for effective implementation of health sector reform there is a need to comprehend fully the community context and complexity of existing health service provision.
authors.affiliation: Department of Public Health, University of Adelaide, Adelaide, Australia.
authors.forename: M A
authors.initials: MA
authors.lastname: Mahmood
authors.forename: J
authors.initials: J
authors.lastname: Moss
authors.forename: R
authors.initials: R
authors.lastname: Karmaliani
mesh_terms: D003153:Community Health Services / Q000458:organization & administration*; D003299:Cooperative Behavior; D003659:Decision Making, Organizational; D018166:Health Care Reform / Q000458:organization & administration*; D006801:Humans; D007373:Interinstitutional Relations; D020380:Needs Assessment / Q000458:organization & administration*; D010154:Pakistan; D011057:Politics; D011209:Power, Psychological; D017149:Private Sector / Q000458:organization & administration; D017150:Public Sector / Q000458:organization & administration; D012111:Residence Characteristics; D019037:Urban Health Services / Q000458:organization & administration*