Pakistan is the fifth most populous country in the world with population approaching 225 million. It is a developing country struggling in many domains due to which the health system has suffered a lot. As a result of that, Pakistan is ranked 122nd out of 190 countries in the World Health Organization performance report.
Life expectancy in Pakistan increased from 61.1 years in 1990 to 65.9 in 2019 and is currently 67.94 in 2024 . Pakistan ranked 124th among 195 countries in terms of Healthcare Access and Quality index, according to a Lancet study. Although Pakistan has seen improvement in healthcare access and quality since 1990, with its HAQ index increasing from 26.8 in 1990 to 37.6 in 2016. It still stands at 164th out of 188 countries in terms of United Nations Sustainable Development Goals and chance to achieve them by 2030.
According to latest statistics, Pakistan spends 2.95% of its GDP on health (2020). Pakistan per capita income (PPP current international $,) is 6.437.2 in 2022 and the current health expenditure per capita (current US$) is 38.18. The total adult literacy rate in Pakistan is 58% (2019) and primary school enrollment is 68%(2018). The gender inequality in Pakistan was 0.534 in 2021 and ranks the country 135 out of 170 countries in 2021. The proportion of population which has access to improved drinking water and sanitation is 91% (2015) and 64% (15) respectively.
The Human Rights Measurement Initiative finds that Pakistan is fulfilling 69.2% of what it should be fulfilling for the right to health based on its level of income. When looking at the right to health with respect to children, Pakistan achieves 82.9% of what is expected based on its current income. In regards to the right to health amongst the adult population, the country achieves 90.4% of what is expected based on the nation's level of income. Pakistan falls into the "very bad" category when evaluating the right to reproductive health because the nation is fulfilling only 34.4% of what the nation is expected to achieve based on the resources (income) it has available.
Health infrastructure
Pakistan has a mixed health system, which includes government infrastructure, para-statal health system, private sector, civil society and philanthropic contributors. Alternative and traditional system of healing is also quite popular in Pakistan.
The country undertook a major constitutional reform in 2011 with the 18th amendment, which resulted in abolishment of Ministry of Health and subsequent devolution of powers.As a result, more powers were given to provinces regarding health infrastructure and finances. In keeping with the increased awareness regarding health services Ministry of National Health Services, Regulations and Coordination was formed in 2011. The main purpose of establishing this body was to provide a health system that gives access to efficient, equitable, accessible & affordable health services. And also, national and international coordination in the field of public health along with population welfare coordination. It also enforced drug laws and regulations. The health care delivery system includes both state and non-state; and profit and not for profit service provision. The country's health sector is marked by urban-rural disparities in healthcare delivery and an imbalance in the health workforce, with insufficient health managers, nurses, paramedics and skilled birth attendants in the peripheral areas. Health care challenges in Pakistan also include issues such as inadequate budgetary allocation, shortage of medical professionals, substandard physical infrastructure, rapid population growth, counterfeit and expensive medicines, shortage of paramedical personnel and presence of unlicensed practitioners.
Sources of health expenditure in Pakistan was mostly "out-of-pocket" spending around 66% followed by the Government health spending at 22.1% in 2005.The situation has improved slightly now with out-of-pocket spending estimated to be 54.3% in 2020 followed by Government health spending of 35.6%.
Primary Health Care Primary Healthcare system is the health system for providing care. Primary healthcare in Pakistan mainly consists of health units, dispensaries, maternal & child health centers and some private clinics at community level. In Sindh (Province in Pakistan), Primary healthcare activities are supported by government itself but managed by external private & non-government organizations like People's primary healthcare initiative, Shifa foundation, HANDS etc. Pakistan has an outreach primary health care, delivered at the community level by 100,000 Lady Health Workers and an increasing number of community midwives, among other community based workers.
Secondary Health Care It mainly includes tehsil & district hospitals or some private hospitals. Tehsil & district hospitals (THQs & DHQs) are run by the government, the treatment under government hospitals is free of cost.
Tertiary Health Care It include both private and government hospitals, well equipped to perform minor and major surgeries. There are usually two or more in every city. Most of the Class "A" military hospitals come in this category. Healthcare and stay comes free of charge in government hospitals. There is also a 24 hours emergency care that usually caters to more than 350 patients every day.
Other health related services The government of Pakistan has also started "Sehat Sahulat Program", whose vision is to work towards social welfare reforms, guaranteeing that the lower class within the country gets access to basic medical care without financial risks. Apart from that there are also maternal and child health centres run by lady health workers that aim towards family planning and reproductive health.
Health status
Communicable Diseases in Pakistan: Trends and Challenge Infectious diseases remain one of the biggest threats to health care in Pakistan, and are considered a major challenge in the field of medicine. Some of the reasons for the growth of these diseases include; high population density, limited medical facilities, poor hygiene, little or no hygiene awareness. It is even worse in Pakistan due to geographical position, political instability and social inequity, more so low health care access in the face of increasing inequality especially in rural settings.
The Government together with health-related organizations of the world has tried to rein diseases like polio, TB, malaria among others, but the country still experiences recurring cases in diseases like dengue fever, hepatitis, HIV/AIDS among others. The continuous pandemic of COVID-19 has taxed the already fragile health sector in Pakistan especially in the rural settings where it is difficult to estimate the exact incidence of the disease and the proportion of the population with limited access to the health services. In addition, the prevalence of resistant microorganisms or simply the concept of antimicrobial resistance (AMR) adds a new layer of difficulties in managing many infections. In this article, the author seeks to review the trends of major communicable diseases in Pakistan, outline the gaps of data availability and despite a plenty of literature available on research articles, the author points out that there are specific areas which lacks information on this topic and it clearly points out the issues faced by the country in dealing with these disease burdens.
+DiseaseEstimated deaths per yearAdditional informationTuberculosis27000Pakistan is a high TB burden country, reporting around 510,000 new cases annually.Malaria50000Rural areas during monsoons report high death ratesHIV-AIDS3000Significant rise, during the 2019 outbreak in Sindh.COVID-19Over 30,000 deathsDeaths peaked in 2020-2021 1. Tuberculosis (TB) Trends: Currently, Pakistan is one of the five high TB burden countries in the global level. The magnitude of TB in Pakistan is considered to be around 510,000 new incidences per annum, although the proportions of MDR-TB have also been identified. Tuberculosis is most widely spread in urban areas and developing countries characterized by high population density, poor sanitation and restricted access to health care services. Challenges: One of the major issues that affect TB control in Pakistan is reporting of the disease especially because it is stigmatized and there are few diagnostic centers, especially in the rural areas. MDR-TB has been identified as a potential problem with new recommendations in cases where treatment regimens are not fully administered, patients do not continue their follow-ups and medication supply is irregular. It evident that overall disease prevalence is much higher than recorded especially in the rural areas in Baluchistan and in Khyber Pakhtunkhwa province due to barriers to timely diagnosis and treatment. 2. Malaria Trends: Malaria is still prevalent in many areas and more prevalent in the province of Sindh, Baluchistan and KP. Based on the recent studies, Pakistan has reported more than 300000 confirmed malaria cases every year with variation and comparatively high incidence during monsoon period that is June to September. Transmission is higher in the rural areas mainly because of stagnant water which favours breeding of the Anopheles mosquito. Challenges: This is especially so since a large number of the malaria patients in the rural areas present themselves to health facilities which are inadequately equipped or staffed to diagnose the diseases appropriately. Furthermore, the national Malaria control strategies for example by the use of insecticide treated nets face challenges of accessibility because some of the regions in the country are not easily accessible. There is a possibility that actual extent of Malaria is way higher than is currently reported because the statistics may not be enough. 3. Dengue Fever Trends. Dengue fever has emerged as an epidemic problem in Pakistan and after the main outbreak in different cities like Karachi, Lahore Islamabad. The country went to see a major outbreak in dengue cases in 2023 with cases recorded crossed over 75,000. Dengue is a serious disease in regions that experience a lot of rain especially during a specific period in the year; this is due to inadequate drainage systems and increased population density in urban areas. Challenges: Majority of dengue incidents are reported in urban areas, as a result of poor handling of wastes, accumulation of water and relatively poor influence of urban authorities over breeding sites. No detailed information is available regarding the temporal distribution of dengue in rural areas while it is estimated that isolated cases occur but remain unreported. Moreover, studies have shown that in times of outbreak, the health infrastructure is usually overstretched in affected cities such that hospitals are unable to deal with the numbers of people seeking health care, especially if the outbreak happens during the monsoon season. 4. Polio Trends: Intensive efforts have been made throughout the world to end poliomyelitis; however, wild poliovirus has never been stopped in Pakistan. In 2022, there were 20 incidences of polio, nonetheless the virus poses a threat to the society specially in Khyber Pakhtunkhwa and Baluchistan where vaccination coverage is low. Challenges: There are several barriers to the polio and among them are vaccine hesitancy and misinformation. Violence related insecurity crises in some of the regions has also been another factor discouraging the fight against polio. While vaccination has improved in the urban areas the rural areas continue to have low coverage due to restricted access and conflict. 5. HIV/AIDS