Evaluating the Effectiveness of Governance in Universal Health Coverage Implementation in Pakistan : A Case Study of the Sehat Sahulat Program = 파키스탄의 보편적 보장 시행에서 거버넌스의 효과 평가: 세하트 사울라트 프로그램 사례 연구

다국어 초록 (Multilingual Abstract)

This study explores the role of governance in the execution of Universal Health Coverage （UHC） in Pakistan, using the Sehat Sahulat Program （SSP） as a case study. Universal Health Coverage seeks to guarantee fair access to high-quality healthcare services without causing financial strain; nevertheless, governance deficiencies persistently hinder successful implementation in numerous developing nations. Pakistan’s healthcare system encounters significant obstacles such as fragmented institutional frameworks, poor coordination between federal and provincial authorities, administrative inefficiencies, issues with financial viability, and disparities in healthcare accessibility. The research examines how this governance elements impact the rollout and performance of the Sehat Sahulat Program.
The study employs a qualitative descriptive case study methodology grounded in the analysis of secondary data. Information was gathered from government policy papers, official reports, scholarly articles, and publications from international health bodies such as the World Health Organization and the World Bank. The research utilizes thematic and policy analysis to explore governance frameworks, institutional collaboration, regulatory supervision, financial viability, and equity in healthcare outcomes. The results indicate that the quality of governance plays a crucial role in shaping both the execution and long-term viability of Universal Health Coverage in Pakistan. While the Sehat Sahulat Program has enhanced healthcare access and financial security for underserved groups, persistent governance issues still hinder policy efficiency and fair distribution of health services. The research suggests that achieving effective and sustainable Universal Health Coverage in Pakistan requires improved institutional collaboration, stronger regulatory frameworks, stable funding approaches, and greater administrative capabilities.

목차 (Table of Contents)

• CHAPTER 1 Introduction 1
• 1.1 Background of the Study 1
• 1.2 Problem Statement 6
• 1.3 Research Aim and Objectives 9
• 1.3.1 Research Aim 9
• 1.3.2 Research Objectives 9
• 1.4 Research Questions 10
• 1.5 Significance of the Study 11
• 1.6 Research Method Overview 12
• 1.7 Structure of the Thesis 13
• CHAPTER 2 Literature Review 15
• 2.1 Introduction 15
• 2.2 Concept and Global Significance of Universal Health Coverage 17
• 2.3 Theoretical Perspectives on Health Sector Governance 20
• 2.4 Governance as a Determinant of Universal Health Coverage 25
• 2.5 Structural Features of Pakistan’s Health System 27
• 2.6 Policy Evolution and the Sehat Sahulat Program 29
• 2.7 Empirical Evidence on Health Governance in Pakistan 31
• 2.8 Research Gap 33
• 2.9 Conclusion 35
• CHAPTER 3 Research Methodology 37
• 3.1 Introduction 37
• 3.2 Research Philosophy 39
• 3.3 Research Design and Case Study Approach 41
• 3.4 Data Sources and Selection 42
• 3.5 Data Analysis 43
• 3.6 Document Selection and Coding Procedure 45
• 3.7 Reliability and Validity 45
• 3.8 Ethical Considerations 46
• 3.9 Limitations of the Study 47
• 3.10 Chapter Summary 47
• CHAPTER 4 Governance Analysis of Universal Health Coverage
• Implementation: Evidence from the Sehat Sahulat Program 49
• 4.1 Introduction 49
• 4.2 Governance Context of the Health Sector in Pakistan 51
• 4.2.1 Historical and Institutional Background 51
• 4.2.2 Federal and Provincial Coordination 53
• 4.2.3 Role of Public and Private Healthcare Providers 54
• 4.3 Thematic Governance Challenges Affecting Universal Health Coverage 56
• 4.4 Case Study Development of the Sehat Sahulat Program 59
• 4.4.1 Policy Origin and Reform Motivation 59
• 4.4.2 Institutional Governance Structure of the Program 59
• 4.4.3 Service Coverage and Benefit Design 60
• 4.4.4 Implementation Experience and Operational Reality 61
• 4.5 Governance Impact on Healthcare Access and Financial Protection 62
• 4.6 Governance and Equity Outcomes 63
• 4.7 Interpretation in Light of Global Universal Health Coverage Experience 65
• 4.8 Integrated Governance Analysis 65
• 4.9 Chapter Conclusion 68
• CHAPTER 5 Conclusion and Policy Recommendations 70
• 5.1 Introduction 70
• 5.2 Summary of Major Findings 71
• 5.3 Theoretical Contributions of the Study 72
• 5.4 Policy Implications for Universal Health Coverage in Pakistan 73
• 5.5 Specific Recommendations for Strengthening the Sehat Sahulat Program 74
• 5.6 Limitations of the Study 75
• 5.7 Directions for Future Research 76
• 5.8 Concluding Reflection 76
• References 78
• Appendices 90
• 국문초록 97