The role of contractual arrangements in improving health sector ...

BACKGROUND
Country profile [1]
Pakistan
Pakistan has an area of 307 374 square miles (796 095 square kilometres), with an
overall population density of 182 persons per square kilometre. There are four provinces,
Punjab, Sindh, North West Frontier Province (NWFP) and Baluchistan, and two regions Azad
Jammu Kashmir (AJK) and Federally Administered Northern Area (FANA). Afghan refugees
reside in certain areas of the country in significant numbers.
Punjab is the most populous province of Pakistan, with a population of 80.3 million and
an area of 205 345 square kilometres. About two-thirds of its population resides in rural areas
and agriculture is the chief source of income and employment in Punjab. Similarly the
population of Sindh is 33.8 million. Asian Punjab most people like live in rural areas and
work in fields to earn their livelihood. The population of NWFP is 19.4 million, and
Baluchistan is 6.5 million. Baluchistan is the largest province in area. The population of AJK
has been estimated at 3.5 million people, most of whom live in scattered hilly areas which are
not accessible at times during the year due to weather.
The human development indicators for Pakistan, particularly for health, are still low
despite progress made in recent years. The national health status is characterized by high
population growth (2.2%), low life expectancy (64.0), high infant mortality (82 per 1000live
births) and child (under 5 years) mortality rates (105 per 1000 live births). This is due to the
shortage of health care personnel, uneven distribution of health facilities in the country, lack
of medicines, regional disparities in the health care services and scarcity of administrative
health care capabilities.
The health system of Pakistan is one of the largest in south-east Asia. The system
comprises an extensive network of primary, secondary, and tertiary health facilities and
specialized health institutes. Medical facilities in the country have improved significantly over
the years. However, there still remains a very large gap between the availability and
requirements. At present, there are 108 062 registered doctors, 5530 dentists and 46 331
nurses in the country, equivalent to ratios of 1404 persons per doctor, 27 414 persons per
dentist and one nurse per 3296 persons. There are about 906 hospitals, 4554 dispensaries,
5290 basic health units and 552 rural health centres. The availability of hospital beds in all
medical facilities has been estimated at 98 684, equivalent to a population–bed ratio of 1536
persons per bed. The figures available for the medical facilities clearly indicate the need for
further expansion or alternative arrangements for provision of health care.
Both public and private spending on health in Pakistan are very low. However, over the
years spending has increased steadily. During 2003–2004, the total expenditure on health was
estimated at 32.8 billion Pakistani rupees (PKR) (PKR 8.5 billion development and PKR 24
billion as recurring), which amounts to 0.84% of GNP and shows an increase of 13.8% over
the previous year.
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