This article examined the performance of the provincial government of Khyber Pakhtunkhwa (KP) (2013-18) in terms of the reforms introduced in the health department in association with the level of public satisfaction. The study revealed that the level of public satisfaction is up to an average extent (35.90%) with the introduced reforms in the health department of KP. It is based on the primary data collected from the general public and experts randomly from a sample size of 464 respondents in districts Peshawar and Charsadda. In making the statistical analysis the chi-square test, p-value and percentage method have been used.

Reforms, Public Satisfaction, Performance, Health Department, Khyber Pakhtunkhwa

Government introduces reforms in every sector in order to enhance the efficiency of the respective sector or department. The term reform actually refers to a positive change for improving the performance of the sector that brings meaningful changes for improving efficiency and effectiveness  (Islam, Health Sector Reform in Pakistan: Why is it needed? March 2002,). Thus health is one of those sectors that directly linked the government to the public. Reforms in the health care system involve many things including financing and organization of the service provider to the package of the services to be offered. It includes improving and protecting the quality of services, enhancing equity and creating new resources for the system (Islam, April 2002). Health Reforms can be that purposeful sustained changes that improve the efficiency, equity and effectiveness of the health sector (Raymond L. Goldsteen, 2017).

The health sector reforms can be categorised 

into the funding changes, managerial changes and policy changes. It is also comprised of a number of interventions, policies and strategies that are designed in such a way that it may achieve better public health goals (Tania Dmytraczenko, 2003). Health reforms are introduced by almost all the major, developed and developing states like the USA, UK, Australia etc. In our neighbourhood, India and Iran are among those states that want to revive their healthcare system and improve its efficacy by implementing reforms. 

In this connection, reforms in the health care system were attempted in Pakistan in the past. But the current reforms were initiated in Khyber Pakhtunkhwa after the promulgation of the Medial Teaching Institution (MTI) Reforms Act in 2015 (Zahid Kamal, 2021). In the current study under the umbrella of the health sector reforms, the focus is on the policy changes introduced by the provincial government of KP (2013-18) in the provincial health department in order to improve the structure and the function of the health care. The study argued that the respondents are satisfied to an average extent (35.90%) with the introduced reforms in the health sector.

The current study operationalized the performance of the provincial government of KP (2013-18) in the health department regarding the reforms introduced. The government of PTI in its tenure (2013-18) introduced various reforms in the provincial health department comprising the MTI Reforms Act, Medical Aid Act, Health Care Commission Act, Mental Act, Safe Blood Transfusion Act, Health Foundation Act, Child Nutrition Act and Protection of Breastfeeding etc. (Tribune, 2018). These reforms highlighted the performance of the provincial government of KP during (2013-18) with respect to the level of public satisfaction in the light of the following indicated questions.

The current empirical study is applied in nature and is based on quantitative and analytical methods.

Primary data has been collected from the general community whereas experts in the health department were also interviewed through a questionnaire. The literature was covered through secondary data available in the forms of books, journals, articles, newspapers, government publications, booklets, records, and published official and non-official reports of elections and party manifestos.

Operationalisation Of The Varibales

The domain of the study is health departments where the health department in the current study means the provincial health department of Khyber Pakhtunkhwa comprising primary, secondary and tertiary care. In the same way, the reforms mean the reforms introduced and implemented by the provincial government in Khyber Pakhtunkhwa (2013-18) in the health department. However, public satisfaction means the perception of the performance where a greater extent means government perform well and an average extent means the average performance of the government while a lower extent is marked as poor performance of the provincial government.

Sampling Method

A simple random sampling technique was used for conducting this survey in District Charsadda and Peshawar. Amongst the four towns of district Peshawar rural and urban ones were selected. Likewise, in district Charsadda there is a total of three tehsils of which two tehsils were selected on a rural and urban basis. 

Sample Size

The criteria for the number of respondents was selected by using the Yamane formula (n= N/1+N*e2) where n is the sampling size, N is the total population and e is the margin of error, which is 5%.  

Calculating the sample size while using the Yamane sample size calculator by putting the total population of 5.8 million (Statistics, 2017) comes to be 399.97 around figure 400. But for knowing the expert views it is taken as 464. This number of respondents was taken from the general public of the two districts.

Q 1. To which extent are you satisfied with the reforms introduced in the health sector in KP (2013-18)? 

Table 1

A significant number of health experts by profession (66.7%) followed by the respondents of the age group 41 and above (54.8%), the postgraduate respondents (50.9%), the rural respondents (49.5%), respondents with lower income group of PKR 21000 and below (49.0%) and male respondents (44.8%) have responded in favour of satisfaction with the reforms introduced in the health department. The chi-square test conveyed a significant p-value in favour of age, education, profession, monthly income and the variable of area. This significance confirmed a strong association between the reforms introduced by the provincial government of KP (2013-18) with all of the above-mentioned significant variables excluding gender showing an insignificant p-value that leads to the disassociation of the reforms introduced and public satisfaction. 

It also portrayed that the health experts were confident about the performance of the provincial government of KP (2013-18) in introducing effective reforms in the health system. 

Q 2. To which extent are you satisfied with the performance of mti in the health sector in KP (2013-18)? 

Table 2

A reasonable number of the respondents from within the government servants (57.4%) followed by the matriculate respondents (53.4%), respondents with PKR 22000 and above group (53.6%), senior respondents aged 41 and above group (44.6%), the respondents of the rural area (40.4%) and male respondents (39.2%) have confessed to an average extent of satisfaction with the performance of the MTI. A significant -value is elaborated by the chi-square test in favour of the variables of age, education, profession and monthly income. Likewise, it further examined an insignificant p-value for the gender and locality of the respondents. The significant variables show a close association with the performance of the MTI and insignificant variables showed disapproval of the performance of the MTI in the health system introduced by the government.

It further illustrated that the respondents of the government servants by profession appreciated the performance of the provincial government of KP (2013-18) for the reforms in the health sector.

Q 3. To which extent was mti effective in improving the health sector in KP (2013-18)?

Table 3

A sizable number of the elderly respondents aged 41 and above group (42.7%) were seconded by the male respondents (41.2%), the postgraduate respondents (61.4%), the respondents serving the education sector (63.0%), the respondents of the undisclosed monthly income (51.3%) and the rural respondents (43.2%) are satisfied to an average extent with the effectivity of the MTI in improving the health sector. Applying the chi-square test portrayed significant p-values for gender, education, profession and monthly income. In the same, an insignificant value is forwarded for the consideration of the variables of age and area. It also advanced with the disconnection between the insignificant variables and the effectivity of the MTI in improving the health sector. On the other hand, the significant variables showed a connection with the improvements noticed in the health sector after the introduction of MTI by the provincial government of KP (2013-18) for revising the health system.

The information inquired that the education experts have credited the performance of the provincial government of KP (2013-18) for introducing public-oriented reforms in the health department in order to enhance the public with health curing privileges. 

Q 4. To which extent did mti improve the performance of doctors in the health sector in KP (2013-18)?

A good number of the elderly age (49.0%) illiterate (49.0%) rural respondents (41.8%) responded to an average extent of pleasure while the female respondents (46.2%), the education experts (51.9%) and those having a lower income of PKR 21000 and below (55.1%) were pleased to a lower extent with the improvements in the performance of the doctors serving in the health care centres. A significant p-value is acquired after the chi-square test is applied for the variables of gender, age, education, profession, monthly income and area in terms of the rural/urban division. The significant variables demonstrated a good relationship between all the mentioned variables and the improved performance of the doctors serving in the provincial health department because its p-value < 0.05.

It also examined that the respondents of the lower income group rated the performance of the provincial government of KP (2013-18) as poor in terms of the improvements noticed in the performance of the doctors with the introduction of the MTI for enhancing the health care system.

Q 5. To which extent did mti enhance the attendance ratio of doctors in the health sector in KP (2013-18)?

Table 5

A considerable number of the elderly respondents (43.3%), male respondents (41.9%), the health experts by profession (47.6%) with a low monthly income of PKR 21000 and below (51.0%) strongly supported while the postgraduate (47.4%) and the respondents of the urban area (43.4%) have supported the enhancement of the attendance of the doctors to an average extent with the introduction of the MTI in the health sector. The variable of gender, age, profession, monthly income and area have got a significant p-value after the chi-square test is applied. This further strengthened the connection of the significant variables with the MTI enhancement of the doctors' attendance ratio, while disconnecting the insignificant variable with the enhanced attendance ratio of the doctors in the health sector for getting p-value < 0.05 and > 0.05 respectively.

It further elaborated that the lower income group of respondents approved of the government while the postgraduate respondents disapproved of the performance of the provincial government of KP (2013-18) for initiation of the public favoured health reforms in the health department.

Q 6. To which extent was the polio control policy effective in KP (2013-18)?

An important number of the younger respondents of the 18-30 age group (48.2%), the matriculate (50.0%), the female respondents (44.1%), the health experts (57.1%) with low monthly income group of PKR 21000 and below (57.1%) from the rural area (43.9%) have supported the polio control policy initiated by the government. The chi-square test furnished insignificant p-values for gender, age and profession, while it showed significant values for the variables of education, monthly income and the area. The significant variables illustrated linkages with effective polio countering policy while it is discontinued by the insignificant variables of gender, age and profession for its p-value > 0.05.

It also investigated that the health experts and the lower income group of respondents were pleased with the performance of the provincial government in adopting beneficial policies for countering polio in the province.

Q 7. To which extent was the policy of

 population control effective in KP (2013-18)?

A sufficient number of the illiterate (51.0%), the elderly respondents of 41 and above age group (40.8%), the respondents of the lower income group of PKR 21000 and below (42.2%) and the urban respondents (37.8%) were satisfied to a greater extent with the policy of population control. In the same way, the female respondents (40.9%) and the education experts by profession (55.6%) have recommended effective population control policy to an average extent. The chi-square test provided significant P-values for gender, education, profession and monthly income, while the variables of age and area received insignificant P-values. It signified that the significant variables were closely associated with the population control for its p-value < 0.05 and the insignificant variables were isolated from the policies adopted for the population control.

It further illustrated that the education experts followed by the illiterate respondents commended the government of KP during (2013-18) for adopting favourable policies for population control in the province.

Q 8. To what extent was the policy of supervision of pharmacies effective in KP (2013-18)?

Table 8