Setting a New Pace: How Punjab, Pakistan achieved unprecedented improvements in public health outcomes
By Fenton Whelan & Will Anderson
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Big wins for public health in Punjab, Pakistan.

Between 2014 and 2017, Punjab achieved unprecedented improvements in its health system

  • Immunisation coverage increased by 35 percentage points, a rate of improvement unheard of in a large health system. By 2017, almost one million more children were being fully immunised each year against a range of deadly childhood diseases, saving thousands of lives.

  • The proportion of women giving birth in the health system increased by 13 percentage points, meaning that 300,000 more children were born each year with medical care during their first moments of life, again saving thousands of lives.

  • A new ambulance service was launched handling roughly 25,000 patient transfers a month by December 2017.

  • Additional vaccines, including rotavirus, were rolled out.

  • A new referral system for complicated cases was established.

  • The performance of primary health facilities rose, with substantial improvements in staffing, medicine availability, facility outlook and patient care.

  • Behind the scenes, new data systems, management routines and processes were implemented.



The improvements targeted and disproportionately benefited the poorest communities in the province. Every indicator improved most among the poorest quarter of the population. The health service was extended to large numbers of previously unreached or underserved communities.


The improvements were the result of a simple set of techniques and processes that could be applied elsewhere. The Punjab Health Reforms Roadmap focused on improving management and implementing simple but effective solutions to problems on the ground. The strategy focused on:

  • Agreeing priorities based on what would make the most difference

  • Using cost-effective and innovative new technologies

  • Getting good data to understand what works and to manage performance

  • Building capacity throughout the system

  • Creating routines to solve problems and drive progress

  • Engaging political leadership

Punjab’s success demonstrates that the key to saving lives in the developing world lies not in complex development theories or massive injections of funding, but rather in the application of good management and innovative technology to improve the delivery of services on the frontline.

This report is the story of that transformation.

About the Authors

Fenton Whelan founded Acasus, he has more than a decade of experience in public health and education development. Will Anderson is the lead researcher for public-sector projects at Acasus.

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