Healthcare Inequality in Pakistan

The public-private division

Healthcare is a privilege in Pakistan. Although access to resources and quality medical care is a basic human right, the system has been divided according to socio-economic groups. This leads to disparities among the citizens. In Pakistan, this division is more evident due to the stark difference in public and private sector hospitals where infrastructure, availability of resources, technology, equipment, and overall environment communicates this bifurcation.

This creates a two-tier system that leaves the masses with limited access to life saving care. This is the ground reality of millions of Pakistanis. According to the federal budget 2025-26, Rs 46.10 billion were allocated for the Ministry of National Health Services, Regulations, and Coordination (NHSRC). That budget saw a reduction in total federal health spending as the previous health budget for 2024-2025 was, Rs 54.87 billion. The margins are the price of a commoner's life.

The growing divergence between public and private sector healthcare facilities indicates structural failure. Decades have passed but this issue has been overlooked, leaving citizens in utter destitution. Over the years, government spending on healthcare has been insufficient leading to underfunded public sector hospitals that struggle to meet the demands of a growing population.

Mostly people from villages and underdeveloped districts rush towards urban centres to seek healthcare facilities, which results in overcrowded government hospitals and insufficient resources allocation. Public hospitals in rural areas are understaffed, under-resourced, and mismanaged making it difficult for healthcare staff to provide the necessary care. Indigent people have to travel long distances to acquire basic medical facilities.

Pakistan’s divided healthcare system is a financial burden on citizens, particularly from lower income backgrounds already struggling to meet both ends. Out-of-pocket payments make up a larger portion of healthcare expenditures in Pakistan. According to the World Bank, impoverished households in Pakistan spend on average 20 percent of their income on healthcare. For many families, this means to choose between getting medical treatment over other basic needs. This situation has left a large portion of the population unguarded to medical expenses. To mitigate this financial burden Sindh government has increased the total health budget to an estimated Rs 371.87 billion for the fiscal year 2025–2026, up from Rs 347.57 billion in the previous year. Indeed, it has been a step toward relief but progress challenged by the dual burden including geography and poverty. Rural realities are reflecting ineffective operations where transparency in budget utilization lacks accountability.

On the other hand, the private sector hospitals are well equipped and big cities like Karachi, Lahore, Islamabad, offers better facilities and patients treated with personalized care. These facilities are not accessible to all because the cost of being a patient in Pakistan is beyond the reach of hand=to-mouth individuals. Despite the government spending billions on the public health sector, the private sector dominates and handles a lion’s share in terms of patients.

Moreover community driven health initiatives, such as awareness campaigns and medical camps can serve a pivotal role linking the government to the people, ensuring that resources reach those who need them the most. Pakistan will come out of this slough by taking bold, decisive action to close the divide between the two healthcare systems across the country. If Pakistan wants to realize its national potential. It must be ensured that every citizen irrespective of their financial status, and geographical location can have access to quality healthcare. Beyond just contemplation, it is the time to act now, before the rift widens further.

This demonstrates the trust gap due to the perception of compromised standards of facilities in the public sector. This paradox stigma can be resolved if the government subsidizes the healthcare expenditures and allocates a segment of the health budget for that.  Medical facilities should be equally accessible to all, irrespective of their income level. This systemic approach to healthcare needs to reform. Authorities should focus on both improving the quality of the public sector while ensuring that the private sector is not a luxury reserved for the elites.

After the 18th Amendment, provinces are regulating healthcare budgets. The total spending for the healthcare sector in Punjab for the year 2025-2026 is Rs 630.5 billion, a roughly 17 percent increase from the previous budget. Whereas in Balochistan Rs 87 billion has been allocated reflecting a six percent increase. Moreover, Khyber Pakhtunkhwa allocated Rs 276 million for healthcare maintain as the pioneer to bridge the prolonged gap and reduce the burden on the urban healthcare system by introducing The Sehat Sahulat Program (SSP) launched in 2015 and later expanded by the federal government in 2019 as a move towards Universal Health Coverage (UHC) initiative.

Providing access to public and private hospitals and has significantly reduced out of pocket expenses of citizens across Khyber Pakhtunkhwa, Balochistan, and parts of Punjab. Here the Inglorious fate of Sindh province needed to acknowledged, where no such program is functional for the citizens. New projects are needed especially for Sindh and its villages where healthcare is still a dream for many. 

The divided healthcare system in Pakistan is not just a result of incompetence, but it is a reflection of fostering social and economic inequality in our country. While provincial budgets vary, higher allocations do not necessarily generate better outcomes but effective governance and implementation will definitely convert into a better future ahead, with Medical care as a fundamental human right and not a fortune for the few.

Moreover community driven health initiatives, such as awareness campaigns and medical camps can serve a pivotal role linking the government to the people, ensuring that resources reach those who need them the most. Pakistan will come out of this slough by taking bold, decisive action to close the divide between the two healthcare systems across the country. If Pakistan wants to realize its national potential. It must be ensured that every citizen irrespective of their financial status, and geographical location can have access to quality healthcare. Beyond just contemplation, it is the time to act now, before the rift widens further.