n Gabral village, nestled amidst snow clad mountains of Swat, stands a basic health unit. Perched atop a hill overlooking the sprawling valley below, the clinic is a lifeline for the local community, providing essential medical services to its residents who would otherwise have to travel long and treacherous distances for basic health needs. It is one of the hundreds of primary care facilities providing healthcare services to the people of Khyber Pakhtunkhwa across a difficult terrain.

Until recently, these facilities were run down, lacking even boundary walls, sitting areas, workplace lights and running water. Critical equipment and emergency medicines rarely met the quality standards. That changed with the introduction of primary care management committees (PCMC) to transfer funds and decision-making to the grassroots level, empowering primary care facilities to cater to their unique needs without waiting for higher tiers of bureaucratic wheels to turn.

A similar concept had existed in the education sector as far back as three decades ago. In the 1990s, Khyber Pakhtunkhwa experimented with the idea of decentralising decision-making at schools through the introduction of parent-teacher councils (PTCs). The PTCs empowered community members, especially parents to improve the educational progress of their children through financial and administrative powers of the councils to spend funds as needed. According to Annual Statistical Report of Government Schools, more than 95 per cent of the primary and secondary public schools have a functional PTC. Over three decades the initiative proved its efficacy, paving the way for a similar approach in the health sector.

83.5 per cent of the population in the KP resides in rural areas. Primary healthcare administrators find the approval process burdensome and tedious. They say they are required to navigate a complex approval process even for minor expenses, such as replacing a light bulb. This, they say, stifles their ability to address even the most basic needs and hinders the smooth operation of these facilities.

Given the PTC success in addressing similar challenges in the Education Department, the provincial government green lit the formation of PCMCs for BHUs, rural health centers (RHCs) and select civil dispensaries (CDs) and hospital management committees (HMCs) in secondary hospitals in 2020. Since then, PCMCs have become functional in more than 80 per cent of BHUs and RHCs in the province. The committees have individual bank accounts to receive funds from the government, donations from donors and philanthropists. They also retain 90 per cent of the user-fee revenue.

By prioritising the needs of local communities, the government can lay the groundwork for substantial improvements in health outcomes.

The committees are empowered to spend funds on repair and maintenance, supplies, service delivery and overall management of the facilities. They can undertake maintenance work using local labour instead of waiting for the Communication and Works Department to go through a long tendering process. They can also hire temporary workers, undertake outreach activities and procure some life-saving drugs.

While primary care facilities are provided with medicines and supplies through the district health officer (DHO), recurring fiscal crunches like the one during the interim government in KP means flow of funds can dry down quickly. Officers in charge of the facilities say the decision to let the PCMCs retain the revenue they generate allowed them to function during the caretaker government when there were no allocations for operations by the provincial government. Some say limiting the PCMCs to the purchase of essential life-saving medicine may be counterproductive.

So far, the PCMCs have spent most of the funds received from the provincial government on infrastructure development. This, however, may be because primary care facilities in the KP had been in a particularly bad shape. If the current and future governments decide to continue with the PCMCs and ensure a steady flow of funds, over time the spending priorities will likely shift away from infrastructure to medicine and equipment.

The apparent early focus on healthcare exhibited by the new government is encouraging. Popular initiatives in healthcare provision during the previous term may have been a factor in the recent electoral victory of the Pakistan Tehreek-i-Insaf. An opportunity exists today to consolidate and maximise the gains by prioritising investment and reforms at the foundation level of the healthcare system: primary care.

Strengthening PCMCs can result in significant improvements with minimal additional resources. By prioritising the needs of local communities, the government can lay the groundwork for substantial improvements in health outcomes. Policymakers must recognise the critical role of the PCMCs and prioritise their strengthening to capitalise on the promising reform initiative.

The writer is a development sector worker. A Fulbright scholar, has a master’s degree from Columbia University, New York. His X handle is @MirSanaullah