Pakistan’s healthcare system, serving a population of over 240 million, is a complex mix of public and private sectors striving to meet growing demands. Despite notable progress in areas like universal health coverage and primary care outreach, systemic challenges such as underfunding, workforce shortages, and urban-rural disparities persist. This article examines the advancements made, the pitfalls that hinder equitable healthcare, and strategies to strengthen the system for a sustainable future.
Overview of Pakistan’s Healthcare System
Pakistan’s healthcare operates through a three-tiered structure: primary care (Basic Health Units and Rural Health Centers), secondary care (district and tehsil hospitals), and tertiary care (teaching hospitals). The system is decentralized, with provinces primarily responsible for health policy since the 2010 devolution. Public facilities serve 30% of the population, while the private sector, often costlier, caters to 70%. Health expenditure is low at 2.95% of GDP ($374.7 billion in 2022), with 54.3% of costs borne out-of-pocket, reflecting limited government funding.
Progress in Healthcare
1. Universal Health Coverage Initiatives
The Sehat Sahulat Program (SSP), launched in 2016 and expanded in 2022, marks a significant step toward universal health coverage (UHC). Covering 110 million people in Punjab alone, it provides up to PKR 1 million annually per family for treatments like heart disease, cancer, and diabetes. By integrating with private hospitals, SSP has reduced financial burdens for 20 million households, earning praise as a model for low-income nations. The UHC index rose from 23 in 2000 to 45 in 2017, reflecting broader service access.
2. Lady Health Worker Program
The Lady Health Worker (LHW) program, started in 1994, employs 100,000 women to deliver primary care to 100 million people, covering 1,000 individuals each. LHWs promote vaccinations, maternal health, and disease prevention, contributing to a 20% increase in immunization coverage since 2010. The program’s door-to-door model has improved rural access, reducing under-5 mortality by 15% in covered areas.
3. Improved Health Indicators
Life expectancy has risen from 61.1 years in 1990 to 67.94 in 2024, and the Healthcare Access and Quality (HAQ) index increased from 26.8 to 37.6 by 2016. Infant mortality dropped from 86 to 69.3 per 1,000 live births, and maternal mortality fell 30% since 2000, driven by better antenatal care and skilled birth attendance, particularly in urban areas.
4. Infrastructure Expansion
Pakistan has 1,201 hospitals, 5,518 Basic Health Units, 683 Rural Health Centers, and 123,394 beds, with private clinics filling gaps in urban areas. Post-2010 devolution, provinces increased health budgets by 25%, enabling new facilities and equipment upgrades. Programs like the Expanded Program on Immunization and National TB Control have reduced disease burdens, with TB incidence declining 10% since 2015.
5. Digital and Preventive Health
Digital tools like the Health Management Information System (HMIS) and telemedicine platforms have reached 10 million users, improving data-driven decisions and remote care. Awareness campaigns, such as those under the Ehsaas program, have boosted preventive health, with 60% vaccination coverage for children, up from 40% in 2000.
Pitfalls of the Healthcare System
1. Inadequate Funding
Health spending remains critically low at 1.4% of GDP per capita ($1,506 in 2021), compared to WHO’s recommended 6%. This underfunding results in shortages of medicines, outdated equipment, and only 0.63 hospital beds per 1,000 people, far below Iran’s 1.56. Out-of-pocket expenses burden 54% of patients, pushing 10 million into poverty annually.
2. Workforce Shortages and Brain Drain
Pakistan has 175,000 doctors (1 per 1,764 people) and 105,950 nurses, against WHO’s recommended 2 doctors per 1,000. Annually, 32,879 physicians graduate, but 40% migrate abroad due to low salaries ($300–$500/month), long hours, and poor conditions. Nurse shortages, at 1 per 2,300 people, cripple care delivery, especially in rural areas.
3. Urban-Rural Disparities
Urban areas host 80% of hospitals, leaving 63% of the rural population underserved. Only 92% of rural areas have basic health access, compared to 100% urban coverage. Travel costs and lack of facilities force 30% of rural patients to seek costly private care, exacerbating inequality.
4. Neglect of Preventive Healthcare
Preventive care is underprioritized, with only 10% of the health budget allocated. Diseases like hepatitis (7.6% prevalence) and diabetes (25% of adults) thrive due to low screening and education. Polio persists, with 150 cases in 2019, reflecting vaccine hesitancy and weak campaigns.
5. Corruption and Mismanagement
Corruption, including fake drug markets costing $200 million yearly, undermines trust. Posts on X highlight public frustration with “incompetence and neglect” in hospitals. Poor governance delays reforms, and HMIS data falsification skews planning, affecting 30% of district-level decisions.
6. Mental Health Stigma
Mental health services are scarce, with only 500 psychiatrists for 240 million people. Cultural stigma promotes spiritual healers over medical care, leaving 50% of disorders untreated. Public facilities cover just 5% of mental health needs, and training for general practitioners is minimal.
Socioeconomic Impact
Healthcare gaps exacerbate poverty, with 78% of medical costs out-of-pocket, causing economic shocks for 66% of poor families. Communicable diseases like TB and hepatitis cost $300 million annually, while non-communicable diseases, like diabetes ($235 per patient), strain 25% of households. Rural women, 50% of whom lack skilled birth attendants, face higher mortality, perpetuating gender disparities.
Opportunities for Improvement
1. Increase Health Budget
Raising health spending to 4% of GDP could add 50,000 beds and 100,000 nurses by 2030. Tax reforms and public-private partnerships could fund 500 new rural clinics, reducing disparities by 20%.
2. Retain Talent
Salary hikes (50% increase) and incentives like housing could retain 10,000 doctors annually. Expanding nursing schools to graduate 20,000 nurses yearly would meet WHO ratios by 2035.
3. Strengthen Preventive Care
Investing $500 million in vaccinations and screenings could cut hepatitis by 30% and diabetes complications by 25%. Community campaigns, leveraging LHWs, could raise vaccine uptake to 80%.
4. Expand Digital Health
Scaling telemedicine to 50 million users and upgrading HMIS with AI could save $100 million in inefficiencies. Training 5,000 health workers in digital tools would enhance rural outreach.
5. Regulate Private Sector
Capping private hospital fees and licensing 10,000 clinics could improve affordability. Public-private models, like those in Sindh, could add 200 facilities, serving 10 million more patients.
Policy Recommendations
- Boost Funding: Allocate 4% of GDP to health by 2028, prioritizing rural infrastructure and drug supplies.
- Enhance Workforce: Offer scholarships and retention bonuses to train and keep 50,000 health workers by 2030.
- Prioritize Prevention: Launch a $1 billion National Action Plan for NCDs and infectious diseases, targeting 50% prevalence reduction.
- Bridge Disparities: Build 1,000 rural health units and subsidize transport for 5 million patients annually.
- Improve Governance: Enforce anti-corruption laws and digitize procurement to save $300 million yearly.
- Integrate Mental Health: Train 10,000 primary care workers in mental health screening and add 50 psychiatric units by 2030.
Pakistan’s healthcare system has made strides through initiatives like the Sehat Sahulat Program and Lady Health Workers, improving access and health outcomes for millions. Yet, chronic underfunding, brain drain, and inequities threaten progress, leaving 40% of the population vulnerable. By increasing investment, retaining talent, and prioritizing prevention, Pakistan can build a resilient system that delivers equitable care. The path forward demands political will and coordinated action to transform healthcare into a pillar of national development.
