Pakistan needs to rethink healthcare

Despite a modest increase, the health sector's share in the overall social sector development budget stands at 2.2 per cent of the total social sector allocation for the current fiscal year. Yet, Pakistan's health outcomes continue to underperform against regional benchmarks.

Life expectancy in the country hovers just over 67 years, nearly five years below the South Asian average, maternal and child mortality rates remain considerably higher than those of several neighbouring countries. Such outcomes are not surprising given decades of underinvestment, weak governance and poor policy choices, which have left the public health system ill-equipped to serve a growing population, the majority of which cannot afford private healthcare.

Pakistan still spends less than 3 per cent of GDP on healthcare, far below the global average of 6.74 percent based on data from 185 countries. Against this backdrop, Official Development Assistance (ODA) has become far more important to Pakistan's health sector than its modest share of GDP would suggest. A recent report by Tabadlab, titled Understanding the Impact of ODA Cuts on Pakistan's Health System, estimates that Pakistan has received under $5 billion annually in development assistance over the past decade or so.

Yet, the significance of this assistance lies not merely in its size, but in what this aid finances. With much of the country's annual budget dedicated to military spending and debt repayments, international aid provides Pakistan's public health system vital support. Internationally-funded initiatives such as Gavi have helped finance the country's immunisation programme. The Global Fund finances prevention, diagnosis and treatment efforts for major diseases such as tuberculosis, malaria and HIV/AIDS.

Pakistan's domestic health budgets are largely committed to meeting fixed and recurring costs such as salaries, hospital operations, administration and procurement of routine medicines. The Pakistan Medical Association has criticised this year's health budget for again prioritising infrastructure projects while underfunding essential public health functions such as primary healthcare, disease prevention and workforce development.

Overseas aid, by contrast, has been funding critical functions such as providing vaccines, diagnostic kits, improving supply chains, outreach, surveillance and technical support. However, this reliance on international aid has become a major problem. Traditional donors, including the United States, several European countries and Japan, are cutting aid simultaneously, creating sudden disruptions in health programmes.

Countries like Pakistan are already experiencing the fallout of this broader phenomenon. Tabadlab notes how cuts to USAID funding have led to the closure or suspension of over 60 health facilities, disrupting services for nearly 1.7 million people. In Sindh's Shikarpur district, a tuberculosis control programme serving about 1,500 families monthly was halted, leaving more than 100 health workers unemployed. TB monitoring in Punjab and Khyber-Pakhtunkhwa has also been affected, while treatment for over 42,000 HIV positive patients is reportedly at risk.

Given how much Pakistan's health service delivery has become dependent on external financing, this sudden aid contraction is undermining the operational backbone of disease control, immunisation and preventive healthcare systems that millions of vulnerable citizens rely upon. Managing this transition will require far more than temporary stopgap financing.

Pakistan must adopt broader structural reforms aimed at rebuilding domestic health financing capacity, strengthening provincial delivery systems and reducing donor dependence. Pakistan does not depend on international aid to sustain its defence expenditures, or to pay the salary of its officials. It should not have to rely on loans and external assistance to ensure basic healthcare for its citizens either.