The State of Health in Pakistan: A Multi-Dimensional Evaluation of the Problems and Prospects

Image Source: Daily Tribune (2023)

The healthcare system in Pakistan is facing many challenges that affect its quality, accessibility, and affordability. Some of the key reasons behind the deteriorating healthcare system are:

The Status: 
Pakistan had the highest maternal mortality ratio compared to its 11 neighboring countries, at 140 deaths per 100 000 live births in 2017. The median value of all 37 OECD countries was 9 in 2018.
Pakistan had the highest neonatal mortality rate among the 11 neighboring countries, at 38 deaths per 1000 live births in 2018. The median value of all 37 OECD countries was 2.3 in 2019.
Pakistan had the lowest life expectancy at birth among the 11 neighboring countries, at 67.3 years in 2018. The median value of all 37 OECD countries was 81.3 years in 2019.

Low public spending on health: 
Pakistan has the 2nd lowest public health expenditures as a percentage of GDP in the world, at 2.9% in 2020. The median value of all 37 OECD countries was 6.32% in 2019.

This means that the government does not allocate enough resources to meet the health needs of the population, especially the poor and vulnerable groups. As a result, many people have to pay out-of-pocket for health services, which can lead to catastrophic health expenditures and impoverishment.
Source: World Bank (2023)

Weak governance and accountability: 
The health sector in Pakistan is complex and fragmented, with multiple actors and levels of responsibility. The federal government is mainly responsible for policy formulation, regulation, and coordination, while the provincial governments are responsible for service delivery and implementation. 
However, there is a lack of effective coordination and communication between the federal and provincial governments, as well as between the public and private sectors. 
There is also a lack of transparency and accountability in the use of public funds, and a weak regulatory framework to ensure quality and safety of health services.

Inadequate human resources for health: 
Pakistan faces a shortage and maldistribution of health workers, especially in rural and remote areas. 
According to the World Health Organization, Pakistan had only 1.5 physicians and 2.3 nurses and midwives per 10 000 population in 2018, which is below the minimum threshold of 4.45 health workers per 10 000 population required to achieve universal health coverage. 
Pakistan also had the lowest number of physicians per 10000 population among the 11 neighbour countries, at 1.5 in 2018. The median value of all 37 OECD countries was 34.1 in 2019.
Moreover, the health workforce is unevenly distributed, with urban areas having more health workers than rural areas, and public sector having fewer health workers than private sector. 
There is also a lack of training, supervision, and motivation of health workers, which affects their performance and retention.
Poor performance of medical universities: 
Medical education in Pakistan is also facing many challenges, such as outdated curricula, inadequate infrastructure, insufficient faculty, and low quality of teaching and learning. 
The Pakistan Medical Commission, which is the regulatory body for medical education and practice, has been criticized for its lack of independence, transparency, and accountability. 
There have been allegations of corruption, nepotism, and political interference in the accreditation and licensing of medical colleges and universities. 
Furthermore, there is a lack of alignment between the medical education system and the health system needs, resulting in a mismatch between the skills and competencies of medical graduates and the health problems of the population.

These are some of the major factors that have contributed to the consistent decline in the healthcare sector in Pakistan. To improve the situation, the government needs to increase its investment in health, strengthen its governance and accountability mechanisms, enhance its human resources for health, and reform its medical education system. These actions will require political commitment, stakeholder engagement, and evidence-based policymaking. 

Sources: 

[1] The allocation of public funding to higher education institutions | Resourcing Higher Education : Challenges, Choices and Consequences | OECD iLibrary (oecd-ilibrary.org)
[2] http://www.ijarp.org/published-research-papers/oct2017/Healthcare-System-Of-Pakistan.pdf
[3] https://www.emro.who.int/pak/programmes/health-policy-governance-and-leadership.html
[4] https://documents.worldbank.org/en/publication/documents-reports/documentdetail/964031468087833171/pakistan-health-sector-report
[5] Multinational Comparisons of Health Systems Data, 2020. https://www.commonwealthfund.org/publications/other-publication/2021/feb/multinational-comparisons-health-systems-data-2020.
[6] Pakistan - World Health Organization (WHO). https://www.who.int/countries/pak/.
[7] https://data.worldbank.org/


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