Choked Pipes: Reforming Pakistan’s Mixed Health System

By drawing an analogy to a ‘choked pipe’, the title of this book underscores a key point—systems plagued by systemic challenges simply cannot deliver on desired public policy endpoints. Understanding these issues and the means of mitigating them assume importance in Pakistan at a time when the need to deliver welfare has never been more dire in view of the country’s prevailing geopolitical challenges.

Within this context, Choked Pipes is the first consolidated review of Pakistan’s health system, which describes the Mixed Health Systems Syndrome and the challenges in an environment where publicly-funded government health delivery coexists with privately-financed market delivery. The author’s vision for reform draws attention to a number of structural factors, both within and outside of the healthcare system and lays emphasis on reform of governance and social welfare as an important adjunct to reform within the healthcare system. The reform agenda proposed herein comes at a critical time in the evolution of interest in global health from ‘diseases’ to ‘systems’. Therefore it has a bearing on health systems in other developing countries—most of them with mixed health systems—with reference to current efforts aimed at achieving development goals in today’s macroeconomically constrained environment.