S.KAMAL HAYDER KAZMI,
Research Analyst, PAGE
Aug 2 - 8, 2010
In Pakistan, investments in the health sector are viewed as an integral part of the government's poverty alleviation endeavour. An improvement in the overall health sector indicators of a country has important ramifications not just for the quality of life of its citizens, but for economic development generally, through the channels of productivity enhancement and poverty alleviation. While there has been noticeable improvement in some health indicators over the years, as a whole Pakistan ranks poorly on this count. Overall, life expectancy in Pakistan remains lower than many in its peer group, while infant as well as maternal mortality rates are amongst the highest.
The National Health Policy of Pakistan of 2009 seeks to improve the health indicators of the country. It aims to do so by delivering a set of basic health services for all by improving health manpower, gathering and using reliable health information to guide program effectiveness and design strategic use of emerging technology.
HEALTH & NUTRITION EXPENDITURES (RS IN BN)
PUBLIC SECTOR EXPENDITURE (FEDERAL AND PROVINCIAL)
TOTAL HEALTH EXP.
HEALTH EXP. AS % OF GDP
2005-06 40.00 16.00 24.00 5.3 0.51 2006-07 50.00 20.00 30.00 25 0.57 2007-08 60.00 27.22 32.67 20 0.57 2008-09 74.00 33.00 41.10 23 0.55 2009-10 79.00 38.00 41.00 7 0.54
Health status of the population at large has improved considerably over time. However, by international comparison the status is mixed. Recent cross-country studies of vital health indicators show a wide variation in epidemiological pattern between different Asian countries. Compared with Bangladesh, India, and Sri Lanka, for example, Pakistan's infant mortality rate is higher. While life expectancy is also higher except for Sri Lanka, the overall population growth at 2.1 per cent is the highest in the region. Similarly, other indicators show that a lot of progress will have to be made to meaningfully improve the health status of the population.
Despite nearly three-fold increase in public sector expenditure since 2001, spending on health remains abysmally low, and has declined as a percentage of GDP. Total public sector expenditure on health, for both the federal as well as provincial governments, in the current fiscal year is projected to be 0.54 per cent of GDP, which is amongst the lowest of all other countries at a similar income level.
While Pakistan enjoys a vast network of healthcare facilities, coverage, accessibility, cost and quality of health care remain critical issues. An effective fight has been launched in prevention and control of both communicable and non-communicable diseases in order to have an impact in the scenario of double burden of diseases in the country.
The health care system in Pakistan comprises public as well as private health facilities. In the public sector, districts have been given power for developing their own strategies, programmes and interventions based on their local needs. In the private sector, the range of health care facilities includes accredited hospitals and clinics, medical practitioners, homeopaths and hakeems.
In addition, NGOs and Pakistan's corporate sector are also active in the health and social sector. The human resource available for health care registered until December 2009 in the country included 139,555 doctors, 9,822 dentists, and 69,313 nurses. The current population doctor ratio is 1,183 persons per doctor and 16,914 persons per dentist. Health care is also provided to the public through vast health infrastructure facilities now consisting of 968 hospitals, 4,813 dispensaries, 5,345 Basic Health Units, 572 Rural Health Centers, and 293 TB Centers etc.
The health sector in Pakistan is beset with numerous problems - structural fragmentation, corruption, gender insensitivity, resource scarcity, inefficiency, and lack of functional specificity and accessibility. Faced with a precarious economic situation characterised by heavy debt and faltering productivity, Pakistan's room to maneuver with health sector reform is quite limited. Although the devolution plan provides a window of opportunity, it must go beyond and introduce far-reaching changes in the health and social sectors.
The government of Pakistan is committed to meeting health promotion goal by 2015 by launching new policy initiatives. Through a major health intervention program and strategies, it is aimed to reduce the under five mortality rate to 52 per 1000, infant mortality rate to 40 per 1000, and maternal mortality ratio to 140 by 2015. The proportion of one-year-old children immunised against measles is targeted to be increased to 85 per cent and the proportion of births attended by skilled health personnel to 90 per cent by 2015.
Healthcare provision depends on a system, which efficiently combines financial and human resources and delivers services. Good governance and transparency are critical factors in making such a system function.
On the other hand, both poor governance and corruption in the health system are manifestations of broad phenomena in the country. Addressing these issues requires mandates and prerogatives both within and outside the health sector.