Experts call for health taxes, double spending to reform Pakistan’s primary healthcare system

Health experts, federal and provincial leaders, and global partners have proposed a bold set of reforms to rescue and rebuild Pakistan’s struggling primary healthcare (PHC) system, urging the government to introduce health taxes on tobacco, sugary drinks, and unhealthy food, shift to tax-based and insurance-backed financing, and double public health spending to 2 percent of GDP by the mid-2030s.

These recommendations emerged from the National Symposium on Primary Health Care: Foundation for Universal Health Coverage in Pakistan, held in Karachi under the PHC Learning Agenda initiative led by the Aga Khan University (AKU) and supported by the Bill & Melinda Gates Foundation.

Key proposals include moving away from out-of-pocket payments toward prepayment systems, including government insurance and tax-based models, to reduce financial burdens on households. Provinces were urged to adopt performance-based financing with stronger contract management, while the federal government was asked to co-create a national PHC strategy aligned with Universal Health Coverage (UHC) and the Sustainable Development Goals (SDGs).

Dr. Sana Hyat, Assistant Professor at AKU, outlined financial reforms including the need to scale up strategic purchasing, apply quality improvement tools, and establish a nationwide electronic medical records (EMR) system across PHC facilities.

She also recommended using Burden of Disease (BoD) data to guide health planning and decisions at all levels, and emphasized building local capacity to use that data effectively.

The symposium also stressed integration between health and population welfare departments to manage rapid population growth and improve access to family planning. Experts urged the appointment of more women in decision-making roles, especially as district health officers (DHOs), and called for new urban PHC networks through public-private partnerships, particularly in underserved communities.

In a special presentation, Dr. Ali Mokdad, chief strategy officer for population health at the University of Washington’s Institute for Health Metrics and Evaluation (IHME), presented new data from the Global Burden of Disease (GBD) 2023 study.

He said that while Pakistan has made progress since 1990, its health system still faces major challenges. Non-communicable diseases (NCDs), such as diabetes, cardiovascular diseases, and depression, have overtaken infectious diseases as the country’s biggest health burden, but investments and policies have not kept pace.

Dr Mokdad pointed out that a large proportion of disability-adjusted life years (DALYs) in Pakistan are due to preventable conditions like high blood pressure, poor nutrition, and tobacco use—problems that can be tackled effectively through strong primary care and community interventions.

He also warned of subnational disparities, with life expectancy and health outcomes varying widely between provinces and even districts. “Data exists—what we need now is the political will to use it,” he said.

Federal Minister of State for Health Dr Malik Mukhtar Ahmad Bharath echoed those concerns, calling for a complete shift in focus from hospitals to community-level care. “In the past, big hospitals were built for optics. But now we understand that the true foundation of health lies in primary care,” he said.

He warned that Pakistan will lose GAVI support by 2031, meaning the country must immediately begin local vaccine production and raise its own health financing mechanisms. Dr Bharath highlighted recent efforts to expand telemedicine, digitize health systems, and enhance vaccine delivery through local ownership.

Provincial leaders shared their experiences and challenges. Sindh Health Minister Dr Azra Fazal Pechuho described efforts to expand the Lady Health Worker programme, integrate telemedicine to reach rural women, and work closely with NGOs like PPHI to scale services. She emphasized the need to empower the nursing and allied health workforce, calling it the “backbone of healthcare.”

From Balochistan, Minister Bakht Muhammad Kakar shared that the province’s health budget had grown from Rs8 billion to a projected Rs100 billion. Despite this increase, he stressed that Balochistan’s vast geography made primary care the most effective way to improve maternal and child health outcomes.

Khyber Pakhtunkhwa’s representative, Ihtesham Ali, said the province had reduced political interference in health appointments and was now holding regular reviews with district officers to improve performance and accountability.

The symposium concluded with a panel discussion moderated by Prof Dr Sameen Siddiqi, chair of community health sciences at the AKU and principal investigator of the PHC Learning Agenda.

Prof Siddiqi reiterated that PHC reform is not just a technical need—it is a moral and political imperative. He highlighted five core priorities: integrating population and health services, addressing NCDs and mental health, building public-private partnerships, improving service delivery, and increasing domestic financing.

“This is our moment,” Prof Siddiqi said. “Primary healthcare is the foundation for a healthier, more prosperous Pakistan. We must co-create, co-lead, and co-invest in its future—starting now.”