A publication of the ministry of health has called for more investment as well as enhancement of implementation capacity to make progress towards reaching these goals.
Already, health indicators of Pakistan, which has graduated to the middle income countries, are very poor as compared to several regional countries.
These facts emerged from the latest document "Health Sector Reforms" presented at the recent national health conference held in Islamabad during this month. The official document calls for greater investment and enhancement of implementation capacity to make significant progress towards reaching the MDGs in the health sector.
According to the official document, a total of Rs 22.21 billion was required to finance the ongoing and new projects of the ministry of health for implementing the action plan, but during the last four years the allocation was Rs 11.895 billion, ie slightly above fifty percent of the actual requirements. In the circumstances, one can imagine how the targets could have been achieved.
The pattern of required expenditure and allocation in PSDP has been as such: Proposed expenditure in 2001-02 was Rs 5.216 billion, but the PSDP allocation was Rs 4.213 billion, in 2002-03 the allocation was Rs 3.309 billion against the proposed amount of Rs 8.115 billion, in 2003-04 allocation was Rs 4.373 billion against the proposed expenditure of Rs 8.880. It was during this year that the allocation rose to Rs 6.044 billion, against the proposed requirement of Rs 7.152 billion.
The document brings out the fact that the expenditures in health sector have been relatively low and that PSDP expenditure in health sector has been lower as compared to other countries of the region.
The per capita total health expenditure (THE) in Pakistan is 16 dollars, of which the per capita government health expenditure (GHE) is only four dollars.
The document adds: it compares unfavourably with a figure of 34 dollars per capita for a package of essential health services proposed in the recent WHO report on Macro Economic Commission on Health.
The document gives the following picture of the total health expenditure (THE) and government health expenditure (GHE) for Pakistan and other countries. In Pakistan, total health expenditure (THE) in percentage of GDP is 3.9 as against 6.3 for Iran, 5.1 for India, Bangladesh 3.5, Sri Lanka 3.6, Thailand 3.7 and Indonesia 2.4. As such the country stands fairly well on this count.
But in the case of government expenditure on health, the position is worst. GHE as percentage of THE, in the case of Pakistan is 24.4, while for Iran it is 43.5, Bangladesh 44.2, Egypt 48.9, India 17.9, Indonesia 25.1, Sri Lanka 48.9 and Thailand 57.1.
Similarly, the per capita THE (total health expenditure) in Pakistan is 16 dollars while in Bangladesh it is 12 dollars, Egypt 46 dollars, India 24 dollars, Indonesia 16 dollars, Iran 350 dollars, Sri Lanka 30 dollars and Thailand 69 dollars.
As regards the per capita government health expenditure (GHE), Pakistan is at the bottom with a figure of four dollars which is at par with India and Indonesia, while Bangladesh shows a figure of five dollars, Egypt 22 dollars, Iran 152 dollars, Sri Lanka 15 dollars and Thailand 39 dollars.
The document further notes that public expenditure on health, at both federal and provincial levels, rarely exceeded 0.8 percent of GNP while corresponding average for low-income countries during 1990-98 has been 1.3 percent ie over 50 percent higher.
The gravity of the health situation can be judged by the social indicators. According to the World Development Report 2003, life expectancy in Pakistan is 64 years while in India it is 63 years, Sri Lanka 74 years, Bangladesh 62 years, Nepal 60 years, China 71 years, Bhutan 63 years, Thailand 69 years, The Philippines 70 years, Malaysia 73 years and Indonesia 63 years.
With regard to infant mortality, Pakistan is at the bottom with a figure of 105 per thousand while it is 67 in the case of India, 16 in Sri Lanka, 52 in Bangladesh, 60 in Nepal, 30 in China, 54 in Bhutan, 24 in Thailand, 25 in the Philippine, eight in Malaysia and 34 in Indonesia. This means Pakistan is far behind the regional countries.
Pakistan is again at the bottom with regard to the child mortality under five per 1000 with a figure of 105 followed by India with 93, Nepal 91, Bhutan 92, Sri Lanka 19, Bangladesh 77, Malaysia 8, Thailand 28 and Philippines 36 and Indonesia 45.
It is interesting to mention that the MDG for Pakistan for infant mortality is 47 per 1000 births. Several regional countries show better statistics than what the county aims at in 2015.
Besides the maternal mortality rate per 1,000,000 births at present is between 340 and 400.
The document Health Sector Reforms states that to achieve the millennium development goals, the government would have to invest more in health sector and enhance the implementation capacity to make significant progress towards reaching the MGDs.