Established in 1998, SINA HealthSystems Foundation is a not-for-profit primary health care (PHC) organization operating 40 facilities across peri-urban and slum communities of Karachi and adjoining areas of Sindh and Balochistan, deliberately situated where access is most constrained. The organization records approximately a million patient visits each year.
PHC is more than the provision of healthcare services at the first point of contact, and a functioning PHC organization requires more than a clinic, a doctor and medicines. It requires systems that connect communities with services, equip health workers to deliver care, establish referral pathways, maintain essential infrastructure, and continuously learn from the experience. The WHO Operational Framework for Primary Healthcare (WHO-OF) translates this into 14 interrelated levers: four core strategic levers covering leadership, governance, financing and community voice, and ten operational levers that shape delivery. SINA’s experience shows how these levers can be embedded across organizational systems in a resource-constrained setting.
WHO-Aligned Core Strategic Levers for Primary Healthcare
SINA’s primary healthcare model is aligned itself with WHO principles, recognizing that effective PHC depends on leadership, governance, resource allocation, and community engagement beyond the consultation room. SINA’s Board of Directors and expert advisors work closely with management to provide strategic direction, mentorship, fundraising support, and guidance on efficiency, contributing to organizational resilience during socioeconomic and geopolitical challenges. Governance is strengthened through strategic planning, sustainability and cost-reduction strategies, defined reporting mechanisms, and standing committees overseeing key financial, clinical, and IT decisions. As a not-for-profit, SINA promotes equity and financial protection through targeted donor funding, corporate sponsorships, and institutional collaborations, with relevant financial and programmatic activities informed by Shariah advisors. Community engagement is embedded in operations not only through feedback mechanisms and awareness activities, but also through employment of local residents as zakat evaluators, receptionists, clinic supervisors, and mental health counsellors, helping address language and cultural barriers, and ensuring services remain responsive to local needs.
WHO-Aligned Operational Levers for Primary Healthcare
Models of Care: With over with over 90% of patients being women and children, SINA provides integrated PHC across maternal and child health, communicable and non-communicable diseases, and mental health, supported by referral pathways that enable continuity of care. Task-shifting further extends care beyond traditional physician-led models, particularly for mental health and NCD prevention.
PHC Workforce: Recognizing Pakistan’s healthcare sector is most impacted by the brain drain phenomenon, workforce capacity is strengthened right from the beginning. SINA’s systems combines structured recruitment and induction, clinical and operational supervision, bi-monthly continuing medical education (CME) sessions, competency assessments, and quarterly clinical audits that identify gaps and guide corrective action.
Physical Infrastructure: SINA facilities are purpose-built with open-air spaces, round-the-clock solar-supported electricity, dual internet connectivity, clean drinking water and separate toilets for staff and patients. Upkeep is informed by regular facility audits. First-response trained personnel and fire drills support emergency preparedness. Ambulatory transport for emergencies remains the main WHO-recommended measure absent.
Medicines and Other Health Products: SINA ensures availability of essential medicines through a quality-assured supplier network, independent quality monitoring, medication-error reporting, and six-week emergency stock buffers.
Engagement with Private Sector Providers: SINA demonstrates that integrated PHC does not require every service to be delivered independently by the same organization. Partnerships with public and private institutions working within its vicinity make immunization, antenatal care, tuberculosis, hepatitis, malnutrition, family planning and eye care available to its service-users.
Purchasing and Payment Systems: Resources committed to PHC hold their value only where financial and procurement systems are sound. SINA runs dedicated finance and supply chain departments, with an ERP system (Odoo) implemented across their operations in line with corporate governance requirements. These controls safeguard funds and stock against leakage and give the organization traceable, auditable procurement.
Digital Technologies for Health: The value of digital health systems comes through its support of continuity of care, learning, coordination, and decision-making. SINA is enhancing its PHC delivery by implementing its in-house built Electronic Medical Records (EMR) system for patient registration, clinical care, and ancillary services such as laboratory, imaging, and pharmacy. Dedicated modules for mental health, ANC, and immunization services are also under development. In addition, the organization has employed a cloud-based learning management system (LMS) for staff development.
Systems for Improving Quality of Care: Quality is embedded through orientation and training, clinical protocols, audits and feedback, incident reporting, performance assessments, CME, and regulatory audits. Creating a continuous cycle of measurement, learning, corrective action, and improvement.
PHC-Oriented Research: PHC organizations generate large amounts of information daily; however, this only becomes valuable if it contributes to learning and better decision-making. SINA’s Public Health and Research arm links clinical data, quality audits, community feedback, and implementation experience to inform service improvement, with 21 publications and participation in a 24-site implementation science trial on mental health in PHC.
Monitoring and Evaluation: EMR data, facility audits, and performance assessments provide a common information base for tracking service utilization, quality indicators, and operational gaps, supporting ongoing decision-making, learning, and improvement.
Conclusion
The value of SINA’s model lies not in being perfect, but in illustrating how the levers of the WHO-OF can be balanced and applied in resource-constrained settings, while keeping opportunities for continued improvement in view.
About SINA HealthSystems Foundation: Established in 1998, SINA HealthSystems Foundation is a Section 42 not-for-profit operating 42 primary healthcare clinics across Karachi and its surrounding communities, and has recorded more than 11 million patient visits since inception.