- Superior public-private partnerships needed for better health coverage in Pakistan
The healthcare system in Pakistan comprises a three-tier system of primary, secondary, and tertiary levels. The public and private sectors work together to provide the best possible care, but the healthcare burden, in general, has led to the failure of the deliverance of quality healthcare, more significantly in the government setup, which, in the last 10 years, has spent a meager 0.5-0.8% of gross domestic product (GDP) on healthcare against recommended 6% of the GDP by the World Health Organisation (WHO).
In recent times, however, Pakistan has been identifying these gaps and formulating policies that guide towards the betterment of its healthcare. Pakistan has covered around 70% of the rural population, providing basic healthcare facilities, such as vaccination, mother and child healthcare services, and nutrition. Later advancements have led to the inclusion of individuals’ well-being, encompassing social and mental health measures along with physical health as determinants of the quality of life.
Task ahead
Pakistan has a long way ahead towards the development of an effective, accessible, and affordable healthcare system. The system is plagued with numerous flaws, ranging from inadequate infrastructure to inequitable distribution of healthcare facilities. The lack of adequate healthcare infrastructure is one of Pakistan’s biggest challenges. There is an extreme shortage of healthcare facilities, including hospitals, clinics, and diagnostic centres. The chronic underfunding of the health sector is a massive reason for the lack of infrastructure, burdened by corruption, an unstable political system, and inequitable distribution of resources.
Pakistan needs to construct and equip many more tertiary care and teaching centres. Moreover, the funding is inequitably distributed to Pakistan’s urban and developed cities. Hence, access to healthcare services is marked by stark disparities, with the rural population and low-income communities lacking basic healthcare facilities.
Pakistan desperately needs to increase its healthcare budget to improve its health infrastructure and overcome its workforce shortage. The government should prioritise constructing and upgrading healthcare facilities, particularly in rural areas. In addition, efforts must be made to explore innovative financing models to generate funds for healthcare. The development of PPPs (Public-Private Partnerships) is an example of such innovative models. Under the universal health coverage (UHC) initiative of the WHO, Pakistan launched the Sehat Sahulat Programme (SSP) in 2015. This operated through a collaboration between the Government of Pakistan and private insurance companies. Its main goal has been to provide free healthcare services to vulnerable and marginalised communities. While this programme has largely been a success and made significant strides in improving healthcare accessibility, some challenges, like limited coverage and delays in reimbursement, hinder its effectiveness. Nevertheless, this programme can serve as the foundation for other PPPs.
Successive governments have engaged private partners to improve health service delivery, but their impact has been limited thus far. In recent years, PPPs have been embraced by successive Pakistani policymakers as a panacea for improving healthcare service delivery. The success of public-private partnerships lies in repositioning partnerships within Pakistan’s efforts to meet the global Sustainable Development Goal Agenda of Universal Health Coverage (UHC) and global health security. The former involves expanding affordable access to quality care, with foremost attention to basic primary health care services. In order to better configure PPPs, there are two pre-requisites:
- Improve the design of existing public-private partnerships with NGOs that narrowly focus on revitalising government healthcare facilities to deliver better on quality health services across a spectrum of care.
- Expand to new partnerships with private commercial providers for primary health care and disease control, filling gaps in urban low-income areas where there is high concentration of credible private providers but the absence of state-funded primary care.
The need of the hour is to devise a strategy for public-private partnerships with a decisive positioning towards universal health care and better health security. Existing partnerships with NGOs or state-funded companies for functionalising public sector facilities can work for remote rural areas, where the government is constrained to deliver but with more impactful design.
New partnerships are needed with private neighborhood providers to meet basic primary healthcare needs, priority disease screening and frontline disease management, supported by upstream diagnostic support to cover service gaps starting from Pakistan’s low-income urban areas. Third-party payments and quality regulation will be required. Ultimately, there is no perfect implementation model of public-private arrangements as seen from the experience of other countries — it’s an evolving equation requiring persistence and innovation. For it to succeed, however, the government will have to take a more holistic approach in order to ensure accessible and affordable healthcare for all.
In conclusion, Pakistan’s healthcare system faces significant challenges in providing effective and equitable healthcare to its citizens. However, these challenges can be overcome by strategic planning, the allocation of adequate funds, and the government’s keen interest in improving the current conditions.
The political unrest in Pakistan has played a huge role as the rapid change in management and leadership interrupts the continuity of policies. Improving the health sector must be a priority regardless of government or regime changes. Prioritising healthcare as a fundamental pillar of national development is crucial for Pakistan’s progress towards developing effective healthcare, which serves its citizens in all capacities.
The deficiencies in the healthcare system of Pakistan have been identified numerous times throughout the decades. Now, it is imperative that policies be made and steps be taken by all stakeholders to minimise and address these deficiencies.