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| Pakistan lowest among South Asian |
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states in health spending
Sunday, November 01, 2009
By Israr Khan
ISLAMABAD: Inadequate public health facilities force the people to spend a major portion of their incomes for private health services, as the government’s spending on health sector is reducing for the last few years and now stands at the bottom in South Asian region, the State Bank says in its latest annual report.
The State Bank of Pakistan (SBP) report released the other day says, “In FY09 public expenditure as a percentage of GDP declined to 0.55 percent from 0.57 percent in FY08. On the other hand budgetary allocation for the implementation of PRSP is also on a declining trend over the last two years.” In FY09 total expenditure in health sector through the PRSP channel declined to Rs26,819 millions only, while it was Rs61,127 millions in FY08.
It is interesting to note that in developing countries only one third of the population have access to medicines through public sector, while private sector provides medicines to rest of the two-thirds. Prices people pay for lowest-priced generic medicines vary from 2.5 times to 6.5 times of international reference prices (IRPs) in the two sectors respectively. This is mainly because developing countries lack proper regulation or assessment system to assess the pricing of medicines.
In Pakistani private sector there exists 28 to 35 percent disparity between consumer and producer prices of essential medicine. The country is relatively in a better position among countries including Tanzania (56 percent), Morocco (53-93 percent), Magnolia (68-98 percent), Mali (87-118 percent), Ethiopia (76-148 percent), Malaysia (65-149 percent), Uganda (100-358 percent), India (29-694 percent) and El Salvador the disparity stood at 165-894 percent. Key contributor to these add-on costs are wholesaler, retailer markups, taxes and duties in the supply chain.
The role of pharmaceutical companies, ranging from multinationals to generic manufacturers to national distributors, would be critical in this effort. Government of Pakistan can improve access to essential medicines through developing stronger partnership with pharmaceutical companies and civil society to ensure universal access to essential medicines.
The World Health Organization at the start of year 2009 had also estimated in its review on Health Inequalities in Pakistan that the out-of-pocket health expenditure in Pakistan stands at 71 per cent - the highest in the Eastern Mediterranean region - and a burden for the poor.
It also said that the unregulated private sector delivers a high proportion of health services and there is a great discrepancy in the quality of services. Those who can only afford to pay a little usually get the poorest quality of the services.
In rural areas, the very poor women and men avail government services as they can afford only those. They visit private doctors as a last resort, and sometimes because of a referral made by the government doctor.
The central bank says that existing health infrastructure is not sufficient to cater to the needs of over 160 million people residing in the country. According to the data on health centres a minimal increase in health centres was witnessed during 2000-2007. Moreover, there exists a significant difference among provinces.
Health facilities in Balochistan and NWFP are lower as compared to Punjab and Sindh. One of the explanations for this difference can be the difference in their respective populations; however the status regarding the number of health centres and beds remains poor.
Health output indicators, reveal that position of Pakistan is relatively weak in some of the important indicators as compared to international standards.
In maternal mortality, with 400 deaths per 100,000 live births Pakistan stands at third last position in South Asia. Pakistan has witnessed improvement in maternal health over the last few years; however it is still far from achieving the target of 140 deaths per 100,000 live births by the end of 2015.
Similarly Infant Mortality Rate (IMR) for the country has improved and IMR in the country has decreased to 76 percent, which is close to the MDG target of 77 percent.
A positive element about this decline in IMR is that this improvement is mainly concentrated in rural areas. In rural areas it decreased to 81 percent in year 2006, from 87 percent in year 2000.
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ISSN 1563-9479 
