According to the economic analysis FY2022 released by the Government of Pakistan, health and wellbeing are central to Sustainable Development Goals (SDGs). SDGs Index claims to track a Pakistan’s performance on the 17 SDGs.
Overall, Pakistan’s SDGs Index score grew from 53.11 in 2015 to 63.5 in 2020. Experts identified that Pakistan no doubt, has a lot of potential and competent workforce in the health sector, however, there is a need to offer training to them on digital technologies to meet the modern-day challenges. The present floods have caused severe damage to the health sector of Pakistan. Around 33 million people have been affected in the flood-hit areas while a large number of people are facing epidemic diseases.
Pakistan fought the coronavirus pandemic bravely. Approximately 17.5 million can be benefitted from the National Health Insurance Scheme, which was launched in 2015. The experts calculated that our country is on track for 3 out of 14 indicators including Maternal Mortality Rate (per 100,000 live births), New HIV infections (per 1,000 uninfected population) and births attended by skilled health personnel.
Statistics showed that Infant Mortality Rate (IMR) in Pakistan has declined to 54.2 deaths per 1,000 live births in 2020 from 55.7 in 2019, while Neonatal Mortality Rate declined to 40.4 deaths per 1,000 live births in 2020 from 41.2 in 2019. Percentage of birth attended by skilled health personnel increased to 69.3 percent in 2020 from 68 percent in 2019 (DHS & UNICEF). Maternal Mortality Ratio fell to 186 maternal deaths per 100,000 births in 2020, from 189 in 2019. With a population growing at 2 percent per annum, Pakistan’s contraceptive prevalence rate in 2020 decreased to 33 percent from 34 percent in 2019. No doubt, Pakistan’s tuberculosis incidence is 259 per 100,000 population and HIV prevalence rate is 0.12 per 1,000 population in 2020.
The share of people paying for healthcare expenses on their own, or out of pocket (OOP) made up 52.8 percent of the total health expenditure during FY2020, according to the National Health Account estimates. Furthermore, people spent greater than the government of Pakistan on healthcare, approximately Rs 775.412 billion, as compared to Rs 468.228 billion spent through the federal, provincial, tehsil and district governments FY2019-20. Statistics showed that the government of Punjab has the highest share (53 percent) followed by Sindh (23 percent) and KP (17 percent, including FATA) while Balochistan has just (6 percent) share of Pakistan’s OOP health expenditures.
According to the NHA report, of the total healthcare expenditures in Pakistan, 39.8 percent is made by general government agents which include social security, Zakat, Baitul Mal expenditures as well.
It is said that in Pakistan, total health expenditure in FY2019-20 is estimated as Rs 1, 466 billion against Rs 1,206 billion. This shows a rise of Rs 260 billion over the FY2017-18, which is a 21.6 percent increase in nominal terms as it includes inflation of health care goods and services. Statistics also identified that there are 1,289 public sector hospitals (114,841 beds), dispensaries 5,849 (1,077 beds), basic health units 5,472 (6,594 beds), rural health centers (10,726 beds), TB clinics 412 (141 beds), maternity and child welfare centres 752 (328 beds). It is also said that most of the hospitals are privately run in Pakistan which caters to OPP and has a larger share in providing healthcare in the country. The Annual per capita current health expenditures for Pakistan as per NHA 2019-20 were recorded $ 40.7 or Rs 6,432 while in NHA FY2017-18 it was recorded $ 48.1 or Rs 5,283. For comparison, the respective statistics for year FY2020 reported to WHO by Iran, India, Afghanistan, Bangladesh & China are $ 470, $ 64, $ 66, $ 46 and $ 535, respectively. Pakistan has been ranked as one of the most exposed nations to poverty risk among 43 countries in the Asia-Pacific region.
Pakistan is a known low-spender on health. To put things into perspective, according to estimates done in 2017-18, Pakistan spent $ 45 per person on health, while Iran spent $ 484 and Qatar spent $ 1,716 per capita. The federal budget 2021-22 has seen an increase of 11 percent relative to the previous year. In nominal terms, the health budget has gone up from almost Rs 25.5 billion to Rs 28.3 billion though it is still a mere 0.4 percent of the total budget. The federal development budget (PSDP) has a “particular focus on strengthening the health sector” and it has seen an increase of 49.6 percent i.e. from Rs 14.5 billion in 2020-21 to Rs 21.7 billion, including Rs 5.6 billion for the Sehat Sahulat Programme.
Statistics also showed that one of the government priorities for the current fiscal year is impact mitigation of Covid-19. Rs 100 billion is dedicated only for Covid-19 related expenditures i.e. almost four times the budget for routine healthcare. Sources recorded that Punjab, which comprises almost half the population of Pakistan, has increased its budget by a gargantuan 134 percent from Rs 156.7 billion in FY2020-21 to Rs 370 billion. Khyber Pakhtunkhwa grew its health allocation in the provincial budget FY2021-22 to Rs 142 billion from Rs 124 billion. Sindh also grew its budget allocation by 29.5 percent i.e. from Rs 132.8 billion last year to Rs 172 billion but also proclaimed a 30 percent raise in the health budget in FY2023. Balochistan has increased its budget by Rs 13.2 billion i.e. from Rs 31.4 billion in 2020-21 to Rs 44.6 billion in the current year. In last I would like to mention here, the country needs primary healthcare-based UHC, and for this new health system investments are needed. Much more attention needs to be given to strengthening primary healthcare where up to 70 percent of essential healthcare can be delivered.