From urban privilege to rural neglect and with public and private sectors out of balance, access to quality care remains elusive
Pakistan ranks 124th among 195 countries in terms of the Healthcare Access and Quality Index. Despite an elaborate and extensive health infrastructure, healthcare delivery suffers from some key issues like the high population growth, uneven distribution of health professionals, deficient workforce, insufficient funding and limited access to quality health care services.
The National Health Vision 2025 aims at universal access to quality essential health services and ensuring financial protection, focusing on vulnerable and delivered through resilient and responsive health systems. In addition to infrastructure, Pakistan faces a dire shortage of healthcare professionals, including doctors, nurses, and support staff. This scarcity is especially pronounced in rural areas, as medical practitioners often prefer urban settings due to better career opportunities and living conditions.
Pakistan’s healthcare system is marred by poor governance and underinvestment, which leads to poor health outcomes for the citizens. The country has one of the lowest government spending on healthcare in the world, with only 0.8% of GDP allocated to healthcare. Pakistan desperately needs to increase its healthcare budget to improve its health infrastructure and overcome its workforce shortage.
Disparities
The government should prioritise constructing and upgrading healthcare facilities, particularly in rural areas. Healthcare disparities in Pakistan arise from various factors, including geographical location, socioeconomic status, gender, and cultural norms. Such services in Pakistan are disproportionately concentrated in urban areas, leaving rural and remote regions with limited access to quality medical facilities. Poverty and lack of education, along with other social determinants, are proven barriers to healthcare in Pakistan. People living in poverty usually haven’t been educated about their health. This lack of education often leads to low life expectancies and high mortality rates.
According to the Pakistani nongovernmental healthcare organisation, Sehat Kahani, more than 50 per cent of Pakistanis do not have access to basic primary healthcare services, and approximately 42 per cent have no access to health coverage. Access to adequate and quality healthcare services is not only a basic human need, it also affects the quality of the workforce. Thus, it has far-reaching implications for the productivity and competitiveness of the economy. For several reasons, the public sector healthcare services could not cater to the growing demand. This resulted in an expansion of the private sector healthcare services. This is not a Pakistan-specific situation, because healthcare has emerged as one of the largest business sectors globally as well.
Good governance
In Pakistan, private healthcare accounts for double the services offered by the public sector. There is a general perception that the rapid growth of the private sector has not generated efficient outcomes for consumers, particularly in terms of quality, cost and other relevant indicators. This is often attributed to the pursuit of pure self-interest by the market players. The supply side of the private healthcare sector, i.e. profit-based healthcare enterprises, primarily consists of clinics run by individual registered medical practitioners (for medical consultation/ check-up) and hospitals/ medical complexes that offer a wide range of services (consultation, specialized/ general/ surgical treatment, etc.). The demand side is quite diverse, consisting of buyers belonging to various income groups.
In Pakistan, the sustained expansion of the private healthcare market corresponds to a surge in the demand for these services, which, in turn, is a function of an increasing population and the existing demand-supply gap, besides a failing public healthcare sector. Health sector governance plays a key role in the provision of equitable healthcare services. Considering that access to healthcare is a constitutionally guaranteed right, the population cannot be left completely dependent on the private sector.
Citizens‘ well-being calls for presence of appropriate regulatory and administrative mechanisms. The National Health Policy, the key building block for the legal and policy framework on health, does not articulate a ‘standards‘ framework for private healthcare. This has led to an absence of appropriate regulation at the federal as well as provincial tiers of the government. The role of health regulatory agencies at the district level also remains visibly weak vis-à-vis the private healthcare market.