Mixed-Methods Evaluation of Policy and Implementation Gaps: Evidence from public funded Primary Health Centers in Sindh and Punjab

Introduction: This study presents a comparative assessment of the primary healthcare (PHC) centers of government funded in regard of current status and capacity in Sindh and Punjab, based on the World Health Organization (WHO) operational levers. Method: Convergent parallel mixed method study was opted in which current capacity and functional areas was assessed through quantitatively and policy gaps and recommendations were addressed by qualitative analysis in which experts from different areas of health systems were approached. Results: Lahore demonstrates higher percentages in workforce availability (63% vs. 52%), physical infrastructure (65% vs. 48%), and M&E systems (51% vs. 34%). These findings suggest more robust investments and policy implementation mechanisms in Lahore, potentially leading to improved access, quality, and system responsiveness. Both cities show relatively strong performance in the availability of medicines and health products, although Karachi (68%) slightly lags behind Lahore (71%). On the other hand, lack of policy Urban PHC policy, limited finances, workforce shortage, weak referral system, and limited emphasis of workforce capacity development are the major gaps identified by stakeholders. Conclusion: Future efforts must also address governance fragmentation and financing inefficiencies to build resilient and equitable urban PHC systems with inclusion of share task through public private partnership.