Under the present fragmented and compartmentalized system the cost effectiveness of each rupee spent out of the budget on vertical programs is quite low. Professional managers and administrators should be appointed to run the health and education programmes and institutions. Second, devolution of financial and administrative powers to the lower tiers of government should be made a priority in the real operational sense.
The present situation where the doctors and other staff are appointed and transferred by the Provincial governments while the health facilities are managed and operated by the local governments has to be resolved immediately. The resource allocation, both human and financial, should be made commensurate with the responsibilities and accountability clearly defined.