title: The district health system: a challenge that remains.
abstract: The health care system in Pakistan has been confronted with problems of inequity, scarcity of resources, inefficient and untrained human resources, gender insensitivity and structural mismanagement. With the precarious health status of the people and poor indicators of health in the region, health care reforms were finally launched by the government in 2001. There are, however, numerous challenges and constraints in the system. The future health of the nation depends on this decentralization initiative. All our efforts should be concerted to support and facilitate the new system, which will mature into institutionalization of the health services at the district level. Most importantly, it will help in strengthening the primary health care services catering to the major fraction of the population. Besides political commitment, we ought to maintain attitudinal, behavioural and cultural conditions conducive to letting this system flourish.
authors.affiliation: Health Systems Division, Department of Community Health Sciences, Aga Khan University Karachi, Pakistan.
authors.forename: B T
authors.initials: BT
authors.lastname: Shaikh
authors.forename: F
authors.initials: F
authors.lastname: Rabbani
mesh_terms: D001294:Attitude to Health; D019985:Benchmarking; D003153:Community Health Services / Q000458:organization & administration*; D003659:Decision Making, Organizational; D003906:Developing Countries; D017598:Efficiency, Organizational; D018166:Health Care Reform / Q000458:organization & administration*; D006291:Health Policy; D006297:Health Services Accessibility / Q000458:organization & administration; D006301:Health Services Needs and Demand; D006304:Health Status; D006801:Humans; D009313:National Health Programs / Q000458:organization & administration*; D010154:Pakistan; D011057:Politics; D011209:Power, Psychological; D011320:Primary Health Care / Q000458:organization & administration*