Health Service Delivery Analysis,

Hospital & Health Workforce

Masterplan
Ms Frances Ng
13th February 2018, Pearl Continental, Peshawar
Why Master Plan?
• Long term technical planning document(s) with system-wide approach
• Demonstrates strategies and outcomes are linked to upstream policies,
priorities and targets
• Long lead times for human resource and hospital developments
• Further increases coverage, access and utilisation of health services
• Recognition of incremental upskilling and technical improvements in
hospital care
• Resource requirements by districts vary due to variations in current state
• Considers other sectors – not for profit and private providers
• Facilitate objectifying prioritisation process for capital and recurrent
allocation
 Population Thousands

Population Growth
10,000

15,000

20,000 17,736

25,000

30,000

35,000

40,000

45,000

50,000
C 1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
E 2014
E 2015
E 2016
Year

30,364

C 2017
2018
2019
33,472

P 2020
2021
2022
2023
2024
37,409

P 2025
2026
2027
2028
2029
41,345

P 2030
2031
2032
2033
2034
45,282

P 2035
 Population

District-wise Population Growth

1,000,000
2,000,000
3,000,000
4,000,000
5,000,000
6,000,000
7,000,000
-
Abbottabad
Bannu
Batagram
Buner

2015
Charsadda
Chitral
Dera Ismail Khan
Hangu

2035
Haripur
Karak
Kohat
Kohistan

Average annual increase (%)

Lakkimarwat
Lower Dir
Malakand Protected…
Mansehra
Mardan
Nowshera
Peshawar
Shangla
Swab
Swat
Tank
Upper Dir
0.0%
0.5%
1.0%
1.5%
2.0%
2.5%
3.0%
3.5%
4.0%

Annual change (%)

Current State
400 1,344 19,000

350 983 1,157 18,000

1,103 1,103 17,070
300 16,619 16,403 17,000
1,069
250 15,764 15,764 16,000
1,428

Hospital Beds
Hospitals

14,951
200 72 15,000
13,912 33 50
34 34 36 36
150 14,000

100 13,000
143 147 147 157 157 166
138
50 12,000

0 11,000
2010 2011 2012 2013 2014 2015 2016
Government Hospitals Private Hospitals Government Hospital Beds Private Hospital Beds
Current State Analysis
35%
30%
25%
20%
15%
10%
5%
0%

Population Beds Doctors Nurses Paramedical Staff

Demand Modelling: Admitted Hospital Care
Obstetrics
Orthopaedics
Respiratory Medicine
Perinatology
ENT; Head & Neck
Gastroenterology
Gastrointestinal Surgery
Psychiatry
2020
General Medicine
Urology 2035

0 50,000 100,000 150,000 200,000 250,000 300,000 350,000 400,000

Demand Modelling: Specialist Medical
Practitioners
General Practice & Primary Care
Hospital Generalist
Anaesthesia
Psychiatry
Emergency Medicine
Paediatric Medicine
Medical Imaging
Obstetrics & Gynaecology 2020
General Surgery
2035
General Medicine

0 2,000 4,000 6,000 8,000 10,000 12,000 14,000 16,000 18,000

Gap Analysis for Service Delivery: Admitted
Hospital Care
• Current and prevailing gap in acute hospital services province-wide

4,000,000

3,000,000 2,835,151
2,327,793
1,887,971
2,000,000 1,526,878
Admitted patients

1,215,481
1,000,000 784,330

-1,000,000 -431,151
-742,548
-1,103,641
-2,000,000 -1,543,463
-2,050,821
-3,000,000
2015 2020 2025 2030 2035
Estimated Supply Demand Gap
Gap Analysis for Service Delivery: Hospital
Beds
• By 2020, to provide the required services of the population the current supply of hospital beds in public and private
facilities is insufficient, and short by 1,500 beds
• Capacity gap worsens into the future to almost 6,000 hospital beds by 2025, and to 17,500 by 2035.
40,000 35,915
29,665
30,000 24,251
18,414 19,959
20,000 17,080
Hospital beds

10,000
1,334
0
-1,545
-10,000 -5,837
-11,251
-20,000 -17,501
-30,000
2016 2020 2025 2030 2035
Supply Demand Gap
Gap Analysis for Service Delivery: Renal
Dialysis Places
• Province-wide a shortage of renal dialysis places currently, expected to grow dramatically due to the burden of disease in
the region
1,500
1,182
1,000 903
680
429 510
500
Dialysis Places

136
0

-500 -293 -374

-544
-1,000 -767
-1,046
-1,500
2017 2020 2025 2030 2035
Supply Demand Gap
Gap Analysis for Service Delivery: Outpatient
Care
• Current and prevailing gap in outpatient visits province-wide

500,000,000
400,000,000 370,502,422
319,380,672
300,000,000 274,320,803
Outpatient consultation

233,159,170
195,728,240
200,000,000
106,389,200
100,000,000
0
-100,000,000
-89,339,040
-200,000,000 -126,769,970
-167,931,603
-212,991,472
-300,000,000 -264,113,222
2015 2020 2025 2030 2035
Estimated Supply Demand Gap
Priority Setting
• Development of hospital bed capacity in Malakand and Mardan Divisions
of Category A and B type hospitals
• Program of delivering two Category A-sized hospitals, three Category B-
sized hospitals, seven Category C-sized hospitals or alternative combination
to deliver between 700 to 900 public hospital beds annually across KP
• Upfront investment in upscaling dialysis services across hospitals be made,
with existing renal dialysis unit
• Deliver an additional thirty to forty dialysis machines across hospital
facilities each year
• Tertiary education facilities (both public and private) are equipped to
educate and train a minimum of 2,000 medical graduates, 5,000 nursing
personnel and equivalent allied health practitioners annually