Linking Clinical Governance And Budgetary Mechanism To Public Health Outcomes: A Study Of Tertiary Healthcare In Punjab

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Nabila Khan , Dr. Rubeena Tashfeen


This study investigates issues related to governance and deficient health funding in tertiary healthcare hospitals in Pakistan. It also addresses whether organizational culture in the hospitals have any moderating influence on service delivery mechanism. The data comprises surveys taken from 393 practitioners working in eight teaching hospitals in Punjab. The data was analyzed using Covariance Based Structural Equation Modeling (CB-SEM) to test the hypothesized relationships.

 The findings show a highly significant impact of governance and budgetary issues on quality of service delivery mechanism. The results of the analyses are statistically significant and show a positive impact indicating that governance and budgetary issues have a positive impact (β = 0.20, β = 0.20, p < 0.001 respectively) on the quality of service delivery at the tertiary hospitals examined. In respect of the moderating impact, there exists a positive influence (β = 0.099, p < 0.001) of organizational culture on the relationship of budgetary issues on service delivery mechanisms in the hospitals. The positive direction indicates that organizational culture enhances the impact of budgetary issues on healthcare service delivery. However, no effects are noticed for the influence of organizational culture on governance and service delivery relationship.

The research expands on the scant available literature on governing issues of tertiary healthcare, especially in this region of an emerging economy. It addresses some critical financial issues related to inequalities, dilapidated infrastructure, budget leakages, non-responding behavior of practitioners, and other management issues that are faced in the public health sector. In face of the dire conditions of healthcare in this region, the study highlights that insufficient resources and funding from the Government for public sector, is a contributing factor in the poor healthcare available to the public.

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