Healthcare for all

Aligning vision with action is imperative for the provision of universal healthcare

Healthcare for all


U

niversal Health Coverage promises a system where everyone can access essential healthcare services without financial hardship. Pakistan has pledged to achieve this goal by 2030. However, significant challenges remain. Despite some progress, as highlighted in the latest Service Coverage Index report released on UHC Day 2024, disparities across regions persist.

The SCI report shows that Pakistan’s overall UHC index improved from 40 per cent in 2015 to 53.9 per cent in 2023, signalling modest progress. Islamabad leads the way with a score of 63.8 per cent, followed by Punjab (55.4 per cent) and Sindh (50.7 per cent). Balochistan lags at 38.4 per cent, revealing stark regional inequalities. These disparities underscore the need for targeted reforms, especially in underserved regions, to achieve equitable healthcare access nationwide.

One of the barriers to meaningful progress is the fragmented and complex narrative around UHC, which often dilutes urgency and overwhelms policymakers. As emphasised in a recent BMJ article, simplifying the UHC narrative by focusing on four actionable pillars—universality, equity, adequate financing and preparedness—can help translate ambition into action. But simplification must be paired with objective-oriented reforms to align policies with measurable outcomes.

The Essential Package of Health Services, developed in 2020, offers a strong foundation for UHC in Pakistan. However, its success hinges on effective implementation, which requires addressing systemic barriers, fostering equity and mobilising resources.

1. Universality: leaving no one behind

UHC is built on the principle of universality—healthcare access for all, regardless of income or geography. However, the 2024 SCI report highlights glaring disparities, with rural areas and marginalised communities facing significant barriers to healthcare access.

For a family in rural Balochistan, the nearest health facility is often several hours away. A mother seeking care for her sick child must travel a long distances and might only find an under-resourced clinic. Stories like these remind us that universality is not just about policy; it’s about transforming lives.

To address this problem, Pakistan must prioritise phased action plans that target underserved regions. The EPHS offers a strong foundation, but its success depends on effectively addressing systemic barriers and ensuring equitable access. The ongoing pilot project in Tando Allah Yar, Sindh, has the potential to develop into a model for how localised interventions can expand coverage and inform nationwide implementation.

Investing in community health workers (CHWs) is another critical step. These frontline workers can extend primary care to remote areas, bridging gaps in service delivery and alleviating the burden on overstrained health facilities.

2. Equity: a health system for everyone

The SCI report reveals troubling inequalities in healthcare access, with wealthier urban populations benefiting from private care while rural communities rely on underfunded public facilities. For example, family planning coverage is 55.1 per cent in Islamabad and 34.5 per cent in Balochistan.

Equity must guide UHC implementation. This means ensuring that essential services are free at the point of care for vulnerable populations. Provincial heterogeneities warrant consideration of a diverse set of policy instruments which may include expanding health insurance programs, grants/ global budget for credible healthcare institutions and other social protection measures to include comprehensive health benefits that can help shield low-income households from catastrophic expenses.

Additionally, healthcare reforms must address the broader social determinants of health, such as poverty, education and gender inequality, to create a truly inclusive system.

Achieving UHC in Pakistan is not just an ideal—it’s a moral imperative. By simplifying the UHC narrative and adopting an objective-oriented approach, Pakistan can transform its healthcare system into one that serves all its citizens. 

3. Adequate financing: investing in health

Pakistan’s chronic under-investment in health—just 1.2 per cent of GDP—remains a major barrier to UHC. The SCI report underscores the consequences of this shortfall, with limited infrastructure and uneven service capacity across provinces.

However, increasing funding alone is not enough. Efficiency and accountability in health spending must also improve. Governments should pay healthcare providers based on the quality of care and results, ensuring resources are used efficiently. This approach can enhance both the quality and efficiency of healthcare delivery. Importantly, accountability should not be confused with rigid financing. Flexible mechanisms, such as global budgets, when combined with effective performance management, can improve service delivery while ensuring financial protection for the poorest.

Beyond domestic resource mobilisation, taxation reforms and public-private partnerships, Pakistan must improve its institutional readiness to access international financing and support to advance its UHC goals. However, rather than relying heavily on external support, the priority should be to address inefficiencies within the current health financing system to achieve ‘more health for the same money.’

4. Preparedness: building resilient health systems

The Covid-19 pandemic and the floods of 2022 underscored the importance of resilient health systems capable of responding to public health emergencies. Pakistan’s health system, already strained by limited resources, struggled to cope with the systemic shocks, highlighting vulnerabilities that must be addressed to achieve UHC.

Investing in UHC is inherently an investment in health security. Strengthening primary healthcare infrastructure, expanding disease surveillance systems and ensuring robust supply chains for essential medicines and equipment are critical to building a resilient health system.

Moreover, Pakistan must prepare for the growing health impacts of climate change, which will exacerbate the frequency and severity of public health emergencies. Integrating climate resilience into health planning and mobilising international climate financing for health initiatives can help Pakistan build a health system capable of withstanding future shocks.

The path forward: a unified and actionable UHC agenda

To achieve UHC, Pakistan needs a unified narrative emphasising universality, equity, financing and preparedness. This narrative must resonate with political leaders, administrators, practitioners, academia, civil society and the public and be grounded in local realities.

Rather than focusing solely on quick fixes, the emphasis must shift to addressing systemic inefficiencies and aligning reforms with clearly defined health objectives. Continuous evaluation and adaptation are crucial to ensure that reforms remain relevant and effective.

Achieving UHC in Pakistan is not just an ideal—it’s a moral imperative. By simplifying the UHC narrative and adopting an objective-oriented approach, Pakistan can transform its health system into one that serves all its citizens. The time to act is now—not just to promise health for all, but to deliver it.


The writer, a technical advisor for an international organisation working on health financing, is a Fulbright scholar with a master’s degree in international development studies. Email: okhan1@gwu.edu

Healthcare for all