Health Care Services & Government

Spending in Pakistan

Submitted To:

Mr. Shehzada Qamar

Batch:

MBA (E8&E9)

Submission Date:

1st December 2015

Submitted By:
Wajid Ali
Rana Tassadaq
Maryam Asghar
Naila Khaild

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ABSTRACT
This research work has been carried out to measure the tendency of government spending on
health in Pakistan at provincial level i.e., both rural and urban using the primitive data of the
Pakistan Social Standard Living Measures Survey, 2013-14, and by exercising the three-step
Benefit Incidence Approach (BIA) methodology. The study examines the national policies
stressing health services as well as the direction in access to and public sector spending on
health care facilities in Pakistan. The study investigates the disparities in resource allotment
and service terms against the government health outlays. The rural areas of Pakistan are the
more deprived in terms of the health care facilities. The outlays in health areas are as a whole
are backwards in rural Pakistan as well as at provincial and regional levels. Mothers & Child
subhead is retrogressive in Punjab and General Hospitals and Clinics are retrogressive in all
provinces. Only the Hygienic Measures and health facilities sub-sector is advanced in
Pakistan. Public health outlays are pro-rich in Pakistan.

INTRODUCTION & BACKGROUND

Health plays the important role in ordaining the human capital. Good health conditions
improve the efficiency & the productivity of the labor force, finally assists the economic
growth and directs to human well-being. To get better, more handy, orderly and productive
human capital resources, governments support the health care facilities for its people. In this
view, the public sector pays whole or few part of the cost of utilizing health care services. The
amount and distribution of these in-kind makeovers to health sector differs from country to
country but the crucial question is how much these outlays are bounteous and effectual? It
very much relies on the magnitude and the distribution of these outlays among the people of
different yards of the country. Apart from the nature of the existing contingencies of the
human resource, any minimal change in public sector spending on health services may have
explicit impact on the human capital and economic growth. Health hatches explicit
externalities for the society as a whole, as well as the fairness refers that without public sector
financial support only the wealthy fragment of the population would be able to afford fair
health care services. Lamiraud asserted that social health protection is an important
instrument intending at fair burden sharing and minimizing barrier stressing access to health
care services. Another good argue for the government spending in giving essential health care
services is to cut down the burden of the ailments (BOD) in the fruitful spans of the life. The
social rate of return & the BOD impel the policy-makers to carry the public resources
towards basic health care facilities. The Economic Survey of Pakistan (2013-14), tells that the
government depleted 0.40 percent of GDP on health sector for making its population more
healthy and firm. For this purpose, a number of vertical and horizontal programs concerning
health facilities are effectual in Pakistan. The federally funded vertical programs include:
Lady Health Worker programs, Malaria Control programs, Tuberculosis & HIV/AIDS
Control programs, National Maternal and Child Health programs, the developed programs on
Immunization, Cancer Treatment Programs, Food and Nutrition Program & the Prime
Minister Programs for Preventive and Control of Hepatitis A and B. To lively address the
health problems meeting Pakistan, a number of policies emphasize better health care services.
These cover: Health linked Millennium Development Goal, Medium Term Development
Frameworks, Poverty Reduction Strategy Paper, and National Health Policies & Vision 2030.
Having these policies, to beat the health related dilemmas in Pakistan seem dubious and
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questionable. The epidemic ailments are still a threat and the statistics unveil that the nutrition
and reproductive health dilemmas in epidemic ailments are still answerable for the 58% of
the BOD in Pakistan. Non-infectious ailments caused by sedentary life style, environmental
pollutions, delicate dietary habits, smoking etc. account for almost 10% of the BOD in
Pakistan. Social Policy Development Centre expresses that out of every 1,000 kids who
endure infancy, 123 expire before attaining the age of five. A huge size of those who
surviving suffers from malnutrition leading, to diseased immunity and higher insecurity to
infections. Malnutrition is big problem in Pakistan. Human Conditions Report (2013) clearly
points out that about 40 percent kids under 5 years of age are malnutrited. Nearly 50% of
deaths of kids under 5 year old kids are because of malnutrition.

LITERATURE REVIEW
An ample review of the literature, researched facts & figures, papers and evaluation
narrations is performed to weigh the existing condition and policy contest. This consists of
documents and reports accessible from World Health Organization (WHO), United Nations
Childrens Fund (UNICEF), Asian Development Bank (ADB), and Centre for Poverty
Reduction & Income Distribution (CRPRID), Poverty Reduction Strategy Paper (PRSP) and
Ministry of Health (Islamabad).
A huge number of the studies have exercised the Benefit Incidence Approach (BIA) on
household data for their examinations. Findings unveil that public sector outlays are either
progressive or regressive and the share of the different income group differs depending upon
the delivery of the gains of the public outlays across region, caste, religions, gender etc.
Few points require further consideration; the first point about the impact of the level of public
outlays on human proficiencies is a debated point, as not all studies have found a hypothetical
link between the two. The relation between richly addressing poverty issues and spending is
not first and foremost a function of the percent of GDP that is promised to total spending on
health and, but depends on the intra-sectorial allocation to health spending. Evidence reveals
that infant and child mortality rates become minimal in countries with high shares of health
care spending assigned to primitive (preventive) health care facilities. Second, the fiscal
policy-makers address head-on the nature and consequences of fiscal tendency. The policy
choices obligate the understanding about which groups are tend to pay for and which groups
are predicted to gain more from public sector outlay. Policy-developers have many questions
regarding how to relive the load of taxation for the poor and about how to multiply the
efficiency and validity of the public sector spending on health? How to mark public spending
for the purpose of improving the circumstances of the poor? The directions of analysis
provide little critical information to favor policy-makers concerning balanced distribution of
income and betterment of efficiency and validity of the public policy.
Enough literature is accessible to understand the questions concerning the nature of tendency
of the public sector expenditures in developing and developed nations. Much of the
researches have been carried out on previous data-sets gathered from household surveys that
have not been revised or updated. These studies are inadequate in contrast of tendency among
the cross countries on one side & in-comparability of the cross country outcomes on the other
side. Likewise, the impact on different groups such as sex and region has not been taken into
account in the case of Pakistan. Furthermore, the literature regarding the tendency of the
public sector expenditures and its distribution in Pakistan is hardly accessible.
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The present study is being initiated to explore the nature of tendency of public sector outlays
in Pakistan on health sector by using the primitive data of the Pakistan Social & Living
Standards Measurement Survey, gathered and published by the Federal Bureau of Statistics,
Pakistan. By using existing data, the prevailing researches highlights the current story line of
tendency of the public spending on health and circuitously provide the guideline to what limit
health policy targets have been victoriously accomplished, who gain how much, which type
of disparities exist in distribution of gains of government expenditures on health, region and
income wise.

POLICIES STRESSING HEALTH CARE SERVICES IN PAKISTAN

Pakistan is in the halfway of epidemiological transformation where almost 40% of total
burden of disease (BOD) is explicated by infectious ailments. These consist of diarrheal
ailments, intense respiratory infections, malaria, tuberculosis, hepatitis B&C, and childhood
ailments. Another 12% is because of reproductive health dilemma. Nutritional deficiencies
especially iron deficiency anemia, Vitamin-A deficiency, iodine deficiency disorder account
for further 6% of the total BOD. Non-infectious ailments, caused by sedentary life style,
environmental pollutions, unhygienic dietary habits, smoking etc. including cardio vascular
ailments, cerebra-vascular accidents, diabetes and cancers account for nearly 10% of the
BOD in Pakistan. With the increase in life-expectancy, ailments/disabilities of old age
particularly eye problems, paralysis and bone ailments are also growing. The drug addiction
issue is rising particularly in the youth. There are about 5 million addicts out of which 50%
are addicts of heroine. The increasing menace of injecting drug users making a great
challenge when one considers the unseen cases of HIV/AIDS and hepatitis-C amongst the
addict population. In Pakistan, the chances of dying under five child mortality are at 101 per
1,000 live births with a life expectancy of 62 years.

Public Sector Spending on Health Care Services

Health is the basic human right and important for individual welfare at micro level, and
essential need for economic growth and development in a country or nation at the macro
level. Similar to water and sanitation sectors, and other social sectors, health has not been a
priority zone of the Pakistani government. The total public sector budgetary expenditures on
health sector show optimistic but not encouraging figures in last many years, however, the
share of development spending on health is still quite low. The entire public sector
expenditures on health has increased from Rs.79.4 billion in 2012-13 to Rs.102.3 billion in
2013-14, with a highest jump of Rs. 22.9 billion in 2013-14.
The share of federal and provinces in total public spending on health sector reveals that on
average the Baluchistan and KPK are spending the least. The major share of spending on
health has been seen in Punjab, followed by the Federal (due to extensive health care vertical
programs). The tendency of public expenditures in Baluchistan reveals horrifying situation
where the public spending is declining since 2010-11 with slight development over 2012-13.

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The total public sector expenditures as percentage of GDP expresses that the public spending
on health sector has improved to 0.40 percent in 2013-14 from 0.35 percent of the GDP in
2010-2011; in last some years, i.e. after being a signatory to the United Nations Millennium
Declaration in the year 2000, the progress was just 0.30 percent of GDP. Excitingly, there was
only a change of 0.23 percent of GDP between 2010-11 and 2012-13. Furthermore, the public
sector development expenditures as percentage of GDP reveals worst picture over the same
period of time; improvement of 0.05 percentage points. These percentages are far less and
below those recommended by the WHO.
According to a report by WHO Commission on Macroeconomics and Health, USD 34 per
capita is required for a package of fundamental health services in Pakistan. Nevertheless, the
overall expenditures on health in Pakistan are USD 18 per capita out of which the total
government health expenditure is USD 4 per capita. This makes clear how much the
government is committed to invest in the health sector, particularly for the deprived that do
not bear private consultation.
The percentage distribution of the government health expenditures by sector reveals that of
the total public sector budgetary expenditures in 2013-14 on health, 65.32 percent was spent
on general hospitals and clinics, 30.37 percent on health facilities and preventive measures,
and only 4.31 percent on mother and child health care facilities. Although, the percentage
share of mother and child health care became more than doubled since 2010-11, but it is still
insignificant believing the medical facilities needed particularly for unserved population
living in urban slums and rural areas.
Pakistans health care system is insufficient, inefficient, and much expensive; and involves an
underfunded and incompetent public sector along with a combined, expensive and
unregulated private health sector. These bad conditions in the health sector may be referred to
a number of reasons like poverty, malnutrition, uneven access to health facilities, inadequate
grant for health, and high population growth & infant mortality. For fairness, efficacy and
effectiveness of the health sector, inputs from both the public and private sector would be
essential.

Conclusion

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(1) Pakistans health care system is insufficient, inefficient, and much expensive; and
involves an underfunded and incompetent public sector along with a combined, expensive
and unregulated private health sector. These bad conditions in the health sector may be
referred to a number of reasons like poverty, malnutrition, uneven access to health facilities,
inadequate grant for health, and high population growth & infant mortality. For fairness,
efficacy and effectiveness of the health sector, inputs from both the public and private sector
would be essential.
(2) The outlays in health sectors are overall progressive in Pakistan while it is regressive in
some sub-head outlays of health at provincial and regional levels.
(3) The assumption that spending on health is on-going at provincial and regional level is
thrown away as the results found great disparities and unevenness across regions.
(4) Third assumption that there exist large disparities in the shares of the different quintiles in
health outlays cannot be thrown away or rejected.
(5) As a whole, the public sector spending on health sector is to some extent progressive in
Pakistan.
(6) Public sector outlays in Preventive Measures and Health Facilities sub-sector are
progressive at provincial and regional level, excluding overall rural Pakistan. It means the
public sector spending on Preventive Measures and Health Facilities are more justly
distributed as compared to the income distribution. Expenditures on Preventive Measures and
Health Facilities are highly subsidized by the federal government in Pakistan through its
vertical programs.
(7) The poor in Pakistan is not only deprived of financial means but also lack reach to
secondary and tertiary health care services. Public outlays in General Hospitals and Clinics
sub-sector of health are retrogressive in most of the regions in Pakistan.
(8) Health outlays on Mother and Child sub-sector is on-going in Sindh, KPK and in overall
Pakistan; that refers that poor are getting more gains from these outlays as compared to the
rich. But in-kind subsidies are regressive in Punjab. The Mother and Child are the most
disadvantages and neglected sub-sector of health.
(9) The rural urban disparities are deeper. The rural areas are more derivate zones underlining
the health care facilities. In health sector more disparities prevails in the share of the lower
and upper quintiles in government outlays on health care facilities.
(10) In the terms of health care services the private sector plays a key role. According to the
PSLM (2012-13) survey, 77% households consult the private sector against only 23% to the
public sector.

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