Related Experiment Video
Updated: May 11, 2026
05:35
A Point-of-Care Method with Integrated Decision Support Tool to Estimate Anemia at Population Level
Published on: January 19, 2024
Pakistan's health system: performance and prospects after the 18th Constitutional Amendment
Sania Nishtar1, Ties Boerma, Sohail Amjad
1Heartfile, Islamabad, Pakistan. sania@heartfile.org
Lancet (London, England)
|May 21, 2013
Summary
Pakistan
Area of Science:
- Health Systems Performance
- Public Health Policy
- Federalism and Health Governance
Background:
- Pakistan's federal structure significantly altered by the 18th Constitutional Amendment.
- Previous 65 years show some health system improvements, yet key indicators lag behind comparable nations.
- High out-of-pocket expenditure (78.08%) and a private sector dominance (75%) characterize healthcare delivery.
Purpose of the Study:
- To assess health-systems performance in Pakistan post-18th Constitutional Amendment.
- To identify challenges and opportunities for health reform in the devolved structure.
- To inform future health policy and planning.
Main Methods:
- Analysis of health-systems performance indicators.
- Review of governance structures and health service delivery models.
- Examination of financial burdens on the population.
Main Results:
- Key health indicators in Pakistan lag behind peer countries despite some improvements.
- Significant out-of-pocket health expenditure affects 78.08% of the population.
- The private sector delivers the majority of health services, with a physician-to-nurse/midwife ratio of 2:1.
Conclusions:
- Complex governance issues and underinvestment impede health system progress in Pakistan.
- Devolution of health responsibilities presents a critical opportunity for reform.
- Targeted policy, institutional, and legislative actions are necessary to overcome existing health system challenges.
Related Concept Videos
01:30Primary Healthcare Services
Primary care promotes wellness and prevents disease. This care includes health promotion, education, protection (such as immunizations), early disease screening, and environmental considerations. Settings providing this type of healthcare include physician offices, public health clinics, school nursing, and community health nursing.
In 1978, international leaders convened in Alma-Ata, Kazakhstan, for what would be a pivotal event in global health. The Alma-Ata Declaration was the first to call...
In 1978, international leaders convened in Alma-Ata, Kazakhstan, for what would be a pivotal event in global health. The Alma-Ata Declaration was the first to call...
01:26Methods Of Healthcare Delivery System
At the different levels of the healthcare system, we see varying methods of healthcare used. These methods include managed care systems, case management, and primary healthcare.
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is limited...
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is limited...
01:18Introduction To Health Care Delivery System
The healthcare system is constantly changing and complex. Various services are available from different healthcare providers, but gaining access to these services has become challenging for people with limited healthcare insurance. Uninsured people present a challenge to healthcare because they frequently postpone or forego treatment.
The Institute of Medicine (IOM) advocates for a patient-centered, effective, safe, timely, equitable, and effective healthcare system. The National Priorities...
The Institute of Medicine (IOM) advocates for a patient-centered, effective, safe, timely, equitable, and effective healthcare system. The National Priorities...
01:29Issues And Trends In Healthcare Delivery System
The issues and trends in healthcare delivery are constantly changing. The COVID-19 pandemic is one recent issue that wreaked havoc on healthcare systems, causing a shortage of healthcare workers, high demand for medicines and supplies, and increased medical expenditure due to a lack of insurance. Other issues include rising healthcare costs and care fragmentation.
Cost Containment
Payment for healthcare services has historically promoted adoption of costly and often unnecessary or inefficient...
Cost Containment
Payment for healthcare services has historically promoted adoption of costly and often unnecessary or inefficient...
01:11Secondary Healthcare System
Secondary healthcare is offered by a specialist, generally in hospitals or clinics for patients referred by primary healthcare providers. It occurs when a person has an illness or injury that requires specific medical care. Secondary care is often referred to as acute care. Secondary care can range from uncomplicated care to repair a minor laceration or treat a strep throat infection to more complicated emergent care, such as treating a head injury sustained in an automobile accident. Whatever...
01:30Health Information Technology and Healthcare Information System
Health Information Technology (HIT)
Health Information Technology, commonly called HIT, integrates advanced information systems and technology in healthcare settings. Its primary functions include:
Health Information Technology, commonly called HIT, integrates advanced information systems and technology in healthcare settings. Its primary functions include: