Health expenditure: 1.2pc of GDP against WHO-recommended 5pc

Islamabad : Pakistan is spending far less on healthcare than what is recommended by the World Health Organisation (WHO), a United Nations agency coordinating international health activities and helping governments improve health services.

As revealed by the Economic Survey of Pakistan 2020-21, the country’s health expenditure totalled 1.2 per cent of the gross domestic product in the outgoing financial year against five per cent advocated by the WHO.

It was slightly more than 2017-18's (1.2 per cent of GDP). The cumulative health expenditure by the federal and provincial governments went up 14.35 per cent from 421.78 billion last year to Rs482.27 billion this year.

During the current fiscal, the federal government made the Rs20.194 billion Public Sector Development Programme allocations for 71 health projects.

In addition, the government introduced a special programme with an outlay of Rs70 billion to mitigate the impact of COVID-19 pandemic by upgrading health facilities, sewerage system, solid waste management, drinking water supply, and education.

The country’s health indicators continued to record improvement.

The life expectancy at birth increased from 66.9 per cent in 2017 to 67.3 per cent in 2019, while the infant mortality rate (per 1,000 live births) went down from 58.8 per cent in 2017 to 55.7 per cent in 2019, maternal mortality rate (per 100,000) from 276 in 2015 to 189 in 2019, under five years mortality rate (per 1,000) from 71.6 per cent in 2017 to 67.2 per cent in 2019, and population growth rate from two per cent in 2017 to 1.9 per cent on 2019. The figures for 2010 weren’t available.

Compared with other Asian nations, Pakistan has the highest life expectancy at birth, infant mortality rate and under-five mortality rate and population growth rate.

The percentage of birth attended by skilled health personnel increased from 58 per cent in 2015 to 68 per cent in 2020 (PSLM 2019-20).

The country has also recorded high rates of malnutrition. According to the ESP report, the country experiences the double burden of malnutrition.

Forty per cent of children under the age of five years are stunted, 18 per cent wasted and another 29 per cent underweight.

“The proportion of overweight children under five years of age is nine per cent. Similarly, more than half (57 per cent) of adolescent girls and 42 per cent women of reproductive age in the country are anaemic.”

The report said over-nutrition in the form of overweight also prevailed among children in both rural and urban areas and among women. Twenty-four per cent of the women of reproductive age are overweight, while 14 per cent are obese with a high rate of 17 per cent in urban settings and a lower ratio of 12 per cent in villages.

The economic costs of malnutrition are high and persistent with around three per cent ($7.6 billion) of loss of GDP every year in the country due to low productivity from the poor physique, cognitive development, schooling, and increased health care costs.

The report also revealed that around 18 per cent (38 million) of the country’s population was severely food insecure. The number of healthcare providers in the country has also registered an increase during the last year.

The registered doctors totalled 233,261 in 2019 and 245,987 in 2020, dentists 24,930 in 2019 and 27,360 in 2020, nurses 112,123 in 2019 and 116,659 in 2020, midwives 41,810 in 2019 and 43,129 in 2020 and lady health visitors 20,565 in 2019 and 21,361 in 2020.

The report said with the government being fully committed to increasing the health coverage to meet the emerging demand of increasing population, the areas that required support for achieving health-related SDGs included realistic budgeting, training and management of health workforce with the use of technology. It recommended public-private partnerships for the better coverage of public health programmes like those for TB, malaria, hepatitis, polio and other communicable diseases.