HealthCare in Pakistan

HealthCare in Pakistan
According to a report entitled” Health Care Services and Government Spending in Pakistan” published by the Pakistan Institute of Development Economics the state of the healthcare is summarized as follows:
(1) Pakistan’s health care system is inadequate, inefficient, and expensive; and comprises an under-funded and inefficient public sector along with a mixed, expensive and unregulated private sector. These poor conditions in the health sector may be attributed to a number of factors like poverty, malnutrition, unequal access to health facilities, inadequate allocation for health, and high population growth and infant mortality. For equity, efficiency and effectiveness of the health sector, inputs from both the public and private sector would be necessary.
(2) The expenditures in health sectors are overall progressive in Pakistan while it is regressive in some sub-head expenditures of health at provincial and regional levels.
(3) The hypothesis that spending on health is progressive at provincial and regional level is rejected as the results found great disparities and
inequalities across regions and among quintiles.
(4) Third hypothesis that there exist large inequalities in the shares of the different quintiles in health expenditures cannot be rejected.
(5) Overall, the public sector spending on health sector is partially progressive in Pakistan. However, the share of the lower quintile is lower than higher quintile in total public expenditures on health.
(6) Public sector expenditures in Preventive Measures and Health Facilities sub-sector are progressive at provincial and regional level, except in overall rural Pakistan. It means the public sector spending on Preventive Measures and Health Facilities are more evenly distributed as compared to the income distribution. Expenditure on Preventive Measures and Health Facilities are highly subsidised by the federal government in Pakistan through its vertical programmes.
(7) The poor in Pakistan is not only deprived of financial resources but also lack access to secondary and tertiary health care services. Public expenditures in General Hospitals and Clinics sub-sector of health are regressive in most of the regions in Pakistan. The share of lower quintile in the Hospitals and Clinics expenditures is only 7 percent while it is 36 percent for the higher quintile in Pakistan over all.
(8) Health expenditures on Mother and Child sub-sector is progressive in Sindh, NWFP and in overall Pakistan; that implies that poor are getting more benefit from these expenditures as compared to the rich. But in-kind subsidies are regressive in Punjab. The Mother and Child
is the most disadvantages and neglected sub-sector of health.
(9) The rural urban inequalities are more profound. The rural areas are more disadvantaged regions underlining the health care facilities. In health sector more inequalities prevails in the share of the lower and upper quintiles in government expenditures on health care facilities.
(10) According to the WHO international standards, the ratio of doctors to nurses should be 1:3; however this is reversed in the case of Pakistan, i.e., ratio of doctors to nurses is 3:1 in Pakistan.
(11) In the provision of health care services the private sector plays an important role. According to the PSLM (2004-05), as many as, 77 percent households consult the private sector against only 23 percent to the public sector.

Recommendations:
1) National Health Policy to support minimum standards for health care facilities. Standardized health clinics across the country must be established with virtually identical services. National Government must take full responsibility to assure that health clinics and hospitals are operating with minimum acceptable standards in serving both urban and rural areas.
2) Health Care Delivery to be integrated with the Regional Planning Districts. Similar to other core issues addressed in this forum such as poverty, infrastructure, education etc  HealthCare facilities must also be planned and delivered on a regional basis. We recommend a Health Care Director for each Regional Planning District.