From crisis to cure—Pakistan’s health future depends on bold, balanced budget reforms
Healthcare financing in Pakistan is a critical issue that warrants urgent attention, particularly in the context of the country’s budgetary allocations. With a growing population and increasing healthcare needs, Pakistan’s healthcare system faces significant challenges in providing accessible, affordable, and quality healthcare services to its citizens. The country’s healthcare financing model is characterised by limited public sector investment, out-of-pocket payments dominating healthcare expenditure, and a lack of effective health insurance mechanisms.
The budgetary decisions made by the government have a profound impact on the healthcare sector, influencing the availability and quality of healthcare services, the distribution of healthcare resources, and the overall health outcomes of the population. As Pakistan strives to achieve its health-related Sustainable Development Goals (SDGs) and improve the health and well-being of its citizens, it is essential to examine the budgetary allocations for healthcare and assess their implications for the healthcare sector. A critical analysis of healthcare financing in Pakistan from a budgetary perspective can provide valuable insights into the challenges and opportunities facing the healthcare system and inform policy decisions that can help strengthen healthcare delivery and promote better health outcomes for the population.
Pakistan’s healthcare system has long been plagued by difficulties in funding, management, and service delivery, despite healthcare being a core right in the country’s constitution. A significant part of the failure stems from shortcomings in budget execution, which involves not just the overall budget amount but also allocating resources to each region, sector, and infrastructure, as well as finding effective ways to utilise those resources.
Past experiences have witnesses the fact that Pakistan has struggled to set healthcare budgets that truly reflect the needs of people from poor and rural areas. Decentralisation policies aimed to improve fund utilisation, but a lack of trained financial staff and local officials’ inability to plan spending according to vital health needs hindered effective budget management. This has resulted in unequal budgeting, with urban and wealthy regions often receiving more funding at the expense of rural and poorer areas.
Province wise outlook
The healthcare budget in Balochistan, the largest province with significant health problems, is strikingly smaller, and without sufficient skills and resources, local health departments struggle to manage their budgets, leading to shortages in critical health services. Furthermore, the reforms failed to distribute budgets equally among provinces and districts, and the central and provincial governments handled much of the budget, prioritizing cities over rural regions. This has widened the gap in health equity between the privileged and the less fortunate. Weak auditing and accountability have also enabled the misuse and abuse of government funds, reducing the effectiveness of the health budget. The healthcare financing system in Pakistan is underfunded, inefficient, and fragmented, with a mix of funding from federal, regional, and municipal groups, as well as donor agencies and private groups. This has led to difficulties in managing resources and providing essential services.
The budgetary allocations for healthcare have been increasing slightly over the years, but they remain insufficient, with Pakistan spending around 1-2% of its GDP on healthcare, far below the recommended 5%. The current situation is marked by inadequate investment in preventive measures, sanitation, and rehabilitation, and the lack of access to quality healthcare services in rural areas. Real-world examples illustrate the consequences of these challenges, including the disparity in healthcare services between urban and rural areas in Punjab and the ineffective management of funds in Khyber Pakhtunkhwa. The Covid-19 crisis exposed the insufficiencies in Pakistan’s approach to budgeting healthcare resources, highlighting the need for a more equitable and effective healthcare financing system.
To improve Pakistan’s healthcare system, a needs-based budget allocation formula should be adopted, considering factors such as disease prevalence, mortality rates, and access to healthcare. This would ensure regions with urgent health needs, like Balochistan and rural districts, receive a larger share of the budget. Training officials in data analysis and budgeting would enable informed decisions, and transparent budget decision-making processes would reduce favoritism and political interference. Additionally, strengthening rehabilitation services is crucial for patient recovery, and funds should be allocated for rehabilitation units in hospitals and training programs for rehabilitation professionals, including physical therapy, occupational therapy, and mental health support.
To further strengthen Pakistan’s healthcare system, enhancing financial oversight and accountability is crucial to prevent corruption and ensure efficient use of funds. This can be achieved by providing auditing institutions with adequate resources and independence, making public health audit reports accessible, and establishing citizen monitoring committees to supervise fund usage. Strict enforcement of anti-corruption laws is also necessary. Moreover, improving federal-provincial coordination is vital to prevent overlap and gaps in health budgeting, which can be facilitated through defined communication channels, joint committees, and established guidelines for emergency spending. Additionally, investing in prevention and health infrastructure is critical, with priorities including vaccination programs, health education, sanitation, clean water initiatives, and modernizing health facilities. Community involvement in health budgeting can also promote transparency and accountability, and can be fostered through public hearings, citizen meetings, and local health committees, ultimately boosting public trust and ensuring that real needs are addressed.
Pakistan’s healthcare system can be transformed through policy reforms that prioritize needs-based budgeting, rehabilitation services, financial oversight, community involvement, and prevention. A needs-based budget allocation formula would consider disease prevalence, mortality rates, and access to healthcare, ensuring regions with urgent health needs receive adequate funding. Strengthening rehabilitation services is crucial, prioritizing them in health budgets and allocating funds for rehabilitation units and training professionals. Enhancing financial oversight and accountability is essential to prevent corruption, and improving federal-provincial coordination is necessary for swift and effective spending. Investing in prevention and health infrastructure is critical, prioritizing vaccination programs, health education, sanitation, and clean water initiatives. Community involvement in health budgeting can bring about transparency and accountability.
A national plan should be put in place to evaluate healthcare spending, with performance monitoring and evaluation systems strengthened to connect spending to well-defined outcomes. Regular audits and independent reviews can reveal areas for improvement, directing future budgeting to maximize resource utilization and achieve better health outcomes, ultimately creating a more equitable and effective healthcare system.
Authors are the Students of BSS-V, Department of H&SS-Bahria University Karachi Campus