Graduation Year


Document Type




Degree Granting Department

Public Health

Major Professor

Russell S. Kirby, Ph.D

Co-Major Professor

Julie A. Baldwin, Ph.D

Committee Member

Carla VandeWeerd, Ph.D

Committee Member

Barbara Langland Orban, Ph.D


Cultural influences, Legitimate expectations, Patient dignity, Prompt attention, Qualitative



The health system has been defined as all people, institutions and resources that undertake actions with the primary intent of improving health, while responsiveness of the health system refers to its objective of responding to the legitimate expectations of the population it serves. Although responsiveness is a non-health objective of the health system, it affects the health status of the population by influencing treatment compliance, patient-provider communication and health services utilization. Furthermore, responsiveness has a fundamental value as it concerns basic human rights of the individuals being served by the health system.

This study was undertaken to determine how well the Pakistani federal health system was responding to the needs of 18-45 year old adults with physical disabilities living in Islamabad, and the barriers that were hindering the government from responding to this vulnerable sub-group of the population. The study employed a qualitative approach. Data were collected through focus group discussions with 18-45 year old physically disabled consumers of healthcare in the three federal government hospitals located in Islamabad. In-depth, face-to-face interviews were conducted with health care providers, managers, policy makers, and disability rights advocates who had been operating within the same system.

Results of the study indicated that the federal health system falls short in responding to the needs of a large population of physically disabled adults living in the Islamabad Capital Territory. This research has identified barriers operating at multiple levels of the health system, and within the policy making, financing and federal human resource milieu. The main barriers to responsiveness of the health system included vulnerability of persons with disabilities, lack of provider training, lack of priority accorded to issues confronting the disabled at the highest policy making levels, and the lack of a referral system. The pluralistic Pakistani culture also posed a barrier to responsiveness of the health system especially in case of women. The researcher expects this study to contribute to informed policy making and spur further research on the needs of this oft-neglected sector of the Pakistani population. The results of this study will be shared at multiple forums including top policy making levels, as well as at the level of healthcare management and provision and disability rights advocacy to address the issue holistically. This study focused on the federal health system and included only the federal government hospitals located within Islamabad. Future research may focus on responsiveness of the larger provincial health departments through quantitative as well as qualitative methods. Furthermore, the effects of responsiveness on healthcare seeking behaviors in vulnerable populations may also be studied. Larger scale studies may be undertaken to ascertain the association between responsiveness, healthcare seeking patterns and health status of the vulnerable populations. Such studies will not only contribute to the knowledge in the field but also provide much needed input for evidence-based policy making in the country.