"Uncovering the Divide: The Stark and Unequal Healthcare Access and Outcome between Private and Government Sectors in Pakistan"

 The advantage of the most optimal and attainable standard of healthcare is one of the fundamental rights of every human being, regardless of distinction of race, religion, political belief, economic or social condition," says the World Health Organization (WHO).

 

Pakistan's healthcare system was modeled after the pre-partition British healthcare system based upon both public and commercial sectors that provide primary, secondary, and tertiary care. Pakistan continues to strive hard toward achieving the Millennium Development Goals (MDGs), that have been established for all developing countries by the United Nations. Since the Declaration of Independence of Pakistan, the advancement of the health sector cannot be ignored. In 1960, Pakistan's national health policy established the concept of collaboration between public and private providers of health care, which began as a model of corporate social responsibility to address the nation's health needs.

Pakistan is known to produce some of the world's best doctors in past years and continues to do so. In recent times, our highly qualified, dedicated, and experienced doctors and paramedics are recognized and acknowledged by the global community for their efforts and performance during the COVID-19 period and encouraged as a model for the rest of the world. But we cannot ignore the healthcare disparities that are highly concerning, with large discrepancies in the quality and accessibility of healthcare services between the private and public sectors.

Pakistan’s healthcare system comprises the governmental sector, parastatal organizations, private sectors, civil society, and charitable contributions. However, the private sector covers 70% of healthcare services in Pakistan and a gap exists between facilities amongst various sectors. Most patients prefer to visit private hospitals and clinics typically as they offer better facilities, equipment, and medical personnel, as well as a broader choice of services. On the other hand, it is more expensive, and many individuals in Pakistan cannot afford the exorbitant prices of private healthcare, rendering quality healthcare inaccessible to a significant portion of the population living below the poverty line.

The remaining 30% of the population that uses public hospitals and clinics is not doing it for free. Anyone who uses government-funded healthcare facilities is obligated to pay a small fee. Though it delivers more affordable healthcare services, the quality of care might vary greatly depending on the locality and available resources. They are usually insufficiently funded, have poor facilities, and are short on medical staff and equipment leading to excessive wait times, overcrowding, and subpar care. This problem is particularly pronounced in peri-urban and rural areas with a chronic shortage of doctors due to unequal distribution.

Furthermore, regional, and socioeconomic variables are also important factors influencing healthcare discrepancies in Pakistan. Rural areas frequently lack access to essential healthcare services, and those in poverty are more likely to face healthcare challenges than those in more affluent places. Presently, Pakistan is dealing with a double illness burden. Not only is the country struggling to combat infectious diseases such as poliomyelitis, but it is also dealing with chronic non-communicable diseases. In terms of health indices, Pakistan has exceptionally high newborn and maternal death rates when compared to other developing countries.

These issues arise due to the flaws existing in our healthcare system, poor governance, lack of resources, a poor-quality Health Information Management System, the discrepancy in monitoring in health policy and planning, and a shortage of educated personnel. Furthermore, there is a high level of corruption in the healthcare system because of the political invasion of authority of those involved in policy making. As a result, not everyone has equal access to healthcare services, and healthcare resources are not distributed fairly.

Moreover, Pakistan lacks a major source of health care coverage by means of medical insurance policies. Only 27% of the population has access to free healthcare coverage, which includes government employees and armed forces personnel. This huge discrepancy in the healthcare sector in Pakistan is alarming. In terms of healthcare quality and accessibility, we rank 154th among 195 countries. In an undeveloped country like ours, where population growth has been one of the greatest in the world, the government's healthcare allocation for the fiscal year 2022-23 was reduced from Rs13.3 billion in the previous fiscal year to Rs12.7 billion in the current fiscal year.

These inequalities in access to healthcare are becoming a bigger concern for Pakistan's government and society. Efforts should be made to bridge the gap between public and private hospitals, especially in remote areas where government health facilities are limited. Additionally, the government should increase its healthcare budget to provide better healthcare services and improve the conditions of public health facilities. Many programs have been launched by the international health community to aid the country in combating healthcare problems. However, the impact of these programs is quite limited, which is why Pakistan's healthcare system is still inefficient.