THE PUNJAB HEALTH FOUNDATION: GOVERNANCE STRUCTURE AND

PROGRAM PORTFOLIO
February 2013: Arif Nadeem, the Secretary of the Punjab Health Department, was reviewing
the performance of various wings and attached organisations of his department. He was
disturbed by the poor performance of the Punjab Health Foundation (PHF). The Foundation
was established in 1992 with the specific objective of supporting the private sector in
providing health services in the province but had largely failed to deliver on its mandate. Its
activities during the last twenty years had remained limited to providing small interest-free
loans to private health practitioners and non-government organisations (NGOs). Even in this
area, its portfolio was small a total amount of Rs. 773.4 million was disbursed to 951 health
practitioners and 52 NGOs. This was too small a support to the private sector to impact
health outcomes in the province in any significant manner. Arif Nadeem realised that PHFs
functioning required a fundamental rethinking in order to become relevant to provision of
health services to the public at large. He was also considering closing down the Foundation.
PHF GOVERNANCE STRUCTURE

The Legal Framework

PHF was established under the Punjab Health Foundation Act of 1992 with the express
objective of promoting and financing the private sector in providing health services in the
province. It was envisaged to be Punjab Governments dedicated institutional mechanism for

This case was written by Dr Ahsan Rana at the Lahore University of Management Sciences to serve as basis for
class discussion rather than to illustrate either effective or ineffective handling of an administrative situation.
This material may not be quoted, photocopied or reproduced in any form without the prior written consent of
the Lahore University of Management Sciences. This research was made possible through support provided by
the United States Agency for International Development. The opinions expressed herein are those of the
author(s) and do not necessarily reflect the views of the US Agency for International Development or the US
Government.

2014 Suleman Dawood School of Business, Lahore University of Management Sciences

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promoting employment opportunities for private sector health professionals as well as for
capacity building of NGOs and community organisations actively involved in health service
provision, especially to remote, rural communities. Its establishment was grounded in a
growing realisation that the government needed the support of the private and the non-profit
sectors to provide healthcare to all citizens and to productively engage health practitioners
being produced by local institutions.
The PHF Act (Exhibit 1) established the Foundation as a body corporate and vested the
governance function in a Board of Directors, which was to comprise official and non-official
members appointed by the government. The number of directors was not specified i.e. it was
for the Punjab Government to appoint as many directors as it deemed appropriate. The
Punjab Government could also remove a director or reconstitute the Board at any time. The
Act specified the tenure of non-official members as three years and also provided for their
reappointment on two-year terms subsequently. It did not specify a tenure for the official
members, as their appointment was ex-officio. It authorised the Foundation to employ
officers, advisors, consultants and other staff to discharge its functions.
Nominally, the overall governance function was vested in the Board, but under the PHF Act
of 1992, the Board could neither appoint the Managing Director (MD) i.e. the Chief
Executive Officer, nor set his terms of employment. Appointment of the MD was for the
Punjab Government to make. The government appointed the MD for a fixed term of three
years (renewable up to a maximum of five years in toto) and could remove him at any time
on grounds of inefficiency, unsuitability or misconduct.
Section 10 of the Act specified the functions to be performed by the Foundation. It was
mandated to perform a broad range of functions, such as establishing and supporting health
institutions, providing loans/grants to institutions and practitioners and assisting the private
sector in providing necessary facilities for population welfare activities. There was also a
general clause that mandated the Foundation to take all such measures which it deems
necessary for the promotion, development and financing of health services in the private
sector.
The Act authorised the Punjab Government to frame Rules to specify procedures for doing
business under the Act. Accordingly, the Punjab Government notified the Punjab Health
Foundation (Provision of Grants/Loans and Lease of Land) Rules in February 1993. These
Rules amended in 1993, 2001 and 2005 to remove minor procedural glitches provided a
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robust legal framework for provision of grants and loans, but they were silent on other
functions that the Foundation could perform under Section 10 of the Act. Although there was
no legal bar on the Foundation to pursue any other activity, the absence of procedures and
protocols which Rules typically provided as subordinate legislation effectively dictated
that none were pursued over the next 20 years of its functioning.
As per the Punjab Governments Rules of Business 1974, the executive authority was vested
in the Chief Minister, who exercised such authority through the Chief Secretary and
Secretaries of various departments. Thus, the Health Department could initiate proposals for
(re)constituting the Board or for framing/amending Rules, but the final decision was made by
the Chief Minister. During 1992-2012, the Board was reconstituted five times and the Rules
were amended thrice. Each time, a summary was initiated by the Secretary Health
Department and sent to the Chief Minister through the Minster of Health and the Chief
Secretary. The appointment of the MD was made by the Services and General Administration
Department after approval from the Chief Minister.
Organisational Structure
In February 2013, the PHF Board comprised ten members (Exhibit 2), only two of which
were from the private sector. The rest were government officials, mostly Secretaries of
various departments. The Health Minister was the ex-officio Chairperson. The portfolio was
held by the Chief Minister during 2008-12 and he had nominated Sahibzada Syed Murtaza
Amin a former member of the National Assembly from Sialkot district to act as the
Chairperson of the Board. Murtaza served as the Chairperson during 2009-12. His tenure had
expired five months ago and no replacement had since been notified. A summary for
nomination of a new Chairman initiated by the Health Department was pending decision in
the Chief Ministers Secretariat for the past four months at that point
The Board did not meet regularly the last meeting was held in October 2007. The PHF Act
did not require the Board to meet at regular intervals. It also did not specify the procedure for
convening Board meetings. Meetings were convened by the Chairman, either on his own
motion or on a request from the MD. In 1997, the Board established two committees and
delegated its powers to sanction loans. These were Doctors Package Scrutiny Committee
and Financial and Technical Committee (Exhibit 3). Such delegation enabled the Foundation
to continue its loaning operations without recourse to the Board. These committees met on
need basis whenever sufficient number of applications was available for decision.
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Day to day management and executive functions were performed by the MD, who was a
senior civil servant (usually of Grade 20) appointed by the Punjab Government. The MD
reported to the Secretary Health Department (an officer of Grade 20 or 21). He was assisted
by a team of 43 people (Exhibit 4). Since PHF was a small organisation and posting as the
MD did not bring any additional perks or privileges, it was not a choice posting for civil
servants. The incumbents were on the lookout for a better posting elsewhere. How quickly an
incumbent moved out depended upon his/her capacity to mobilise professional and personal
networks. Average tenure was short 18 civil servants had worked as the MD between 19922012 (Exhibits 5 and 6). Two of them later also worked as the Secretary of the Punjab
Health Department. The current MD, Izhar Ahmed Sheikh, was a Grade 20 officer of the
Provincial Management Service and had been working as the MD since March 31, 2012. Arif
Nadeem had been working as the Secretary Health Department since 27th January 2012.
FINANCIAL RESOURCES AND EXPENDITURE

To finance PHF operations, the Punjab Government had created a fund, to which were
credited Rs. 376.78 million during 1992-2000. This amount was invested in term deposits.
Income therefrom sustained loaning operations and overheads. The income was a small
amount, but the expense was smaller (Exhibit 7). Almost all years ended in blue. The surplus
bloated the fund over the years, which stood at Rs. 995 million in 2013. Initially it was hoped
that the Foundation would attract grants and donations from international aid agencies and
private businesses, but that did not happen. Only one donation was ever received from a
private source Rs. 148.91 million in 1999-2000 from a German charity named KfW to
support NGOs working in the health sector. The government had also not contributed any
amount to the fund since 2000. Since the Foundation met all its expenses from its income
from investment, no regular allocation was made in the annual budget of the Health
Department, which was Rs. 63,807 million in 2012-13.
THE PROGRAM PORTFOLIO LOANS AND GRANTS
Loan Disbursement Procedures
Both NGOs and individual health practitioners could apply for interest-free credit. The
former could also receive grant-in-aid from the Foundation. Both were required to formulate
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a project indicating the purpose for which loan/grant was sought. NGOs could receive 1/3 of
the total project cost as grant and another 1/3 as loan the rest had to be recipient
contribution. Health practitioners could receive 2/3 of the total project cost as interest free
loan the rest was their contribution.
The Rules of 1993 provided for the establishment of a District Health Promotion Committee
(DHPC) at the district level. Applications could be submitted either at the PHF Head Office
in Lahore or to the respective DHPC in the district. Only a small number of applications were
received at the Head Office. These were sent to respective DHPCs for verification. Whether
or not and how quickly an application was processed varied from district to district. Since the
DHPC was chaired by the respective DCO (Exhibit 8), it depended largely on the
incumbents interest in this low-priority item. The Foundation hardly ever followed up with
DHPCs to encourage them to process applications quickly. Consequently, the number of
borrowers was far larger in some districts than in others (Exhibit 9). Once an application was
received, the relevant staff scrutinised the application, carried out ground checks as necessary
and formulated recommendations regarding grant of credit. The MD examined these
recommendations and placed them before the Financial and Technical Committee (Exhibit
3) for a decision.
The loan was provided under a bank guarantee or a property mortgage. Initially the mortgage
fee was charged at 3% with 3% stamp duty (total 6%). This was reduced to 0.25% each (i.e.
total 0.5%) in 2010 in response to a specific demand from the doctors professional network,
the Pakistan Medical Association. Additionally, a service fee of 2% was deducted at source
from the first instalment. The loan was released in three equal instalments and was payable in
eight years in half-yearly instalments starting from the release of the last tranche. Late
payment had a financial penalty.
Borrowers were prohibited from altering or amending the scope of their project and/or selling
or transferring moveable or immoveable assets purchased with Foundation assistance without
approval. They were required to keep records of their income/expenditure and to engage
properly qualified staff in sufficient numbers at their health facilities. They could charge only
reasonable fees for the services provided. What constituted a reasonable fee was,
however, left unspecified. PHF or a DHPC could inspect any facility in which Foundation
assistance had been utilised. In case of any violation, the Foundation could stop disbursement
of remaining instalments and/or start the process for the recovery of amount already
disbursed.
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The Loan/Grant Portfolio

Grants to NGOs were provided in 1999-2000 when the Foundation received a donation from
KfW specifically for assisting NGOs engaged in health provision in the province. A total
grant of Rs. 149 million was provided to six NGOs. The largest share (53%) went to just one
NGO i.e. the Family Planning Association of Pakistan. No grant was provided to NGOs
thereafter.
Interest-free loans comprised the mainstay of PHF operations. There were two packages: 1)
Regular Package and 2) Young Doctors Package (disbursement data in Exhibit 10). The
Regular Package was offered to doctors with more than three years of experience and the
loan could be as large as Rs. 1.5 million1. The recipient could use this loan for purchase of
medical equipment, building/upgrading the infrastructure, etc. The Young Doctors Package
was available to fresh graduates (doctors with less than 3 years of work experience) and the
loan could be as large as Rs. 4 lac2. Most loaning had been under the Regular Package.
Disbursement under the Young Doctors Package had picked up only recently (Exhibit 10).
There was no policy shift from the Foundation. Apparently, a greater number of young
doctors were now applying to DHPCs. PHF had not made an effort to analyse this recent
shift from one package to another. The total number of applications under both packages in a
given year was small only 415 applied during the last four years (2009-12), of which 283
were approved. Recovery was 100%.
The Foundation did not keep track of how its loans/grants had been used and whether or not
they benefitted the public at large. Anecdotal evidence suggested that loans were often used
to finance consumption, such as purchase of a car, rather than for productive investment.
There were also cases in which borrowers had moved abroad after obtaining loans and in
their absence instalments were paid by their relatives. Although the Foundation staff was
authorised to inspect health facilities established or upgraded through its support, such
inspections were seldom carried out, as neither PHF nor DHPCs had allocated any resources
for this purpose. There was no mechanism whatsoever for obtaining feedback either from
health professionals who had received Foundation assistance or from the public at large who
was supposed to eventually benefit from the assistance.

1
2

Initially Rs. 5 lac, but gradually the loan size was increased to Rs. 1.5 million.
Initially Rs. 1 lac; gradually increased to Rs. 4 lac.

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In the absence of regular inspections and a system to obtain feedback on loan utilisation, the
loan recipient was under no obligation whatsoever to pass on the subsidy to the public at
large and to charge less-than-market fees for the services provided. Borrowing health
practitioners charged approximately the same fee for their services as the non-borrowing
practitioners in the area.
UN-PACKAGING THE CONUNDRUM
Arif spent some time looking at the financial and disbursement statements. He was perturbed
as well as intrigued by the Foundations consistent under performance. He had several
questions, which begged an answer before he could make up his mind on what to do about
the Foundation. He convened a meeting of his senior associates and asked Izhar Ahmed
Sheikh, the MD of the Foundation, to present a status update on the Foundations activities,
finances and constraints. He wanted Izhar to also present a viable plan if he had any to
revamp the Foundation into a vibrant and functional organisation that could contribute to
achievement of health policy objectives of the department. Arif also invited two experts from
the private sector, namely Dr. Mohsin Rana and Dr. Waheed ud Din Mian. Both had several
years of experience in institutional development and legal reform in the health sector. Arif
made it clear at the outset that he considered the Foundation in its present form largely
irrelevant to healthcare in the province. He was frank: We must revitalise the Foundation or
prepare a close down plan.
Izhar made a detailed presentation covering various aspects of PHF structure and operations.
He agreed that all was not well with the Foundation and that its current operations were too
small to justify a dedicated institutional infrastructure. However, he did not support its
winding up. He was of the following view:
Interest-free loans are useful for health practitioners, especially the ones who
are starting their careers, as they need subsidised financing to set up clinics
and to purchase equipment. We should, therefore, find ways and means to
increase our loaning operations. We should make our packages more
attractive, even if it requires changing some of the procedures or doing away
with the collateral requirements. We can easily double our loaning operations
from the existing resources. If we can maintain our current recovery rate of
100%, we can gradually increase the operations several fold by revolving the
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recovered amount to new borrowers. As the loan portfolio grows, the
transaction cost per case will shrink.
This was followed by the conversation below:

Arif: True, it will. But why have you not done it already? You have surplus every year.
Izhar: Well have to change the procedure to attract more applications. This requires Board
approval.
Arif: Is that a problem?
Izhar: But there is no Chairman.
Arif:

So? Are other members barred from convening if there is no Chairman?

Izhar: I requested Murtaza Sahib several times. Each time he promised to convene a meeting
soon. But he is a busy man.
Arif:

His tenure is now over.

Izhar: Yes, we sent a summary to the Chief Minister Secretariat four months ago. We
proposed three names, but none of these has been approved so far.
Arif:

Did you follow up?

Izhar: Yes sir; several times. I also spoke to you personally once and requested your staff
thrice to indicate a time for a Board meeting, but they said you were busy in dengue
operations and other things. I can only request.
Arif:

Oh yes, now I recall. Dengue has been quite a challenge during the past year.

Then Arif asked Mohsin what he thought about the loan operations. Mohsin had a different
perspective:

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If loaning is all that the Foundation intends to do in coming years, does the
Health Department really need a dedicated institution for this purpose? Even
if loan operations are doubled, the annual number of loans and the amount
disbursed will still be less than what a single loan officer would ordinarily
handle in a commercial bank. Why, then, should the Punjab Government not
ask the Bank of Punjab to take over the loaning operations, assign the
portfolio to an experienced loan officer and charge the government transaction
costs including the cost of capital? This will enable the government to wind
up the Foundation, productively use its fixed assets (offices and endowments)
elsewhere and yet continue to provide subsidised loans to health practitioners.
Arif asked if there was enough demand to multiply loaning operations several times. Mohsin
was of the opinion that nothing could be said for sure. There are only 100 or so applications
every year. We dont know if many more doctors will apply, if collateral requirement is
relaxed and procedure is simplified, said Mohsin. Arif asked if the Foundation had
conducted any market surveys. No, said Izhar.
In addition to an uncertain demand, Mohsin also saw a deeper, more fundamental problem
with the loan portfolio. He felt that PHF was by and large subsidising a small number of
market players in an already established and functional market without ensuring in any
manner whatsoever that the subsidy was passed on to poor clients. He proposed:
After all, the support to health practitioners is justified only in the name of
poor households. If it is instead being provided mostly to practitioners in
developed districts, especially Lahore, can it still be justified on equity
grounds? If the Foundation wanted to survive, it should look beyond loaning
operations. It should reimagine itself as a support organisation that provided
useful services to the private sector, especially of the low-cost sort.
Arif was sceptical. He said I am not sure if diversifying into other services is a good idea,
considering that we are unable to do a good job on the one product that we currently have.
Babar Hayat Tarar, the Special Secretary said that the Foundation needed to be restructured
before it could be assigned additional tasks. We should reconstitute the Board without
further delay. He requested Arif to speak to the Chief Ministers Secretary for an early
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nomination of the Chairman. I will, said Arif, lets hope this time they nominate someone
more interested in Foundations work.
Mohsin advised them that appointing a new Chairman would not help unless the Boards
composition was also changed. How will replacing the current lot with a different set of
hand-picked specialists change anything at all? he asked. He feared that the Board would
remain as disinterested and ineffective as it had historically been, unless its members had a
direct stake in making its operations a success. He argued as follows:
None of the non-official members sits on the Board in an institutional
capacity. They are hand-picked by officials in the Health Department. Their
appointment to the Board is not due to their past or potential contribution;
rather, it is due to their ability to keep the senior managers in the department
in good humour. No wonder none of them agitated at any forum whatsoever
or resigned from its membership during the last five years while the Board lay
dormant.
In Mohsins opinion, reconstituting the Board was urgently required; yet it was a step in the
right direction that did not go far enough. The composition of the Board must be changed
fundamentally, he felt. Mohsin suggested that the Foundation needed a private-sector-led
Board in which private members outnumbered officials and could run the Foundation
independent of the official dictate. These private members must be nominated by institutions
that had a direct stake in the promotion of private provision of healthcare, especially in rural
areas and for other target groups of the Punjab Government. Only then will they represent
institutional interests of health practitioners, rather than personal whims of bureaucrats, he
emphasised.
Babar cautioned against giving too much autonomy to the Board, especially if it was to be
led by the private sector. He reminded the participants that the Foundation was a government
organisation, which managed resources and provided services on its behalf. What was wrong,
then, with the government giving directions and expecting the Foundation to broadly
conform to its guidelines and priorities? He also quipped that if bureaucrats were not efficient
and honest, neither did the private sector consist of angels. Entrepreneurs had specific
business interests to protect and may use their positions in the Board to pursue personal
ambitions, rather than public good.
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Arif was in favour of bringing more people from the private sector on the Board. But he was
not sure who in the private sector would be sufficiently interested in the Foundations affairs
to invest his/her time into superintending its operations. Will they also contribute some
money? he asked.
Waheed supported greater stakeholder participation in managing the Foundations affairs and
said At least they will hold the officials accountable for their failures. He argued:
In the current governance paradigm, civil servants are not accountable for
their failures. Their promotions come automatically and their posting is a
function of their ability to mobilise personal and professional networks, rather
than their expertise in a particular field or their contribution thereto. They
have other things to fill their day with than to attend to PHF business and
worry that it is not discharging its mandate.
He felt that everyone had been complacent in this under performance and added:
There have been two Chief Secretaries, four Health Secretaries and six MDs
during the past five years. During all these years, could none of them find time
to convene a Board meeting and see how the Foundation was faring? Did the
Chief Minister ever ask anybody anything about the Foundation? I am sure he
knows the Foundation exists, at least since he nominated Murtaza as the
Chairman. Why did Murtaza accept to be the Chairman when he had no
interest whatsoever in its working?
Waheed was also critical of the overall governance framework. He wondered if Foundations
failure had structural causes:
Failure inheres in the governance structure. PHF Rules of 1993 only speak of
loaning procedures, thereby effectively closing the door on all other
interventions. The Act allows the government to appoint as many directors as
required, but it does not allow the directors to elect a Chair or to appoint the
MD. Neither can the Board frame its own Rules. The role of the Board is to
advise and to broadly oversee, rather than to make fundamental decisions
regarding PHF mandate, structure and functions. The executive functions vest
in the provincially appointed MD. I am not sure if having a larger private
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sector presence on the Board or asking for institutional nominations will
matter much if the Act is not fundamentally altered.
He also advocated expansion in the program portfolio:
Just continuing with the loan program will not do. I agree that the Health
Department does not need a full-fledged Foundation just to disburse loans to
doctors. Loan should be only one of the services the Foundation offers. Why
dont we envision some role for the Foundation in the Punjab Governments
recently announced health insurance scheme? They are going to need an
organisation to implement this scheme; then why not use the Foundation for
this purpose? This is something close to Chief Ministers heart. Once the
Foundation is on Chief Ministers radar, everyone will start taking it seriously.
However, Waheed emphasised that amending the Act was the sin qua non and the starting
point. Unless this was done, there was no point in hoping that the Foundation would make its
procedures less bureaucratic or that it would be able to handle a larger program portfolio. He
stated:
I understand that amending the Act is easier said than done, especially since
we are asking the government to abdicate space in favour of the private sector.
So if this is not possible, lets not waste time and resources any further. Lets
plan the winding up instead.
At this, Shahid Aziz, a junior staffer from the Foundation, drew the Secretarys attention to
what closing down the Foundation would mean to its staff:
Kindly also think about the future of the staff and their livelihoods while
casually recommending closing down the Foundation. The officials on
deputation will go back to their departments, but there are only five of them.
The rest of us are either on contract or on daily wages. For us, closing down
will mean losing our jobs. If the Foundation is not doing what the government
wants it to do, how are we to be blamed? We perform our duties diligently six
days a week. If the government or the Board is clueless, why is our future
being put at risk?
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CONCLUSION
Arif thanked the meeting participants for their candid views. He said that closing down was
one option, but it meant throwing the PHF staff out of jobs and discontinuing the interest-free
credit facility for health practitioners. The other option was to revitalise the Foundation by
enhancing its credit operations and diversifying into other services for the private sector. But
this required fundamental changes in the PHF Act and Rules, which was quite an undertaking
by itself. Both options also posed a set of important questions. In case of winding up, what
was to be done to the existing staff and other assets, including the endowment? Similarly,
should the government make alternate arrangements for credit or let the private practitioners
obtain it from the commercial sector? On the other hand, revitalisation required a decision on
how much space the government wanted to cede to the private sector in managing the
Foundations affairs. Such fundamental decisions required the Chief Ministers prior assent.
Arif started organising his thoughts for a briefing to the Chief Minister.

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Exhibit 1 (p1 of 5)
THE PUNJAB HEALTH FOUNDATION: GOVERNANCE STRUCTURE AND
PROGRAM PORTFOLIO
The PHF Act, 1992
THE PUNJAB HEALTH FOUNDATION ACT, 19923

(Pb. Act XI of 1992)

[10 November 1992]
An Act to provide for the establishment of the Punjab Health Foundation
Preamble Whereas it is expedient to provide for the establishment of the Punjab Health
Foundation to promote and finance the development of the health sector in the Province of
the Punjab and matters incidental and supplemental thereto.
It is hereby enacted as follows:1. Short title, extent and commencement (1) This Act may be called the Punjab Health
Foundation Act, 1992.
(2) It extends to the whole of the Province of the Punjab.
(3) It shall come into force at once.
2. Establishment of the Foundation (1) The Government may, by notification, establish
a Foundation to be known as the Punjab Health Foundation.
(2) The Foundation shall be a body corporate having perpetual succession and a common
seal with power to acquire, hold and dispose of property, both movable and immovable, and
shall by the said name sue and be sued.
(3) The Head Office of the Foundation shall be at Lahore.
3. Board of Directors (1) There shall be a Board of Directors of the Foundation consisting of
such number of official and non-official members, including the Chairman, as may be appointed by
the Government.
(2) A Director other than an ex-officio Director shall hold office for a period of three
years but he may be reappointed as such for a period not exceeding two years at a time.
(3) The Government may remove a Director on the ground of inefficiency, unsuitability or
misconduct after giving him an opportunity of being heard.

This Act was passed by the Punjab Assembly on October 29, 1992, assented to by the Governor of the Punjab
on November 4, 1992 and was published in the Punjab Gazette (Extraordinary), dated November 10, 1992, pp.
3083-E to 3083-H.

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Exhibit 1 (p2 of 5)
THE PUNJAB HEALTH FOUNDATION: GOVERNANCE STRUCTURE AND
PROGRAM PORTFOLIO
The PHF Act, 1992
THE PUNJAB HEALTH FOUNDATION ACT, 1992

[(4) Notwithstanding anything contained in sub-sections (2) and (3) the Government may, at
any time, reconstitute the Board of Directors]4.
4. Management (1) The administration and management of the Foundation and its affairs
shall vest in the Board of Directors which may exercise the powers exercisable, and do all
acts and things that may be done by the Foundation.
(2) The affairs of the Foundation shall be conducted subject to the supervision and
control of the Government.
5. Managing Director (1) The Government shall appoint a Managing Director of the
Foundation whose qualifications and terms and conditions of service shall be such as may be
determined by the Government.
(2) Subject to sub-section (3), the term of office of the Managing Director shall be three
years but the Government may extend the same for a period not exceeding one year at a time.
(3) No person shall hold office of the Managing Director for a total period of more than
five years.
(4) The Government may remove the Managing Director on the ground of inefficiency,
unsuitability or misconduct after giving him an opportunity of being heard.
(5) The Managing Director shall be the Chief Executive of the Foundation and shall
perform such functions as may be prescribed or assigned to him by the Board.
6. Committees The Board may constitute such financial, technical and advisory
Committees as may be deemed necessary for carrying out the purposes of this Act.
7. Appointment of Officers etc. The Foundation may employ such officers, advisers,
consultants and employees in its service as may be necessary for the efficient performance of
its functions in such manner and on such terms and conditions as may be prescribed.

Added by the Punjab Health Foundation (Amendment) Act, 1995 (III of 1995).

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Exhibit 1 (p3 of 5)
THE PUNJAB HEALTH FOUNDATION: GOVERNANCE STRUCTURE AND
PROGRAM PORTFOLIO
The PHF Act, 1992
THE PUNJAB HEALTH FOUNDATION ACT, 1992
8. Delegation of powers The Board may delegate to any officer, authority or employee
of the Foundation any of its powers, duties or functions.
9. Business of the Board (1) The meetings and the business of the Board shall be
conducted in such manner and according to such procedure as may be prescribed and until
these matters are prescribed, as may be determined by the Board.
(2) No act or proceedings of the Board shall be invalid on the ground of the existence of
any vacancy in or any defect in the constitution of the Board.
10. Functions of the Foundation (1) The Foundation shall take all measures which it
deems necessary for the promotion, development and financing of health services in the
private sector.
(2) Without prejudice to the generality of the functions mentioned in sub-section (1), the
Foundation may
(a) establish or cause to be established health institutions and allied projects;
(b) give grants to health institutions operating on non-commercial basis for the purchase of land,
construction of buildings, purchase of equipment, furniture and for other allied projects;
(c) give loans to health institutions;
(d) provide loans to doctors for opening clinics;
(e) assist health institutions and doctors in getting loans from scheduled banks and financial
institutions;
(f) lease or sell plots or assist in getting plots and land from Government, Development
Authorities and Housing Agencies controlled by the Government;
(g) assist the private sector for providing necessary facilities for population welfare programme;

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Exhibit 1 (p4 of 5)
THE PUNJAB HEALTH FOUNDATION: GOVERNANCE STRUCTURE AND
PROGRAM PORTFOLIO
The PHF Act, 1992
THE PUNJAB HEALTH FOUNDATION ACT, 1992
(h) with the approval of the Government raise loans and receive grants; and
(i) perform such other functions as may be assigned to it by the Government.
11. Foundation Fund (1) There shall be a fund to be known as the Health Foundation
Fund which shall vest in the Foundation and to which shall be credited:(a) grants made by the Government and the Federal Government and Local Bodies;
(b) income from investments made by the Foundation;
(c) donations and endowments;
(d) revolving funds placed by the Government at the disposal of the Foundation; and
(e) all other sums received by the Foundation and incomes from other sources.
(2) The fund shall be kept in such custody and shall be utilised and regulated in such
manner as may be prescribed.
(3) The Foundation may invest money in Government Saving Schemes, fixed deposits
with banks approved by the Government or in such other manner as may be prescribed.
12. Budget The budget of the Foundation shall be approved and its accounts shall be
maintained and audited in such manner as may be prescribed.
13. Immunity of the Foundation and its employees (1) Every Director, Adviser,
Officer and employee of the Foundation shall be indemnified by the Foundation against all
losses and expenses sustained or incurred by him in the discharge of his duties, save such
losses and expenses as are sustained and incurred as a result of his own wilful act or default.
(2) The Managing Director shall not be personally responsible for the acts of any other
Director, Adviser, Officer or employee of the Foundation which he could not have
reasonably prevented by the due exercise of his powers and functions under this Act and the
rules and regulations made thereunder or

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16-172-2014-2

Exhibit 1(p5 of 5)
THE PUNJAB HEALTH FOUNDATION: GOVERNANCE STRUCTURE AND
PROGRAM PORTFOLIO
The PHF Act, 1992
THE PUNJAB HEALTH FOUNDATION ACT, 1992

for any loss or expense resulting to the Foundation by reason of the insufficiency or
deficiency in value of, or title to any property or security acquired or taken on behalf of the
Foundation by the wrongful act of any person under a liability to the Foundation or anything
done by him in good faith in execution of the duties of his office.
14. Rules The Government may, by notification, make rules for carrying out the
purposes of this Act.
15. Regulations Subject to this Act and rules framed thereunder, the Board may, with the
previous approval of the Government, make regulations for all matters not provided for in the rules
for which provision is necessary for carrying out the purposes of this Act and the rules.
16. Repeal The Punjab Health Foundation Ordinance, 1992 (XXXV of 1992) is hereby
repealed.

Source: Punjab Health Foundation Records

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16-172-2014-2
Exhibit 2
THE PUNJAB HEALTH FOUNDATION: GOVERNANCE STRUCTURE AND
PROGRAM PORTFOLIO
Membership of the PHF Board (February 2013)
1. Minister, Health Department, Government of Punjab (or his nominee) (Chairman)
2. Chief Secretary, Government of Punjab
3. Chairman, Planning and Development Board, Government of Punjab
4. Secretary, Health Department, Government of Punjab
5. Secretary, Finance Department, Government of Punjab
6. Secretary, Social Welfare Department, Government of Punjab
7. Secretary, Population Welfare Department, Government of Punjab
8. Dr. Naeemuddin Mian, Public Health Specialist
9. Dr. Farrukh Zaman, former Professor of Gynaecology and Obstetrics/Principal, Post
Graduate Medical Institute, Lahore
10. Managing Director, PHF (Secretary)
Source: Punjab Health Foundation Records

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16-172-2014-2
Exhibit 3
THE PUNJAB HEALTH FOUNDATION: GOVERNANCE STRUCTURE AND
PROGRAM PORTFOLIO
Membership of PHF Committees (February 2013)
Doctors Package Scrutiny Committee (DPSC)

Managing Director, PHF (Chairman)

Additional Director, PHF (Secretary)

Additional Secretary, Finance Department

Additional Secretary, Health Department

Additional Secretary, Population Welfare Department

Additional Secretary, P&D Department

Financial & Technical Committee

Secretary Health (Chairman)

Managing Director, PHF (Secretary)

Secretary Finance

Mr. Shoukat Mahmood, former IG Prisons, Punjab

Dr. Fakhar-un-Nisa, former Principal, Fatima Jinnah Medical College

Dr. Qamar-ul-Islam Lodhi, Medical Superintendent, Data Darbar Hospital

Source: Punjab Health Foundation Records

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16-172-2014-2
Exhibit 4
THE PUNJAB HEALTH FOUNDATION: GOVERNANCE STRUCTURE AND
PROGRAM PORTFOLIO
Organisational Structure

Chairman

Board of Directors

Doctors' Package
Scrutiny Committee

Managing Director

Financial &
Technical
Committee

Deputy Managing
Director

Additional Director
(Administration &
Evaluation)

Assistant Director
Administration

Additional Director
(Finance)

Assistant Director
Technical

Assistant Director
Recovery

Account Officer

Staff composition (February 2013)

Supervisory staff
(MD et al.)

Support staff

Auxiliary staff

(cashiers, clerks, etc.)

(drivers, peons, etc.)

17

22

4
Regular staff
2

Total staff
43

Contract staff

On deputation

Daily wages

Total

34

43

Source: Punjab Health Foundation Records

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16-172-2014-2
Exhibit 5
THE PUNJAB HEALTH FOUNDATION: GOVERNANCE STRUCTURE AND
PROGRAM PORTFOLIO
Incumbency Chart (1992-2013) - MDs
Sr. No.

Name

From

To

Yousuf Kamal

01.02.1993

03.04.1993

Muhammad Ismail Qureshi

03.04.1993

14.07.1994

Muhammad Atique Khan

21.07.1994

20.10.1996

M. Hanif Khan Kakar Hanfi

07.11.1996

25.11.1996

Lt. Col.(R) Tariq Saadat

28.12.1996

26.06.1999

Zafar Iqbal

26.06.1999

04.12.1999

Anwar Ahmed khan

04.12.1999

03.04.2002

Muhammad Ijaz Chaudhary

03.04.2002

31.07.2003

Iftikhar Ahmed

01.08.2003

02.09.2004

10

Shafiq Hussain Bokhari

02.09.2004

01.10.2005

11

Mian Bashir Ahmad

01.10.2005

15.03.2007

12

Dr. Ismat Tahira (Addl. Charge)

30.03.2007

06.05.2007

13

Mian Bashir Ahmad

07.05.2007

12.04.2008

14

Maj.(R) Tariq Javed Afridi

18.04.2008

24.02.2010

15

Bushra Amaan

24.02.2010

30.09.2011

16

Aman Ullah Khan

30.09.2011

12.03.2012

17

Sohail Shahzad

12.03.2012

31.03.2012

18

Izhar Ahmed Sheikh

31.03.2012

Source: Punjab Health Foundation Records

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16-172-2014-2
Exhibit 6 (p1 of 2)
THE PUNJAB HEALTH FOUNDATION: GOVERNANCE STRUCTURE AND
PROGRAM PORTFOLIO
Incumbency Chart (1992-2013) Chief Ministers, Chairmen, Secretaries Health
Department and MDs
Year
1992

Chief Minister
Ghulam Haider Wyne

Chairman

Secretary Health

MD

Tariq Saeed Haroon

Ghulam Haider Wyne

Manzoor Wattoo
1993
1994

Yusuf Kamal
-

Tariq Saeed Haroon

Ismail Qureshi

Tariq Saeed Haroon

Ismail Qureshi

Muhmmad Khalid Bhatti

Muhammad Atique Khan

Manzoor Ahmad Wattoo

Muhammad Khalid

Muhmmad Atique Khan

Sardar Arif Nakai

Bhatti

Manzoor Elahi
Manzoor Ahmad Wattoo
Manzoor Ahmad Wattoo
Sardar Arif Nakai

1995

Tariq Farooq
Sardar Arif Nakai
Afzal Hayat

Sardar Arif Nakai

1996

Muhammad Atique Khan

Tariq Mahmood

Hanif Khan Kakar Hanfi

Shahzad Hassan Pervez

Afzal Hayat
Shahbaz Sharif

Shahzad Hassan Pervez

Shahbaz Sharif

1997
1998

Tariq Farooq

Lt. Col. (R) Tariq Saadat

Muhammad Ismail
Qureshi

Shahbaz Sharif

Shahbaz Sharif

Muhammad Ismail

Lt. Col. (R) Tariq Saadat

Qureshi
Shahbaz Sharif

Shahbaz Sharif

Gen. Muhammad Safdar

1999

Muhammad Ismail

Lt. Col. (R) Tariq Saadat

Qureshi

Zafar Iqbal

(Governor)

Anwar Ahmad Khan

Muhammad Ismail

Anwar Ahmad Khan

Qureshi
Gen. Safdar

Tariq Mahmood

2000

Shahid Hussain Raja

Gen. Khalid Maqbool

Professor Mehmood

Hassan Waseem Afzal

Anwar Ahmad Khan

Hassan Waseem Afzal

Anwar Ahmad Khan

Ahmad Chaudhry
2001

(Minister Health)
Professor Mehmood

2002

Gen. Khalid Maqbook

Ahmad Chaudhry

Pervaiz Elahi

(Minister Health)

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Ijaz Chaudhary

16-172-2014-2
Exhibit 6 (p2 of 2)
THE PUNJAB HEALTH FOUNDATION: GOVERNANCE STRUCTURE AND
PROGRAM PORTFOLIO
Incumbency Chart (1992-2013) Chief Ministers, Chairmen, Secretaries Health
Department and MDs
Professor Mehmood

Hassan Waseem Afzal

Ijaz Chaudhary

Ahmad Chaudhry

Shahid Rasheed

Iftikhar Ahmad

Dr. Tahir Javed

Shahid Rasheed

Iftikhar Ahmad

(Minister Health)

Sohail Ahmad

Shafiq Hussain Bokhari

Dr. Tahir Javed

Sohail Ahmad

Shafiq Hussain Bokhari

(Minister Health)

Rashida Hayat Malik

Mian Bashir Ahmad

(Minister Health)
2003

Pervaiz Elahi

Dr. Tahir Javed

(Minister Health)

2004

2005

Pervaiz Elahi

Pervaiz Elahi

Muhammad Javed Malik

Dr. Tahir Javed

2006

Pervaiz Elahi

Muhammad Javed Malik

Mian Bashir Ahmad

Muhammad Javed Malik

Mian Bashir Ahmad

(Minister Health)

Raees Abbas Zaidi

Ismat Tahira

Ch. Muhmmad Iqbal

Anwar Ahmad Khan

(Minister Health)
Dr. Tahir Javed

2007

Pervaiz Elahi
Ejaz Nisar

2008

Ejaz Nisar
Dost Muhammad Khosa
Shahbaz Sharif

(Minister Health)
Ch. Muhammad Iqbal

2010

Shahbaz Sharif

Maj. (R) Tariq Javed

Afridi

Shahbaz Sharif

2012

Shahbaz Sharif

Amin

Shahbaz Sharif

Maj. (R) Tariq Javed

Afridi

Sahibzada Syed Murtaza

Anwar Ahmad Khan

Maj. (R) Tariq Javed

Amin

Fawad Hasan Fawad

Afridi
Bushra Amaan

Sahibzada Syed Murtaza

Fawad Hasan Fawad

Bushra Amaan

Amin

Mohammad Jehanzeb

Aman Ullah Khan

Khan
Sahibzada Syed Murtaza
Amin

2013

Anwar Ahmad Khan

Shahbaz Sharif

2011

Mian Bashir Ahmad

(Minister Health)
Sahibzada Syed Murtaza

2009

Anwar Ahmad Khan

Source: Punjab Health Foundation Records

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Mohammad Jehanzeb

Aman Ullah Khan

Khan

Sohail Shahzad

Arif Nadeem

Izhar Ahmed Sheikh

Arif Nadeem

Izhar Ahmed Sheikh

16-172-2014-2
Exhibit 7
THE PUNJAB HEALTH FOUNDATION: GOVERNANCE STRUCTURE AND
PROGRAM PORTFOLIO
Summary of Income and Expenditure (2011-12)

Receipts (Rs. in millions):

o Profit earned from investment

49.33

o Recovery

77.35

o Other income

0.05

o Total

126.68

Expenses:

o Loan disbursement

36.09

o Administrative expense

19.13

o Total

55.22

Source: Constructed from Data Provided by Punjab Health Foundation

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16-172-2014-2
Exhibit 8
THE PUNJAB HEALTH FOUNDATION: GOVERNANCE STRUCTURE AND
PROGRAM PORTFOLIO
Composition of the District Health Promotion Committee (2013)
District Health Promotion Committee (DHPC):

District Coordination Officer

Executive District Officer (Health)

One Member of the District Assembly (nominated by the District Nazim)*

Community District Officer

* Currently vacant in all districts, as District Assemblies do not exist.

Source: Punjab Health Foundation Records

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16-172-2014-2
Exhibit 9 (p1 of 2)
THE PUNJAB HEALTH FOUNDATION: GOVERNANCE STRUCTURE AND
PROGRAM PORTFOLIO
District-wise Disbursement up to June 2012

Sr.
No.

No. of
Recipients

District

Loan
(Million Rs.)

Lahore

214

172.59

Rahim Yar Khan

55

56.01

Multan

67

42.57

Faisalabad

50

41.7

Gujranwala

42

38.6

Sialkot

34

30.66

Sheikhupura

39

27.28

Muzzaffargarh

38

23.97

Rawalpindi

28

21.89

10

Sargodha

27

20.27

11

Layya

41

19.2

12

Bahawalpur

26

17.6

13

Vehari

34

17.19

14

Khanewal

24

16.22

15

Okara

22

15.53

16

Toba Tek Singh

19

15.22

17

Narowal

18

14.25

18

Rajanpur

16

13.32

19

Lodhran

18

12.32

20

Gujrat

21

11.35

21

Dera Ghazi Khan

23

9.9

22

Jehlum

11

9.51

23

Attock

10

9.40

24

Sahiwal

15

9.01

25

Khushab

8.3

26

Bahawalnagar

8.18

27

Jhang

14

7.52

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16-172-2014-2

Exhibit 9 (p2 of 2)
THE PUNJAB HEALTH FOUNDATION: GOVERNANCE STRUCTURE AND
PROGRAM PORTFOLIO
District-wise Disbursement up to June 2012

Sr.
No.

No. of
Recipients

District

Loan
(Million Rs.)

28

Chakwal

14

5.55

29

Kasur

4.55

30

Mianwali

10

4.40

31

Chiniot

4.08

32

Hafizabad

2.45

33

Pakpattan

1.7

34

Nankana Sahib

1.6

35

Bhakkar

1.6

36

Mandi Bahauddin

1.44

Source: Punjab Health Foundation Records

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16-172-2014-2
Exhibit 10
THE PUNJAB HEALTH FOUNDATION: GOVERNANCE STRUCTURE AND
PROGRAM PORTFOLIO
Year-wise Loan Disbursement (million Rs.) up to June 2012
Year

Regular Package

Young Doctors Package

Total

1996-97

0.25

0.25

1997-98

6.47

2.7

9.17

1998-99

10.95

3.1

14.05

1999-2000

2.67

1.15

3.82

2000-01

15.26

1.05

16.31

2001-2

37.79

1.85

39.64

2002-3

64.75

7.65

72.4

2003-4

57.55

11.1

68.65

2004-5

55.8

5.7

61.5

2005-6

60.36

3.88

64.24

2006-7

80.37

6.38

86.75

2007-8

83.8

10.7

94.5

2008-9

65.6

16.4

81.0

2009-10

49.25

15.9

65.15

2010-11

2.8

56.07

58.87

2011-12

3.6

32.5

36.1

TOTAL

597.02

176.38

773.4

Total number of borrowers: NGOs 52;

Women borrowers:

Practitioners 951

12%

Source: Punjab Health Foundation Records

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