Primary Healthcare system is the first level of Healthcare system, where mostly patients have their initial interaction with Curative and Preventive Healthcare Services.

Secondary Healthcare system is the second level of Healthcare system that is directly concerned with the provision of technical, therapeutic and diagnostic services to the patients. It is considered first referral level at district and tehsil. Specialist consultation doctors fall into system and patients are admitted in the hospital in this category.

Tertiary Healthcare Hospitals are for more specialized inpatient care (Keane & Richmond, 1993). And all these services are provided to the inpatients, which were referred from primary or secondary healthcare centers. And now at this time, “Pakistan has 1,142 hospitals”. (Mashhadi et al. 2016).

Healthcare System has been facing many challenges like the shortage of trained human and financial resources with Poor Governance, political interference and lack

of accountability for poor performance etc. In Pakistan, “Health system has been designed by politicians, while it has been implemented by the health professionals on the ground level” (Shaikh & Rabbani, 2004). Especially the access and stability of the country’s rural population regarding health services is a major problem “because of severe shortage of healthcare professionals and inadequate allocation of funds for Primary Healthcare sector” (Punjani et al. 2014). Reliable Health Information Management system is not available at primary and secondary levels though we can improve the health services. Another place Shaikh & Rabbani (2004) illustrates the same point of view that “lack of medical research and technology at national level is one of reason to deliver sub-standard services”. In Pakistan, Mostly Health Policies are developed without planning, so they can’t give fruitful results at the mention time.

Pakistan announced its First formal National Health Policy in 1990. In this policy, it is clearly declared that the health expenditures will be up to 5% of GNI and second priority will be given to clean water and family planning to improve health. Khan & Heuvel (2005) showed in their study that “Pakistan’ Second National Health Policy was introduce in 1997, which basic aim was “Health for All (HFA)” and in this policy special attention was given to HIV/ AIDS, road traffic accidents, violence, tuberculosis, cancer, diabetes and mental health diseases”. Pakistan formulated third National Health Policy in 2001, which was again based on “Health for All (HFA)” approach. At that time, ten key areas identified reducing communicable disease, addressing inadequacies in primary/secondary healthcare, promoting gender equity, correcting rural/ urban discrepancy in health sector and improvements in drug sector etc. (Akram et al. 1961). Only draft policy was prepared in 2010 but was not approved due to their disbursement process. Federal and Provincial Governments agree on common Nation Health Vision (2016-2025). Wirtz et al. (2017) also reflect the same point of view that “Vision statement is to improve health of all Pakistanis particularly women and children through affordable universal access to quality Healthcare Services, delivered through responsive health system”.

Pakistan is an economically poor country, which is trying to achieve its indicators in the regions. However there are some preventive and curative programs, which ensure to the public health timely. “National Program for Family Planning & Primary Healthcare was launched in 1994” (Wazir et al. 2013). From these programs, around about 80 million people of rural and urban areas are got benefits. “Expanded Programme of Immunization (EPI) was launched in Pakistan in 1978” (Rafi et al. 1995). Its main objectives were to reduce mortality and morbidity by offering timely immunization services. Malaria Control Programme was started in Pakistan since 1950. Rasheed et al. (2013) and it strengthened the same point of view that “Malaria control program was initiated in Pakistan in 1950s”. It has been passed through several evolutionary phases. In 1975, Malaria Control Strategy was adopted with the aim of provincial commitment to Execution and our Govt. has been successful execute it in 1977 at provinces level with communicable disease control program. The Federal Ministry of Pakistan has launched National AIDS Prevention and Control Program (NACP) in 1987 with the objective to diagnosis all those cases that came to hospitals.

In 2001, the first National Strategy Framework was developed with collaboration of provincial programs, after that 2^nd National Strategy Framework and then 3^rd Framework was developed. So that its services of treatment could be quality wise improved. And after that National AIDS Prevention and Control Program (NACP) shift on community level with the help of UN agencies. National TB Control Program is one of the Public Health Programs, which is integrated with Primary Health Care (PHC) system. It is a basically Millennium Developmental Goal’ target, which was achieved in 2015 with the objectives “to reduce the prevalence of MDR-TB among the patients who have never received any tuberculosis treatment by at least 5% per year by 2020” (Khan et al. 2006). Drug Abuse Control Program was started by Ministry of Narcotics Control in 201014 with the objective of “drug free Pakistan”. There are numerous other programs are run at National level and Provincial level like; National Program for the Prevention and Control of Blindness, Cancer Treatment

Program, Tobacco Control Cell, National Nutrition Program and National Maternal, Newborn and Child Health Program, School Health Program etc.

Pakistani Health Policies are designed by the politicians, who have no knowledge about the field, while the policy has been implemented by the health professionals on the ground level then it can’t give positive responses instead of the wastage of resources. In our beloved country mostly policies are focused on Curative Healthcare Programme instead of Preventive Healthcare Programme. In Curative Healthcare Programme, our main motive is to promote the services for the patients such as: laboratories, ambulances and modern equipment. But on the other hand, in Preventive Healthcare Programme, we mentally promote our nation for the future so that they can defend their self from the diseases. The developed country is the best example because they have focused on the preventive Healthcare Programme instead of the Curative Healthcare Programme in their countries.

In Pakistan, we should follow the developed countries strategies as they have follow in the health field irrespective of religious, cultural values, social dimension and economic differences etc.The Health policies of the country can determine to prevent from disease rather than covering the same cultural and environmental values. In which, All vertical programs are implemented at primary Healthcare facilities level but these programs are administered and run by Federal Government (Magnussen et al. 2004). It disrupts the BHU and district level because they do not involve in the planning of programs. There is no system to step up, estimate and use data for district level assessment and policy reforms. As a result data is not presented to Federal Ministry for feedback and evaluation of vertical programs (Fisman & Gatti, 2002).

Primary Healthcare system of Pakistan is facing numerous problems. Decentralization provides an opportunity to bring basic changes in Primary Healthcare system to make effective and more efficient to the masses. The basic purpose of the Primary Healthcare Sector is to restore the effective system from federal to the district level. Punjani et al. (2014) concluded that “Primary Healthcare system includes building blocks such as leadership, service delivery, technology, health workforce, healthcare finance and research”. In which monitoring and evaluation play an important role to get quality services and chase target at the time.