Chapter 1: Introduction

1.1

Background of the study

Budget is defined as the collection of documents of organization

comprising detail description of anticipated revenue and expenditure
associated with activities planned for obtaining desired purposes and
goals within specified period. (Mathew, 2015).
The budget represents central logic tool for planning control and
accountability for an organization. The aim of budget is efficient and
effective use of allocated resource in public sector for welfare
purposes. If the allocated resources in budget are not properly utilized
and transformed into welfare services of public interest, the realization
of priorities of public organization is incomplete and the public sector
organization value become useless to citizen than intended. The
aspiration of public sector budget to greater attention on the
relationship with policy implementation, development, and
performance monitoring for allocated resources for intended goals and
objectives.
Budget gives a mechanism of how to assess and evaluate the
anticipated plan. Budget enables an organization to point the cost of
specific activities and their respective performance on allocated

resources. In short budget is a map that guide and enable an

organization to achieve its targeted anticipated plans and objectives.
The health sector improvement has been the main focus area under
the present government of Khyber Pakhtunkhwa (KPK)1 in reforms
initiatives. To find the role of budget in implementing these reforms.
e.g. provision of free medicine in district hospital of the province. This
study discussed the role of budget in the proposed initiatives and to
evaluate these changes in the health sector after increasing budget
and use and extent use of budget. In the study an attempt has been
made to identify the role of the budget control in these reforms. The
study circles around the question that up to what extent the budget is
important and its role in implementing the proposed health initiatives?
1.2 Rationale of the study:
According to the best of knowledge no that type study has been
carried to know important element (budget) role in the implementation
of large changes at the local public sector level. This study is aimed to
investigate the role of budget control in reforms initiated by the current
government of KPK in health sector by analyzing the subsequent
changes in government hospitals performance accordingly and the
people perception about such proposed initiated reforms.

1 Khyber Pakhtunkhwa is the province of Pakistan. Throughout the document it will be

represented by its abbreviation as KPK
2

1.3 Objective of the Study:

The main purpose and objective of this study is to arrive at the point where the
government could identify the role of effective budget in initiated reforms at institutional
level. It has been tried to provide the role of budget in implementing reforms and the
required level of budget for these reforms initiatives. Furthermore an issuance of proper
recommendations, provincial institutions and other concerned authorities for the
importance of budget control in health sector has been level best tried.

1.4 Scope of the study:

The study was just focused on only one hospital of the district Kohat, located in the north
of KPK. The interviews and survey were conducted at the DHQ hospital Kohat.

Chapter 2: Literature Review

Overview:
Budget and budget control plays an important role and remains the
central logic for planning, controlling and accountability in every public
and private organization. The main aim of public sector budgeting is to
allocate the state resources for welfare purposes (Marginson, 2005).
Budget control refer as a forward looking set of numeric or numbers
which projects the future performance of organization and which us
useful to evaluating the viability of organization chosen anticipated
plans (Wallander, 1999; Hope and Fraser, 2003; Bourmistiv and Kaaroe,
2013). Budget control benefits include efficiency through proper
planning, supporting both control and learning and comparing the
projected or forecasted plan with actual results.
4

Budget practices relationship with performance depends on the budget

adoption and the extent of budget use. Specifically those
organizations that use written budgets are positively associated to the
organization performance based on the decentralized structure (Robyn,
2010). Positive relationship among the adoption, extent use of budget
and performance since the organization performance is linked with to
its choice of budgeting practices (Abernethy, 1999). (Adoption) means
those public sector organizations that use written budget have
positively associated with performance. Written budgeting practice
consist of two stages the decision regarding the adoption and
subsequent decision is regarding extent of use. Adoption reflects
the management decisions about a formal process to project future
financial performance and term extent of use both different kinds of
budget the organization uses and the frequency of their use
(Abernethy, 1999).
The Disruptive performance effects during change could be reduce
through using budget of interactive style what refer to budget as a
diagnostic role (Simons, 1990) other role of budget answer machine
role (Burchell, 1980) , in organization carrying the process of strategic
change. Interactive budget define the continual interaction between
the top and lower management to facilitate organizational learning.

Budget: a medium of organizational transformation (Jacobs, 1995) a

case of health sector reform in New Zealand the budget was a
fundamental factor in health reforms with decentralizing the health
sector activities the delegated authority transferred to regional areas
units and new health system completely based on budget (purchaser
and provider role) all the regional authorities received population
based budget funding pool and make them responsible health services.
Every regional health unit doctors its autonomous power the formation
of health care system and given power of a significant input for policy.
The proposed solution for performance creates system a cost and
budget information to use more effective and efficient use of
resources.
Budget and budgetary control play key role in developing health sector
reform the case of health sector reform: key health issue in
developing country study conducted by Cassels (1995) the finding
was that the improper resource allocation and utilization, inadequate
funds allocation, improper use of budget, there was no proper
budgetary control management of spending these budgets have no
check and balance and use of budgets with no transparency.
Inadequate funds availability and single control power authority with
no decentralizing system as study conducted on Australian primary
health care the finding was that the decentralizing are more effective
with using written budget are positive associated with performance
6

because of proper management control and transparency (Robyn,

2010). Literature reveals that the decentralizing the governing bodies
the better will be the result as make them autonomous giving them
power of decision making both management and budget control and
make them responsible will be answerable for their responsibility.
Budget has multiple facts and role and different reason for use in
organization (operational planning, performance evaluation, communication of goals, and
strategy formation) that possibly influence the reason-to-budget performance (Hansen,
2004). Finding of the study was that budget can be used for performance evaluation clear
traceable resources with making changes in budgets with time to time to management and
find and monitor the use of budgets that how the respective departments are efficiently
use the allocated resources and budget throw this way performance can be measure or
judge, a tool for communicating organization goals and strategy planning for future. Over
all finding of the study the performance of budget for, performance evaluation,
operational planning, strategy formulation and communication of goals are found all
positively correlated to with greater satisfaction for organization budgeting system and
effect the unit performance of organization in other words unit performance of
organization has directly associated with use of budget and reason-to-budget. (Hansen,
2004)

Chapter: 3 Research Method

3.1 Objective for study:
The objective that was aimed to be investigated was the role of budget control in bringing
reforms or changes at the public sector level through government long term initiatives. To
identify the problem and the impacts of variable, the budget control, the study was
localized to a district level hospital where the government initiative such as provision of
free medicine impact was examined and researched.
3.2 Research Methods:
The study was carried at local level. The research area selected for the problem
investigation was the Divisional Headquarter hospital (DHQ) Kohat, in KPK. The
research was carried out through documents analysis REFORMS INITIATIVES
in KPK (KPK, 2015) Initiatives and the interview of the hospital and patients in
the hospital where the case study was conducted. For primary data collection
interview and observations as an instrument were used. Sources used for data
collection, Primary data collected through interviews of patients, hospital
management, hospital medical staff and observations.
Source used for secondary data collection was internet, articles, documents,
newspapers, and government reports, hospital statistics (DHQ Kohat finance and
computer cell)
3.3 Research Instrument:
The documents of the government budget and the finances report of the hospital
was approached through a written permission letter got from the institute. In
8

addition for more effective result, the research data was collected through hospital
staff interviewed and the survey method was used for collecting data from the
patients.
3.4 Sample Size for interview and survey:
Interview and sample was based on 50 personnel both patients and hospital
officials and staff. Due to lack of time of 35 were interviewed and survey in both
emergency and ward. In 35 personnel the 14 personnel were interviewed and
remaining was based on survey in which 14 persons were hospital tops 3 official
which appointment and access was available and remaining were working staff
and patients. The 3 officials who interviewed were the Medical Superintendent
(MS), Medicine Coordination Cell Manager, and Emergency treatment center
Medical officer the other 4 were nurses and working staff in emergency and ward.
The remaining 7 interviews conducted with patients of Medical wards. The rest
sample of survey is open questions from patients regarding availability of
medicine which is contain on 21 patients in emergency and Out Patient
Department. The data collection through the interview and survey was divided
into two parts.
Staff interview: The high officials including MS of the hospital, deputy MS,
Store manager, Finance manager and Emergency ward in-charge were deeply
interview through structured and closed ended questioned aimed for extracting
data on the main objective of the case. A total of five officials in the management

were interview and the important points were quoted in the analysis strengthening
our theme.
Patients, nurse and general public survey:
A total of 32 individuals were surveyed through open and close ended questions
reflecting our case objective amongst which best 32 respondent response was
analyzed and recorded with the help of excel. Their response was judge on the
scale of agreed or not agreed with questions asked about the current medicine
provision by the present government and the benefits they are enjoying from these
initiatives.
3.5 Interviews structure:
Medical superintendent, medicine store in charge, nurses, ward supervisor and
emergency coordinator interviews were included to find the effectiveness of the
reforms.

3.6 Survey Structure:

18 random patients were selected from different wards who were Indoor patients
(NPD) and 12 were from Outdoor patients (OPD) for the survey about the free
medicine provision and other new initiatives services they received.
3.7 Research theme:
The main aim and theme of the study was to find the effectiveness of budget control in
bringing reforms in the public sector, to find this effectiveness a structure questions were

10

asked during surveys and interviews. In the interviews and survey analysis, the main
theme that was followed was to know the availability of free medicines, any new
increases or decrease in the budget, any new change in the hospital become possible of
budget cause.

11

Chapter 4:Analysis
This case major investigation objective was to analyze the importance of budget control
in implementing reforms and changes drive through this economic variable. It had used to
analyze this relationship by taking the case of current reforms brought by KPK
government in health sector which was one of the main agenda of the current
government. (KPK, 2015) Improvement in this sector was started through the
breakthrough initiative of provision of free medicine in government hospitals of the
province. Time has realized us that they were standing on this agenda and many
initiatives has been started as reflected in the government 121.38% increase in provincial
health budget during the period 2013-2014 (See table 1).
4.1 Document analysis:
Taking step toward implementing the health reforms initiatives government passed
different health acts of (Medical and health institution reforms act. 13th Jan. 2015), (KPK
injured person and Emergency Medical Aid act. 14th Nov. 2014), (The KPK health care
commission act. 13th Jan.2015) (KP Assembly, 2013). The application of these health
reforms initiatives could be observed on the grass root level (District Hospitals) where
this budget increase is applied. As our case is Divisional Head Quarter (DHQ) hospital
Kohat and main focus area is the provision of free medicine to the patient used as a
variable for significant measurement of these reforms. Below is the overview of the
health budget statistics of KPK government with comparison of previous government
budget. (KP Finance, 2008-2015)

12

Years
Health
Budget

2008-09
3543.97

2009-10
4,024.780

2010-11
5940.68
5

2011-12
7837.251

2012-13
2013-14
10,330.37 Rs.22870.21

2014-15
25,237.12

Table 1: Health budget statistics of KPK (Rs.Million)

Data Source: Finance and computer cell department DHQ Kohat (supervised by yasir)
Table 1 shows the annual health budget allocation by the province KPK over the past 8
years comparing two different governments periods, previous government for the period
2008-13 and current government for 2013-16.The current government health budget for
year 2013-14 showing a drastic increase from 10330.37 million to 22870.21 million
showing a 121.38% increase. The increased amount was the new policy of free medicine
and other health initiatives started in 2013 after declaring health emergency in the whole
province. For the period 2014-15 health budget increased by 10.34% (From Rs.22870.9
million to Rs.25237.12 million) and for period (2015-16) health budget increased
18.46% (from Rs25237.12 million to Rs. 29953.4 million) collectively 28.90% further
increase in years ( 2014 and 2015) was added to the health budget to continue initiatives
and to other programs. After successful and significant results of pro-poor program,
mobile health facility , 100% free emergency medicines and other such initiatives in the
previous two years (2013-2015) the new budget for the year 2015-16 was further more
increased from Rs.25237.12 to Rs.29953.4 showing 18.67% increased as compared to the
previous two years duration. (KP Finance, 2008-2015)
During past 8 years of two different governments, the previous government 5 years
budget (2008-2012) and current government 3 years (2013-2015) budget comparison for
health sector shows a clear image of their concerns for health sector where a huge
13

2015-16
29,953.4

increased was found in allocation by the current government. Previous government 5

years budget sum up to total of Rs.31677 million (2008-12) while the current
government 3 years budget total sum is Rs.78060.71 which show that the current
government 3 years health budget is 2.46 times (or 146% increase) greater than previous
government 5 years budget. (See grahph1).
Graph: 1 Total KPK past 8 years Annual Health Budget (Rs. Million)
35000
30000

29953.4

25000
20000

22870.21

15000

Total Budget

10000
5940.69
7837.25
5000 3543.97
4024.78
0
10330.37

25237.12

14

During the current fiscal year (i.e.2015-2016) Rs.29953.4 million budget for health sector
is 272.75% increased as compared to the previous government annual average budget of
Rs.6135.396 million during period 2008-2012. This increase in health budget was for
starting different new health program e.g. Sehat ka insaaf program in Peshawar,
recruiting of doctors, nurses and technicians, Sehat ka Etihaad program for polio
eradication, free emergency health services, free medicine services, free insulin bank for
diabetes patient, incentives for maternal health services, incentives for immunization,
mother and child health services, mobile health services and health insurance cards for
poor people. (KPK, 2015), (Reforms KP, 2013)
4.2 Major health initiatives during period 2013-2015:
After drastic increase in health budget by government the step towards the
implementation of health initiatives government start different health program in which
one is Chief Minister Special initiative program for poor people of the province i.e Health
Insurance Scheme for 20% poor against fatal diseases, (KPK, 2013) Rs.500 million
Special initiative on Parental healthcare for poor women in 12 deserving districts
(Battagram, Buner,Chitral, Nowshehra, Lower Dir, Uper Dir, Hangu, Kohistan, Lakki
Marwat, Shangla, Tank, and Tor Ghar,) Rs 200 million (KPK Government Finance,
2013-2014), Financial incentive for immunization course to poor in 12 deserving districts
(i.e (Battagram, Buner,Chitral, Nowshehra, Lower Dir, Uper Dir, Hangu, Kohistan, Lakki
Marwat, Shangla, Tank, and Tor Ghar,) (KPK Govt, Reforms Initiatives booklet, 2015)
15

Rs 200 million, Up scaling of Emergency Wards in all District HQ hospitals Rs 1 billion,

Professional Administrative Units in all tertiary hospitals in the province. Establishment
of a comprehensive Referral System in the province Cancer and Hepatitis treatment for
poor: PRs 675 million, Integrated Vertical Program for consolidation of health institutions
Rs 7.99 billion (KP Finance, 2008-2015) (KP Reforms, 2013).

4.3 DHQ Kohat Document Analysis:

To examine the above reforms and its full functioning and the way they are implemented
at the grass root level, a one core area that could be affected is the district and city level
major hospitals, for this purpose a (DHQ) hospital of KPK in district kohat and focusing
the major step taken in this regard by the present KPK government of provision of free
medicine provided at all government hospitals. Following are the four years free
medicine allocation budget out of the total DHQ Kohat budget issued by the provincial
government of KPK.
Table-2 DHQ KHOAT BUDGET (Rs million)
Years

2012-13

2013-14

2014-15

2015-16

Total DHQ Kohat Budget

155.57

209.26

324.02

227.29

Free Medicine

9.5

11.956

23.469

24.44

16

Graph:2 Free Medicine Budget DHQ (Kohat)

450

397.26

400
350

324.02

300
250
200
150

209.26

DHQ Budget (Rs. Million)

Free Medicine (Rs.million)

155.57

100
50

9.5

11.96

23.47

24.44

2013-14

2014-15

2015-16

0
2012-13

Table 2 shows budget increase for the period (2013 to 2016) regular and free medicine
budget of DHQ hospital Kohat ,for provision of free medicine and other free health
facility (emergency care medicine, operation theater, ward patient medicine, different
insulin etc.) to patient on emergency basis and routine (ward patients) while the
17

government start the special budget initiative for provision free medicine to patients
under the platform of their special initiative (KPK Govt, Reform Implementation Cell KP,
2013) and Reforms initiative in Khyber Pukhtunnkhwa (KPK Govt, Reforms Initiatives
booklet, 2015). The government start health initiatives programs by passing health acts
such as Free Emergency Services, Insulin Banks in the provincial assembly of KPK in
(Free emergency services and free insulin Act. 2014) as a special fund beside regular
annual budget. The government had increased the budget for health drastically through
passing different legislations and had increase the health budget by 121% in the year
2013-14 which also result an increase in the total DHQ Kohat health budget.
In the total DHQ Kohat for the year 2012-2013 only 6% was allocated for the free
medicine, after government started reform initiatives in health sector 5.7% (2013-2014)
was allocated for the free medicine only for wards, emergency and OPD patients, and Rs
20 million extra for the special initiative budget showing a combine 15.27% allocation
for the free medicine allocation out of total budget.
The initially started finding from the increased in budget with comparison of previous
government health budget. The hospital officially started different programs of free
medicine in addition of new medicine and lifesaving drugs first time after government
initiatives in health sector, the provincial government approve a special budget beside the
regular budget Special initiative budget first time in health sector.
4.4 Special pro-poor Program (2014)
The main objective of this program was to provide free vaccine and severe case treatment
medicine to patient admitted specially for poor people who cannot afford the price of
18

high cost medicine (injection streptokinase market price Rs.7500 is completely free
provide to severe heart patient, erythropoietin injection for kidney fail patient or other
similar severe case patient with market price Rs.10995 is provided free to patient as of
the information provided by the ward medicine store in charge ). Adding free medicine
and free health diagnosing health facility of heart patients, kidney patients, appendix
patients, casualty patients, poising eating patients, arm fire patients, bomb blast and
victims of terror attacks and natural disaster victims. The hospital policy of emergency
patients treatment is completely free in emergency with medicine provision, all those
severe patients who refer from emergency to ICU/CCU2 admitted medicine and all
diagnosing facility including test and surgery are completely free for 72 hours, patients of
terror attacks will get free treatment of emergency and till to full recovery the medicine
and other health diagnosing facility provided free, trauma patients will have the facility of
free medicine and diagnosing health facility for 48 hours and this was for the first time
started at the hospital as per the provincial government instructions, although in other
governments it was available but only emergency treatment were provided to such
patients.
The mechanism of free medicine provision was first only for emergency basis now it has
been extended to ICU/CCU and operation theater all the operation and other surgery
instruments and medicine is now provided free to all patients.
4.5 Medicine Coordination Cell (MCC KPK) to District Medicine Cell (DMC):

2 ICU/CCU: Intensive Care Unit or Critical Care Unit is a special department in hospital which is
used for server case injuries or treating other life threating ill patients.
19

To make timely and fast availability of the quantity and required medicines, the
government has converting provincial medicine coordination cell (MCC) to authorized
and autonomous district coordination cell (DMC) in the main district hospital. The main
aim of this establishment of DMC was to make the fluent and uninterrupted flow of
medicines to the hospital at district level where this autonomous cell in district was
authorized to procure medicine as per their hospital requirement from the allocated
budget through tender approval from the provincial concerned authorities. This DMC was
available in our case study hospital where the concerned in charge has confirmed this
establishment. This autonomous body has made the medicine flow fast and rapid and
makes the management of medicine. The free medicine provision program
implementation becomes more effective through this sub-division of medicine cell
through which the required quantities of medicine can be easily assessed.
4.6 Central and separated Sub-Ward and OT medicine store:
For the first time separated sub-ward and sub-OT store was established in the hospital
beside the central main medicine store where the medicine was then sent to the whole
wards as per their patient requirements. This make an easiness for access to free medicine
for 24/7 service facility in wards where the admitted patients were given free treatment
with available medicines. This make the medicine quick and easy availability purpose for
every ward store effective usage of the allocated medicine.
To further explore the changes and reforms brought by the present government in health
sector, use interviews and observation of the case area as an instrument for investigating
the significant results of the proposed programs in the health sector i-e free medicine at

20

the hospital OPD, emergency and admission wards in DHQ Kohat. We divide our
interviews into two parts, interview from staff and interview from the patients in OPD,
emergency and admitted patients in the wards of the hospital.
4.7 Interview and Survey Analysis:
The study aim was to examine and find out the role of budget in implementing reforms
by government and the selected area was hospital sector Divisional Headquarter Hospital
for free medicine provision in emergency basis and ward patients. For this purpose the
interview and survey conducted from hospital official and patients about provision and
availability of free medicine after increasing health budget by provincial government.
During the new reforms brought by the government in health sector, special micro level
associated programs were started to implement the macro level programs at district and
city level hospitals. At our case area hospital the MS of the hospital mention the steps
taken in regard for the health sector improvement,
Pro-Poor Initiative Budget which is a special budget except the regular budget through
which enabled us to almost provide free medicine at emergency and new special program
for ward admitted patients.
The pro-poor initiative was mainly focused to provide free medicine under special
circumstances to the different situations causalities for a specified duration during the
stay of the patient. Free medicines and indoor treatment was aimed to provide through
this regular budget exclusive program. Extra special case unit was established in the
hospital under this scheme and was successfully operational in the hospital providing new
facilities under this scheme for which extra special budget was allocated.
21

Free medicine provision was the major objective of the government to facilitate
government operated hospitals and to provide free medicine in the OPDs and admitted
patients in the hospital. The number of free medicine volume was increased to a sufficient
quantity to facilitate the poor patients and provide them free treatment.
The availability of free medicine in DHQ Kohat, the medical superintendent said,
Patients in OT are not required to bring any type of medicines and other apparatus
during operation; we provide them all required medicines free of cost from the new
established OT medicine store.
Operation Theater (OT) was also renovated under the new reforms. Operation was free
during the hospital treatment and all the medicines and apparatus required for the
operation was provided free of cost to the patients during their different cases operation.
The budget they received from provincial government for free medicine and other health
facility, the MS of the hospital replied in these words;
We have been provided with sufficient budget to implement the new proposed programs
by the present government but we required management personnel for proper utilization
of this budget resource
During the interview and survey we have come crossed with major problem of deficiency
of work personnel to manage and handle the extra work burden increased due to new
facilities centers and the management of these free medicines stores for timely updating
of the inn and outflows.

22

Beside free medicines other related facilities to the patients during their stay at hospital
was also improved. Trauma Centre was established for the first time in DHQ hospital
Kohat. .While adding to the statement about other facilities started under the new
government had come he said;
For the first time in DHQ Kohat Trauma Centre is establishing and its main
objective was to provide treatment to special cases of trauma injuries water purification
plant in hospital, dead bodies storage cooler machine, beautification of hospital and
other such initiatives are in progress
Ward store has been established for the first in the hospital to provide 24 hours free
medicine facility to the ward admitted patients. Separate ward stores were established for
every ward which was provided with the specific requirement of that hospital, free
medicine and insulin bank for diabetics patients replied by medicine store coordinator
We have new types of insulins and with sufficient quantities. New and more patients
have been registered for the regular treatment
As in the previous year the number of diabetes and hepatitis patients has been increased
and more people are infected by these dieses. Insulin for diabetic and hepatitis patients
has been started under the new government free medicine provision. The insulin was also
available in the previous government rule but was not sufficient quantities and were also
for the initial stage patients and the doses prescribed by the doctors were not available,
luckily it has now sufficient volume and has advanced type of the medicine.
A medicine store assistant adding to the explanation, said:

23

The Moxifloxacin antibiotics which provide to OPD and ward patients free of cost is
now available with us in main store and inwards in a sufficient quantity for different
patients and with all dosage
Lifesaving drugs which was not available in the past and patients have to be referred to
the provincial government capital, Peshawar large hospital. To eliminate these hurdles for
the patients, now all the district hospital large hospital have been provided with these
medicine for free of cost, these medicine are much costly in price but provided in a large
number to these hospital under the free medicine provision program. Medical ward store
supervisor about the supply and provision of free medicine to patients; said that
medicine in this ward is free to all patients including high antibiotics first time started
after government start initiative in health sector. She mentioned injection (erythropoietin
injection for kidney fail patient) which is very high level dose for very severe cases
patients and too expensive is now available with us in this ward for free and its market
price is Rs.11000.
As the number of patients have been increased attracted by the free medicine provision
but the staff required to handle these facilities, insufficient staff is creating hurdles in
implementation of these proposed initiatives, In response to her opinion asked for current
government initiatives steps said;
Yes the government initiatives are welcomed by the public and are appraised by
everyone but i am not happy (laughed on the response) with this steps because of
suffering from extra burden of work due to shortage of staff and the management

24

cooperation is very weak and we have now increased number of patients to be served
attracted by the new facilities and other free services provided at hospital.
The flow and number of patients have been increased after the free medicine provision
have been announced but the required small changes at micro level to implement these
programs are not focused and the management are facing problems to give 100% result of
such programs.
Different patients of different wards about the availability and provision of free medicine
and the services they are receiving, most of patients replied; most of the patients found
provided with the free medicines, new facilities at bed were found,
Yes almost free medicine we are receiving through very easy process and very few
medicine prescribed by the doctors are needed to bring from the market.
The patients that were treated with special cases were satisfied and all of their treatment
have been afforded through the hospital provided medicine and none of the medicines
were haven brought from the outside shop though the patients pocket. A patient in the
surgical ward injured from arm firm admitted in the ward and have been operated for the
diagnoses stated;
I have been operated two days ago and I am feeling healthy now, during my operation I
have been only asked a drip of Rs.200, the rest were provided from the ward store, during
my three days stay here I have nothing to bring from the market and I am too much happy
with the new initiatives.

25

All the patients surveyed in the wards were satisfied with the new announced steps in
health sector, the patients treatment were from the ward sub-store , the operation theature
was now equipped with new machinery and new digital processes of the current
technological advancement.
Emergency unit was advanced with new apparatus and free first aid and other emergency
medicines were now available in large volume. The emergency operation theatre was
supplied with new technicians and advance machineries. When opinion of the emergency
patients, nurses and medical store supervisor was asked, all of them replied (in
summery);
We received timely medicines and doctor treatment, we havent been asked to bring
medicine on own cost, it was better visit here as compare to my last visit, I am happy with
the government reforms
I have now more and sufficient quantity available in the store for patients, as stated by
emergency medicine store supervisor
An emergency morning shift in charge replied in these words;
After new government initiatives toward health sector the flow of patients increased
with very high level even now to OPD patients free medicine available before this OPD
patients only checkup was free
4.8 Summary of interviews Analysis:
The survey done and the interview of the hospital staff reveal that that the new proposed
initiatives are highly successful and the initiatives are not limited to the paper works only
26

but found fully implemented and operational at the hospital case carried out in this study.
All the regular and day base treatment was free at OPD but was not provided with
medicines except for special diseases. The admitted patients and emergency treatment as
well their required medicines were free in their admitted wards. The emergency and
special cases patients during different casualties were also provided with free medicines
during specified duration at the hospital. The proposed new idea of separate wards
medicines store was found highly successful as this make capable the staff to also provide
medicine 24 hours to the patients as in the past the central medicines store of the hospital
was used to close at night.
Now every district hospital is autonomous to order and bid their own medicines
according to their requirement beside the provincial purchase of medicines. The patients
survey carried out in OPD, emergency department, operation theatre and medical wards
show that everyone was provided with equal treatment and provided with almost all free
medicine. Medical superintendent and other staff interview finding indicate that now they
receive regular and extra budget on time for the free medicines and they had appreciate
these programs and marked them highly successful and beneficial for the general public.
The new insulin bank for diabetic patients has been made available with the new
government initiatives. Beside these with the increasing threat from the hepatitis patients,
their overall treatment is now provide free of cost with more effective vaccines having
more defensive immune for the severe cases diseases. Lifesaving drugs and other heavily
cost injections for different fatal diseases are now available in the hospital at very ease.
Table 3: Annual Patients Statistic of DHQ KOHAT (2012-2015)

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INDOOR
OUTDOOR
OPD+Casualty
OT
(Major+Minor)
Total

2012
9936
178702

2013
10437
204574

2014
11898
252355

2015
12003
146135

6821

9433

27717

39578

195459

224444

291430

370432

Graph 3 represent statistics annual patients served in hospital during 4 years from (2012
to 2015). In 2012 the flow of patients or patients served low in comparison of 2013 and
onward years. In 2015 the served patient statistics become double in comparison of 2012
after implementing and taking initiatives in health e.g provision of free medicine and
other free health diagnosing facilities.
Graph 3: Annual patients served in DHQ Kohat
400000
350000
300000
250000
200000

Patient served

150000
100000
50000
0
2012

2013

2014

2015

Source: provided by Yasir,Computer cell (Finance dpt), DHQ, Kohat

The above graph shows annual patients increase when more the allowance for free
medicines (see table 2 for free medicine budget) have been increased the more flow of

28

patients to the hospital has been increased (. In the year 2012 a total of Rs.8.05 million
was allocated for medicine and 195459 patients had been served in that year. Total of
224444 patients were served showing 14.82% increased number when the budget for free
medicine was increased from 8.05 million to 7.3 million plus special extra budget beside
regular budget in the year 2013. In the later year when the free medicine and other health
initiatives were full implemented a tremendous flow of patients were seen from public to
the government hospitals, in 2014 when the budget allocated for free medicine was
increased from Rs.7.3 million to Rs.11.969 million a drastic increase of 29.84% (from
224444 to 291430) of number of patients served was recorded. In the following year of
2015 an increase in patients 370432 (this current year 2015 patients statistics taken on
basis of average monthly patients served in 2015 because yet the year not completed) of
the previous year patients served was seen when the budget has been further increased to
Rs.23.958 million.

29

Chapter 5:Conclusion
This Study examined the role of budget in public sector organizations to evaluate
performance of allocated resources and targeted goals and objectives. After drastic
increase in provincial health budget by 121.38%, the study focus was to find the effects
of that increase in grassroots level of the province local District Headquarter Hospital
(DHQ), Kohat. Conducted study to evaluate and find the proposed initiatives and the role
of budget in these initiatives. As the budget increased by the provincial government the
district hospital found also increased found in the DHQ hospital Kohat for various new
changes in the hospital. Free medicines program was found fully implemented in the
hospitals. The new sub-stores in hospital for the first time were established after the
government initiatives.
The hospital spending on free medicines found periodically increased and ward
improvement of apparatus and diagnosis instruments were modernized. The staff
interviewed were satisfied and the current autonomy they were holding were remarked as
sufficient and were enough much to implement the initiatives. The ward patients in the
30

hospital were observed and interviewed, they found supplied with free medicines for
period during their stay at hospital and all the operation and diagnosis done were free
from the hospital budget.
I have learnt that political agenda could be replicated in budget provision. If the budget
allocated on time the local actors will also cooperate on time and more effectively. Not
only the budget increase is necessary but also the structure changes are needed to
improve. The large long-term reforms could be implemented through micros programs.
Recommendations
The study was conducted only at one hospital in just one district; this could be repeated in
other main city and district hospitals of the KPK province to investigate the effectiveness
of the proposed new government reforms.
The case was only focused on free medicine free provision in the hospital. Other
initiatives such infrastructure development of the hospitals, need of additional employees
for the new changes should be assess and identify.
It is recommended for the government to develop a monitoring unit for the initiatives and
there should be digital and easy distribution channels for the medicines provisions.
Implication for future researchers:
The future researchers need to have developed and well planned interview appointments
with the staff if conducting research in such public sector organization. Moreover further
work is necessary to identify the hurdles coming in implementations of these reforms.
Limitations of the study:
31

The study was limited to the local example of the hospital.

Unwillingness of the staff to provide complete data of the hospital due to confidentiality
was the main limitation in the study.
Limited time was available with us to carry the research with more interview and
surveys.

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