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Abstract Background Effective skills and training for physicians are essential for communicating difficult or distressing information, also known as breaking bad news (BBN). This study aimed to assess both the capacity and the practices of clinicians in Pakistan regarding BBN. Methods A cross-sectional study was conducted involving 151 clinicians. Quantitative component used a structured questionnaire, while qualitative data were obtained through in-depth interviews with 13 medical educationists. The responses were analyzed using descriptive statistics and thematic analysis. Results While most clinicians acknowledged their responsibility of delivering difficult news, only a small percentage had received formal training in BBN. Areas for improvement include time and interruption management, rapport building, and understanding the patients’ point of view. Prognosis and treatment options were not consistently discussed. Limited importance is given to BBN in medical education. Discussion Training in BBN will lead to improved patient and attendants’ satisfaction, and empathetic support during difficult times.

Summary: The attainment of the noble objective of Universal Health Coverage (UHC)- ‘leaving no one behind’ necessitates sufficient financial resources, an ample supply of skilled healthcare professionals, and the availability of essential services as part of a basic package This paper presents an analysis of the health system, health seeking behaviours and health service utilization en route to UHC in Pakistan. We have used the UHC 14 tracer indicators of service coverage to see where Pakistan stands, what are the gaps and what needs to be done. Pakistan clearly is lagging behind its neighboring countries. The country's health system ought to work on health seeking behaviours and broader determinants of health. The pursuit of UHC demands a shared responsibility and collective action, with stakeholders from different sectors uniting their efforts and expertise. Together, they can establish robust systems, design comprehensive policies, allocate adequate resources, and implement interventions that transcend disciplinary boundaries.

Depression among married women of reproductive age is on the rise in Pakistan, owing to post-COVID-19 phase, super-inflation, increasing poverty, deteriorating law and order situation and perpetuating the uncertain political situation in the country. This study aimed to investigate the factors associated with depression among married women of reproductive age in Pakistan, using a mixed methods approach. The quantitative phase utilized the Urdu version of the Patient Health Questionnaire-9 (PHQ-9) to assess depression among 340 married women. Twelve women with higher scores on the PHQ-9 were selected for in-depth interviews in the qualitative phase. The quantitative analysis revealed a higher prevalence of depression among women with poor socioeconomic status, lower educational levels, larger family sizes, and recent deaths in the family. In the qualitative phase, the main themes identified were the impact of social conditions, such as societal expectations and gender roles, the influence of medical conditions on mental health, financial difficulties, the stress associated with caring for a larger number of children, and the emotional burden of recent deaths in the family. This study highlights the importance of addressing depression among married women of reproductive age in Pakistan. It is crucial to focus on early diagnosis and prompt treatment to mitigate the adverse effects of depression on the affected individuals and their families. Targeted interventions should consider the social determinants of depression, including improving socioeconomic conditions through safety nets, providing mental health support at the primary health care level, and addressing the specific health issues and needs of women in the reproductive age group. A multi-pronged approach and health system's thinking can reduce the burden of depression among women, ultimately enhancing their overall well-being, productivity and quality of life.

Background: Pakistan’s health system over the past three decades has experienced social, economic, geopolitical instability, and notwithstanding man-made and natural catastrophes. Since 2001, the health system in Pakistan has undergone three phases of organizational and management reforms and does not have a unified national health policy since then. The aim of this research was to assess the factors behind the decision-making by policy planners in the health system of Pakistan. Methods: An exploratory qualitative study based on grounded theory was designed where in-depth interviews conducted with 20 representatives of the political constituencies, civil bureaucracy, health planners and managers, research and educational institutions, NGOs providing technical support in the health sector, development partners and media. Results: There leading reason cited was the dearth of leadership in health sector, which is compounded by a range of factors such as “institutional monopoly”, “contextual deterrents”, “power for turf”; “inadequate knowledge”, and “design faults”. Such factors were perceived to have a serious effect on the competencies, roles and responsibilities, use of knowledge for decision making. The behavioral aspects of decision makers include the “mindset,” and “conflicting interests”. Conclusions: The multitude of factors and complexities within the health sector of Pakistan continue to widen the vacuum in the leadership echelons. Hence, there is a high probability of taking wrong decisions not based on evidence, and resulting in a grossly under-performing health system.

Abstract Background There is a strong and wide consensus that Pakistan must pursue universal health coverage (UHC) attainment as the driving force for achieving sustainable development goals by 2030. Nevertheless, several institutional and socioeconomic challenges may hinder the progress toward UHC. Main body It is important that the health system of Pakistan must be transformed to strengthen all three dimensions of UHC i.e. maximizing the population covered, increasing the range of services offered, and reducing the cost-sharing. To make UHC dream a reality in Pakistan, there are some pre-requisites to meet upfront: a) budgetary allocation for health as percentage of GDP must be increased; b) health system’s readiness especially in the public sector ought to improve in terms of human resource and availability of essential services; c) safety nets for health must continue regardless of the change in the political regimes; d) decrease the reliance on donors’ funding; and e) accountability to be ensured across the board for service providers, managers, administrators and policymakers in the health system. Conclusion COVID-19 pandemic has revealed some major gaps in the health system’s capacity to deliver equitable healthcare, which is a cornerstone to achieving the UHC agenda. The priority-setting process will need to be aligned with the SDGs to ensure that the agenda for action towards 2030 is comprehensively addressed and successfully accomplished preferably before, but hopefully not beyond the targeted dates.

Abstract Tuberculosis (TB) is on the rise in Pakistan and there could be multiple reasons including poverty, difficulty in access to TB treatment services, non-compliance with treatment, social stigma etc. According to the TB program managers, limited treatment and testing sites for tuberculosis and lack of trained human resources play a major role in compromising TB management. A major lacuna in the TB control program is the absence of active contact tracing strategy. This is essential for a disease where positive cases are known to be able to infect a further 10‒15 individuals in a year. Tackling tuberculosis in Pakistan has been beleaguered by funding challenges and other systems’ bottlenecks such as lack of skilled human resources and insufficient supply of medicines, despite the fact that disease burden is one of the highest in the world. Although it is a notifiable disease, active case finding, contact tracing and reporting is notoriously low throughout the country. Access to diagnostics and treatment facilities has been limited and stigma attached to the disease remains deeply entrenched among the communities. Researchers have shown that enhanced and active approaches to contact investigation effectively identifies additional patients with TB among household contacts at a relatively modest cost. USAID’s Integrated Health Systems Strengthening and Service Delivery Activity extended support to the Health Departments of Sindh and Khyber Pakhtunkhwa provinces. In collaboration with the two provincial TB programs, community based active contact tracing was conducted on 17,696 individuals, based on the index cases. Among the contacts traced, 243 cases were diagnosed as drug sensitive or drug resistant TB. Awareness sessions were conducted to sensitize people on the various aspects of disease and importance of getting tested. The project also supported establishing three satellite Programmatic Management of Drug Resistant Tuberculosis (PMDT) sites for drug resistant TB treatment, enhancing the programs’ diagnostic and testing capacity.