By Shahzaib Saqib
Pakistan is the second largest South Asian country with a population of 169.7 million (2009 estimate),13 making it the sixth most densely populated country in the world.
However, in terms of human development, it is ranked 125th among 169 countries.14 Although Pakistan’s Human Development Index (HDI) has improved from 0.346 in 1975 to 0.490 in 2010, this improvement has been slow.14, 15 The health system in Pakistan consists of public and private sectors.16 The Ministry of Health (MOH) at the federal level develops national policies and strategies for the entire population of the country, especially those who are under-served, and sets national goals and objectives, including for maternal healthcare.15 The public sector encompasses a wide network of dispensaries, basic health units, rural health centres and hospitals. However, in the private sector, apart from some accredited outlets and hospitals, there is mushrooming growth of medical general practitioners, homoeopaths, traditional/spiritual healers, Greco–Arab healers, herbalists, bonesetters and quacks.17 This may lead to inappropriate or delayed healthcare resulting in undesirable outcomes.
Despite an elaborate and extensive network of health infrastructure, especially in the public sector, the healthcare delivery system in Pakistan has failed to bring about improvement in health status, especially of rural populations. The health system is characterized by inadequate expenditure, poor quality services, and poor access to and utilization of services.15 The life expectancy stands at 67 years, with a high infant mortality rate of 72/1000 live births14, 18 and a maternal mortality rate of 320/100,000 live births.14, 15 Non-communicable diseases represent a major and rapidly-growing problem in Pakistan.19
The National Health Survey of Pakistan was a cross-sectional population-based survey, conducted between 1990 and 1994, of 18 135 individuals aged 6 months and above; 9442 of them were aged ≥15 years. Our main outcome was SRH which was assessed using the question: "Would you say your health in general is excellent, very good, good, fair, or poor?" SRH was dichotomized into poor/fair, and good (excellent, very good, or good).
The Government of Pakistan spends 2% of its gross domestic product on healthcare (2006 estimate)13 which, while increased from 0.8% in 1998/1999, is still lower than other South Asian countries such as Bangladesh (3.2% in 2006).20, 21 However in the 2009–10 budget, the health sector was marked by six policy highlights, one of which is ‘scale up of existing budget’.22 An increase in the budget for the healthcare system might improve the overall healthcare delivery system in Pakistan. However, policy making for the healthcare system must also be informed by information relating to health-seeking and utilization behaviour and factors affecting these behaviours, in order for the policies to be more evidence-based, realistic and beneficial. Unfortunately, literature pertaining to these topics in Pakistan is generally lacking, which could be one of the reasons why health policies have not been translated into improvements in healthcare.