HEALTH STATUS

PAKISTAN
Achievements, Challenges and
the Way forward
 Contents of the presentation
 Health indicators and targets
 Major problems in health
 Health systems in Pakistan
 Resources for health in Pakistan
 Achievements, Challenges and the Way
forward
Health: A basic human right
 Basic facts
 Population: 180 million
 Growth rate: 1.9 %
 Life expectancy: 65 yrs
 GNP: 1200 USD
 Poverty:
 Health related MDGs
MDG Baseline Current Targets
indicator 1990 status 2015
Under 5 mortality
140 94 52
IMR
120 64 40
MMR
550 276 140
Births SBAs
18% 59% 90%
HIV prevalence
<0.01 <0.01 <0.01
TB cases detection
rate
- 90% 85%

Source: PDHS 2012

 Age Pyramid

35 million 33 million
Ages 15-49 Ages 15-49

6 Current Approach to Reduction of

Maternal and neonatal Mortality
 Age Pyramid

62 million 58 million
Ages 15-49 Ages 15-49

7 Current Approach to Reduction of

Maternal and neonatal Mortality
 Burden of Disease
Mortality (Deaths) by Cause and Gender

Injuries
Females

Other Non-Comm Males

Neoplasms

Neuro-psy

Cardio-vascular
diseases

Diabetes

Nutritional deficiencies

Maternal /Perinatal
cond
Communicable diseases

0 50000 100000 150000 200000 250000 300000 350000

Source: WHO, 2007

 Double Burden
 Communicable diseases
 Polio
 TB, Malaria & HIV
 Hepatitis (12 million cases)
 Emerging diseases
 Non communicable diseases
 Diabetes (5 millions), hypertension(24%
above 18), heart diseases (27% above 40)
 Injuries, RTA (11% of disease burden)
 Tobacco epidemic (22 million smokers)
 Nutrition
 National nutrition survey 2011
 Static over last two decades
 About 48% children malnourished
 60% women anemic
 Acute malnutrition 10 to 20 %
 Contribution to mortality
 Long term implications
 Health Delivery System
Integrated Rural Health Complex

Health Care Providers Population Served

Specialists, Doctors,
Nurses, Paramedical Tertiary Referral Centers
Staff Hospitals

Specialists, Doctors,
Nurses, Paramedical District 100,000 – 300,000
Headquarters
Staff Hospital

Doctors, Nurses,
Paramedical Staff Rural Health 25,000 – 50, 000
Centers

Paramedical Staff Basic Health 5,000 – 10,000

LHWs Units

© 2006 POPULATION
REFERENCE BUREAU
 Health Delivery System
 Public sector
 DHQ, THQ, BHU, Health houses
 5000 basic health units
 PPHI
 Utilization
 Private sector
 Unregulated
 Concentrated in urban areas
 Quality of care
 Total Expenditure on Health
(Federal &Provincial)
Rs in Billions

Year Development Non-development Total Health

Expenditure
as % of GDP
2003-04 8.5 (25.9%) 24.3 (74.0%) 32.8 0.58

2004-05 11.0 (28.9%) 27.0 (71.0%) 38.0 0.57

2005-06 16.0 (40.0%) 24.0 (60.0%) 40.0 0.51

2006-07 20.0 (40.0%) 30.0 (60.0%) 50.0 0.57

2007-08 27.0 (45.0%) 32.0 (53.3%) 60.0 0.57

2008-09 33.0(45.5%) 41.1(54.5%) 74.0 0.55

Source: Economic Surveys of Pakistan

 Financing Health
Pak Afgh India Bangl

Indicator
Year 2006

Total health expenditure (THE) as % of GDP 2.6 9.2 3.6 3.2

General government exp. on health as % of THE 33.6 32.4 25 31.8

Private expenditure on health as % of THE 64.5 67.6 75 68.2

General government expenditure on health as % of total

7.5 6.2 3.4 7
government expenditure

Social Security expenditure on health as % of General

0.3 0 4.9 0
government expenditure on health

Per capita THE (US$) 19.37 27 29 12

Per capita government expend. on health (US$) 6.50 9 7 4

Source: National Health Accounts 2005-6

 Financing Health
Contributions to health care

3%

28%

Tax
Donors
Out of pocket
5%
Others

65%

Source: National Health Accounts 2005-6

 Health Investment by GoP & Partners
GoP (MoH & DoHs)= Rs 45 billions MoPW
Partners= Rs 11 billions 5%

Multilateral
10% Partners
21%

Bilaterals
6%

UN system
5%
MoH & DoHs
74%

Source: Inventory of H & P Investment Pakistan, GoP & WHO 2005

 Major Challenges
 Low investment in health
 Rapidly increasing population
 Double burden of disease
 Emerging and re emerging diseases
 Absence of social safety nets
 Sub optimal performance of health
systems
 Unregulated private sector
 Way forward
 Universal Health Coverage
 Public private partnership
 Social Security nets for poor
 Essential Health services Package
 Regulations for improvement
 Decentralization (18th amendment)