Public policy and implementation: health

Policy framework

• National Health Policies (1990, 1997, 2001, 2009 draft) set priorities for primary health care.
• National Health Vision 2016–2025 provided a common framework for federal and provincial health strategies after devolution.
• Provinces have their own health sector strategies.
• The federal Ministry of National Health Services, Regulations and Coordination handles coordination, international health regulations, and bodies such as DRAP and the Pakistan Medical and Dental Council.

Major programmes

• Lady Health Workers Programme (1994): community health workers serving rural households, widely regarded as a success.
• Expanded Programme on Immunization (1978).
• Polio Eradication Initiative: Pakistan and Afghanistan are the last countries with endemic wild poliovirus.
• Sehat Sahulat Programme (Sehat Card): health insurance for hospital treatment, expanded to near-universal coverage in Khyber Pakhtunkhwa and Punjab, though coverage has since varied with funding.
• Maternal, newborn and child health and nutrition programmes.

Implementation challenges

• Low public spending (about 1% of GDP), leading to high out-of-pocket spending by families.
• Shortage and uneven distribution of doctors and nurses; absenteeism in rural facilities.
• High child stunting (around 40%), maternal and infant mortality.
• Weak primary health care, overcrowded tertiary hospitals.
• Poor coordination between federal and provincial bodies after devolution.
• Vaccine hesitancy and attacks on polio workers.

Way forward

• Increase health spending and invest in primary care.
• Universal health coverage with sustainable financing.
• Strengthen health information systems and accountability.
• Community-based programmes and public-private partnerships.

Conclusion

Pakistan's health policies are generally sound on paper; the gap lies in financing and implementation. Strong primary care and accountability would make the greatest difference.