In 2010 Pakistan decentralized the health system, passing many management functions to the provincial level. Decentralization is widely accepted as a step toward a more efficient and responsive health system. In Pakistan however, supervision, coordination, and communication mechanisms at both the provincial and district levels must be established to ensure stakeholder engagement and inter-sectoral collaboration. Specifically, supportive supervision between the provincial and district levels must be reinforced and strengthened. District-level management coordination forums must be established and linked to existing provincial-level mechanisms. These health system strengthening actions will improve the Sindh health system’s responsiveness, efficiency, and delivery of district-level health services, and will ultimately improve accountability. JSI, 2017.
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