Health Issues in Pakistan and Government's Role

RURAL SOCIOLOGY
HEALTH ISSUES IN PAKISTAN & GOVERNMENT’S ROLE
Syed Nauman Tauqir

Ali Raza
Khurram Rana
Uliya Suleman
M.A IV
Syed Nauman Tauqir, Ali Raza, RURAL SOCIOLOGY Final Assignment
Khurram Rana, Uliya Suleman
Contents
The issue of health..........................................................................................................................3

Cleanliness / Hygiene...................................................................................................................4
Water Pollution............................................................................................................................5
Medical Conditions......................................................................................................................6
Child Health Issues.......................................................................................................................7
Women Health.............................................................................................................................8
Health according to Islam............................................................................................................9
Health Indicators and Targets......................................................................................................12
Total Expenditure on Health (Federal &Provincial)...................................................................12
Financing Health (2009 stats)....................................................................................................13
Health Investment by Government of Pakistan & Partners (2008 stats)..................................15
Health Delivery System (2008 stats)..........................................................................................16
Burden of Disease (2009 stats)..................................................................................................17
Infant Mortality Rate (2009-10 stats)........................................................................................18
Government of Pakistan’s Expenditure on Health Affairs and Services (2008-09 stats)..........19
Statistics about Hospitals in Pakistan (2008 stats)....................................................................19
Statistics about Registered Doctors and Nurses in Pakistan (2008 stats).................................20
Per Capita Water Availability (2009 stats).................................................................................21
Pakistan’s Water Scenario.........................................................................................................21
Wastewater produced annually by towns and cities (2007 stats)............................................22
Estimated Cost from Water related Mortality and Morbidity..................................................24
Government’s role........................................................................................................................25
Health Policy of the Government..............................................................................................26
Government’s Health Programs in Pakistan..............................................................................28
Bibliography..................................................................................................................................31
Page 2 of 35
PAKISTAN’S HEALTH CHALLENGES AND GOVERNMENT’S ROLE
The issue of health
Health is an important sector in human life. In Pakistan, attempts have been made to improve
the health conditions of the people through availability of trained personnel, adequate supply
of medicines and establishment of health services. Yet the health care system as a whole is not
encouraging. The main health problems are preventable communicable diseases, severe
malnutrition and high incident of birth resulting of high proportion of infant and maternal
mortality. There are also clear differentials in health conditions by rural and urban areas and
socio-economic groups. Malaria, Tuberculosis and wide variety of childhood diseases such as
diarrhea, measles and tetanus etc. still continue to pose potential threat to the health of
millions of people in the country. Unsanitary condition, polluted water and illiteracy among
rural mother, urban slum and high fertility, small budgetary allocation and inadequate
administrative structure have been identified as the main hurdles in the progress of health
conditions.
Amongst the population of Pakistan, the burden of diseases

can be classified under two broad categories: half due to
communicable diseases, reproductive health and
malnutrition while the other half due to non communicable
diseases, injuries and mental health disorders. Polio and
hepatitis B & C are endemic and Pakistan ranks 6th amongst
the 22 highest TB burden countries in the world. In parts of
Pakistan, malaria and dengue fever are prevalent and HIV is increasing among some segments
of the population. At least one quarter of Pakistani adults are obese, have cardiovascular
conditions and over 40% of men are smokers. Injuries and accidents account for more than 11%
of the burden of diseases. Nutritional disorders are common and particularly effect women and
children. Pakistan also needs to be prepared for emerging global diseases like swine flu and
other viral infections.
Pakistan has a high fertility rate with 4.2 million new births annually. This rapid population
growth will further strain an already overstretched and underperforming health care services
delivery system, including deliveries by skilled birth attendants. Efforts made over the years to
improve health standards have been partially neutralized by the rapid growth of the
population. In addition, gender bias and limited access to health services further compromise
health of Pakistanis.
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Sub-optimal performance of the health sector in Pakistan is primarily because of low level of
health spending. Total expenditure on health as percent of GDP is only about 2 percent of GDP,
which is much lower than other countries with similar income levels.
The government contributes about a third of this and the remaining 70 percent is paid out-of-
pocket by citizens at the points of service delivery.
A number of non-financial constraints have played an equally important role in the

underperformance of health systems. Health workers are demotivated and distracted from
their work by conflicting interests. Weak governance, imbalance of human resource, lack of
equitable service delivery, absence of social safety nets, lack of effective implementation of
regulations particularly in a large unregulated private sector are some of these factors having
an adverse impact on the performance of the health sector.
Pakistan faces numerous problems in the health section which are discussed herein.
Cleanliness / Hygiene
About 80% of all major diseases such as diarrhea, cholera, typhoid, hepatitis are due to unsafe
drinking water, inadequate sanitation and poor hygiene. Health and hygiene are causing major
disruptions in the lives of people of Pakistan.
Outside the houses, you will see the reckless disposal of wastage.
Just outside the boundary wall of house, there will be the waste of
that or other houses in the street. The streets are littered with
garbage, which include papers, polythene bags, stale meals, dung,
debris and other weird things. People habitually throw things in
street after cleaning their houses.
Commuters throw wrappers and other things from the vehicles while traveling. Picnic spots and
parks have converted into a heap of dung. You will commonly see people urinating on the
sidewalks. There are many roads and streets which are suffering from the disorder of sewerage
system.
Cleanliness has been declared as an element which comprises the half part of faith of Muslims.
Ironically, more than 98% of Pakistanis are Muslims.
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Water Pollution
Water is an essential element for our survival. Unfortunately, while

Pakistan is blessed with adequate surface and groundwater
resources, rapid population growth, urbanization and unsustainable
water consumption practices have placed immense stress on the
quality as well as the quantity of water resources in the country.
Deterioration in water quality and contamination of lakes, rivers and
groundwater aquifers has resulted in increased waterborne diseases and other health impacts.
Per capita water availability in Pakistan has decreased from 5,000 cubic meters per annum in
1951 to 1,100. The principal source of drinking water for the majority of people in Pakistan is
groundwater. About 80% of the Punjab has fresh groundwater, but in Sindh, less than 30% of
groundwater is fresh. In NWFP, increasing abstraction has resulted in wells now reaching into
saline layers, and much of Balochistan has saline groundwater.
As per Government figures, the Punjab has the best rural water supply amongst the provinces.
It is stated that only 7 % of the rural population depends on a dug well or a river, canal or
stream. In Sindh, some 24% of the rural population depends on these sources. The rural water
supply situation in NWFP and Balochistan is worse; about 46% and 72% respectively of the rural
population depend on water from a dug well or from a river/canal/stream.
Unchecked use of hazardous chemicals, vehicle emissions, and industrial activity has
contributed to a number of environmental and health hazards, chief among them being water
pollution. Much of the country suffers from a lack of potable water due to industrial waste and
agricultural runoff that contaminates drinking water supplies.
There is very little separation of municipal wastewater from industrial effluent in Pakistan. Both
flow directly into open drains, which then flow into nearby natural water bodies. There is no
regular monitoring programme to assess the water quality of the surface and groundwater
bodies. There is no surface water quality standard or drinking water quality standard in
Pakistan.
It is estimated that 40 million residents depend on irrigation water for their domestic use,
especially in areas where the groundwater is brackish. The associated health risks are grave, as
bacteriological contamination of irrigation water often exceeds WHO limits even for irrigation.
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Major industrial contributors to water pollution in Pakistan are the petrochemicals, paper and
pulp, food processing, tanneries, refineries, textile and sugar industries. Only a marginal
number of industries conduct environmental assessments (about 5 % of national industries).
The sugarcane based industry, the 2nd largest in the country, is a major cause of industrial
water pollution.
The problem of industrial water pollution has remained uncontrolled because there have been
little or no incentives for industry to treat their effluents.
The salinity level of groundwater is increasing. Industrial
wastewater including toxic chemicals, organic matter and
heavy metals is discharged directly into public sewers
without prior treatment. There is reported leaching of
wastes into groundwater, causing outbreaks of water-borne
dis eases. At present, irrigation uses about 93% of the water
currently utilized in Pakistan.
The links between water quality and health risks are well established. An estimated 250,000
child deaths occur each year in Pakistan due to water-borne diseases. Apart from the human
losses, these diseases are responsible for substantial economic losses.
(Source for stats: Pakistan Council for Research in Water Resources)
Medical Conditions
Human Resource in health care is not appropriately planned in Pakistan, with the result that
there are more doctors than nurses, lack of trained midwives, urban concentration, brain drain
from rural to urban areas and abroad, along with other issues related to curriculum, quality of
graduates and their continuing supervision. The service structure for health workers is poorly
defined. It favors tenure over competence, largely ignores technical capacities and does not
allow incentives or rewards for performance.
There is absence of doctors in government hospitals and clinics and medical staff only comes to
mark their attendance and go away and are not available at the time of need or emergency.
Furthermore, quacks are destroying the health of innocent people.

More than 600,000 quacks are operating across the country. Quacks
trap credulous people by making false claims and through media
campaigns. These practitioners advertise through hoardings
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inscribed with misleading claims and through wall chalking in commercial and residential
localities across the country. Many of these quacks are rapists and lure naïve patients towards
them with the intention of raping them.
Unhygienic conditions and use of unsterilized equipment by quacks sitting at different localities
are spreading a number of diseases including cancer, hepatitis B and C, and AIDS. A number of
quacks are doing business unchecked while the main cause for spread of these diseases is
dental treatment.
HIV/AIDS spreads through unscreened blood transfusion, reuse of used synergies and unsafe
sexual behavior. The disease also spread through use of used razors and needles mainly
amongst drug addicts. There is a dire need to create awareness among people, of the disease
for their protection.
Child Health Issues
Child health in Pakistan is among the most important national issues

that have been given much attention. Nutritional disorders are
common and particularly effect women and children. According to
statistics, 27 infant deaths occur per thousand, 19 child deaths per
thousand and 11 percentage babies are born with low birth weight.
The child mortality in Pakistan is a major cause of concern, with every 1
among 10 children dying before reaching the age of five and 1 among
30, just after they are born. Pneumonia and air pollution seem to be
the factors affecting the health of the children.
Some other reasons of why child birth issues arise are:
 High fertility rates

 Lack of skilled birth attendance
 Insufficient availability of proper maternal and child care services
 Communicable diseases
 Low female literacy poverty
 Insufficient emergency obstetric and newborn care system
 Lack of clean water and hygiene milk
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Women Health
Ours is a male dominant society where only very few females enjoy
full rights and have access to opportunities of even very basic
human needs. This is even more true in the health sector, where
unfortunately there is a great lack of female doctors combined with
a large number of female 'quacks' in the country and the situation is
at its worst in some rural areas where there is only one or two
qualified female doctors. The female doctors are neither easily available nor easily affordable
and women do not prefer to be examined by male doctors.
There are a lot of government hospitals which provide free or low fee treatment to women but
those are not preferred because of:
 The casual and offhand behavior of doctors

 More than one male doctor examining the patient at one time
 The fear of crowds of medical students present at time of examination
 The fear that doctor may misuse this opportunity for some evil deed
Women in rural Pakistan have lesser access to health care than men, because of absence of
female doctors. Factors like lack of awareness regarding women’s health requirements, low
literacy ratio, low social status and civil constrains on females are responsible for women’s
below standard health.
Intra-household bias in food distribution leads to nutritional deficiencies among female

children. Early marriages of girls, excessive childbearing, lack of control over their own bodies,
and a high level of illiteracy adversely affect women's health. More than 40 percent of the total
female population is anemic.
The maternal mortality rate is high, as only 20 percent of women are assisted by a trained
provider during delivery.
In rural areas, women are unaware of contraceptives, thus sexually transmitted diseases and
bad health in women are common. They are at a risk of contracting HIV-AIDS and other sexually
transmitted diseases (STDs) because of male dominance in sex relations and lack of access to
information. In these areas, women are like slaves subject to drudgery. They are there just to
obey their fathers, brothers and husbands. They do not have the right to decide about
themselves because women are considered as foolish creatures according to the dominant
social and cultural norms. Likewise marriage is also a sort of trade between different families
Page 8 of 35
both in the rural and urban areas. They are highly vulnerable to violation of their rights to life.
Many women lose their lives in the name of honor killings.
There is a direct link between the health statuses of women and women’s low societal standing
in Pakistan. For instance, the maternal mortality rate in rural Balochistan is 800 maternal deaths
to 100,000 live births. This ratio in the end adversely strikes at the health of her children as well
as national economy. Not only can these but evident differences among health status of women
and men are visible in Pakistani polity. The poor women’s health is as much a social plight as
much it is medically.
Factors like lack of awareness regarding women’s health requirements, low literacy ratio, low
social status and civil constrains on females are responsible for women’s below standard health
in Pakistan. Men and women both are poorly educated about family planning consequently
affecting the health of mother and child. Perhaps the greatest loss to the family and economy
of a country as one need to comprehend that woman is the glory of all that is created.
Health according to Islam
From an Islamic perspective health is viewed as one of the greatest blessings that God has
bestowed on mankind. It should be noted that the greatest blessing after belief is health, as
narrated in the following Hadith:
The final messenger of God, Prophet Muhammad (pbuh) mounted the pulpit, then wept and
said, "Ask Allah (swt) for forgiveness and health, for after being granted certainty, one is given
nothing better than health."
Related in Tirmidhi
Islam emphasizes on not taking health for granted. God has entrusted us with our bodies for a
predestined period of time. He will hold us to account on how we looked after and utilized our
bodies and good health.
The preservation of this blessing can only be achieved through

taking good care of one’s health and taking every measure to
maintain and enhance it. With this in mind every Muslim should
make sure they undertake all necessary actions which are
conducive to the preservation of good health. Healthy living is
part and parcel of Islam, introduced with the inception of Islam
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more than 14 centuries ago. Furthermore, the Quran and the Sunnah outline the teachings that
show every Muslim how to protect his health and live life in a state of purity. Numerous
examples in Islam instruct its followers to live a healthy life by performing actions such as:
 Daily Prayer
 Ablution / Ghusal
 Taking good / healthy diet and nutrition
 Fasting
 Prohibition of intoxicants
Islam places great emphasis on cleanliness, in both its physical and spiritual aspects. On the
physical side, Islam requires the Muslim to clean his body, his clothes, his house, and the whole
community, and he is rewarded by God for doing so. Prophet Muhammad (pbuh) said, for
example:
"Removing any harm from the road is charity (that will be rewarded by Allah)." [Bukhari]
While people generally consider cleanliness a desirable attribute, Islam insists on it, making it
an indispensible fundamental of the faith. A Muslim is required to be pure morally and
spiritually as well as physically. Through the Qur'an and Sunnah Islam requires the sincere
believer to sanitize and purify his entire way of life.
In the Qur'an Allah commends those who are accustomed to cleanliness:
"Allah loves those who turn to Him constantly and He loves those who keep themselves pure
and clean." [2: 22]
In Islam the Arabic term for purity is Taharah. Books of Islamic jurisprudence often contain an
entire chapter with Taharah as a heading.
Allah orders the believer to be tidy in appearance:
"Keep your clothes clean." [74:4]
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The Qur'an insists that the believer maintain a constant state of purity:
"Believers! When you prepare for prayer wash your faces, and your hands (and arms) to the
elbows; rub your heads (with water) and (wash) your feet up to the ankles. If you are ritually
impure bathe your whole body." [5: 6]
Ritual impurity refers to that resulting from menstrual release, menstruation and the first forty
days after childbirth. Muslims also use water, not paper or anything else to after eliminating
body wastes.
Prophet Muhammad advised the Muslims to appear neat and tidy in private and in public. Once
when returning home from battle he advised his army:
"You are soon going to meet your brothers, so tidy your saddles and clothes. Be distinguished in
the eyes of the people." [Abu Dawud]
On another occasion he said:
"Had I not been afraid of overburdening my community, I would have ordered them to brush
their teeth for every prayer." [Bukhari]
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Health
Indicators and Targets
Some graphs and statistics related to health in

Pakistan shows the reality of health conditions:
Total Expenditure on Health (Federal &Provincial)

Year Develop Non- Tota Health
ment developm l Expend
ent iture as
% of
GDP
2003 8.5 24.3 32.8 0.58
-04 (25.9%) (74.0%)
2004 11.0 27.0 38.0 0.57
-05 (28.9%) (71.0%)
2005 16.0 24.0 40.0 0.51
-06 (40.0%) (60.0%)
2006 20.0 30.0 50.0 0.57
-07 (40.0%) (60.0%)
2007 27.0 32.0 60.0 0.57
-08 (45.0%) (53.3%)
2008 33.0(45.5 41.1(54.5 74.0 0.55
-09 %) %)
Page 12 of 35
• The health expenditures have increased to 74 billion rupees in recent years however it has
not increased in terms of % of GDP, the WHO recommended % of GDP on health is atleast
2%
• The development component of health expenditure has grown significantly
Source: Economic Surveys of Pakistan
Page 13 of 35
Financing Health (2009 stats)
• The following table shows the exact layout of health expenditure in Pakistan
• The annual per capita health expenditure is about 19 USD out of which 6.5 USD are spent by
the Government of Pakistan channels and the rest of 65% is out of pocket expense.
• In developed countries the total health expenses are much higher e.g. UK has more than
2000 USD Total Health Expenditure (THE).
• However the recommendations for developing countries to achieve Millennium

Development Goals by 2015 are to spend between USD 30-40 on minimal essential health
services.
Pak Afgh India Bangl

Indicator
Year 2009
Total health expenditure (THE) as % of GDP 2.6 9.2 3.6 3.2
General government exp. on health as % of THE 33.6 32.4 25 31.8
Private expenditure on health as % of THE 64.5 67.6 75 68.2
General government expenditure on health as % of

7.5 6.2 3.4 7
total government expenditure
Social Security expenditure on health as % of General

0.3 0 4.9 0
government expenditure on health
Per capita THE (US$) 19.37 27 29 12
Per capita government expend. on health (US$) 6.50 9 7 4
Page 14 of 35
Contributions to health care
3%
28%
Tax
Donors
Out of pocket
5%
Others
65%
• We can see from above pie chart that the proportion of out of pocket expenses is high
considering the poverty levels in Pakistan and the presence of an unregulated private
sector.
• This inevitably leads to increase in poverty because of catastrophic health expenses.
Source: National Health Accounts Survey
Page 15 of 35
Health Investment by Government of Pakistan & Partners (2008 stats)
*GoP: Government of Pakistan

*MoH: Ministry of Health
*DoH: Department of Health
*MoPW: Ministry of Population Welfare
• The amount contributed by health partners is about 20%.
• This is low as compared to other countries in the region and is variable depending on
political environment.
• Donor money is mostly channeled into development projects.
• In order to achieve Millennium Development Goals targets. not only the Government
spending should increase but it should also be complimented by international community.
Source: Inventory of H & P Investment Pakistan, GoP & WHO
Page 16 of 35
Health Delivery System (2008 stats)
• Pakistan has about 134,000 registered doctors and, 65,000 registered nurses with one bed
for about 1500 of population.
• There are about 5000 basic health units and rural health centers in the Government sector
spread all over the country.
• The private sector has a larger presence in urban communities and exact figures are not
available.
Source: Population Reference Bureau
Page 17 of 35
Burden of Disease (2009 stats)
• Pakistan has a double burden of disease.
• However, it is heavily dominated by communicable diseases as shown in the graph.
• Diseases like diarrhea, pneumonia, TB and Malaria are further compounded by malnutrition
(about 45% of children and 50% of women are effected) leading to more than 50% share in
mortality.
• In non communicable diseases heart conditions, diabetes, hypertension, cancer and injuries
are important diseases.
• 11% of deaths are contributed by heart diseases.
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• Polio is still present in Pakistan and efforts are being made to eradicate polio.
Source: WHO
Page 19 of 35
Infant Mortality Rate (2009-10 stats)
The table below shows the number of deaths of infants under one year old in a given year per
1,000 live births in the same year; included is the total death rate, and deaths by sex, male and
female.
Infant mortality rate: total: 67.36 deaths/1,000 live births

male: 70.65 deaths/1,000 live births
female: 63.91 deaths/1,000 live births
Year Infant mortality rate Rank Percent Change

2003 76.53 33 -
2004 72.44 36 -5.34 %
2005 72.44 37 0.00 %
2006 70.45 37 -2.75 %
2007 68.84 33 -2.29 %
2008 66.94 32 -2.76 %
2009 65.14 32 -2.69 %
2010 67.36 28 3.41 %
Source: CIA World Factbook
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Government of Pakistan’s Expenditure on Health Affairs and Services (2008-09 stats)
Under health Affairs and Services a total allocation of Rs 6484 million has been made in the
budget 2009-10. This allocation is higher by 18% when compared with budget of 2008-09.
Details are given in the following Table:
Classification Budget 2008 – 09 Budget 2009 – 10

Million PKR Million PKR
HEALTH AFFAIRS AND 5490 6484
SERVICES
Medical Products, Appliances 54 65

and Equipment
Hospital's Services 4892 5708
R & D Health 2 2
Health Administration 195 241
Statistics about Hospitals in Pakistan (2008 stats)
Total Health Facilities: 13,937
Hospitals: 965
Dispensaries: 4,916
Basic Health Units: 4,872
Rural Health Centers: 595
MCH Centers: 1,138
TB Centers: 371
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First Aid Points: 1,080
Beds in hospitals & dispensaries: 105,005
Population per bed: 1,515
Population to health facility ratio: 11,413
Source: Federal Bureau of Statistics, Government of Pakistan
Statistics about Registered Doctors and Nurses in Pakistan (2008 stats)
Doctors: 107,835
Doctors registered as specialists: 19,623
Dentists: 7446
Dental specialists: 433
Nurses: 43,646
Midwives: 2,788
Lady Health Visitors: 3,864
Lady Health Workers: 95,000
Lady Health Supervisors: 3,385
Population per doctor: 1,475
Population per dentist: 21,362
Population per nurse: 3,644
Source: Federal Bureau of Statistics, Government of Pakistan
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Per Capita Water Availability (2009 stats)
Year Population Per Capita Availability (m3)
1951 34 5300
1961 46 3950
1971 65 2700
1981 84 2100
1991 115 1600
2000 148 1200
2010 207 850
2025 267 659
Source: Draft State of Environment Report
Pakistan’s Water Scenario
Year 2004 2025

Availability 104 MAF 104 MAF
Requirement(including 115 MAF 135 MAF
drinking water)
Overall Shortfall 11 MAF 31 MAF
It is observed that the expanding imbalance between supply and demand has not only led to
water shortages but also initiated an unhealthy competition amongst end users, which is
ultimately causing environmental degradation in the form of persistent increase in water
logging in certain areas, decline of groundwater levels in other areas, intrusion of saline water
into fresh groundwater reservoirs, etc.
Source: Ten Year Perspective Development Plan 2001-11, Planning Commission
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Wastewater produced annually by towns and cities (2007 stats)
Domestic waste containing household effluent and human waste is either discharged directly to
a sewer system, a natural drain or water body, a nearby field or an internal septic tank. It is
estimated that only some 8% of urban wastewater is treated in municipal treatment plants. The
treated wastewater generally flows into open drains, and there are no provisions for reuse of
the treated wastewater for agriculture or other municipal uses. Table below shows ten large
urban centers of the country, which produce more than 60% of the total urban wastewater
including household, industrial and commercial wastewater.
City Urban Total % of % Receiving

Population Wastewater Total Treated Water
Produced Body
(million m3/y)
Lahore 5,143,495 287 12.5 0.01 River Ravi,
irrigation
canals,
vegetable
farms
Faisalabad 2,008,861 129 5.6 25.6 River Ravi,
River
Chenab and
vegetable
farms
Gujranwala 1,132,509 71 3.1 - SCARP drains,
vegetable
farms
Rawalpinidi 1,409,768 40 1.8 - River Soan
and
vegetable
farms
Page 24 of 35
Sheikhupura 870,110 15 0.7 - SCARP drains
Multan 1,197,384 66 2.9 - River Chenab,
irrigation
canals
and vegetable
farms
Sialkot 713,552 19 0.8 - River Ravi,
irrigation
canals
and vegetable
farms
Karachi 9,339,023 604 26.3 15.9 Arabian Sea
Hyderabad 1,166,894 51 2.2 34.0 River Indus,
irrigation
canals
and SCARP
drains
Peshawar 982,816 52 2.3 36.2 Kabul River
Other 19,475,588 967 41.8 0.7 -
Total Urban 43,440,000 2,301 100.0 7.7 -
Source: Master Plan for Urban Wastewater (Municipal and Industrial) Treatment Facilities in
Pakistan. Final Report, Lahore: Engineering, Planning and Management Consultants.
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Estimated Cost from Water related Mortality and Morbidity
Source: Pakistan Strategic Country Environmental Assessment Report, May 2008
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Government’s role
Government of Pakistan has made commitments to the Millennium
Development Goals (MDGs). Through its major health intervention
programs, the Ministry of Health has pursued strategies aimed at:
 Reducing:
o The under-five mortality rate from an estimated 140 in 1990

to a target of 52 by 2015.
o The infant mortality rate from an estimated 110 in 1990 to a target of 40 by 2015.
o The maternal mortality ratio from an estimated 530 in 1990 to a target of 140 by
2015.
 Increasing:
o The proportion of 1 year-old children immunized against measles from an estimated

50% in 1990 to a target of 85% by 2015.
o The proportion of births attended by skilled health personnel from an estimated 20%
in 1990 to a target of > 90% by 2015.
 Combating:
o TB, Malaria, HIV/AIDS and other communicable diseases.
The 2008 report of the MDG Gap Taskforce revealed that while there has been much progress
during the last decade, the delivery on commitments has lagged behind schedule.
Pakistan has:
 Reduced the under-five mortality rate by 25 during the 1990s but has achieved no further
reductions in the past decade;
 Maintained the same infant mortality rate of around 75 in the past decade;
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 Slightly increased the proportion of 1 year-old children immunized against measles to 60%;
 Significantly reduced the maternal mortality ratio to 280; and
 Doubled the proportion of births attended by skilled health personnel to 40%.
However, these gains would still fall short of the targets identified for the remainder of the
current timeframe.
The government is cognizant that there are other determinants of health, such as illiteracy,
unemployment, gender inequality, social exclusion, food insecurity, rapid urbanization,
environmental degradation, natural disasters, lack of access to safe water and sanitation that
aggravate Pakistanis’ health status. The ministry of health has the human resource capacity and
is willing to assume a leadership role wherever deemed necessary in initiatives that remove
these barriers for the betterment of health and eradication of diseases.
The effectiveness of health initiatives will only be maximally achieved

if the ministry of h ealth is able to reach out to and help coordinate
the activities of other authorities responsible for education,
sanitation, water supply and environment.
The Government recognizes that Primary Health Care (PHC) is the

only practical approach to improve health of our population. The
Government needs to strengthen the health systems to respond
better and quickly to the challenges of an evolving Pakistan, resulting
in a healthy nation.
Health Policy of the Government
Vision
The vision of the National Health Policy is to improve the health and quality of life of all
Pakistanis, particularly women and children, through access to essential health services.
Goal
The goal of the national health policy is to remove barriers to access to affordable, essential
health services for every Pakistani.
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Policy Objectives
To achieve the above stated goal of removal of barriers to essential health services, the
Government of Pakistan adopts the following six Policy Objectives to reform and strengthen
critical aspects of its health systems to enable it to:
1. Provide and Deliver a basic package of quality Essential Health Care Services.
2. Develop and manage competent and committed health care providers.
3. Generate reliable health information to manage and evaluate health services.
4. Adopt appropriate health technology to deliver quality services.
5. Finance the costs of providing basic health care to all Pakistanis.
6. Reform the Health Administration to make it accountable to the public.
The Ministry of Health recognizes that provinces

have varied needs and expectations regarding
health and that each Department of Health is fully
capable of identifying as well as delivering
appropriate health care to their populations. It is in
this spirit that the federal ministry will support and
facilitate the provinces in implementation of their
strategies by providing relevant financial and
technical resources to ensure that essential health service package is accessible to all the
citizens. The national health policy has been formulated with the primary objective of
resonating with the expectations of Provinces. It is designed to contribute to advancing and
strengthening the provincial health strategies.
The National Health Policy of Pakistan of 2009 sought to improve the health of the nation.
Despite global financial constraints, national economic down turn and inefficiencies of the
health system, the policy will harness existing resources to reduce the burden of disease in
Pakistan and overcome barriers to access to health care for the very poor. It will do so by
defining and delivering a set of basic health services for all by optimizing available funds use,
improving health manpower, gathering and using reliable health information to guide program
effectiveness and design by strategic use of emerging technology. To achieve these objectives
Page 30 of 35
the policy will be guided by the Poverty Reduction Strategy Paper and Pakistan’s international
commitments such as to the Millennium Development Goals.
Government’s Health Programs in Pakistan
Expanded Program on Immunization (EPI)

The Expanded Program on Immunization (EPI) was launched in 1978. It aims at protecting
children by immunizing them against Childhood Tuberculosis, Poliomyelitis,
Diphtheria, Pertussis, Measles, Tetanus and also their mothers against Tetanus.
The Program has significantly progressed during the period of time in terms of
immunization coverage and disease reduction and has developed its own
surveillance system, cold chain system, field supervisory mechanism, regular
monitoring system, evaluation strategy and sufficient trained manpower at all
levels throughout the country. The expenditure by Federal Ministry of health on
this Program for 2008-2009 was a total cost of Rs. 11.484 billion. This ensures the commitment
of the Federal Government for provision of vaccines, syringes, cold chain equipment, transport,
printed material and launching of health education/motivation campaign.
National Program for Family Planning & Primary Health Care (LHW Program)
The Program aims to deliver basic health services at the doorsteps of the poor segments of the
society through deployment of Lady Health Workers (LHWs) living in their own localities. The
program is currently being implemented in all the districts of the country.
The program has strength of 96,000 LHWs nationwide with concentration in rural areas and
urban slums of the country. Each LHW covers 1000 population or 150 houses. These workers
are providing services to their communities in the field of child health, nutrition, family planning
and treatment of minor ailments. Population coverage of the program is about 70%.
National Tuberculosis Control Program

Tuberculosis (TB) is a major public health problem in Pakistan. The country
ranks 6th globally among the 22 high disease burden countries, and
contributes 43% of the disease burden towards the Eastern-Mediterranean
region of WHO. Responding to the challenge, the Government of Pakistan
allocated an amount of Rs. 1184 million for the period of 2005-2010.
Besides, the Global Fund has approved an amount of US$56 million to fill the
funding gap.
Page 31 of 35
National Malaria Control Program
The goal of the Program is to improve the health status of the population by effectively
controlling malaria through implementation of the Roll Back Malaria strategies. The five year
plan is a step towards achieving the WHO global RBM target of 50% reduction in the malaria
burden by the end of this year 2010. Considerable progress has been made with regard to
involvement of NGOs, awareness and operational research. The Directorate of Malaria Control
was successful win a grant of over US$23 million in Round 7 of the Global Fund.
National Maternal, Neonatal and Child Health (MNCH) Programme

Pakistan’s Maternal and Child Health indicators remain extremely poor every year
as 25,000 to 30,000 women die from complications of pregnancy and child birth.
Millions more suffer ill health and disability. One million children die before the
age of 5 while 16,000 die in the first month after birth.
Prior to 2005, Ministry of Health did not have a separate strategy on MNCH, as a
result of which the maternal newborn and child health services were w eak, insufficient and
fragmented. The Ministry of Health established a cell in the Ministry in February 2005.
National Programme for Prevention and Control of Hepatitis

Responding to the growing trends of hepatitis in general population, the programme (2005-10)
was launched to decrease substantially the prevalence, morbidity and mortality.
National AIDS Control Programme

Pakistan is the second largest country in SouthAsia that stands only a few steps
behind India and Nepalin terms of HIV epidemic. Until recently Pakistan was
classified as a ‘low prevalence high risk’ country but now Pakistan is in a
‘concentrated phase’ of the epidemic with HIV prevalence of more than 5%
among injecting drug users (IDUs) in at least eight major cities. According to the
latest national HIV estimates there are approximately 97,400 cases of HIV/AIDS
in Pakistan.
The National AIDS Control Program and its provincial units are currently implementing a
program throughout the country to halt the HIV epidemic. The principal components of the
program include interventions for target groups, HIV prevention campaign for general public,
prevention of HIV transmission through blood and blood products, and capacity building and
Programme management. The programme aims to control HIV/AIDS cases by creating
awareness and promoting blood safety through strengthening safe blood transfusion services.
Current cost of the program is of Rs. 2.85 billion (2008-09).
Page 32 of 35
Major components of the programme include expansion of interventions for vulnerable
population, prevention of transmission through blood transfusion, improved HIV prevention by
the general public through behaviour change communication, targeted intervention for youth,
labour, and uniformed personnel.
Page 33 of 35
Bibliography
 Health care in Pakistan: http://en.wikipedia.org/wiki/Health_care_in_Pakistan
 Water pollution: http://www.environment.gov.pk/PRO_PDF/PositionPaper/Water

%20Pollution.pdf
 Women in Pakistan: http://www.marxist.com/women-pakistan-victims-of-desecration.htm
 Quacks spreading aids: http://www.dailytimes.com.pk/default.asp?page=story_30-5-

2005_pg7_36
 People falling prey to quacks: http://www.pakspectator.com/naive-people-falling-prey-to-

quacks/
 Analysis of maternal mortality: http://www.ayubmed.edu.pk/JAMC/PAST/15-2/shamshad

%20maternal%20mortality.htm
 Maternal mortality rates in Pakistan: http://www.chowrangi.com/maternal-mortality-rates-

in-pakistan-a-human-rights-issue.html
 Cleanliness in Pakistan: http://www.chowrangi.com/cleanliness.html
 Child health in Pakistan: http://www.mapsofworld.com/pakistan/health-care/child-

health.html
 The determinants of child health in Pakistan:

http://www.sdpi.org/whats_new/recent_publications/The-Determinants-of-Child-Health-
in-Pakistan.pdf
 Cleanliness in Islam: http://www.islamtomorrow.com/islam/cleanliness.htm
 Health and well being in Islam: http://www.missionislam.com/health/index.htm
Page 34 of 35
 Women health status in Pakistan: http://www.chowrangi.com/women-health-status-in-
pakistan.html
 Women’s health problems in Pakistan: http://www.mejfm.com/journal/oct03/Women.pdf
 Ministry of health Pakistan: http://www.health.gov.pk/
 Pakistan Council for Research in Water Resources: http://www.pcrwr.gov.pk/
 Economic Surveys of Pakistan: http://www.finance.gov.pk/finance_economic_survey.aspx
 WHO National Health Accounts for Pakistan: http://www.who.int/nha/country/pak/en/
 National Health Accounts Pakistan:

http://www.statpak.gov.pk/depts/fbs/publications/national_health_account2005_06/Natio
nal_Health_Accounts.pdf
 Population Reference Bureau Pakistan: http://www.prb.org/Countries/pakistan.aspx
 CIA World Factbook Pakistan: https://www.cia.gov/library/publications/the-world-

factbook/geos/pk.html
 Federal Bureau of Statistics Pakistan: http://www.statpak.gov.pk/depts/index.html
 WHO: http://www.who.int/countries/pak/en/
 Draft State of Environment Report: http://www.environment.gov.pk/pub-

pdf/StateER2005/Title%20&%20TOC.pdf
 Ten Year Perspective Development Plan 2001-11, Planning Commission:

http://unpan1.un.org/intradoc/groups/public/documents/APCITY/UNPAN018851.pdf
 Pakistan Strategic Country Environmental Assessment Report: http://www.boell-

pakistan.org/downloads/Strategic_country_assessment.pdf
Page 35 of 35

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RURAL SOCIOLOGY

HEALTH ISSUES IN PAKISTAN & GOVERNMENT’S ROLE

Syed Nauman Tauqir

The issue of health..........................................................................................................................3

The issue of health

Amongst the population of Pakistan, the burden of diseases

A number of non-financial constraints have played an equally important role in the

Water is an essential element for our survival. Unfortunately, while

(Source for stats: Pakistan Council for Research in Water Resources)

Furthermore, quacks are destroying the health of innocent people.

Child Health Issues

Child health in Pakistan is among the most important national issues

Some other reasons of why child birth issues arise are:

 High fertility rates

 The casual and offhand behavior of doctors

Intra-household bias in food distribution leads to nutritional deficiencies among female

Health according to Islam

The preservation of this blessing can only be achieved through

 Taking good / healthy diet and nutrition

In the Qur'an Allah commends those who are accustomed to cleanliness:

Allah orders the believer to be tidy in appearance:

"Keep your clothes clean." [74:4]

On another occasion he said:

Some graphs and statistics related to health in

Total Expenditure on Health (Federal &Provincial)

• The development component of health expenditure has grown significantly

Source: Economic Surveys of Pakistan

Financing Health (2009 stats)

• However the recommendations for developing countries to achieve Millennium

Pak Afgh India Bangl

Total health expenditure (THE) as % of GDP 2.6 9.2 3.6 3.2

General government exp. on health as % of THE 33.6 32.4 25 31.8

Private expenditure on health as % of THE 64.5 67.6 75 68.2

General government expenditure on health as % of

Social Security expenditure on health as % of General

Per capita THE (US$) 19.37 27 29 12

Per capita government expend. on health (US$) 6.50 9 7 4

Contributions to health care

• This inevitably leads to increase in poverty because of catastrophic health expenses.

Source: National Health Accounts Survey

Health Investment by Government of Pakistan & Partners (2008 stats)

*GoP: Government of Pakistan

• The amount contributed by health partners is about 20%.

• Donor money is mostly channeled into development projects.

Source: Inventory of H & P Investment Pakistan, GoP & WHO

Health Delivery System (2008 stats)

Source: Population Reference Bureau

Burden of Disease (2009 stats)

• Pakistan has a double burden of disease.

• However, it is heavily dominated by communicable diseases as shown in the graph.

• 11% of deaths are contributed by heart diseases.

Infant Mortality Rate (2009-10 stats)

Infant mortality rate: total: 67.36 deaths/1,000 live births

Year Infant mortality rate Rank Percent Change

Source: CIA World Factbook

Government of Pakistan’s Expenditure on Health Affairs and Services (2008-09 stats)

Classification Budget 2008 – 09 Budget 2009 – 10

Medical Products, Appliances 54 65

Hospital's Services 4892 5708

Health Administration 195 241

Statistics about Hospitals in Pakistan (2008 stats)

Total Health Facilities: 13,937

Basic Health Units: 4,872

Rural Health Centers: 595

Health Issues in Pakistan and Government's Role

Health Issues in Pakistan and Government's Role