imgTThe PPHI represents a new way of working. It is driven by a passion, by a commitment and a resolve to serve the poor. It is commonly observed that such norms of work are only privately subscribed to by individuals. These norms rarely drive public service delivery in Pakistan. The sharp focus on the assignment, close oversight and untiring facilitation of every key element of the operation by its managers have few parallels. It denotes an altogether new work culture. The description may appear immodest, unreal – perhaps even esoteric. However, the spirit that drives the PPHI is precisely what sets it apart from the delivery of every other public service. To describe the PPHI, it is necessary to describe the driving spirit. Without understanding the spirit that defines it, it is not possible to comprehend its unique–ness nor its accomplishments.

The PPHI has been patterned on the CMIPHC in the Punjab. The operation in the Punjab is the mother plant upon which four scion operations have been grafted. In other words, the CMIPHC has matured into the PPHI. Prominent features of the Punjab operation, and its national version, are outlined here.


  1. Following broad understanding reached with a Provincial Government, a Program Director (PD) is appointed to lead the Provincial Support Unit (PSU).
  2. Where governance has been devolved, the District Government is competent to assign – out the management of RHFs. A District Support Manager (DSM) is appointed to lead the District Support Unit (DSU) in every District where the assignment is taken up. A typical Agreement which outlines the terms and conditions of assignment, is annexed at the end of this Manual.
  3. One of the first steps upon the conclusion of the Agreement(s) is the establishment of a “Resource Group”. The Group comprises widely respected specialists in every service that the BHU is expected to deliver. The Group is constituted with the greatest care so as not to lose sight of any of the eight PHC constituents – a balance often not easy to maintain.
  4. After taking a thorough stock of the staff availability, the DSU clusters the RHFs so as to arrange for the medical staff to serve at more than one facility and appoints new contract staff where necessary and possible. The principle in this regard is that scarce resources, like the services of medical professionals, must be as equitably shared as practicable. It is because medical professionals are not always available for service at every RHF where vacancies exist.
  5. This is also connected with the funds made available by the Government. District Budgets for the RHFs can commonly suffice not merely for engaging fresh staff but also for financing incentives to staff for performing additional services.
  6. A regular and adequate supply of medicines and materials is ensured at the earliest possible stage. This is not only necessary for restoring the confidence of those who use the RHFs but also makes staff presence purposeful. In the new environment at the RHFs, responsibility with corresponding authority is placed with the medical professionals. This empowerment, in our experience, yields rich dividends.
  7. Monthly Review Meetings” (MRM) are institutionalized to bring together the medical staff, the District Support staff and the relevant field officers of the Government. These meetings, held during the first week of every month, provide opportunity for participative discussion on the services delivered, on new measures taken at the RHFs, on resolution of old and new issues, etc. Most importantly, the MRM positions the medical professional at the centre of the operation – this being a corner-stone of the PPHI strategy.
  8. . Capacity Building of medical and paramedic staff is a major area of focus. Quality issues are also a serious concern and are addressed in different forms across the entire range of services.
  9. Monitoring work at the RHFs is a major activity and a distinguishing feature of the PPHI. This is undertaken as part of “facilitation” from the District Support Unit. Visits to the RHFs are an important way to observe the staff at work and to ascertain ways for supporting them. There is a fine, though obvious, line that sets apart “facilitation” from “inspection.” PPHI has a strong preference for the first of the two methods.
  10. Starting new and re-starting dormant services, like the School Health Sessions, Community Health Sessions, Family Planning services, Female Health Program, community participation, computerization, etc to name only a few, is a continuing preoccupation. All these receive reference in this Manual.


Website: Peoples Primary Healthcare Initiative (PPHI)