THE enhancement of public health is essential for fostering a thriving society and driving economic prosperity. Pakistan, under Article 38 of its Constitution, is committed to providing basic life necessities, including healthcare, to its citizens. Despite notable improvements in healthcare indicators, the allocation of health expenditure (HE) as a percentage of GDP remains significantly low, raising concerns about the sustainability of these improvements and Pakistan’s ability to achieve universal health coverage (UHC).
Between 2015 and 2022, Pakistan made commendable progress in health outcomes. Life expectancy increased from 65.7 to 67.3 years, the incidence of child stunting reduced from 41.4% to 34%, and immunization coverage for DPT rose from 72% to 85% for children aged 12-23 months. These achievements were supported by government initiatives, such as expanded immunization programs, the Hepatitis elimination program, and diabetes prevention campaigns. However, Pakistan’s health outcomes still lag behind regional averages, such as the South Asian life expectancy of 71.6 years and an infant mortality rate of 30.8 per 1,000 live births compared to Pakistan’s 52.8.
The health sector’s expenditure trends highlight significant gaps. In FY 2023, Pakistan allocated 1.0% of its GDP to health expenditures, amounting to Rs 843.2 billion. This represents a decline from Rs 919.4 billion in FY 2022. The consolidated health expenditures, inclusive of federal and provincial allocations, are heavily skewed towards recurrent expenditures, with limited resources dedicated to developmental projects. For instance, Punjab, the largest province, allocated Rs 450.61 billion in FY 2023, with development expenditures accounting for Rs 147.55 billion.
Low health financing poses substantial challenges for Pakistan’s healthcare system: Insufficient Resources for Universal Health Coverage: Health expenditure per capita remains inadequate, impeding the ability to provide comprehensive care. Disparities in Access and Quality: Balochistan and Sindh face significant disparities in healthcare access and quality due to underfunding. Heavy Reliance on Out-of-Pocket (OOP) Expenditures: The absence of robust health insurance mechanisms exacerbates OOP expenses, affecting marginalized populations disproportionately.
Despite financial constraints, Pakistan has initiated several projects aimed at improving healthcare outcomes: Prime Minister’s National Health Programs: Initiatives like the elimination of Hepatitis C and diabetes prevention have been launched with significant federal and provincial co-financing. Expanded Program on Immunization (EPI): EPI ensures immunization against vaccine-preventable diseases through a network of 15,000 vaccinators and 9,000 sites. Provincial Efforts: Punjab and Sindh have prioritized health information systems, telemedicine, and disaster-resilient healthcare infrastructure. Khyber Pakhtunkhwa’s cancer treatment project and Balochistan’s health care reform initiatives aim to enhance care quality in underserved regions.
To improve Pakistan’s health expenditure scenario, it is crucial to raise health spending to at least 3% of GDP, in line with regional standards and expand health insurance programs like Sehat Sahulat Card to reduce out-of-pocket costs. Prioritizing preventive healthcare through increased funding for immunization, maternal health and nutrition can ease long-term healthcare burdens. Additionally, promoting public-private partnerships (PPPs) for infrastructure, technology and workforce development can help bridge service delivery gaps. While Pakistan has made notable progress in health outcomes, low health expenditure remains a barrier to sustainable improvements. Addressing these financial and systemic challenges will ensure equitable access to quality healthcare, fulfilling constitutional commitments and aligning with the SDGs for health by 2030.
—The writer is contributing columnist, based in Islamabad.
(tariqali@hsa.edu.pk)
