Pakistan Medical Structure: Overview, Facilities, WHO Support, Rankings, and Pathways for Improvement

Introduction

Pakistan's health system is a mixed public–private network organized across federal, provincial, and district tiers. It combines government-owned primary, secondary, and tertiary facilities with an extensive private sector that ranges from solo practitioners and small clinics to large philanthropic hospitals and commercial diagnostic chains. The system faces structural fragmentation, uneven resource distribution, workforce shortages in rural areas, and financing constraints that limit universal access and quality of care.

Health System Architecture

Federal and Provincial Roles

• Federal level: Sets national policy, regulation, disease control programs, and international coordination. It manages specialized institutes, vertical programs (immunization, TB, polio, hepatitis), and national health financing frameworks.
• Provincial level: Delivers most health services through provincial health departments, manages hospitals, primary care networks, and human resources. Devolution after the 18th Amendment shifted operational responsibility to provinces, increasing variability in service quality and priorities across regions.

Service Delivery Layers

• Primary care: Basic Health Units (BHUs), Rural Health Centres (RHCs), and urban primary care clinics provide preventive services, maternal and child health, and first-contact care.
• Secondary care: District and Tehsil hospitals offer emergency care, inpatient services, surgery, and basic specialist outpatient clinics.
• Tertiary care: Teaching hospitals and specialized institutes in major cities deliver advanced diagnostics, specialist services, and training.

Financing and Insurance

• Public financing is limited relative to need, resulting in high out-of-pocket (OOP) expenditures for households.
• Government schemes and provincial health cards provide targeted financial protection, while private health insurance remains nascent.
• Philanthropic hospitals and donor funding partially offset gaps in tertiary care and specific disease programs.

Government Facilities and Services

Primary and Preventive Care

• Extensive BHU and RHC networks focus on immunization, antenatal care, child health, and basic curative services.
• National programs run mass campaigns for immunization (EPI), polio eradication, TB control, hepatitis elimination, maternal and newborn health, and family planning.

Secondary and Tertiary Care

• District and teaching hospitals deliver surgical, obstetric, pediatric, and internal medicine services.
• Centers of excellence and national institutes provide oncology, cardiology, nephrology, and advanced surgical interventions in urban hubs.

Public Health Infrastructure and Surveillance

• National and provincial surveillance for communicable diseases, environmental sampling for polio, and specialized laboratories for outbreak diagnostics.
• Cold-chain systems for vaccines and logistics networks for mass campaigns.

Private Sector Contributions

Clinical and Diagnostic Services

• Private hospitals and clinics supply a large share of outpatient consultations and specialist services, especially in urban areas.
• Commercial diagnostic laboratories and imaging centers expand access to tests and radiology.

Philanthropic and Teaching Hospitals

• Large philanthropic hospitals provide subsidized or free tertiary care, medical education, and research.
• Public–private partnerships (PPPs) are increasingly used for service delivery, contracting management of facilities, and diagnostics.

Health Technology and Innovation

• Private providers drive adoption of advanced imaging, minimally invasive surgery, and digital health platforms (telemedicine, electronic medical records) in metropolitan areas.
• Pharmacies and private clinics are critical touchpoints for primary care and often participate in public health reporting initiatives and vaccination drives.

Technology, Diagnostics, and Modern Equipment

• Advanced diagnostic equipment (CT, MRI, digital X-ray, GeneXpert molecular platforms) and ICU capabilities are available in tertiary public and private hospitals.
• Laboratory networks support molecular diagnostics, PCR testing, and specialized assays in major urban centers.
• Cold-chain and vaccine logistic technology supports EPI and large-scale immunization campaigns.
• Increasing use of telemedicine, mobile health units, and digital registries is improving access and monitoring, though interoperability gaps persist.

World Ranking and International Support

• Pakistan is classified as a lower-middle-income country and is an active member of WHO's Eastern Mediterranean Region.
• Global health rankings show progress on some fronts (life expectancy improvements, rising immunization coverage) but persistent challenges in maternal mortality, child nutrition, and universal health coverage.
• WHO and other international partners provide technical assistance, capacity building, laboratory strengthening, surveillance support, and financing for priority programs.
• Multilateral and bilateral partners support health systems strengthening, procurement, and emergency preparedness.

What the Government Is Doing for Betterment

• National and provincial strategic plans to strengthen primary health care, expand immunization, and eliminate priority diseases.
• Investment in infrastructure upgrades for selected tertiary hospitals and diagnostic labs.
• Campaigns to expand routine immunization, mass vaccination drives, and disease surveillance modernization.
• Pilot and scale-up of provincial health insurance and health card programs to reduce catastrophic OOP spending.
• Public–private engagement frameworks and contracting for service delivery in underserved areas.
• Human resources initiatives to expand training, increase rural postings, and incentivize specialty training.
• Digital health initiatives for e-registries, electronic immunization records, and mobile data collection.

Immediate Improvements Required

1. Increase Public Health Financing: Raise recurrent health budget allocations and target funds to primary care, preventive services, and essential medicines.
2. Strengthen Primary Health Care: Upgrade BHUs and RHCs with reliable staffing, essential diagnostics, and medicines; establish clear referral pathways.
3. Expand the Health Workforce: Scale up training for nurses, midwives, and community health workers; deploy incentives to retain staff in rural areas.
4. Improve Data Systems: Implement nationwide interoperable electronic health records and real-time surveillance dashboards.
5. Strengthen Supply Chain: Decentralize cold-chain and vaccine storage, expand point-of-care diagnostics.
6. Scale Up Universal Health Coverage: Broaden provincial health cards and standardize benefit packages.
7. Enhance Regulatory Oversight: Strengthen licensing, accreditation, and quality monitoring for facilities.
8. Focus on Prevention: Invest in pollution control, tobacco cessation, nutrition, water and sanitation.
9. Expand Rehabilitation Services: Build community rehabilitation for chronic disease and disability care.
10. Deepen Public–Private Collaboration: Create structured PPM models for reporting, financing, and shared service delivery.

Role of the Private Sector

• Scale low-cost diagnostics and telemedicine to reach peri-urban and rural patients.
• Partner in training programs and continuing education to raise clinical capacity.
• Invest in public health communications, workplace health screening, and mobile outreach.
• Contract with government for last-mile logistics, laboratory services, and supply-chain management.
• Extend CSR funds to subsidize screening, treatment, and rehabilitation for low-income groups.

Conclusion

Pakistan's medical structure is broad and capable in pockets, with advanced tertiary care and a vibrant private sector, but it remains fragmented and underfunded for universal, equitable coverage. Continued WHO support and international partnerships are essential, yet the country itself must boost public financing, strengthen primary care, modernize data systems, and invest in human capital. With coordinated action across government, private sector, and civil society, Pakistan can transform its health system into a more resilient, equitable, and people-centered network that meets the needs of all its citizens.