Decentralization of OPDs of Basic and Rural Healthcare Units of Punjab, Pakistan


  • Awais Gohar University Institute of Public Health, The University of Lahore, Lahore, Pakistan
  • Ejaz Qureshi University Institute of Public Health, The University of Lahore, Lahore, Pakistan
  • Farah Ahmad Healthcare Systems Management Unit, College of Physicians and Surgeons, Ziauddin Medical University, Karachi, Pakistan
  • Hasnain Javed Provincial Public Health Reference Lab, Punjab AIDS Control Program, Lahore, Pakistan
  • Warda Fatima Institute of Microbiology and Molecular Genetics, University of the Punjab, Lahore, Pakistan
  • Nida Abdul Qadir Provincial Public Health Reference Lab, Punjab AIDS Control Program, Lahore, Pakistan



Decentralization, Rural Health Centers, Basic Health Unit, Outdoor Patient Department


Decentralization is associated with political administration and historical development, and varies according to region and implementation factors. In the 1980s, the IMF (International Monetary Fund) and World Bank demonstrated that corruption and bad administration in society are due to centralization policies which concentrate authority and power in the hands of the elite upper class. This criticism was an initial point to start the period of structural decentralization adjustment. Decentralization is a substantial process for equal distribution of healthcare service delivery in the community. The outdoor patient department (OPD) is one of the most important parts of any health care unit to diagnose and treat patients who do not require overnight care or stay in hospitals. The main purpose of this research was to analyze the effect of decentralization and improvements in health services for OPD by analyzing the number of patients in Primary Healthcare Centers (Basic Health Unit (BHU) and Rural Health Centers (RHCs)) in Punjab before and after de-centralization. Non-probability convenient and simple random sampling technique was employed, and patients visiting PHCs (primary healthcare centers) OPD were included in the study population. OPD patients of rural and basic healthcare units were categorized into three pairs OPD 1, 2 and 3, and the means and other statistical parameters were calculated using SPSS. The average mean of all groups of OPD patients of RHCs were 119441.1111, 192536.5185 and 153487.1358, respectively. The average mean of all groups of BHU was 94818.5062, 109331.7160, and 124231.0123, respectively. The results showed that the number of patients in the OPD increased after decentralization due to more health facilities.


Y. Ustu, M. Ugurlu, M. Ornek, and S.Y. Sanisoglu. Evaluation of Primary and Secondary Health Care Services in the Erzurum Region Between 2002-2008. Balkan Medical Journal 28: 55–61 (2011).

H. Yikilkan, S. Gorpelioglu, C. Aypak, Z. Uysal, and O.O. Ariman. Differences between rural and urban primary care units in Turkey: implications on residents’ training. Journal of family medicine and primary care 2(1): 15 (2013).

T.J. Bossert, A.D. Mitchell, and M.A. Janjua. Improving health system performance in a decentralized health system: capacity building in Pakistan. Health Systems & Reform 1(4): 276-84 (2015).

M. Akram, S. Inayat, and M. Hussain. Analysis of the health care delivery system in Pakistan and Nepal. Independent Journal of Allied Health Sciences 4(01): 22-8 (2021).

A.M. Sumah, L. Baatiema, and S. Abimbola. The impacts of decentralisation on health-related equity: A systematic review of the evidence. Health Policy 120(10): 1183-92 (2016).

S.Z. Aziz, and I. Hanif. Primary care and health system performance in Pakistan: A study of basic health units of South Punjab. Journal of Pakistan Medical Association 66(12): 1632-6 (2016).

J. Konde-Lule, S.N. Gitta, A. Lindfors, S. Okuonzi, V.O. Onama, and B.C. Forsberg. Private and public health care in rural areas of Uganda. BMC International Health and Human Rights 10(1): 1-8 (2010).

I. Nawaz, A.A. Maan, I.A. Khan, and B. Shahbaz. The Effect of Physical Work Environment on the Job Satisfaction of Nurses in the Rural Health Care Settings of Punjab, Pakistan. Pakistan Journal of Medical & Health Sciences 16(03): 401 (2022).

J. Khan, M.S. Iftikhar, U. Noor, R. Sulaiman, T. Qadeer, and M.A. Iftikhar. Comparison of Depression in Women with Primary and Secondary Infertility in Patients at OB/GYN OPD at Sharif Medical City, Lahore, Pakistan. Pakistan Journal of Medical & Health Sciences 16(05): 454 (2022).

A. Hussain, M. Asif, A. Jameel, and J. Hwang. Measuring OPD patient satisfaction with different service delivery aspects at public hospitals in Pakistan. International Journal of Environmental Research and Public Health 16(13): 2340 (2019).

A. Dwicaksono, and A.M. Fox. Does decentralization improve health system performance and outcomes in low and middle income countries? A systematic review of evidence from quantitative studies. The Milbank Quarterly 96(2): 323-68 (2018).

J.S. Tulchin, and A.D. Selee. Decentralization and democratic governance in Latin America. Woodrow Wilson International Center for Scholars, Latin American Program: (2004).

M. Duggiral, C. Rajendran, and R. Anantharaman. Patient-perceived dimensions of total quality service in healthcare. Benchmarking International Journal 15: 560–583(2008).

B.D. Guedes, F.L. Vale, R.W. Souza, M.K. Costa, and S.R. Batista. The Organization of Secondary Outpatient Care at SHS-DF. Ciência & Saúde Coletiva 24: 2125-34 (2019).

H.H. Iversen, O. Holmboe, and O.A. Bjertnæs. The Cancer Patient Experiences Questionnaire (CPEQ): Reliability and construct validity following a national survey to assess hospital cancer care from the patient perspective. BMJ Open 2(5): e001437 (2012).

E. Zarei. Service quality of hospital outpatient departments: Patients’ perspective. International Journal of Health Care Quality Assurance 28(8): 778–790 (2015).

A. Suhail, A. Gohar, and T. Steen. Decentralization Reforms in the Public Health Sector in Pakistan. In: Public Sector Reforms in Pakistan, (Eds.) A. Zahra, G. Boukaert, M.Z.I. Jadoon, and N. Jabeen. Palgrave Macmillan Publishers pp. 195-222 (2022).




How to Cite

Awais Gohar, Ejaz Qureshi, Farah Ahmad, Hasnain Javed, Warda Fatima, & Nida Abdul Qadir. (2023). Decentralization of OPDs of Basic and Rural Healthcare Units of Punjab, Pakistan. Proceedings of the Pakistan Academy of Sciences: B. Life and Environmental Sciences, 60(4), 653–660.



Research Articles