PAKISTAN’S health sector has been seriously underperforming because of long-term of neglect, underinvestment and weak governance. In a country of over 240 million people, public health spending remains below one per cent of the national gross domestic product (GDP). The result is a system where illness often translates into financial catastrophe, and where preventable deaths — particularly among our mothers and newborns — remain distressingly common. This is not simply a policy failure; it reflects deeper structural and political neglect.

At the core of the crisis lies the persistent marginalisation of primary healthcare. Basic health units and primary health centres remain inadequate both in terms of number and quality, particularly in rural areas. Also, preventive ctare continues to receive minimal attention. Although programmes, such as the Lady Health Worker initiative, have expanded outreach, they remain underfunded and poorly coordinated. Meanwhile, the disease burden is undergoing a significant transition. Non-communicable diseases, including cardiovascular conditions, diabetes and cancer, are now leading causes of mortality.

Yet, policy continues to prioritise tertiary, hospital-based interventions when the focus should be specifically on preventive and community-based strategies. This mismatch reflects a system that is driven more by political visibility than by long- term health outcomes. The consequences of this structural imbalance are increasingly visible in the quality of care delivered across public hospitals. A woman in Islamabad reportedly died recently following a biopsy procedure in which doctors allegedly extracted tissue from the wrong organ.

Similarly, hospitals in Lahore have come under scrutiny after videos circulating on social media appeared to show instances of patient mistreatment and unprofessional conduct by medical staff. It is important to situate these failures within a broader systemic context. Overburdened systems can compromise even well-trained professionals, leading to delayed diagnoses, reduced patient engagement, and increased likelihood of medical error. Therefore, while accountability is essential, it must be accompanied by structural reforms that address the root causes of institutional dysfunction.

Pakistan today faces a dual burden of disease: communicable diseases as well as maternal and neonatal health challenges persist, while non-communicable diseases are rising sharply. Yet, the health system remains ill-equipped to manage this transition. Resource allocation continues to favour curative, hospital-based care, while preventive services remain quite neglected. Challenges of governance cexacerbate the crisis even further.

Meaningful reforms would demand a fundamental reorientation of priorities. First, public spending must be significantly increased and redirected towards primary and preventive healthcare. Furthermore, governance structures must be streng- thened through merit-based appointments, transparent procurement and independent regulatory oversight to ensure overall accountability in cases of negligence. Besides, Pakistan must invest in its health workforce by standardising professional training to reduce strain on doctors and paramedical staff. Finally, stronger federal-provincial coordination is essential to integrate fragmented initiatives into a coherent national health framework.

Zakir Ullah
Islamabad

Published in Dawn, June 18th, 2026