Performance of the Provincial Government of Khyber Pakhtunkhwa (2013-18) in Terms of Reforms Introduced in the Health Department

Muhammad Ibrahim; Shahbaz Khan

doi:10.31703/gpr.2022(VII-II).13

PERFORMANCE OF THE PROVINCIAL GOVERNMENT OF KHYBER PAKHTUNKHWA (2013 18) IN TERMS OF REFORMS INTRODUCED IN THE HEALTH DEPARTMENT

http://dx.doi.org/10.31703/gpr.2022(VII-II).13 10.31703/gpr.2022(VII-II).13
Authored by : Muhammad Ibrahim , Shahbaz Khan

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13 Pages : 110-126

Abstrict

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.

Keywords

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

Introduction

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.

Methodology

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

Variables	Sub-Category	Greater Extent	Average Extent	Lower Extent	Total	Chi-Square Value	P-Value
Gender	Male	102	151	84	337	0.032	0.984
	Male	30.3%	44.8%	24.9%	100.0%
	Female	28	41	24	93
	Female	30.1%	44.1%	25.8%	100.0%
	Total	130	192	108	430
	Total	30.2%	44.7%	25.1%	100.0%
	18-30	45	33	32	110	21.748	0.000
Age	18-30	40.9%	30.0%	29.1%	100.0%
	31-40	55	73	35	163
	31-40	33.7%	44.8%	21.5%	100.0%
	41and Above	30	86	41	157
	41and Above	19.1%	54.8%	26.1%	100.0%
	Total	130	130	192	108
Education	Total	30.2%	30.2%	44.7%	25.1%
	Illiterate	19	47	34	100	15.912	0.044
	Illiterate	19.0%	47.0%	34.0%	100.0%
	Matriculate	14	27	17	58
	Matriculate	24.1%	46.6%	29.3%	100.0%
	Intermediate	35	46	24	105
	Intermediate	33.3%	43.8%	22.9%	100.0%
	Graduate	43	43	24	110
	Graduate	39.1%	39.1%	21.8%	100.0%
	Postgraduate	19	29	9	57
	Postgraduate	33.3%	50.9%	15.8%	100.0%
	Total	130	192	108	430
	Total	30.2%	44.7%	25.1%	100.0%
Profession	Government Servant	21	27	6	54	31.855	0.000
	Government Servant	38.9%	50.0%	11.1%	100.0%
	Private Service Sector	19	38	22	79
	Private Service Sector	24.1%	48.1%	27.8%	100.0%
	Businessmen & Shopkeepers	19	51	21	91
	Businessmen & Shopkeepers	20.9%	56.0%	23.1%	100.0%
	Health Experts	6	14	1	21
	Health Experts	28.6%	66.7%	4.8%	100.0%
	Education Experts	13	9	5	27
	Education Experts	48.1%	33.3%	18.5%	100.0%
	Others	52	53	53	158
	Others	32.9%	33.5%	33.5%	100.0%
	Total	130	192	108	430
	Total	30.2%	44.7%	25.1%	100.0%
Monthly Income	PKR 21000 and Below	30	72	30	72	14.808	0.005
	PKR 21000 and Below	20.4%	49.0%	20.4%	49.0%
	PKR 22000 and Above	53	79	53	79
	PKR 22000 and Above	31.5%	47.0%	31.5%	47.0%
	Sorry	47	41	47	41
	Sorry	40.9%	35.7%	40.9%	35.7%
	Total	130	192	130	192
	Total	30.2%	44.7%	30.2%	44.7%
Area	Rural	79	142	66	287	8.137	0.017
	Rural	27.5%	49.5%	23.0%	100.0%
	Urban	51	50	42	143
	Urban	35.7%	35.0%	29.4%	100.0%
	Total	130	192	108	430
	Total	30.2%	44.7%	25.1%	100.0%

Explanation

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

Variables	Sub-Category	Greater Extent	Average Extent	Lower Extent	Total	Chi-Square Value	P-Value
Gender	Male	93	132	112	337	0.468	0.791
	Male	27.6%	39.2%	33.2%	100.0%
	Female	29	35	29	93
	Female	31.2%	37.6%	31.2%	100.0%
	Total	122	167	141	430
	Total	28.4%	38.8%	32.8%	100.0%
	18-30	44	27	39	110	16.777	0.002
Age	18-30	40.0%	24.5%	35.5%	100.0%
	31-40	36	70	57	163
	31-40	22.1%	42.9%	35.0%	100.0%
	41and Above	42	70	45	157
	41and Above	26.8%	44.6%	28.7%	100.0%
	Total	122	167	141	430
Education	Total	28.4%	38.8%	32.8%	100.0%
	Illiterate	25	31	44	100	23.754	0.003
	Illiterate	25.0%	31.0%	44.0%	100.0%
	Matriculate	14	31	13	58
	Matriculate	24.1%	53.4%	22.4%	100.0%
	Intermediate	40	35	30	105
	Intermediate	38.1%	33.3%	28.6%	100.0%
	Graduate	35	40	35	110
	Graduate	31.8%	36.4%	31.8%	100.0%
	Postgraduate	8	30	19	57
	Postgraduate	14.0%	52.6%	33.3%	100.0%
	Total	122	167	141	430
	Total	28.4%	38.8%	32.8%	100.0%
Profession	Government Servant	10	31	13	54	21.026	0.021
	Government Servant	18.5%	57.4%	24.1%	100.0%
	Private Service Sector	23	35	21	79
	Private Service Sector	29.1%	44.3%	26.6%	100.0%
	Businessmen & Shopkeepers	27	37	27	91
	Businessmen & Shopkeepers	29.7%	40.7%	29.7%	100.0%
	Health Experts	6	10	5	21
	Health Experts	28.6%	47.6%	23.8%	100.0%
	Education Experts	5	10	12	27
	Education Experts	18.5%	37.0%	44.4%	100.0%
	Others	51	44	63	158
	Others	32.3%	27.8%	39.9%	100.0%
	Total	122	167	141	430
	Total	28.4%	38.8%	32.8%	100.0%
Monthly Income	PKR 21000 and Below	52	29	66	147	39.184	0.000
	PKR 21000 and Below	35.4%	19.7%	44.9%	100.0%
	PKR 22000 and Above	36	90	42	168
	PKR 22000 and Above	21.4%	53.6%	25.0%	100.0%
	Sorry	34	48	33	115
	Sorry	29.6%	41.7%	28.7%	100.0%
	Total	122	167	141	430
	Total	52	29	66	147
Area	Rural	81	116	90	287	1.102	0.576
	Rural	28.2%	40.4%	31.4%	100.0%
	Urban	41	51	51	143
	Urban	28.7%	35.7%	35.7%	100.0%
	Total	122	167	141	430
	Total	28.4%	38.8%	32.8%	100.0%

Explanation

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

Variables	Sub-Category	Greater Extent	Average Extent	Lower Extent	Total	Chi-Square Value	P-Value
Gender	Male	88	139	110	337	10.270	0.006
	Male	26.1%	41.2%	32.6%	100.0%
	Female	40	32	21	93
	Female	43.0%	34.4%	22.6%	100.0%
	Total	128	171	131	430
	Total	29.8%	39.8%	30.5%	100.0%
	18-30	42	43	25	110	7.731	0.102
Age	18-30	38.2%	39.1%	22.7%	100.0%
	31-40	48	61	54	163
	31-40	29.4%	37.4%	33.1%	100.0%
	41and Above	38	67	52	157
	41and Above	24.2%	42.7%	33.1%	100.0%
	Total	128	171	131	430
Education	Total	29.8%	39.8%	30.5%	100.0%
	Illiterate	24	34	42	100	24.034	0.002
	Illiterate	24.0%	34.0%	42.0%	100.0%
	Matriculate	20	19	19	58
	Matriculate	34.5%	32.8%	32.8%	100.0%
	Intermediate	38	34	33	105
	Intermediate	36.2%	32.4%	31.4%	100.0%
	Graduate	32	49	29	110
	Graduate	29.1%	44.5%	26.4%	100.0%
	Postgraduate	14	35	8	57
	Postgraduate	24.6%	61.4%	14.0%	100.0%
	Total	128	171	131	430
	Total	29.8%	39.8%	30.5%	100.0%
Profession	Government Servant	11	23	20	54	27.940	0.002
	Government Servant	20.4%	42.6%	37.0%	100.0%
	Private Service Sector	16	38	25	79
	Private Service Sector	20.3%	48.1%	31.6%	100.0%
	Businessmen & Shopkeepers	22	35	34	91
	Businessmen & Shopkeepers	24.2%	38.5%	37.4%	100.0%
	Health Experts	10	8	3	21
	Health Experts	47.6%	38.1%	14.3%	100.0%
	Education Experts	5	17	5	27
	Education Experts	18.5%	63.0%	18.5%	100.0%
	Others	64	50	44	158
	Others	40.5%	31.6%	27.8%	100.0%
	Total	128	171	131	430
	Total	29.8%	39.8%	30.5%	100.0%
Monthly Income	PKR 21000 and Below	56	38	53	147	20.011	0.000
	PKR 21000 and Below	38.1%	25.9%	36.1%	100.0%
	PKR 22000 and Above	44	74	50	168
	PKR 22000 and Above	26.2%	44.0%	29.8%	100.0%
	Sorry	28	59	28	115
	Sorry	24.3%	51.3%	24.3%	100.0%
	Total	128	171	131	430
	Total	29.8%	39.8%	30.5%	100.0%
Area	Rural	80	124	83	287	4.280	0.118
	Rural	27.9%	43.2%	28.9%	100.0%
	Urban	48	47	48	143
	Urban	33.6%	32.9%	33.6%	100.0%
	Total	128	171	131	430
	Total	29.8%	39.8%	30.5%	100.0%

Explanation

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)?

Table 4

Variables	Sub-Category	Greater Extent	Average Extent	Lower Extent	Total	Chi-Square Value	P-Value
Gender	Male	102	137	98	337	10.048	0.007
	Male	30.3%	40.7%	29.1%	100.0%
	Female	19	31	43	93
	Female	20.4%	33.3%	46.2%	100.0%
	Total	121	168	141	430
	Total	28.1%	39.1%	32.8%	100.0%
	18-30	43	26	41	110	19.410	0.001
Age	18-30	39.1%	23.6%	37.3%	100.0%
	31-40	41	65	57	163
	31-40	25.2%	39.9%	35.0%	100.0%
	41and Above	37	77	43	157
	41and Above	23.6%	49.0%	27.4%	100.0%
	Total	121	168	141	430
Education	Total	28.1%	39.1%	32.8%	100.0%
	Illiterate	17	49	34	100	15.040	0.058
	Illiterate	17.0%	49.0%	34.0%	100.0%
	Matriculate	17	27	14	58
	Matriculate	29.3%	46.6%	24.1%	100.0%
	Intermediate	34	40	31	105
	Intermediate	32.4%	38.1%	29.5%	100.0%
	Graduate	36	35	39	110
	Graduate	32.7%	31.8%	35.5%	100.0%
	Postgraduate	17	17	23	57
	Postgraduate	29.8%	29.8%	40.4%	100.0%
	Total	121	168	141	430
	Total	28.1%	39.1%	32.8%	100.0%
Profession	Government Servant	17	26	11	54	18.639	0.045
	Government Servant	31.5%	48.1%	20.4%	100.0%
	Private Service Sector	24	34	21	79
	Private Service Sector	30.4%	43.0%	26.6%	100.0%
	Businessmen & Shopkeepers	21	33	37	91
	Businessmen & Shopkeepers	23.1%	36.3%	40.7%	100.0%
	Health Experts	8	7	6	21
	Health Experts	38.1%	33.3%	28.6%	100.0%
	Education Experts	10	3	14	27
	Education Experts	37.0%	11.1%	51.9%	100.0%
	Others	41	65	52	158
	Others	25.9%	41.1%	32.9%	100.0%
	Total	121	168	141	430
	Total	28.1%	39.1%	32.8%	100.0%
Monthly Income	PKR 21000 and Below	30	36	81	147	54.001	0.000
	PKR 21000 and Below	20.4%	24.5%	55.1%	100.0%
	PKR 22000 and Above	48	79	41	168
	PKR 22000 and Above	28.6%	47.0%	24.4%	100.0%
	Sorry	43	53	19	115
	Sorry	37.4%	46.1%	16.5%	100.0%
	Total	121	168	141	430
	Total	28.1%	39.1%	32.8%	100.0%
Area	Rural	85	120	82	287	7.015	0.030
	Rural	29.6%	41.8%	28.6%	100.0%
	Urban	36	48	59	143
	Urban	25.2%	33.6%	41.3%	100.0%
	Total	121	168	141	430
	Total	28.1%	39.1%	32.8%	100.0%

Explanation

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

Variables	Sub-Category	Greater Extent	Average Extent	Lower Extent	Total	Chi-Square Value	P-Value
Gender	Male	125	127	85	337	5.732	0.057
	Male	37.1%	37.7%	25.2%	100.0%
	Female	39	23	31	93
	Female	41.9%	24.7%	33.3%	100.0%
	Total	164	150	116	430
	Total	38.1%	34.9%	27.0%	100.0%
	18-30	47	39	24	110	11.695	0.020
Age	18-30	42.7%	35.5%	21.8%	100.0%
	31-40	49	69	45	163
	31-40	30.1%	42.3%	27.6%	100.0%
	41and Above	68	42	47	157
	41and Above	43.3%	26.8%	29.9%	100.0%
	Total	164	150	116	430
Education	Total	38.1%	34.9%	27.0%	100.0%
	Illiterate	32	29	39	100	14.870	0.062
	Illiterate	32.0%	29.0%	39.0%	100.0%
	Matriculate	24	18	16	58
	Matriculate	41.4%	31.0%	27.6%	100.0%
	Intermediate	39	39	27	105
	Intermediate	37.1%	37.1%	25.7%	100.0%
	Graduate	48	37	25	110
	Graduate	43.6%	33.6%	22.7%	100.0%
	Postgraduate	21	27	9	57
	Postgraduate	36.8%	47.4%	15.8%	100.0%
	Total	164	150	116	430
	Total	38.1%	34.9%	27.0%	100.0%
Profession	Government Servant	23	14	17	54	17.962	0.056
	Government Servant	42.6%	25.9%	31.5%	100.0%
	Private Service Sector	33	30	16	79
	Private Service Sector	41.8%	38.0%	20.3%	100.0%
	Businessmen & Shopkeepers	38	20	33	91
	Businessmen & Shopkeepers	41.8%	22.0%	36.3%	100.0%
	Health Experts	10	6	5	21
	Health Experts	47.6%	28.6%	23.8%	100.0%
	Education Experts	9	12	6	27
	Education Experts	33.3%	44.4%	22.2%	100.0%
	Others	51	68	39	158
	Others	32.3%	43.0%	24.7%	100.0%
	Total	164	150	116	430
	Total	38.1%	34.9%	27.0%	100.0%
Monthly Income	PKR 21000 and Below	75	42	30	147	26.994	0.000
	PKR 21000 and Below	51.0%	28.6%	20.4%	100.0%
	PKR 22000 and Above	44	61	63	168
	PKR 22000 and Above	26.2%	36.3%	37.5%	100.0%
	Sorry	45	47	23	115
	Sorry	39.1%	40.9%	20.0%	100.0%
	Total	164	150	116	430
	Total	38.1%	34.9%	27.0%	100.0%
Area	Rural	117	88	82	287	6.784	0.034
	Rural	40.8%	30.7%	28.6%	100.0%
	Urban	47	62	34	143
	Urban	32.9%	43.4%	23.8%	100.0%
	Total	164	150	116	430
	Total	38.1%	34.9%	27.0%	100.0%

Explanation

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)?

Table 6

Variables	Sub-Category	Greater Extent	Average Extent	Lower Extent	Total	Chi-Square Value	P-Value
Gender	Male	140	107	90	337	0.649	0.723
	Male	41.5%	31.8%	26.7%	100.0%
	Female	41	31	21	93
	Female	44.1%	33.3%	22.6%	100.0%
	Total	181	138	111	430
	Total	42.1%	32.1%	25.8%	100.0%
	18-30	53	30	27	110	5.309	0.257
Age	18-30	48.2%	27.3%	24.5%	100.0%
	31-40	69	48	46	163
	31-40	42.3%	29.4%	28.2%	100.0%
	41and Above	59	60	38	157
	41and Above	37.6%	38.2%	24.2%	100.0%
	Total	181	138	111	430
Education	Total	42.1%	32.1%	25.8%	100.0%
	Illiterate	31	31	38	100	15.081	0.058
	Illiterate	31.0%	31.0%	38.0%	100.0%
	Matriculate	29	13	16	58
	Matriculate	50.0%	22.4%	27.6%	100.0%
	Intermediate	45	38	22	105
	Intermediate	42.9%	36.2%	21.0%	100.0%
	Graduate	51	36	23	110
	Graduate	46.4%	32.7%	20.9%	100.0%
	Postgraduate	25	20	12	57
	Postgraduate	43.9%	35.1%	21.1%	100.0%
	Total	181	138	111	430
	Total	42.1%	32.1%	25.8%	100.0%
Profession	Government Servant	24	24	6	54	12.375	0.261
	Government Servant	44.4%	44.4%	11.1%	100.0%
	Private Service Sector	34	24	21	79
	Private Service Sector	43.0%	30.4%	26.6%	100.0%
	Businessmen & Shopkeepers	33	30	28	91
	Businessmen & Shopkeepers	36.3%	33.0%	30.8%	100.0%
	Health Experts	12	6	3	21
	Health Experts	57.1%	28.6%	14.3%	100.0%
	Education Experts	12	8	7	27
	Education Experts	44.4%	29.6%	25.9%	100.0%
	Others	66	46	46	158
	Others	41.8%	29.1%	29.1%	100.0%
	Total	181	138	111	430
	Total	42.1%	32.1%	25.8%	100.0%
Monthly Income	PKR 21000 and Below	84	27	36	147	27.560	0.000
	PKR 21000 and Below	57.1%	18.4%	24.5%	100.0%
	PKR 22000 and Above	52	67	49	168
	PKR 22000 and Above	31.0%	39.9%	29.2%	100.0%
	Sorry	45	44	26	115
	Sorry	39.1%	38.3%	22.6%	100.0%
	Total	181	138	111	430
	Total	42.1%	32.1%	25.8%	100.0%
Area	Rural	126	99	62	287	8.131	0.017
	Rural	43.9%	34.5%	21.6%	100.0%
	Urban	55	39	49	143
	Urban	38.5%	27.3%	34.3%	100.0%
	Total	181	138	111	430
	Total	42.1%	32.1%	25.8%	100.0%

Explanation

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)?

Table 7

Variables	Sub-Category	Greater Extent	Average Extent	Lower Extent	Total	Chi-Square Value	P-Value
Gender	Male	138	101	98	337	10.653	0.005
	Male	40.9%	30.0%	29.1%	100.0%
	Female	21	38	34	93
	Female	22.6%	40.9%	36.6%	100.0%
	Total	159	139	132	430
	Total	37.0%	32.3%	30.7%	100.0%
	18-30	40	37	33	110	3.186	0.527
Age	18-30	36.4%	33.6%	30.0%	100.0%
	31-40	55	59	49	163
	31-40	33.7%	36.2%	30.1%	100.0%
	41and Above	64	43	50	157
	41and Above	40.8%	27.4%	31.8%	100.0%
	Total	159	139	132	430
Education	Total	37.0%	32.3%	30.7%	100.0%
	Illiterate	51	20	29	100	19.550	0.012
	Illiterate	51.0%	20.0%	29.0%	100.0%
	Matriculate	23	15	20	58
	Matriculate	39.7%	25.9%	34.5%	100.0%
	Intermediate	35	34	36	105
	Intermediate	33.3%	32.4%	34.3%	100.0%
	Graduate	33	47	30	110
	Graduate	30.0%	42.7%	27.3%	100.0%
	Postgraduate	17	23	17	57
	Postgraduate	29.8%	40.4%	29.8%	100.0%
	Total	159	139	132	430
	Total	37.0%	32.3%	30.7%	100.0%
Profession	Government Servant	10	23	21	54	27.395	0.002
	Government Servant	18.5%	42.6%	38.9%	100.0%
	Private Service Sector	39	24	16	79
	Private Service Sector	49.4%	30.4%	20.3%	100.0%
	Businessmen & Shopkeepers	37	23	31	91
	Businessmen & Shopkeepers	40.7%	25.3%	34.1%	100.0%
	Health Experts	7	10	4	21
	Health Experts	33.3%	47.6%	19.0%	100.0%
	Education Experts	5	15	7	27
	Education Experts	18.5%	55.6%	25.9%	100.0%
	Others	61	44	53	158
	Others	38.6%	27.8%	33.5%	100.0%
	Total	159	139	132	430
	Total	37.0%	32.3%	30.7%	100.0%
Monthly Income	PKR 21000 and Below	62	45	40	147	11.678	0.020
	PKR 21000 and Below	42.2%	30.6%	27.2%	100.0%
	PKR 22000 and Above	54	67	47	168
	PKR 22000 and Above	32.1%	39.9%	28.0%	100.0%
	Sorry	43	27	45	115
	Sorry	37.4%	23.5%	39.1%	100.0%
	Total	159	139	132	430
	Total	37.0%	32.3%	30.7%	100.0%
Area	Rural	105	97	85	287	0.943	0.624
	Rural	36.6%	33.8%	29.6%	100.0%
	Urban	54	42	47	143
	Urban	37.8%	29.4%	32.9%	100.0%
	Total	159	139	132	430
	Total	37.0%	32.3%	30.7%	100.0%

Explanation

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

Variables	Sub-Category	Greater Extent	Average Extent	Lower Extent	Total	Chi-Square Value	P-Value
Gender	Male	139	108	90	337	10.746	0.005
	Male	41.2%	32.0%	26.7%	100.0%
	Female	23	45	25	93
	Female	24.7%	48.4%	26.9%	100.0%
	Total	162	153	115	430
	Total	37.7%	35.6%	26.7%	100.0%
	18-30	44	45	21	110	4.728	0.316
Age	18-30	40.0%	40.9%	19.1%	100.0%
	31-40	59	55	49	163
	31-40	36.2%	33.7%	30.1%	100.0%
	41and Above	59	53	45	157
	41and Above	37.6%	33.8%	28.7%	100.0%
	Total	162	153	115	430
Education	Total	37.7%	35.6%	26.7%	100.0%
	Illiterate	41	36	23	100	15.496	0.050
	Illiterate	41.0%	36.0%	23.0%	100.0%
	Matriculate	30	19	9	58
	Matriculate	51.7%	32.8%	15.5%	100.0%
	Intermediate	39	34	32	105
	Intermediate	37.1%	32.4%	30.5%	100.0%
	Graduate	33	48	29	110
	Graduate	30.0%	43.6%	26.4%	100.0%
	Postgraduate	19	16	22	57
	Postgraduate	33.3%	28.1%	38.6%	100.0%
	Total	162	153	115	430
	Total	37.7%	35.6%	26.7%	100.0%
Profession	Government Servant	13	28	13	54	17.969	0.055
	Government Servant	24.1%	51.9%	24.1%	100.0%
	Private Service Sector	30	23	26	79
	Private Service Sector	38.0%	29.1%	32.9%	100.0%
	Businessmen & Shopkeepers	43	27	21	91
	Businessmen & Shopkeepers	47.3%	29.7%	23.1%	100.0%
	Health Experts	4	8	9	21
	Health Experts	19.0%	38.1%	42.9%	100.0%
	Education Experts	9	9	9	27
	Education Experts	33.3%	33.3%	33.3%	100.0%
	Others	63	58	37	158
	Others	39.9%	36.7%	23.4%	100.0%
	Total	162	153	115	430
	Total	37.7%	35.6%	26.7%	100.0%
Monthly Income	PKR 21000 and Below	52	55	40	147	20.494	0.000
	PKR 21000 and Below	35.4%	37.4%	27.2%	100.0%
	PKR 22000 and Above	51	75	42	168
	PKR 22000 and Above	30.4%	44.6%	25.0%	100.0%
	Sorry	59	23	33	115
	Sorry	51.3%	20.0%	28.7%	100.0%
	Total	162	153	115	430
	Total	37.7%	35.6%	26.7%	100.0%
Area	Rural	99	108	80	287	3.747	0.154
	Rural	34.5%	37.6%	27.9%	100.0%
	Urban	63	45	35	143
	Urban	44.1%	31.5%	24.5%	100.0%
	Total	162	153	115	430
	Total	37.7%	35.6%	26.7%	100.0%

Explanation

A good number of the matriculate respondents (51.7%), the undisclosed income group (51.3%) and the urban respondents (44.1%) strongly supported the supervisory policy of the pharmacies. While the female respondents (48.4%), the younger respondents of the 18-30 age group (40.9%) and the government servants by profession (51.9%) rated the supervisory policy as average. The chi-square test gave a significant p-value for the variables of gender, education,

profession and monthly income. It gave an insignificant p-value for the consideration of the variables of age and area. The p-value < 0.05 guided the strong alliance between the significant variables and the supervision of the pharmacies in the province. While the p-value > 0.05 disengaged the insignificant variables and the government regularisation of the pharmacies.

It further informs that the respondents from within the government servant by profession highly favoured the government and supported its

performance in terms of the regularisation of the pharmacies in order to enhance result-oriented reforms in the health system.

Q 9. To which extent was the policy of malaria control effective in KP (2013-18)?

Table 9

Variables	Sub-Category	Greater Extent	Average Extent	Lower Extent	Total	Chi-Square Value	P-Value
Gender	Male	111	87	139	337	0.019	0.991
	Male	32.9%	25.8%	41.2%	100.0%
	Female	30	24	39	93
	Female	32.3%	25.8%	41.9%	100.0%
	Total	141	111	178	430
	Total	32.8%	25.8%	41.4%	100.0%
	18-30	41	28	41	110	7.567	0.109
Age	18-30	37.3%	25.5%	37.3%	100.0%
	31-40	48	35	80	163
	31-40	29.4%	21.5%	49.1%	100.0%
	41and Above	52	48	57	157
	41and Above	33.1%	30.6%	36.3%	100.0%
	Total	141	111	178	430
Education	Total	32.8%	25.8%	41.4%	100.0%
	Illiterate	26	19	55	100	25.214	0.001
	Illiterate	26.0%	19.0%	55.0%	100.0%
	Matriculate	13	15	30	58
	Matriculate	22.4%	25.9%	51.7%	100.0%
	Intermediate	49	22	34	105
	Intermediate	46.7%	21.0%	32.4%	100.0%
	Graduate	34	37	39	110
	Graduate	30.9%	33.6%	35.5%	100.0%
	Postgraduate	19	18	20	57
	Postgraduate	33.3%	31.6%	35.1%	100.0%
	Total	141	111	178	430
	Total	32.8%	25.8%	41.4%	100.0%
Profession	Government Servant	18	20	16	54	22.879	0.011
	Government Servant	33.3%	37.0%	29.6%	100.0%
	Private Service Sector	26	18	35	79
	Private Service Sector	32.9%	22.8%	44.3%	100.0%
	Businessmen & Shopkeepers	28	13	50	91
	Businessmen & Shopkeepers	30.8%	14.3%	54.9%	100.0%
	Health Experts	5	11	5	21
	Health Experts	23.8%	52.4%	23.8%	100.0%
	Education Experts	8	9	10	27
	Education Experts	29.6%	33.3%	37.0%	100.0%
	Others	56	40	62	158
	Others	35.4%	25.3%	39.2%	100.0%
	Total	141	111	178	430
	Total	32.8%	25.8%	41.4%	100.0%
Monthly Income	PKR 21000 and Below	47	32	68	147	10.218	0.037
	PKR 21000 and Below	32.0%	21.8%	46.3%	100.0%
	PKR 22000 and Above	48	56	64	168
	PKR 22000 and Above	28.6%	33.3%	38.1%	100.0%
	Sorry	46	23	46	115
	Sorry	40.0%	20.0%	40.0%	100.0%
	Total	141	111	178	430
	Total	32.8%	25.8%	41.4%	100.0%
Area	Rural	96	84	107	287	7.630	0.022
	Rural	33.4%	29.3%	37.3%	100.0%
	Urban	45	27	71	143
	Urban	31.5%	18.9%	49.7%	100.0%
	Total	141	111	178	430
	Total	32.8%	25.8%	41.4%	100.0%

Explanation

A substantial number of the illiterate (55.0%), female respondents (41.9%), respondents of the middle age group of 31-40 (49.1%), self-employed group the businessmen and shopkeepers by profession (54.9%), respondents of the lower income group of PKR 21000 and below (46.3%) belonging to the urban areas (49.7%) meagrely supported the counter malaria policy adopted by the provincial government of KP (2013-18). The chi-square test issued significant results of p-values in favour of the variables comprising the education, profession, monthly income and area of the livelihood of the respondents. It further confirmed that gender and age were declared insignificant in this case. The significant variables have p-value < 0.05 and were in syndication with the effective counter-malaria policy, while there is no relationship between the insignificant variables and the efficacy of the malaria control policy initiated by the government in Khyber Pakhtunkhwa.

It also unearthed that the illiterate respondents were conveniently satisfied with the performance of the provincial government of Khyber Pakhtunkhwa for adopting such reforms in the health department that facilitated the common people and were in a position to acquire top-class health curing privileges in the public sector hospitals.

Conclusion

The provincial government of PTI after coming into power in Khyber Pakhtunkhwa (2013-18) get a chance for converting its electoral manifesto into policies. The electoral manifesto highlighted the provision of world-class health facilities. In this connection, a number of reforms were introduced in the health sector. It tried to ensure health insurance and granted autonomy to the medical teaching institutes under the MTI Act of 2015. The study revealed that the reforms introduced in the provincial health sector satisfied the public to an average extent (35.90%).

Health reforms are also important to be understood in terms of the variable including gender, age group, education, profession, monthly income and rural and urban division. In considering gender, the male respondents are more satisfied in comparison with female respondents with the performance of the provincial government of KP (2013-18) in terms of the introduced reforms. In reference to the age group, the middle age group respondents are more satisfied. The graduated respondents are more satisfied with the health reforms. The professional consideration revealed that the professionals of the private services sector are crediting the government for the introduction of good reforms in the health department. As for the monthly income, consideration is concerned, the respondents having a high-income group of 22000 and above are pleased with the provincial government. Likewise, the rural respondents have encouraged the provincial government for providing health facilities in the rural health care centres.

The Pakistan Tehrik-e-Insaf gave high hope and expectations to the public in running an electoral campaign for the 2013 general elections and announced upgrading the standard of the health care centres. Thus after assuming power it tried its best for improving the healthcare sector which is unearthed in the study. The study revealed that the public is satisfied with the performance of the provincial government of PTI in KP (2013-18) which leads to the applicability of the expectancy disconfirmation theory.

References

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APA

APA :

Global Political Review, VII(II)

https://doi.org/10.31703/gpr.2022(VII-II).13

PERFORMANCE OF THE PROVINCIAL GOVERNMENT OF KHYBER PAKHTUNKHWA (2013 18) IN TERMS OF REFORMS INTRODUCED IN THE HEALTH DEPARTMENT

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