Abstract 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.

Le système juridique français accorde une grande importance aux droits du patient, essentiellement à travers la loi du 4 mars 2002. Ce texte a été construit de manière à placer le patient au centre du dispositif et à lui attribuer des droits liés à sa qualité de sujet de droit. Cette idée est quasiment absente dans la législation tunisienne. En Tunisie, la législation relative aux droits des patients est insuffisante. Il est vrai que le législateur tunisien a défini certains droits pour le patient. Cependant, ces consécrations législatives ne nous permettent pas de confirmer l’idée selon laquelle le patient est le centre de la relation médicale, particulièrement parce que le paternalisme médical trouve encore une consécration en Tunisie. L’étude comparative a montré certaines convergences entre les deux systèmes juridiques mais aussi d’importantes divergences. Ainsi, pour un pays, comme la Tunisie, dont le système sanitaire confronte des difficultés intenses non seulement sur le plan infra-structurel mais également législatif, le code de la santé publique en général et la loi du 4 mars 2002 pour les droits des malades, en particulier, peuvent constituer une source efficace pour des changements en profondeur. Cependant, si en France la loi du 4 mars 2002 occupe une place primordiale dans le corpus des règles du droit de la santé, on ne peut nier que les droits du patient confrontent aujourd’hui des difficultés de mise en œuvre. En effet, même si le souci du législateur français était de protéger au maximum les droits des patients, certaines failles restent à signaler / The french legal system attaches great importance to patient rights, mainly through the law of 4 March 2002. This text was constructed to place the patient at the center of the device and assigning the rights to as a subject of law. This idea is almost absent in tunisian law. In Tunisia, legislation on the rights of patients is inadequate : the rights of patients are devoted so scattered in several legal texts. It is true that the tunisian legislature has defined certain rights for patients. However, these legislative consecrations do not allow us to confirm the idea that the patient is the center of the medical relationship, particularly because medical paternalism still finds consecration in Tunisia. The comparative study showed some convergence between the two legal systems but also important differences. Thus, for a country like Tunisia, whose health system confronts severe difficulties not only its infrastructure but also the legislative, the code of public health in general and the law of 4 March 2002 for the rights of patients, particular, can be an effective source for in-depth changes. However, if in France the Law of 4 March 2002 occupies a prominent place in the corpus of rules of health law, there is no denying that the patient's rights today facing implementation difficulties. Even if the concern of the french parliament was to maximally protect the rights of patients, some flaws still to report