Pakistan is a South Asian country that is officially known as the Islamic Republic of Pakistan. It is the world’s second-largest Muslim nation and the fifth-most populous country in the world, with a population of about 227 million.
Pakistan is a developing nation that faces challenges in a variety of areas, including health. As a result, the country’s health system has suffered significantly. Pakistan is now ranked 122nd out of 190 countries in the World Health Organization’s performance evaluation. Pakistan is ranked 154th out of 195 countries in terms of the quality and accessibility of healthcare, according to Lancet research. The research claims that since 1990, Pakistan has improved access to and the standard of healthcare, with its HAQ rating growing from 26.8 in 1990 to 37.6 in 2016.
Demographics
According to 2022, Pakistan is growing with a rate of 1.90% having a population of 22.9 Cr. It has a birth rate of 26.95 births per 1000 population, death rate of 6.1 deaths per 1000 population, and average life expectancy of 67.27 years. The sex ratio is 105 males per 100 female.
Healthcare Overview
The health care delivery system in Pakistan includes both state and non-state; and profit and not for profit service provision. The country’s health sector is marked by urban-rural disparities in healthcare delivery and an imbalance in the health workforce, with insufficient health managers, nurses, paramedics and skilled birth attendants in the peripheral areas.
In keeping with the increased awareness regarding health services, the Ministry of National Health Services, Regulations and Coordination was formed in 2011. The main purpose of establishing this body was to provide a health system that gives access to efficient, equitable, accessible & affordable health services. And also, national and international coordination in the field of public health along with population welfare coordination. It also enforced drug laws and regulations.
Some government/ semi government organisations like the armed forces, parastatals such as Sui Gas, WAPDA, Railways, Fauji Foundation and the Social Security Institution provide health service to their employees and their dependents through their own system, however, these collectively cover about 10% of the population.
Healthcare Indicators
Maternal Health Indicators
The fertility rate in Pakistan is 3.53 children born per woman in 2021, which is significantly higher than the WHO recommended 2.1 children per woman. Maternal mortality rate in Pakistan is 140 deaths per 100,000 live births, and contraceptive prevalence is 34%.
Child Health Indicators
Neonatal mortality rate is 40 per 1000 live births. Infant mortality rate in Pakistan is 50.73 deaths per 1,000 live births which is much higher than the global average of 29 deaths per 1000 live births. Under-five mortality rate (probability of dying by age 5) is a staggering rate of 65.2 per 1000 live births.
Health Care System in Pakistan
The health care delivery system in Pakistan consists of public and private sectors. Under the constitution, health is primarily the responsibility of the provincial government, except in the federally administered areas.
Service delivery is being organised through preventive, promotive, curative and rehabilitative services. The curative and rehabilitative services are being provided mainly at the secondary and tertiary care facilities. Preventive and promotive services, on the other hand, are mainly provided through various national programs; and community health workers’ interfacing with the communities through primary healthcare facilities and outreach activities.
The state provides healthcare through a three-tiered healthcare delivery system and a range of public health interventions:
- Tertiary Level: Includes both private and government hospitals well equipped to perform minor and major surgeries. There are usually two or more in every city. Most of the Class “A” military hospitals come in this category. Healthcare and stay comes free of charge in government hospitals. Also, there is 24 hours emergency care that usually caters to more than 350 patients every day.
- Secondary Level: Tehsil & district hospitals (THQs & DHQs) are run by the government, the treatment under government hospitals is free of cost.
- Primary Level: Primary healthcare in Pakistan mainly consists of basic health units, dispensaries, Maternal & child health centres (MNCH) and some private clinics at community level. In Sindh Province, Primary healthcare activities are supported by the government itself but managed by external private & non-government organisations like People’s primary healthcare initiative (PPHI Sindh), Shifa foundation, HANDS etc.
The government of Pakistan has also started “Sehat Sahulat Program”, whose vision is to work towards social welfare reforms, guaranteeing that the lower class within the country gets access to basic medical care without financial risks. Apart from that there are also maternal and child health centres run by lady health workers that aim towards family planning and reproductive health.
Hospitals
According to 2016 statistics, Pakistan has more than 1200 public hospitals and 700 private hospitals.
Public Sector
Public sector health care system endeavours to deliver healthcare through a three-level healthcare delivery system and a range of public health interventions. The first level includes Basic Health Units (BHUs) and Rural Health Centres (RHCs) founding the fundamental of the primary healthcare model, secondary care encompassed first and second referral facilities providing acute, ambulatory and inpatient care through Tehsil Headquarter Hospitals (THQs) and District Headquarter Hospitals (DHQs) and tertiary care including teaching hospitals.
The public health activities have persistently increased in terms of physical infrastructure and workforce. The national health infrastructure comprises of 1201 Hospitals, 5518 Basic Health Units, 683 Rural Health Centres, 5802 Dispensaries, 731 Maternity & Child Health Centres and 347 TB centres, and the total availability of beds in these health facilities is estimated at 1,23,394. In addition, more than 95,000 Lady Health Workers are providing primary health care services to the community through home healthcare.
The numbers of doctors, dentists, nurses and LHVs have increased and availability of one doctor, dentist, nurse and one hospital bed versus population has gradually improved.
Few major Public Hospitals in Pakistan are:
- Pakistan Institute of Medical Sciences (PIMS), Islamabad: This research-oriented health sciences institute is one of the area’s leading tertiary level hospitals which incorporates 22 therapeutic and surgical specialist centres. Situated in Islamabad, Pakistan, this government hospital is a 592-bed hospital spread over 3.5 hectares.
- Jinnah Hospital, Lahore: Jinnah Hospital Lahore (named after Quaid-e-Azam Muhammad Ali Jinnah, founder of Pakistan), established in 1996 in Lahore is a teaching hospital in the Pakistani province of Punjab. It is spread over 105 acres. With very few facilities when it first started operations in 1994, it is now fully operational with 1500 beds and has seen an increase in patients from 500,000 in 2003 to 700,000 in 2007.
- Services Hospital, Lahore: Services Hospital, located on Jail Road, Lahore, in Punjab, Pakistan, is the teaching hospital for the Services Institute of Medical Sciences (SIMS). Initially established in 1958, Services Hospital started as an outdoor mini hospital for government employees, as a satellite clinic of Mayo Hospital. The hospital had 60 beds to provide basic health facilities. In 1960, it was named Wahdat Hospital, and was subsequently renamed to Services Hospital.
The hospital has expanded considerably and has been transformed since then. Today, its 1,196 beds are located in 31 departments, with 27 major and 8 minor operation theatres and an out-patient attendance of 700 patients on average per day. Fiscal constraints have led the hospital’s leadership to seek out alternative ways of funding, including philanthropic support. The hospital’s ageing infrastructure remains severely overstretched, resulting in electrical overload and fire accidents
- Lady Reading Hospital, Peshawar: A 200-bed hospital, Lady Reading is also called Loye Huspatal (big hospital) and Gernali Huspatal. It is named after Lady Reading, the wife of the Viceroy of India, Lord Reading. It is the biggest hospital of Khyber Pakhtunkhwa province, providing tertiary care facilities. Its OP clinic sees above 5500 patients per day and the cases at the Accidents and Emergency department number see more than 2500 or 3000 per day according to a 2018 report. Lady Reading Hospital Peshawar is known for treating poor and working-class individuals and for providing therapeutic, surgical, ENT, and T.B. wards.
- Sindh Institute of Urology and Transplantation, Karachi: This centrally located hospital of Karachi, with 110 beds, is listed among the best government hospitals in the world. The hospital is Pakistan’s biggest kidney ailment centre that gives free medical treatment to patients from the rustic and poorer urban strata. The hospital is known for its crisis unit, effective labs, radiology department and convenient treatment of patients with no separation of poor and rich. All services provided by SIUT, including dialysis and transplantation, are provided free of cost.
Private Sector
The rising population pressure on state health institutions has allowed the private sector to bridge the gap of rising demand and limited public health facilities. The number of private hospitals, clinics and diagnostic labs has increased considerably and is contributing to health services in the country. Majority of private sector hospitals have sole proprietorship or a partnership model of organisation. Stand-alone clinics across Pakistan are the major providers of out-patient care; the majority of these clinics fall in the sole proprietorship category.
Few major Private Hospitals in Pakistan are:
- The Indus Hospital- Indus Hospital & Health Network (IHHN) provides quality healthcare absolutely free-of-cost to millions of deserving patients through its countrywide network of hospitals in Pakistan. Starting with only one hospital in Karachi in 2007, IHHN is now managing multiple tertiary and secondary care Hospitals, Physical Rehabilitation Centres, Regional Blood Centres, Community Health Centres, and various Public Health Programs spread across Pakistan. It is the first paperless hospital in the country; the hospital has an e-cardiology system.
- Tabba Heart Institute- Tabba Heart Institute is a 120-bed state-of-the-art cardiac institute equipped with the most modern equipment. It is a not-for-profit hospital and their technologically advanced equipment is backed by the services of renowned cardiologists and cardiac surgeons. They also have a team of nurses and supporting staff who are equipped with modern skills to look after patients’ comfort with courtesy and ease.
- Shaukat Khanum Memorial- Shaukat Khanum Memorial Cancer Hospital and Research Centres (SKMCH&RC) are state-of-the-art cancer centres located in Lahore and Peshawar, Pakistan. It is Pakistan’s largest tertiary care hospital. The Lahore hospital has 195 beds and has established a reputation for clinical excellence, and for research, and was awarded JCI accreditation in 2018. Consistently, the hospital has continued to treat more than 75% of all cancer patients seen completely free of charge.
- Shifa International Hospital- Shifa International Hospital Islamabad is a 550-bed quaternary care healthcare facility, offering quality services to local as well as international patient communities for over 25 years. The hospital has a pool of highly experienced consultants (200+) in over thirty-five critical medical and surgical specialties who are US and Europe trained and have served for decades in world’s best health care facilities in the US, Europe and Middle East.
Disease Burden
Along with numerous political, financial, social, and cross-boundary challenges, Pakistan should focus on dealing with some serious health issues. For example, the life expectancy of Pakistan is 66 which is the lowest among the regional countries and lower than other developing countries. Likewise, the infant mortality rate is the highest in the region. Also, in youngsters, diarrhoea and breathing problems are still major killers. Maternal demise because of avoidable causes like sepsis, haemorrhage, hypertensive crises, and sepsis, are common.
Pakistan is one of the three leftover nations where Polio is still widespread. Furthermore, Pakistan has an endemicity of hepatitis B and C in the overall inhabitants with 7.6% affected individuals; stands 5th highest for tuberculosis burden in the world, has a focal geographical area of malaria endemicity, and an established HIV concentration among high-risk groups. Pakistan is ranked 7th highest in the world for diabetes prevalence. One in four adults over 18 years of age is hypertensive, and smoking levels are high. Pakistan has one of the notable incidences of underweight children in South Asia. Gender discrimination, Poverty, low literacy, joblessness, and enormous treatment gap have directed to an indistinguishable burden of psychological health complications.
Human Resource & Infrastructure
There were 245,987 registered doctors, 27,360 registered dentists and 116,659 registered nurses in Pakistan in 2020.
There are only 0.63 hospital beds per 1000 population which is very less than WHO’s recommended standard of beds which is 3 beds per 1000. The physician density is 1.1179 physicians per 1000 population, just equal to the WHO recommended 1 physician per 1000 population. There are 0.5 nurses per 1,000 population, falling short of the WHO recommended rate of 3 nurses per 1,000 population.
Healthcare Financing
In 2020, Pakistan’s spending on health at the federal level was 1.2% of its GDP, much below the World Health Organisation’s recommendation that states that countries should spend 5% of its GDP on health. The Government contribution is about a quarter and reflects only about a 50% increase over the past 15 years (when adjusted for inflation and population growth).
According to Pakistan National Health Accounts, Pakistan’s total health expenditure in 2015-16 was Rs.908 billion (3.1% of GDP). Out of total health expenditures in Pakistan, 35% are done by the government. Private expenditures constitute 63.4% of total health expenditures in Pakistan, out of which 91% are household’s out-of-pocket (OOP) health expenditures. Development partner/ donor organisations have a 1.7% share in total health expenditures. Out-of-Pocket payments have a very large share in Pakistan’s total health financing. Hence, when this OOP health expenditure exceeds a defined threshold of the Household’s Non-Food consumption expenditure then the Household faces financial catastrophe.
Conclusion
In a study that The Lancet conducted, healthcare in Pakistan currently ranks 154th out of 195 countries in terms of overall system performance. As a developing country with a mere 2% of its GDP allocated for total health expenditures, Pakistan struggles to maintain a proper healthcare system with regard to quality and accessibility. Catastrophic health expenditure is an escalating issue in Pakistan where many people cannot afford health care services when these expenditures increase up to a certain level. It should be the government’s foremost objective to reduce the prevalence of CHE and to achieve this objective it is therefore important to analyse the determining factors of CHE in Pakistan. Pakistan’s numerous cases of communicable and vaccine-preventable diseases highlight its struggling healthcare system. Viral hepatitis, dengue, tuberculosis, malaria, typhoid, HIV and cholera have long been leading causes of death. They are the result of overpopulated cities, poor sanitation, unsafe drinking water and inadequate socioeconomic conditions.
Pakistan is improving very slowly in the health sector for the last five decades as is evident by its health indicators and above-mentioned strengths and weaknesses. Therefore, the Government needs to take strong initiatives to change the current health care system.
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