6 Review Article Health system analysis: Pakistan and Afghanistan Wais Mohammad Qarani and Samina Iqbal Kanji School of Nursing and Midwifery, Aga Khan University, Karachi, Pakistan Corresponding author: wais.qarani@gmail.com Abstract The purpose of this paper is to analyze the health system of the two neighboring countries i.e. Pakistan and Afghanistan; and recommend strategies to translate the available opportunities into effective actions within the countries. Therefore, the WHO, Health System Framework is used to analyze the Pakistan and Afghanistan health system in terms of; 1) leadership and governance 2) health financing 3) health workforce 4) medical products and technologies 5) information and research and 6) service delivery. Both the countries are having multiple strengths and opportunities in terms of healthcare delivery system. On the other hand, both the countries are affected by multiple challenges including; un-met Millennium Development Goals and un-met national health indicators. Thus, appropriate strategies are required to be developed and executed in order to meet the national need for health. Keywords Afghanistan, Pakistan, Health System, analysis Introduction With an ongoing increase in health challenges globally; health care delivery remains a huge area of concern for many countries. Particularly, under-developed and developing countries are greatly affected due to low socio-economic status and the double burden of disease. Health care systems should address the needs of its population with respect to their unique characteristics and demands, and it should be “population centered” (Starfield, 2009). Therefore, it is very significant to have a defined population-based collaborative health delivery system specific for a country. In addition, according to WHO (2014), a good health care delivery system is essential for achieving the Millennium Development Goals (MDGs) considering the social determinants of health. As an advanced public health nurse, it is essential to recognize and analyze the health care delivery system of our country from multiple dimensions, so that efforts could be made at the national and international level to overcome the actual and potential health challenges. This paper focuses on the analysis of the health care delivery systems of Pakistan and Afghanistan. Health care delivery system of Pakistan Pakistan is sixth populated country in the world with a population of 185 million people (Nishtar et al., 2013). Hence, with the rising population, unfortunately Pakistan was unable to achieve set target indicators. Historically, the delegation of overall health policy decisions and reforms were completely owned and politically influenced by federal government since 1947. However, after the provision of 18 th amendment in 2010, the responsibilities have been decentralized to the provincial level mainly the districts; as federal government was ineffective in fulfilling national needs (Nishtar et al., 2013). Therefore, the purpose of 18 th amendment was to have better management authority at the district level, so that health service is made accessible to each and every individual. The health care system in Pakistan is delivered either by public or private sector. Pakistan spends only 3.36% of its total GDP towards health, and almost 70% of the health expenses are out of the pocket (USAID, 2012). Furthermore, the utilization of primary health services by public sector is only 20%-30% of the total population as compared to the private sector (WHO, 2013). This huge difference may persist because of the several challenges which will be discussed later in the paper. Health care delivery system of Afghanistan Afghanistan is a landlocked and low income South Asian country with a population of 30.55 million (WB, 2013). Afghanistan has 34 provinces and each province is divided into districts. The health care system of the Afghanistan is managed through the Ministry of Public Health (MoPH), a central governmental body to identify health needs of the Afghan population, formulate policies and plans, mobilize resources, and establish rules and regulations for both public and private sector. Historically, the Afghan health sector has been damaged during the decades of war and instability; hence, the indicators of the country lie within lower range. After the withdrawal of the Taliban government in 2001, the Afghan MoPH took initiatives to reconstruct the country’s health sector infrastructure. Thus, MoPH with the support from other partners and donor established Basic Package of Health Services (BPHS) as a base for the Afghan health care system in 2003 followed by the