The health system in Pakistan is plagued with several challenges – structural fragmentation, financial resource scarcity, less developed human capital, lack of functional specificity and accessibility. Faced with a hazardous social and economic position of country forwarded by piling debt and uncertain productivity, Pakistan’s position to exercise health sector reforms after devolution is quite limited. Although the 18th amendment brought room for opportunities, it should go far and bring long term transformation in the health, and socio-economic sectors. The underlying research compared the pre and post devolution health sector process. The study has discussed the parameters which concerns with various fluctuations in the health sector i.e. improved, deteriorated and stagnation. Integration of contemporary horizontal programs across provinces within the federal framework of comprehensive primary healthcare system is necessary phase. The research is based on a critical deep analysis of secondary data collected within public and private domain collected by government authorities across country in provinces. It also brings six block health care system approach to analyze pre and post devolution process on relevant indicators. Time series data paucity in health sector is unavoidable fact in Pakistan, so secondary data with gaps is deployed to analyze the 18th amendments effects across the provinces. The study results showed that certain health sectors improved during the analysis period, and simultaneously deteriorated and stayed stagnant. Supervisor:- Dr. Muhammad Jehangir Khan