Pakistan has one of the best-knitted networks of health care facilities in public sector; and a very
large private sector. The public sector facilities mostly, face the problems of underutilization and
under functioning along with the technical and allocative inefficiency. This situation has been
described in different donor reports and evaluations carried out by the Government of Pakistan.
The management of private sector has also been considered inefficient and not very effective.

Specific Management tools and techniques, such as strategic management, management by
objectives, quality assurance methods, monitoring and evaluation of the health systems outputs
and outcomes, and economic appraisal are not practiced in both public and the private sector.
One of the primary reasons for all these issues is that most health managers lack expertise in
health management. Insufficient management knowledge, inappropriate skills and lack of
expertise in management, further undermine their capability to improve the health system.

The way forward is the continuous education and training leading to the capacity building of the
midlevel health managers and encouraging them to apply their knowledge in their respective
settings. On the other hand, there is no well-developed and properly facilitated management
training being offered in Pakistan which can fulfil the need of the health managers in public as
well as private sector.