Khyber Pakhtunkhwa’s administrative cadre within the provincial health department is rapidly losing relevance after years without new inductions, officials say. Created in 2009 to place doctors with training in health administration into leadership roles, the cadre was intended to staff posts such as district health officers, medical superintendents and directors.
The health department is organized into three streams: a general cadre and a specialist cadre focused on clinical care, and a management cadre charged with administrative and financial oversight of hospitals and health institutions. Recent policy shifts have allowed general-cadre doctors to fill administrative posts, undermining the role of specially trained management professionals.
As a result, many doctors who hold formal qualifications in health administration — including overseas degrees — have been sidelined. At the same time, junior clinicians without specialised administrative training have been appointed to senior management positions such as DHO, regional director, deputy medical superintendent and director-level offices. These roles often require complex coordination with international agencies, including the World Health Organization and UNICEF.
Several management-cadre physicians have reportedly been placed on officer-on-special-duty (OSD) status, facing reduced pay and suspended allowances while they await reassignment. Officials also point to the outsourcing of public hospitals as accelerating the cadre’s erosion: roughly 25 hospitals have already been outsourced, with more expected to follow.
Pressure from medical teaching institutions is compounding the problem. Because administrative-cadre doctors are civil servants, they must resign to take posts at teaching hospitals, and those institutions increasingly favour contractual hires from the private market over permanent civil-service appointments.
Taken together, these developments have weakened the institutional pathway for trained health administrators in KP, raising concerns about governance, financial management and the ability to engage effectively with national and international partners.
