ISLAMABAD - Public resources allocated for health sector in general and mother, newborn, and child health (MNCH) in particular are not only woefully low but are often spent in a manner that disproportionately benefits the rich relative to the poor.
This feature of healthcare finance in Pakistan puts many households, especially those belonging to marginalized groups, into a vulnerable situation. A study in the area of MNCH has highlighted that the public spending on health as percentage of GDP has never exceeded 0.7 per cent and this proportion has been dwindling over time.
The study launched on Monday has been conducted by Dr Sadia Malik and funded by Maternal, Newborn and Child Health Programme, Research and Advocacy Fund (RAF). Sadia Mariam Malik holds a PhD in economics and is currently assistant professor at York University, Canada. She is also vice-president of Centre for Research on Economic and Social Transformation (CREST), Pakistan.
According to research, although poverty reduction has been an overarching goal of successive governments in Pakistan, public contribution in health financing remains extremely limited: around 72 per cent of the total health expenditure is financed by private sources out of which 92 per cent are out of pocket expenses.
This feature of healthcare finance in Pakistan puts many households, especially those belonging to marginalized groups, into a vulnerable situation. A sudden illness, accident or medical emergency can push many households - especially those who do not have any assets to fall back upon - below the poverty line.
Existing allocations within hospital care shows less than 0.1 per cent is currently being allocated for MNCH related services. Ironically, even this meagre spending is not effectively targeted towards the poor.
Using the latest Pakistan Standard of Living Measurements Survey (PSLM), Dr Malik in her study shows that the current distribution of utilization of some publicly provided MNCH related services especially those that are hospital based such as institutional maternal delivery and post-natal care is skewed in favour of higher income groups.
In contrast, the utilisation of services that fall within the purview of basic health services such as immunisation, and prenatal consultation (through basic facilities such as LHW and LHV) are relatively more equitably distributed. The distribution of the usage of basic health units (BHUs) is found to be pro-poor.
At the provincial level, the study finds that the extent of inequality in the distribution of public health services utilisation is higher in Balochistan with benefits from most services captured by the rich rather than the poor. This could be due to poor governance in terms of public service delivery in the province or due to the deteriorating law and order situation as well as sparse availability of public health services due to which poor people, especially those who live in remote areas, are not able to bear access costs related to transportation.
The study recommends that the government needs to invest more in basic health services such as immunisation and other services provided through BHUs as well as trained midwives, LHVs and LHWs. Secondly, the study urges the government to address the imbalance against MNCH within hospital-based services and effectively target hospital-based services towards the poor. In terms of regional allocation of health sector budget, the study recommends more resources be allocated towards regions that have poor health indicators and where the ability to pay for health care is low.
Integrating MNCH related programmes with income support programmes can potentially increase the effectiveness of all programmes involved. Such integrated programmes are effectively run in developed countries like the United States through basic and primary health care units, it says.
The report was launched by Prof Ahsan Iqbal, Federal Minister for Planning, Development and Reforms. He highlighted that Pakistan is facing serious nutritional challenge; 10-20 per cent learning deficiency in children results from lack of adequate nutrition to mothers in pre-birth stage.
Reiterating the significance of human resources he said that through inappropriate allocation of resources, previous governments, have made poor more vulnerable. Every military regime has shifted allocation from civilian expenditure, meant for health and education, to military expenditures. In a democratic regime the representatives are accountable to their constituencies, hence they focus on delivering social services in their areas.
On the occasion Sarah Hall of Research and Advocacy Fund (RAF) indicated that the study reveals a number of inefficiencies and inequities in existing allocations of healthcare budget in Pakistan. Mothers and children are highly vulnerable segments of the population both in terms of socio-economic empowerment as well as health status.
Maternal and perinatal conditions are one of the leading causes of mortality in Pakistan. However, inter-sectoral allocation of healthcare budget shows that less than 0.2 per cent of the total budget on health is allocated to treat these conditions. A major chunk of the budget is spent on specialised hospital and curative care (71.75 per cent), the benefits of which are neither captured adequately by mothers and children nor by the poor.