Healthcare inequality

When being poor means delayed or no treatment 

Imagine your child has a high fever that won't break. It's been two days. You know something is wrong, but the nearest government hospital is 45 km away, there's no ambulance, the roads are terrible, and the Rs. 2,000 you'd need for transport and a consultation is money you simply don't have. So you wait. You hope. And sometimes— too many times— that waiting has consequences no parent should ever have to face.

This isn't a scene from a decades-old documentary. This is what healthcare looks like for millions of Pakistani families right now. And the hardest part? It's not that people don't want treatment. It's that the system has made it almost impossible for the poor to access it.

Let's be honest about what's happening at the top. Pakistan spends less than one percent of its GDP on public health — this comes straight from the Economic Survey 2024–25. The WHO says low-income countries should be spending at least six percent. We are nowhere close. For comparison, Iran spends 2.63 percent, Sri Lanka 1.76 percent, and even India manages 1.29 percent. Pakistan is consistently among the lowest health spenders in the entire region.

What that underspending looks like on the ground is this: more than 54 percent of all healthcare costs in Pakistan are paid out-of-pocket by families at the point of care. There is no safety net catching you when you fall sick. If you can't pay, you often just don't get treated. Research is clear that low-income households regularly skip medications, delay check-ups, and avoid the doctor until something becomes an emergency. By that point, it's often much harder— and much more expensive— to fix.

Cost is one wall. Geography is another. Despite roughly 64 percent of Pakistan's population living in rural areas, only 25 percent of the country's healthcare facilities are located there. That imbalance isn't a minor administrative oversight— it means that for the majority of Pakistanis, getting medical care requires a journey many simply cannot make.

The Pakistan Demographic and Health Survey found that only 15.4 percent of the population has a basic health unit within their community, and a mere 5.4 percent have access to a rural health centre nearby. Only 40 percent of rural areas are covered by ambulance services. So when something goes wrong at 2 am in a village in Balochistan or interior Sindh, what exactly is a family supposed to do?

The spending gap between urban and rural areas makes this even worse. A 2024 analysis by the Ministry of National Health Services found that per capita government health spending in Lahore was above $70. In 24 out of 36 districts in Punjab, it was less than $1. The same province. One dollar versus 70. That's not a gap— that's a chasm.

Every year, families in this country lose members to illnesses and complications that were entirely treatable— not because medicine failed them, but because money and distance did. That's not fate. That's a policy failure, and it has names and faces behind it. Being poor in Pakistan already comes with so many disadvantages. It should not also come with a shorter life expectancy. But right now, for far too many people, it does— and that should make all of us uncomfortable enough to demand better.

Pakistan has one of the highest maternal mortality rates in South Asia, and delay is a massive reason why. A recent study found that women who died from pregnancy complications waited an average of 3.8 days before even deciding to seek care— often because of money, distance, or needing a husband's permission. Then it took another 3.7 hours to actually reach a facility. By then, conditions that are completely manageable with timely care— haemorrhage, sepsis, hypertensive disorders— had already become fatal.

Researchers call this the 'Three Delays Model': the delay in deciding to seek care, the delay in getting to a facility, and the delay in receiving treatment once you're there. For poor families in rural Pakistan, all three delays often hit at once. A 12-year study at a Pakistani tertiary care hospital found that the first delay alone— just the delay in deciding to go— was present in over 41 percent of maternal deaths.

And it's not only mothers. Neonatal, infant, and under-5 mortality rates in Pakistan stand at 42, 62, and 74 deaths per 1,000 live births respectively. The gap between rich and poor children has actually widened in recent years, even as national averages slowly improve. A Lady Health Worker in South Punjab said it plainly in a research interview: "In poor families, pregnant women can't even get two decent meals; not to mention timely and proper medical care."

The Sehat Sahulat Programme (SSP) deserves a mention here because it was a genuine attempt at fixing this. Launched in 2015 in KP, it eventually expanded to cover around 44.6 million households by 2022— giving low-income families access to inpatient hospital care worth up to Rs 1 million per year, free of charge, at both public and private hospitals.

But the results have been messier than the headlines suggest. Only 11.8 percent of enrolled households had actually used their card, partly because people didn't know about it and partly because empanelled hospitals were still too few and too far. In some districts, one hospital was expected to serve 73,000 families. And as of July 2025, Punjab has suspended the SSP in public hospitals entirely— meaning millions of cardholders can no longer access free treatment. Progress that took years to build, reversed in a policy decision.

Telemedicine is being discussed a lot as a solution, and it does have real potential for reaching remote communities. UNFPA has already piloted reproductive health telemedicine for women in Pakistan. But until internet access, digital literacy, and basic smartphone ownership are more evenly distributed, it can only go so far.

The fixes aren't complicated— they're just inconvenient for people who control budgets. Pakistan needs to actually fund its health sector properly, not just in Lahore and Karachi but in every district. It needs more primary healthcare centres in rural areas, not just big hospitals in cities. It needs Lady Health Workers to be better supported and better paid. And it needs insurance schemes like SSP to be expanded, not gutted.

More than anything, it needs people to stop treating this as a background issue. Every year, families in this country lose members to illnesses and complications that were entirely treatable— not because medicine failed them, but because money and distance did. That's not fate. That's a policy failure, and it has names and faces behind it.

Being poor in Pakistan already comes with so many disadvantages. It should not also come with a shorter life expectancy. But right now, for far too many people, it does— and that should make all of us uncomfortable enough to demand better.