Pakistan Medical Sector

Introduction

Pakistan's health-care landscape combines government-run hospitals, an extensive private sector, and military medical facilities that together serve a population of over 240 million. Despite pockets of advanced tertiary care, the system faces persistent gaps in financing, equitable access, and service quality outside major urban centres. Recent federal budget allocations and development-project funding show targeted investment in tertiary infrastructure, but many structural issues remain to be addressed for universal, resilient care.

Public Hospitals: Structure and Officially Available Services

• Network and tiers: Public care is delivered through Primary (Basic Health Units, Rural Health Centres), Secondary (district and tehsil hospitals), and Tertiary (teaching hospitals and national institutes) levels. These facilities provide preventive care, maternal and child services, inpatient and outpatient curative care, emergency surgery, and disease-control programmes.
• Standard facilities: At district and tertiary hospitals the officially available services typically include emergency departments, maternity and neonatal care, general surgery, medicine, pediatrics, laboratory diagnostics, radiology (digital X-ray, CT in higher centres), and pharmacy services.
• Special programmes: Public hospitals also host vertical programmes (Expanded Programme on Immunization, TB, polio response, hepatitis treatment) and government-run specialist centres for cancer, cardiac care, and maternal health in selected urban hubs.

Private Hospitals: Scope, Services, and Reach

• Range and role: The private sector spans solo practitioners and small clinics to large private and philanthropic tertiary hospitals. They deliver a large share of outpatient consultations, elective surgeries, advanced imaging, oncology, and specialized care in major cities. Private diagnostic chains and laboratories expand testing capacity and often introduce newer technologies faster than the public sector.
• Officially available services: Private hospitals commonly provide emergency care, ICU and CCU services, modern imaging (MRI, CT), endoscopy and minimally invasive surgery, dialysis, chemotherapy, and specialist outpatient clinics. Many also offer private-pay wards and subscription-based packages for complex care.
• Regulation and reporting: While private facilities supply substantial capacity, regulatory oversight, standardization of pricing, and mandatory reporting of notifiable diseases are uneven across provinces, limiting integrated public-health response.

Military Hospitals: Civil Support and Emergency Role

• Capacity and capability: Pakistan's military hospitals (e.g., Armed Forces Institute of Cardiology, Combined Military Hospital network) maintain advanced tertiary facilities, specialist training programs, and well-resourced laboratories and ICUs. They operate high-quality referral services and trauma care, and possess logistical capacity for rapid medical mobilization.
• Civil assistance: During public-health emergencies, disasters, and mass-casualty events, military hospitals provide surge capacity, specialist teams, and operational support to civilian authorities. Military medical assets often collaborate on nationwide vaccination drives, emergency evacuations, and training exercises for civilian clinicians.
• Civil–military collaboration gaps: Despite frequent cooperation, formalized mechanisms for long-term civil–military integration—such as shared referral protocols, cost-recovery arrangements, and routine information sharing—could be strengthened to optimize resource use.

What Facilities Are Officially Available (Across Sectors)

• Diagnostics: Clinical laboratories, radiology (digital X-ray, CT, MRI in tertiary centres), pathology, microbiology, and molecular platforms (in major public and private labs).
• Critical care and surgery: ICUs, neonatal ICUs, operating theatres, and blood-bank services in tertiary and many private hospitals.
• Maternal and child health: Delivery suites, antenatal care, immunization services, and pediatric wards.
• Specialized services: Oncology (radiotherapy, chemotherapy), cardiology (cath labs), nephrology (dialysis), pulmonary medicine, and mental-health outpatient services in larger centres.
• Support services: Pharmacy, physiotherapy/rehabilitation units (variable coverage), hospital information systems (increasingly digital in private sector).

Medical Budget: What Is Allocated and Is It Enough?

• Recent allocations: The federal Public Sector Development Programme (PSDP) for FY 2025–26 earmarked around Rs. 14.3 billion for health projects, focused largely on teaching hospitals, tertiary upgrades, and infrastructure projects.
• Overall budget context: While capital injections target select tertiary upgrades, recurrent spending (staff salaries, medicines, operating costs) and provincial allocations determine service continuity; commentators argue the overall health budget remains insufficient to close systemic gaps and expand primary care comprehensively.
• Assessment of adequacy: Current allocations address targeted projects but fall short of the multi-year, predictable financing required for primary-care scale-up, rural staffing incentives, and universal health-coverage expansion. Many analysts view the 2025–26 measures as partial progress rather than a full remedy to systemic underfunding.

Military Hospitals' Contribution to Civil Medical Requirements

• Training and human resources: Military medical colleges and hospital training programs supply skilled clinicians who sometimes transition to civilian practice, supporting national workforce capacity.
• Surge and emergency support: Military facilities supply ICU beds, specialist teams, and rapid medical logistics during floods, earthquakes, and pandemic surges; they also contribute to national vaccination logistics and cold-chain management.
• Research and referral: Some military institutes conduct advanced research and receive civilian referrals for complex cases, reducing pressure on public tertiary hospitals.

Gaps, Challenges, and Why the Budget Alone Is Not Enough

• Imbalanced spending: Emphasis on tertiary infrastructure without parallel investment in primary health-care staffing, medicines, and supply chains sustains urban-rural inequities.
• Human resources: Shortages of nurses, midwives, and specialists in rural districts persist; retention incentives and training pipelines are inadequate.
• Regulation and quality: Fragmented regulation leaves variable standards across private providers; accreditation and outcome monitoring are limited.
• Financing design: Health financing remains heavily out-of-pocket for many households, increasing financial hardship and limiting access to needed care.
• Data and systems: Interoperable health information systems and unified registries are not yet nationwide, impeding surveillance and efficient resource allocation.

Recommendations: What Government and Partners Should Do Next

1. Increase recurrent and primary-care financing: Move beyond one-off capital projects to multi-year funding that secures staff salaries, essential medicines, and facility maintenance at BHUs and district hospitals.
2. Strengthen civil–military integration: Formalize referral protocols, shared training programs, and surge-capacity agreements to maximize the use of military medical assets for civilian benefit.
3. Scale provincial health-card schemes and social protection: Standardize benefit packages and expand coverage to reduce catastrophic out-of-pocket spending.
4. Invest in human resources: Fund rural incentive packages, expand midwife and nursing education, and implement bonded rural-service agreements with supportive supervision.
5. Regulate and accredit private providers: Enforce quality standards, mandate disease reporting, and encourage affordable service tiers for low-income patients.
6. Build primary-care referral networks: Upgrade BHUs with essential diagnostics, telemedicine links to tertiary hubs, and reliable ambulance services.
7. Expand digital health and data systems: Implement interoperable electronic records, immunization registries, and facility dashboards to guide resource allocation and transparency.
8. Prioritize preventive health and essential supplies: Ensure uninterrupted supply chains for vaccines, essential medicines, and oxygen, especially in smaller hospitals.

Brief Overview

Conclusion

Pakistan's health sector comprises a capable mix of public, private, and military institutions that together deliver a wide range of services. Recent PSDP allocations show federal intent to invest in tertiary upgrades but are insufficient alone to realize universal, equitable care. Strengthening primary care financing, formalizing civil–military collaboration, regulating private providers, and investing in human resources and digital systems are immediate priorities to convert capital investments into sustained health gains for the population.