Why the health care delivery system fails?

There are various reasons for the Failure of health systems, economists have suggested at least three reasons why the health systems of many countries Fail to perform well in "producing" better health, particularly for the poor, given their spending.
According to the work done by Nancy Birdsall, President, Center for Global Development; poor governance and unrepresentative politics are two vital factors posing delay in progress. Many governments of the poor countries are weak and corrupt. It is a fact that health systems run by governments cannot be insulated from the problems of other government programmes in many countries. These include poor leadership and constant turnover of senior officials for political reasons, poorly managed or corrupted procurement, inadequate allocation of budgets for routine maintenance, and civil service systems that lack incentives for good performance. Health systems are particularly vulnerable because they are so employee-intensive.
They are subject to the pressure of public unions for job security. Because health systems involve considerable amounts of hiring, and many health staff work in dispersed environments that are difficult to monitor, they are a tempting resource For patronage. Along with personnel difficulties, petty thievery of supplies and medicines are among the problems that create the perception of the health sector as one of the most corrupt among public sectors.
The poorest quintiles systematically benefited more from spending on primary care compared to hospitals (not because primary care is particularly pro-poor but because hospital care is nearly always pro-rich). Yet in most countries, curative services - many of which are hospital-based - absorb about 60 percent of total public spending.
Some analysis suggests that the effect of public spending on health outcomes is greater in the countries with better overall governance - for example where the government bureaucracy is better and corruption is limited. In low-income countries (below 4bout $1000 per capita income in purchasing power parity terms), it is more democratic governments that manage higher rates of immunisation. But democracy has a negative effect in middle-income countries, perhaps because governments are more responsive to demand for hospitals and pharmaceuticals, which leads to reallocation of government spending away from immunisation and other strictly public health programmes.
According to 2000 World Health Report: Health systems are one of the vehicles through which the government, and the political forces behind government decision making, respond to the expectations and demands of the population. Health systems also are the vehicles through which individuals and Families can be protected from the impoverishing effects of ill health, and particularly the impact of our-of-pocket expenditures for drugs and services in the case of an acute illness.
The "responsiveness to demand" and the "protection From Financial shock" aims of health systems quite directly compete in many countries with the aim of better health. Part of this has to do with political economy and the influence of various constituencies described above and part with the nature of demand For health services, and with the relative costs of different type of health services.
Demand is greatest for health services that provide treatment to individuals for urgent health problems: broken legs, trauma, acute illnesses, heart attacks. Demand is much less for preventive health services that may be more effective and more cost-effective, but seem to have only an indirect relationship to illness: immunisations that prevent diseases years or even, as in the case of hepatitis B, decades later1 nutrition counseling or supplementation that may not prevent disease, but rather lessen the chances that a child, once ill, will die.
Compounding the problem, the under-Funded health services and programmes tends to be those that help mostly the poor, because the non-poor can obtain them privately (immunisations) or are less vulnerable (many endemic diseases) because of power exposure to risks. That elite groups in the population have more influence over political decision making greatly reduces the likelihood that a health system will tackle to health problems of the poor in a concerted way. Thus, ORS, which is of far more benefit to rural populations with little access to safe water, is likely to be a less popular item in the budget than increasing the availability of antibiotics in urban health centers.
Finally there is the problem of the absence of any public or private insurance systems in developing countries to protect rich and poor households from the catastrophic losses associated with critical illnesses and accidents. In the absence of insurance, governments resort to direct financing of costly curative treatment and care.
Anecdotes and studies point to the government paid doctors who never show up at rural health clinics, working instead in their own private clinics, and to the government or donor financed medicines that disappear from the shelves of these clinics and appear in the black market. Absence rates among all health care workers ranged from 30 to 45 percent in 2002 studies in Bangladesh, Honduras, India, Peru and Uganda. Even in the absence of corruption, inefficiency in public health facilities is likely because of poor incentives for workers - good performance is not rewarded - and because good performance in the many small encounters with patients is difficult to monitor.
In summary, we know some reasons why health systems often fail to produce better health in developing counties (and in some cases, in rich countries too). Those reasons include poor governance, the complication of offsetting objectives, and the inherent difficulties of public sector delivery of health care services. The three overlap with each other. Each is rooted in one way or another in questions of public spending and public policy, and in the political economy of systems that rare managed by governments. Each is rooted in the fact that health is a sector in which the fundamental role of government is to address the problem that the market works poorly in health, both with respect to effectiveness (because of the gap between private and social costs and benefits of many health programmes), and with respect to equity (because the poor cannot afford some health care which society views as a Fundamental right). Yet governments, whose role ideally is to correct market failures, are themselves a source of "policy failure." They and the health systems they manage (or fail to manage) are far from perfect - and the poorer and less politically mature a society, the more likely it is to suffer the costs of those imperfections.
Pakistan comes under the umbrella of low-income countries where we see that the health care delivery system is still not up to the mark. The public sector fails to meet the demands of the ever growing population whereas the private sector causes out-of-pocket expenditures to a significant level. The above mentioned reasons fix well in with the current scenario.
It is high time when the government should reorganise health system with efforts at elimination of all sorts of corruption and maintaining utmost stability. The private sector and the non-government organisations can play very effective role with government collaboration, thereby bringing Pakistan to a respectable level when it comes to health systems among developing countries.