Dr Bilawal Kamran

December 12 marks International Universal Health Coverage (UHC) Day, an occasion aimed at raising awareness about the importance of strong and resilient health systems. Celebrated globally since 2017, UHC Day draws attention to the urgent need for equitable access to health services without causing financial hardship. According to the United Nations, Universal Health Coverage means that everyone, everywhere, should have access to the health services they need, without the risk of financial burden. While this goal seems noble and imperative, it remains a distant aspiration, even for the most developed countries.

In fact, the U.S., the world’s largest economy, is often cited as an example of one of the most inadequate healthcare systems, where millions of individuals remain without proper healthcare access due to unaffordable costs. Even within the European Union, which boasts more extensive welfare systems, marginalized populations, such as migrants, often face exclusion from essential health services. The situation is even more dire in the developing world, where the majority of the 4.5 billion people lacking access to essential health services reside. The promise of UHC remains elusive for many, particularly in low-income countries, where many people struggle to access basic care. Even when health services are accessible, they are often not free, forcing individuals to choose between their health and their financial security. In fact, two billion people globally experience financial hardship due to health spending, with 1.3 billion pushed into poverty by out-of-pocket healthcare expenses.

For many in Pakistan, facing a severe medical condition or emergency feels like a death sentence. The lack of quality healthcare, particularly in rural areas, coupled with the inability to afford treatment even when available, makes healthcare a luxury that many cannot access. During a dialogue hosted by the World Health Organization (WHO) in Islamabad, the WHO representative in Pakistan highlighted the need for increased support from stakeholders and donors to strengthen Pakistan’s healthcare system and work toward achieving Universal Health Coverage. While Pakistan has made some progress, improving its UHC index from 40% in 2015 to 53% in 2022, much remains to be done. The Sehat Sahulat Programme (SSP), a government initiative aimed at providing health coverage to underserved populations, now reaches approximately 190 million people. However, a substantial portion of the population—approximately half—still lacks access to basic health services. Moreover, there are significant disparities in the quality of healthcare available, with socioeconomic status often determining the level of care one can access.

One of the most critical issues in Pakistan’s healthcare system is the high out-of-pocket spending, which constitutes around 55% of the total current health expenditure as of 2020. This leaves the poor especially vulnerable to the financial consequences of medical emergencies. The rising cost of medicines, coupled with the country’s ongoing economic challenges, has further exacerbated this vulnerability. Despite a twofold increase in healthcare budget allocation for the current fiscal year, government spending remains woefully inadequate to meet the country’s healthcare needs. Without a substantial increase in public spending, Pakistan will continue to lag behind both globally and within its region in terms of health outcomes.

The challenge Pakistan faces is not necessarily about creating entirely new systems but improving existing ones. Many simple yet effective solutions could drastically improve the nation’s healthcare landscape. For instance, Pakistan has the world’s highest burden of hepatitis C, with an estimated 10 million cases. A significant contributor to this staggering number is the lack of awareness and diagnosis—many people do not know they have the disease. Providing free checkups and screenings to all citizens could prevent millions of cases and save countless lives. Unfortunately, such basic measures often face significant barriers, including political inertia, lack of resources, and poor infrastructure. The failure to address these simple yet impactful interventions is emblematic of Pakistan’s broader healthcare crisis.

This situation highlights the challenges Pakistan faces in its pursuit of UHC and the broader goal of achieving healthcare equity for all its citizens. The government’s commitment to UHC is evident in initiatives like the Sehat Sahulat Programme, but the scale of the problem demands more. The fact that millions of Pakistanis still lack access to essential healthcare services underscores the gravity of the situation and the need for urgent reform.

One of the most pressing issues is the unequal distribution of healthcare resources across the country. While urban centers like Islamabad and Lahore may have relatively good healthcare facilities, rural areas are often neglected. This urban-rural divide in healthcare access creates a two-tier system, where the wealthy and urban populations can afford quality care, while rural and low-income individuals are left to suffer. The government’s efforts to increase access to healthcare in rural areas must be expanded significantly, and private healthcare providers must be encouraged to invest in underserved regions. This would require substantial investment in healthcare infrastructure, both physical and human, in these areas.

Another critical aspect of Pakistan’s healthcare challenge is the inadequate public health financing. Government expenditure on health remains low, and despite some recent increases, it is still not enough to meet the growing demands of the population. This underinvestment leads to inadequate medical facilities, poorly paid healthcare workers, and a lack of essential medicines and equipment. A more substantial commitment to public health funding is necessary if Pakistan is to provide adequate care for all its citizens. Additionally, the government must take steps to reduce the financial burden on citizens by regulating private healthcare providers and ensuring that medical costs are more affordable for the average person.

Pakistan must also tackle the deep-rooted issue of corruption in its healthcare system. Mismanagement of resources, embezzlement, and inefficiency have plagued the healthcare sector for years, exacerbating the challenges the country faces. Transparency and accountability must become central tenets of Pakistan’s healthcare policy to ensure that resources are effectively used and that healthcare services reach those who need them most.

Addressing the social determinants of health is also critical for improving Pakistan’s healthcare outcomes. Poverty, malnutrition, lack of education, and poor sanitation all contribute to the country’s health challenges. Efforts to improve public health must go beyond healthcare services and focus on tackling these underlying factors that influence health outcomes. A comprehensive approach to healthcare must include investments in education, clean water, sanitation, and nutrition to ensure that all Pakistanis can lead healthier lives.

In conclusion, achieving Universal Health Coverage in Pakistan is a formidable challenge, but it is not an insurmountable one. With sustained investment, political will, and comprehensive reforms, Pakistan can make significant strides toward providing healthcare for all. However, this will require a radical shift in how healthcare is approached, from increasing public spending to improving infrastructure and tackling corruption. As Pakistan commemorates UHC Day, the focus should be on holding the government accountable for delivering on its promises of better healthcare access and ensuring that no one is left behind. The path to universal health coverage may be long, but the journey must begin now, for the future of the nation’s health depends on it.