Improving healthcare coverage

Pakistan's healthcare crisis is not simply a problem of too few hospitals or too little medical infrastructure. It is a deeper problem of access, affordability, governance, and the distribution of public resources.

Pakistan has launched several initiatives in recent years to address its dismal health record. One of its key aspirations is to achieve universal health coverage, ensuring that everyone can access the health services they need without suffering financial hardship. Yet universal health coverage extends well beyond hospital admission; it encompasses the full continuum of essential health services, including preventive care, early diagnosis, treatment, rehabilitation and palliative care.

To address the problem of affordability, Pakistan expanded the Sehat Sahulat initiative under Imran Khan. This was followed by the development of the Universal Health Coverage Benefit Package, also known as the Essential Package of Health Services. Efforts to strengthen primary healthcare have also received support, including through a World Bank loan to reinforce provincial primary healthcare systems. However, much needs to be done to address accessibility, quality and equitable distribution of healthcare services.

Even securing insurance coverage for hospital treatment does not translate into comprehensive healthcare. A patient may have access to a covered hospital procedure but still struggle to pay for medicines, diagnostic tests, transportation, routine consultations or follow-up treatment. Insurance programmes cannot address all these needs unless their benefits are designed to do so. Thus, comprehensive formal coverage does not necessarily guarantee effective access. Patients need participating facilities within a reasonable distance, competent medical personnel, available equipment and treatments that meet appropriate standards. Where these conditions are absent, an insurance entitlement has limited practical value.

A comprehensive healthcare system needs to provide accessible local facilities where people can obtain vaccinations, maternal and child health services, routine consultations, screening, health education and treatment for common illnesses. It also requires the capacity to identify serious conditions early and refer patients to hospitals when specialised treatment becomes necessary.

Pakistan needs a durable framework for healthcare financing that can survive political transitions. Governments may disagree about the best way to finance services, but they should be able to agree on minimum standards of access, continuity of care and financial protection. The political visibility of hospital insurance can obscure a less dramatic but equally important task: strengthening primary healthcare. Universal coverage requires political ambition, but it also requires a realistic and sustainable financing plan.

The main obstacle is whether Pakistan is willing and able to finance the healthcare system it says it wants. Pakistan's Economic Survey 2025–26 reports places public health expenditure at 0.8% of GDP in the preceding financial year. Households continue to bear a substantial burden of direct healthcare costs. Commonwealth Fund reports that out-of-pocket payments account for more than half of total health expenditure in Pakistan. This financial burden has serious consequences. Families delay treatments, borrow money, sell assets or cut spending on food and education to meet medical expenses. Even when a hospital procedure is covered, associated treatment costs can remain substantial.

A credible universal healthcare strategy must therefore go beyond thinking of securing financing for selected hospital treatments. It should progressively expand access to essential services while protecting households from catastrophic expenditure. Public funds must be allocated transparently, purchasing arrangements must be accountable, and policymakers must assess whether the benefits of expenditure reach those with the greatest need.

The real test of effective healthcare coverage is whether a child can receive timely treatment, a pregnant woman can access safe maternal care, a person with diabetes can obtain regular treatment and essential medicines, and a family can manage illness without sacrificing its financial security.