Local to Global Perspectives: Challenges Faced By the Healthcare System in Pakistan
by Minal Zaman Cheema*
Healthcare in Pakistan faces several challenges, including inadequate infrastructure, limited access to quality healthcare services, and major disparities between rural and urban areas.
Pakistan has a mixed healthcare system comprising of public and private healthcare facilities. The public sector includes government-funded hospitals and dispensaries, while the private sector includes privately owned setups, clinics, and laboratories. The public system and infrastructure in Pakistan is often overburdened and vastly under-resourced. Government hospitals can face issues such as overcrowding, lack of essential medical supplies, and long waiting hours. The quality of care can also vary between different public setups. The private sector offers a range of services and is often perceived to have better facilities and shorter wait times compared to the public system. However, private healthcare services are very costly and may not be affordable for a large segment of the population.
Moreover, accessibility of healthcare varies across different regions of Pakistan. Bigger cities have relatively better access to the health facilities, specialists, and medical equipment. But rural areas, on the other hand, often face challenges in terms of infrastructure, qualified medical professionals, and even basic health services.
Health insurance coverage in Pakistan is extremely low, with the majority of the population relying on out-of-pocket payments for their health related expenses. Government initiatives are underway to expand health insurance coverage and provide financial protection against these costs. This includes the National Health Vision 2016-2025, which aims to enhance primary healthcare services, improve health infrastructure, and also to strengthen the healthcare workforce.
Pakistan faces various health challenges, including infectious diseases – for example tuberculosis, hepatitis, and malaria – and non-communicable diseases – such as cardiovascular diseases, diabetes, and cancer. The government has also launched programs to address specific health issues such as the polio eradication campaigns.
What percentage of GDP Pakistan spends on healthcare?
The health expenditure as a share of GDP in Pakistan increased by 0.1 percentage points in 2020. Therefore, the share in Pakistan reached a peak in 2020 with 2.95%. It’s also worth mentioning that the share has been continuously increasing over the last years, with the exception of 2011.
This indicator estimates current health expenditures, including healthcare goods and services consumed during each year. This indicator does not include any sort of capital health expenditures such as buildings, machinery, IT, and stocks of vaccines for emergencies or outbreaks. The level of current health expenditure is expressed as a share of the country’s GDP.
Wealthier nations have reluctantly promised resources to assist poorer countries in dealing with the climate-related consequences of their irresponsible industrialization. Pakistan, having experienced two major flooding incidents within a decade, suffered unprecedented devastation during the summer floods of 2022. These floods have not only caused severe economic damage but are also significantly impacting human development in the nation.
Pakistan faces a severe health crisis but lacks the necessary resources for its healthcare system. The country has the highest infant mortality rate in South Asia and the region’s lowest life expectancy, excluding Afghanistan. Pakistani hospitals have only six beds per 10,000 people, and the doctor-to-patient ratio is extremely low, with one doctor for every 1,300 people.
Ref: https://www.statista.com/statistics/780861/health-expenditure-share-of-gdp-pakistan/
How is Pakistan ranked on the Human Development Index?
The HDI is a measure of a nation’s standard of health and education. In September 2021, Pakistan was ranked 154th out of 189 countries on the Human Development Index (HDI) published by the United Nations Development Programme (UNDP) in 2020. The HDI takes into account factors such as life expectancy, education, and per capita income to measure the overall development of a country.
According to the most recent UN Human Development Report, Pakistan has dropped by seven positions in the HDI rankings for 2021-2022. In 2020, Pakistan’s HDI had already fallen by two notches, placing it in the low human development category, primarily due to inadequate indicators in education, health, and income.
Presently, Pakistan ranks 161st out of 192 countries in the HDI rankings. The average life expectancy at birth in Pakistan is slightly over 66 years, and individuals receive only around eight years of schooling on average. Additionally, the gross per capita national income is just over $4,600.
Since the early 1990s, Pakistan has made gradual progress in improving its HDI. But the significant decline in its HDI ranking in 2021-22 can be attributed partially to methodological factors. The number of countries and territories included in the index increased from 189 in 2020 to 192 in 2021-22. Nonetheless, a more significant reason for Pakistan’s lowered HDI ranking is its relatively modest progress compared to other nations, leaving it far behind in terms of human development within the region.
Although Pakistan managed the Covid-19 pandemic reasonably well, the lingering effects of the recent flooding will continue to impact its HDI ranking for a considerable time. It’s important to note that the HDI for 2021-22 was released in September 2022, after the massive country-wide flooding occurred.
Ref: https://tribune.com.pk/story/2400318/pakistans-depressing-state-of-human-development
Comparison of Pakistan’s healthcare with other South Asian Nations
On an average a South Asian country invests 3.5% of its GDP for health per year.
Looking at neighboring South Asian nations – which include Afghanistan, India, Bangladesh, Bhutan, Maldives, Nepal, Pakistan, Sri Lanka – India currently ranks 132nd on the HDI index, while Bangladesh is performing better with a ranking of 129th. Sri Lanka, with its impressive history of human development, held the 73rd position on the HDI index. Meanwhile, only Pakistan and Afghanistan – which is at 180th position – are the lowest HDI.
In 2021, the total investment in health – public and private combined – in Bangladesh was equivalent to 2.34% of the GDP. Meanwhile, Sri Lanka’s total expenditure on healthcare in the same year was 3.8% of GDP.
In India, the central and state governments’ budgeted expenditure on healthcare touched 2.1 % of GDP in 2023, 2.2% in 2022, and the lowest was 1.6% in 2021, as per the Economic Survey 2022-23.
Pakistan, with its 2.95% GDP healthcare expenditure, is the lowest amongst the South Asian countries.
How to improve the healthcare system?
There are both local and global movements focused on healthcare justice that can contribute to improving the healthcare system in Pakistan. These movements aim to address disparities in access to healthcare, promote equitable distribution of resources, and advocate for the right to health for all individuals. Some of these movements include:
Global Health Equity Movements: There are several global movements advocating for healthcare justice and equity, such as the People’s Health Movement, Health for All, and the Global Health Justice Partnership. These movements work towards addressing systemic issues in healthcare, promoting universal health coverage, and ensuring that healthcare services are accessible and affordable for all.
Local Activism and NGOs: Within Pakistan, various local activism groups and non-governmental organizations (NGOs) are actively working towards healthcare justice. These organizations focus on issues such as improving healthcare infrastructure, advocating for health policies that benefit marginalized communities, and enhancing access to essential healthcare services.
Patient Rights and Advocacy: Patient rights movements play a crucial role in demanding accountability and transparency within the healthcare system. These movements strive to empower patients, protect their rights, and ensure they receive high-quality and dignified care. Patient advocacy groups in Pakistan work to improve healthcare delivery, highlight patient grievances, and push for policy reforms.
Health Education and Awareness: Health education initiatives contribute to improving healthcare systems by promoting preventive healthcare, raising awareness about diseases and their management, and educating communities on healthy behaviors. These efforts help individuals make informed decisions about their health and can lead to better utilization of healthcare services.
Health Policy Advocacy: Organizations and individuals advocating for evidence-based health policies and reforms also play a significant role in shaping healthcare systems. They engage with policymakers, conduct research, and provide recommendations to improve healthcare financing, governance, and service delivery in Pakistan.
These movements work towards achieving healthcare justice by addressing structural inequalities, advocating for changes in policies, and empowering communities to demand their right to accessible healthcare.
By supporting and participating in these movements, improvements can be made to Pakistan’s healthcare system, leading to better health outcomes and increased equity in its provision.
Local Pakistani NGOs working on improving healthcare
Below is a list of some local NGOs who are working towards better and more accessible health care in Pakistan. Each organization has its own focus and approach, but they share a common goal of improving healthcare services and reaching underserved populations in the country.
Edhi Foundation: The Edhi Foundation is one of the largest and most well-known NGOs in the country. While they provide a wide range of social services, they also operate hospitals, clinics and dispensaries that offer free medical treatment to those in need. They have centers across the nation, including ambulance services, blood and drug banks, as well as orphanages and old homes.
Indus Health Network (IHN): IHN is a non-profit organization that operates a network of hospitals and clinics across Pakistan. They provide free subsidized healthcare services to underprivileged communities, focusing on areas such as primary healthcare, maternal and child health, as well as treatment for infectious diseases like tuberculosis and hepatitis.
Chhipa Welfare Association: Chhipa is a humanitarian institution that provides emergency medical services, ambulance facilities, and healthcare to marginalized communities. They also run free medical camps and mobile healthcare units to reach remote areas and provide much needed medical assistance.
The Citizens Foundation (TCF): TCF primarily focuses on improving access to quality education for underprivileged children in Pakistan. They also work on providing healthcare facilities in their school campuses, including regular medical check-ups, vaccinations, and basic healthcare facilities for students and their families.
Mercy Corps: Mercy Corps is an international NGO which operates in Pakistan, among other countries. They work to improve access to healthcare by implementing programs that address nutrition, maternal and child health, water, sanitation, and hygiene (WASH) practices in vulnerable communities.
Shaukat Khanum Memorial Cancer Hospital & Research Centre (SKMCH&RC): This organization specializes in cancer treatment plus research. They provide free cancer treatment to deserving patients and also offer a variety of diagnostic and therapeutic services to the public. SKMCH&RC is well known across the nation for its state-of-the-art facilities and high-quality cancer care.
Pakistan Kidney and Liver Institute and Research Center (PKLI) was established with the aim of addressing the increasing burden of kidney and liver diseases in Pakistan. The institution provides advanced medical care, including transplantation, to patients suffering from ailments of these organs. Their main focus is on making quality healthcare accessible to all segments of society and providing subsidized treatment to financially disadvantaged patients, ensuring that individuals from all income groups have access to its services. PKLI collaborates with local and international institutions, healthcare professionals, and organizations to exchange knowledge and expertise.
Ref: https://www.transparenthands.org/list-of-top-10-ngos-organizing-medical-camps-in-pakistan/
A medical camp organized in Mehrabadi – informal settlement in Islamabad
* Minal Zaman Cheema is fourth year medical student at Fazaia Medical College in Islamabad, Pakistan. She is a volunteer for healthcare for all campaigns.