Post 18th Constitutional Amendment, health became a provincial subject almost over a decade ago. After the enactment of the 18th Amendment, the provincial governments are accountable for setting the policies, targets, and budgets for health. However, the country failed to see any major benefits of this policy change apart from blame game between the provinces.
The initial post devolution phase was challenging with regard to developing health policies. In order to fill the human resource gaps, availability of vaccines, improved health infrastructure, and so on. There is a dire need to allocate sufficient budgetary resources towards public health. While talking about increase in budgetary allocation for health, the issue related to unspent budget, delayed disbursements of funds, accountability and monitoring should be considered. Outcome budgeting is another way to motivate provincial governments to perform better and convert financial outlays into outcomes with measurable targets.
The budgetary allocation trends in the last 10 years has remain under 4% which is very low when compare to other countries in the region. In 2018 Pakistan budgetary allocation for health sector marked to 3.20% of GDP while Afghanistan, Senegal, Sudan, Nepal and Norway allocated 9.40%, 3.98%, 4.51%, 5.84% & 10.05% respectively. The community health workers (per 1000 people) in Pakistan were 0.06 in 2009, according to a World Bank report, published in 2010.
There is a universal consensus on the fact that the universal target of health cannot be achieved without the involvement of private sector. Pakistan is amongst the countries where the consultation of private health providers is at a high. The external resource for health (% of total expenditure on health) in Pakistan was reported at 4.83 % in 2010. The resources may come from international organisations, other countries through bilateral arrangements, or foreign nongovernmental organisations and are part of total health expenditure.
The total health expenditure (% of GDP) in Pakistan was reported at 2.20 in 2010. Before the passage of the 18th constitutional amendment, public spending on health in Pakistan in 2004 was about 2.91% of GDP. During 2006, government health spending failed to keep up with the expanding economy and only 2.72 % of GDP was allocated to health. These numbers fell to 2.6 and 2.54 in 2007 and 2008, respectively. The 2009–10 budgets followed the same trend and budgetary allocations for health decreased to 2.2 % of GDP.
Considering the situation, major policy shift would be required in human and financial resource allocation, away from a mechanism based. This policy shift has to be based on the particular needs of the specific areas instead of applying a blanket approach. An effective resource allocation mechanism is a key factor in supporting decentralised health systems. Decentralisation of autonomy provides an opportunity to respond to local needs within a national equity focused policy for allocating resources.
Author: Malik Wasim | Humanitarian and Social Activist
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