Health systems worldwide are realising that prevention is the most cost-effective way to save lives and reduce long-term costs. Pakistan, however, continues to rely on a reactive, hospital-centred model where resources are consumed by expensive treatments rather than preventing disease in the first place.
This approach is neither sustainable nor equitable. With a rising disease burden, limited fiscal space and widening health inequities, the country can no longer afford to ignore preventive healthcare.
Pakistan suffers from a double burden. Communicable diseases remain common, yet non-communicable diseases such as diabetes, hypertension, cardiovascular illness and cancer now account for more than 60 per cent of all deaths.
For instance, Pakistan ranks third globally in the prevalence of diabetes with over 33 million adults affected. These conditions are largely driven by modifiable risk factors including unhealthy diets, tobacco use and sedentary lifestyles, and they often remain undetected until serious complications develop. Treatment imposes catastrophic costs on families and on the public purse.
The situation is compounded by poor maternal and child health indicators. Maternal mortality remains around 154 deaths per 100,000 live births, neonatal mortality about 40 per 1,000, and under-five mortality 63 per 1,000. Nearly four in ten children under five are stunted, one of the highest rates in the region. Such figures reflect chronic under-investment in nutrition, antenatal and postnatal care and early childhood development. They also signal an urgent need to reorient the health system towards prevention rather than cure.
With nearly two-thirds of the population under 30, Pakistan has only a narrow window to reap the benefits of its demographic dividend. Rising NCDs and persistent inequities threaten to undermine workforce productivity and drive households into poverty through high out-of-pocket spending. Without urgent reforms the country risks locking itself into a cycle of poor health, lost economic potential and widening inequality.
Evidence from regional peers is instructive. Sri Lanka achieved a maternal mortality ratio under 40 by investing for decades in midwife-led community outreach. Bangladesh and India scaled community health worker programmes that combine maternal care, vaccination, nutrition counselling and basic screening. These countries demonstrate that embedding prevention within primary health care yields large health gains at low cost.
Despite the scale of the challenge, Pakistan possesses an existing platform: The Lady Health Worker (LHW) programme, launched in the 1990s, remains one of the world’s largest community-based health initiatives. With around 90,000 workers linked to basic health units, LHWs provide health education, immunisation referrals, growth monitoring and family planning to millions of households. Evaluations have shown measurable improvements in vaccination, antenatal care and contraceptive use.
Yet preventive initiatives remain fragmented, under-funded and overly vertical. LHWs face irregular salaries, weak supervision, inadequate supplies and an expanding workload that includes repeated polio campaigns. Essential community-level tasks such as routine screening for hypertension or diabetes remain absent from their mandate. Basic health units often lack diagnostic tools, trained staff and reliable referral pathways. As a result, opportunities for early detection and health promotion are routinely missed.
To shift from crisis to control, Pakistan must place preventive health at the core of its health strategy. The first step is to upgrade basic health units with diagnostic tools for NCDs, ensure regular training for staff and link financing to measurable outputs. Routine screening for hypertension, diabetes and cervical or breast cancer should become standard at primary facilities. The LHW network should be revitalised through regularised contracts, fair remuneration, refresher training, digital tools and strengthened supervision so that workers can take on community-based screening, counselling and follow-up care.
Preventive health cannot be achieved through the health sector alone. Safe water, sanitation, adequate nutrition, clean air and urban planning are equally critical. Budgets must earmark a fixed share for preventive interventions, while progress is tracked through indicators such as annual adult NCD screening coverage, immunisation rates for children under five, reduction in catastrophic health spending and the proportion of primary facilities meeting service-delivery standards.
Every dollar invested in prevention saves multiple dollars in treatment costs. Countries that reoriented their systems early now enjoy healthier populations and lower healthcare expenditure. For Pakistan, strengthening prevention is not merely a health imperative but an economic one. A healthier population is more productive, less impoverished and better able to contribute to national development.
The window of opportunity is short. Pakistan already possesses a proven community platform in its Lady Health Workers. By integrating preventive maternal, child, nutrition and NCD services into this network and ensuring sustained financing, the country can reverse its troubling health indicators and secure the wellbeing of future generations. The choice is clear: invest in prevention today or pay far more tomorrow in lost lives and squandered potential.
The writer is a member of social sector and devolution, Ministry of Planning, Development and Special Initiatives.