Pakistan’s health sector, historically neglected and underfunded, has long been plagued by poor indicators, inadequate services, and widespread dissatisfaction.
With health spending hovering around a meager 1 per cent of GDP, the sector has rarely been given the policy space it deserves in national discourse. Yet, against this backdrop of inertia and underachievement, a remarkable transformation has taken place, one leader has emerged as a beacon of hope.
Enter Dr Nadeem Jan, a professional with an impressive track record both nationally and internationally, who took the helm of the federal health ministry in an interim setup. His appointment was like a breath of fresh air, heralding a new dawn for Pakistan’s health sector. Dr Jan brought with him not just experience, but a clear vision, unyielding commitment, and a determination to deliver meaningful reform.
On his very first day in office, Dr Jan boldly declared, “I have come with a plan and will actualize it in whatever little time we may have.” His ambitious goals were met with skepticism by the bureaucracy, which had seen countless ministers come and go with little to show for their time in office. Many dismissed his plans as yet another set of lofty promises that would never materialize.
However, Dr Jan quickly proved his detractors wrong. His leadership set a new standard for governance and public service delivery, one that was not only economical but also accessible and widely accepted. He outlined three key objectives: to reform the health sector, to leverage health as a driver of national economic growth, and to enhance the dignity of Pakistan on the global stage.
One of his most ambitious initiatives was the digitalization of the federal health ministry and its associated institutions. This move, which many thought impossible in such a short time frame, was a testament to his commitment to transparency, efficiency, and modernization.
But perhaps the crowning achievement of Dr Jan’s tenure was the successful organization of Pakistan’s first “Global Health Security Summit.” This landmark event brought together more than 70 national and international ministers, experts, ambassadors, and senior figures from the global development community. The summit, which focused on pandemic preparedness, response, and vaccine equity, produced a global charter that was hailed by both the Global North and South. The charter included groundbreaking strategies such as the “Sovereign Pandemic Financing Facility,” a concept that shook the global health community.
Dr Jan’s influence extended far beyond Pakistan’s borders. During the COVID-19 pandemic, he introduced the slogan “No one is safe until everyone is safe,” a mantra that was adopted by nations and international organizations worldwide. Now, with his new slogan, “Together for a Healthy Planet,” he has once again united countries across the globe in the fight against future health catastrophes.
The summit not only positioned Pakistan as a key player in the global health sector but also significantly enhanced the country’s international image. Remarkably, the event was organized without any expenditure from the government, a feat that speaks volumes about Dr Jan’s leadership and resourcefulness.
In just a few short months, Dr Jan oversaw the rehabilitation of 500 health facilities without a single penny from the government treasury. This extraordinary achievement is a testament to his appetite for quality and prompt delivery, as well as his ability to inspire and mobilize resources.
Dr Nadeem Jan’s brief yet impactful tenure as the head of Pakistan’s federal health ministry ushered in a new era of governance, characterized by unprecedented transparency, efficiency, and accountability. His leadership set a precedent in public service, particularly in the health sector, where reforms were urgently needed. The governance model implemented under his leadership can be categorized into several key aspects, each contributing to the overall transformation of the health sector in Pakistan.
A. MINISTERIAL REFORMS
Digitalization for Accountability and Efficiency:
To enhance accountability, transparency, and ease of doing business, Dr Jan spearheaded the digitalization of all ministerial functions. This shift towards a more transparent system allowed for better tracking of performance and streamlined operations within the ministry.
Real-time Data Integration:
A data-integrated dashboard was installed in the ministry, enabling real-time collection, analysis, and review of key health indicators across the country. This technological innovation allowed for data-driven decision-making and timely interventions.
Merit-Based Appointments:
To promote merit and transparency, a Placement and Promotion Committee was established. This committee ensured that all appointments and promotions within the ministry were based on merit, reducing the influence of discretionary powers and favoritism.
Internal Accountability Mechanisms:
An Accountability and Internal Audit System was introduced, along with a high-powered committee and an Employee Grievance Cell. These measures provided a platform for addressing grievances and ensuring that all actions within the ministry adhered to high ethical and performance standards.
Global Expertise in Health and Nutrition:
An independent “Health and Nutrition Advisory Council” was created, comprising top health experts from around the world. This council provided the ministry with advice on best practices in patient care, nutrition, health systems, and governance, ensuring that global standards were met.
Interministerial Coordination:
An Interministerial Task Team, consisting of provincial and federal ministers, was established to harmonize decision-making and coordinate health interventions across the country. This group became so efficient that meetings were held on 12-hour WhatsApp notices, resolving longstanding federal-provincial controversies and improving fund allocation and monitoring.
Donor Coordination Platform:
A platform for donor coordination was created and functionalized, ensuring that all international aid and funding were effectively managed and aligned with national health priorities.
B. ENHANCING HEALTH FUNDING
Dr Jan adopted a four-pronged strategy to boost health sector funding and contribute to the country’s economic growth:
Boosting Exports of Medicines and Equipment:
Under his leadership, exports of medicines increased by 300 per cent, from $337 million to $1 billion, significantly contributing to the national economy.
Plasma Farming and Medical Tourism:
Initiatives such as plasma farming and medical tourism were introduced to create new revenue streams for the health sector.
Self-reliance in Medicines:
Dr Jan focused on achieving self-reliance in medicines by promoting the production of Active Pharmaceutical Ingredients (APIs) and initiating vaccine manufacturing within Pakistan. A consortium of key pharmaceutical and business enterprises was created, and meetings were held with Indonesian and Chinese firms for technology transfer.
Securing International Funding:
In a short time, Dr Jan secured $1 billion from donor funds, with another $1 billion from the Global Fund in the pipeline. Additional funds included $5 million from JFF, $150 million from various donors for nutrition, and a $100 million matching fund from the Child Investment Foundation for nutrition initiatives in Pakistan.
Universal Health Coverage:
A $438 million National Health Support Program was initiated to ensure universal health coverage in public sector health facilities. This program aimed to make quality healthcare accessible to all Pakistanis.
Polio Eradication Funding:
Dr Jan also secured $150 million for the Polio Program from the Bill & Melinda Gates Foundation (BMGF), Islamic Development Bank (ISDB), and the French Development Agency, furthering efforts to eradicate polio in Pakistan.
C. ACCOUNTABILITY AND TRANSPARENCY IN THE HEALTH SECTOR
Transparency and Accountability Cell:
Dr Jan established a Transparency and Accountability Cell within the federal ministry, staffed by senior professionals and equipped with advanced technological tools. This cell was responsible for scrutinizing and monitoring the performance management system, conducting independent reviews of programs, hospitals, and projects, and evaluating the ministry’s staff.
Internal Audit System:
An Internal Audit System was launched to ensure that all associated institutions and functionaries observed high performance and ethical standards. This system not only conducted financial audits but also reviewed performance and grievances.
Merit-Based Placements and Promotions:
A Placement and Promotion Committee was instituted to replace discretionary powers with a broad-based, technical, and systematic approach. This ensured that all postings, transfers, and promotions were evidence-based and merit-centric.
Resolving Employee Grievances:
The Transparency and Accountability Cell played a crucial role in resolving a backlog of 850 pending employee cases within the ministry. The swift and fair resolution of these cases, some pending for five years, sent a wave of relief and satisfaction among the staff.
D. ADVANCEMENT OF MEDICAL AND PARAMEDICAL EDUCATION SYSTEM
Standardization of Service and Fee Structures:
Dr Jan introduced a star ranking system for private hospitals, clinics, and laboratories. This initiative aimed to standardize service quality and fee structures, curbing exorbitant charges and ensuring better service delivery across the board.
Affordable Medical Education:
The fee structure of private medical colleges was revised to make education more affordable. A 5 per cent quota for free medical education for underprivileged students was established, empowering the Islamabad High Court (IHC) to enforce these changes without ministry interference.
Establishing Standards and Protocols:
For the first time, standards and protocols were developed for the Pakistan Medical and Dental Council (PMDC), Nursing Council, and Pharmacy Council, ensuring uniformity and quality in medical education and practice.
WFME Accreditation:
Dr Jan led the accreditation of PMDC with the World Federation for Medical Education (WFME), a significant achievement that enhances the value of Pakistani medical degrees. This accreditation opens up more opportunities for Pakistani students abroad and aligns the country’s medical education with global standards, particularly in comparison to neighboring countries like India.
The WFME accreditation also promises to improve nursing and paramedic education in Pakistan. It ensures that educational institutions meet global standards, thereby enhancing the credibility and international recognition of Pakistani healthcare professionals.
Structural and Management Reforms in PMDC:
Structural reforms were initiated within PMDC to eradicate corrupt practices and standardize the process for Pakistani students pursuing medical education abroad. A No Objection Certificate (NOC) system linked to PMDC was introduced to regulate and support these students.
Alignment with International Best Practices:
By aligning PMDC’s regulations with international standards, Dr Jan’s reforms improved curriculum design, teaching methodologies, clinical training, and assessment practices. These changes ensure that graduates are well-prepared to meet the evolving healthcare needs of the population.
Nursing Council Reforms:
Recommendations were provided to the Nursing Council to update standards, regulations, and initiate proper accreditation of nursing schools. These reforms have since been adopted, further improving the quality of nursing education in Pakistan.
E. IMPROVEMENT IN HEALTH SERVICE DELIVERY
Essential Health Services Package:
An essential health services package was rolled out, with standards developed for its implementation.
Rehabilitation of Flood-Damaged Facilities:
In a record three months, 500 health facilities damaged by floods in Punjab, Sindh, Balochistan, Khyber Pakhtunkhwa, and Gilgit-Baltistan were rehabilitated at zero cost to the government.
Solarization of BHUs:
400 Basic Health Units (BHUs) were solarized to ensure uninterrupted service delivery in remote areas.
Installation of Modern Medical Equipment:
State-of-the-art eco-friendly incinerators and MRI machines were installed in Islamabad.
National Health Initiatives:
Programs for the control of Hepatitis C and diabetes were launched, along with the Mental Health Support Program (MHSP), which included the launch of the 1166 Humraz phone line.
Innovative Health Services:
The Masjid Health Clinics pilot was initiated at Badshahi Masjid in Lahore. Additionally, HPV vaccines were introduced, and the national health system was bolstered with mobile vans, motorcycles, and ambulances from donor contributions.
International Contributions:
Diplomatic efforts resulted in a gift of 10 dialysis machines from Iran, which were installed in resource-deficient hospitals in Balochistan. An international charity was also persuaded to donate $5 million worth of multivitamins for pregnant and lactating women in Khyber Pakhtunkhwa and Balochistan.
Crisis Management in Federal Hospitals:
Faced with financial distress in federally run hospitals, Dr Jan conducted a thorough budget review, reallocating underspent funds to meet essential needs such as medicines, commodities, and salaries, thus averting a potential shutdown.
Tobacco and Sugary Beverages Legislation:
A ban on tobacco use in the Kohsar Complex was implemented, and legislation for increasing taxes on tobacco and sugary beverages was initiated.
One-Patient ID System and Hospital Digitalization:
The introduction of a one-patient ID system and the digitalization of hospitals promises to modernize Pakistan’s healthcare system. This initiative is expected to improve patient outcomes, streamline healthcare services, enhance access to care in remote areas, and facilitate data-driven decision-making.
SDG Midterm Review:
The Ministry of NHSR&C collaborated with the Ministry of Planning, Development & Special Initiatives to conduct a midterm review of the Sustainable Development Goals (SDGs), ensuring alignment with national health priorities.
Universal Health Coverage Monitoring:
The Pakistan UHC Monitoring Report 2023 was developed, approved, and disseminated, providing a ranking of provinces and districts. A snapshot on the health workforce with national and provincial evidence was also created.
Integrated Disease Surveillance:
With support from the UK Health Security Agency, the implementation of integrated disease surveillance across the country was completed, with all district health data digitized.
Antimicrobial Resistance:
Interventions to combat antimicrobial resistance were scaled up with the support of the Fleming Fund.
Policy Development and Initiatives:
A draft policy paper on the regulation of national associations and organizations working in health, population, and nutrition was initiated. A deworming initiative for children was also launched in collaboration with the International Rescue Committee (IRC).
Mental Health and Disability Initiatives:
Several working group meetings were convened to address the challenges of disability and mental health. A mental health helpline was set up, and efforts to update the national mental health policy were initiated.
National Ulema Conference:
Dr Jan presided over a National Ulema Conference to involve community stakeholders in polio eradication efforts. During the conference, the concept of Masjid Health Clinics was proposed.
Health Workforce Sustainability:
A multi-purpose approach for engaging polio workers in various health workforce cadres, such as Lady Health Workers (LHWs) and Family Planning Workers, was devised.
Establishment of a Pharma Park:
Pakistan’s first-ever Pharma Park is being established to focus on the indigenous production of active pharmaceutical ingredients (APIs). This initiative is expected to enhance self-sufficiency in healthcare, stimulate economic growth, and improve the quality of medicines produced in Pakistan.
Public-Private Partnership with Roche:
A letter of intent was signed with Roche Pakistan to strengthen public-private partnerships for the provision of cancer treatment to patients in Federally Administered Areas.
Reformed Sehat Sahulat Program:
Dr Jan’s vision of “One Country, One Health, and One Health Sustainable Insurance System” led to the reform of the Sehat Sahulat Program. The program now includes Primary Healthcare (PHC), a patient facilitation mobile app, and a robust dialogue for a uniform health insurance policy across provinces.
F. MEDIA MANAGEMENT
Proactive Engagement with Media:
Dr Jan maintained an open and proactive relationship with the media, frequently engaging in press conferences, media talks, functions, and individual interviews to highlight the need for health reforms and investment.
International Media Presence:
He represented Pakistan at international platforms such as COP28, WHO high-level meetings, and the Nutrition Summit, where his interactions were covered by global media outlets like BBC, Al Jazeera, and CNN.
Social Media Growth:
Under his leadership, the Ministry of Health’s social media presence grew significantly, with the Facebook and Twitter accounts’ followership jumping from four thousand to one million.
G. EXTERNAL NETWORKING AND STAKEHOLDER COORDINATION
Global Advocacy for Health:
Dr Jan championed Pakistan’s health agenda on global platforms, raising the slogan of making “Health Apolitical” and steering Pakistan’s priorities at the WHO EMRO Regional Committee and World Health Assembly 2023.
Participation in Global Summits:
He actively participated in the Global Food Security Summit in the UK, engaging with UK ministers and partner organizations.
National Health Support Programme:
Dr Jan engaged with the World Bank and partners (GFF, BMGF, GAVI, and GFATM) to initiate the National Health Support Programme (NHSP) amounting to $432 million.
UK-Pakistan Health Partnership:
The Evidence for Health (E4H) Programme was implemented at the federal and KP levels, with preparations for its launch in Punjab.
Polio Eradication Financing:
Dr Jan secured $155 million in financing for the Polio Eradication Initiative from the Islamic Development Bank, BMGF, and AFD.
Leadership at COP-28:
The Minister led Pakistan’s delegation at the 28th session of the UN Conference of Parties (COP-28) in the UAE.
He played a pivotal role in advocating for the COP28 Declaration on Climate and Health.
Pakistan’s stance on equity-based climate funding, climate justice, and proportionate compensation for vulnerable countries was strongly represented.
Formation of Nutrition Taskforce:
A comprehensive Nutrition Taskforce was established, bringing together all relevant stakeholders.
Under the taskforce, an MMS (Multiple Micronutrient Supplements) Technical Team was created.
Secured a $5 million donation for MMS, which is currently being implemented.
Collaboration with Junaid Family Foundation:
Successful dialogue with the Junaid Family Foundation in the USA resulted in an agreement to manufacture MMS in Pakistan.
Functionalization of the Donor Working Group for Family Planning:
The Donor Working Group for Family Planning was activated, enhancing coordination and support in this critical area.
Engagement with US Ambassador and USAID:
Initiated active dialogue with the US Ambassador and USAID to explore support in nursing education and trauma center development.
The US Government expressed enthusiasm for establishing state-of-the-art nursing institutions and trauma centers in Pakistan, particularly on the Motorway for managing road traffic accidents (RTAs).
Advocacy at UNGA and WHA:
Conducted special side meetings at the United Nations General Assembly (UNGA) and the World Health Assembly (WHA).
Pakistan took the lead in advocating for Global Health Security, pandemic preparedness, and vaccine equity.
Unprecedented Diplomatic Engagement:
Held meetings with 52 Ambassadors, 32 Health Ministers from various countries, and participated in high-level panels on health, nutrition, and family planning.
Set a record for the most diplomatic engagements by any health minister in Pakistan’s history.