PRIMARY healthcare infrastructure is often the first contact with the national health system, and it focuses on prevention, basic treatment and health promotion. All over the world, governments strengthen primary services, but in Pakistan, the focus happens to be on tertiary services that are strengthened in the name of specialised category.

Nearly 46 per cent of Sindh’s population lives in rural areas, where access to quality primary and secondary healthcare remains inadequate. Despite this undeniable reality, the latest Sindh budget has allocated approximately 52pc of health expenditure to the tertiary level, while primary healthcare is set to get about 36pc and the remaining 12pc goes to secondary care services. These allocations reflect continued emphasis on teaching and specialised hospitals.

While tertiary hospitals play a rather important role in providing advanced medical treatments, an over-reliance on curative care comes at the expense of preventive and community-based health services. International evidence consis-tently demonstrates that stronger primary healthcare systems improve population health outcomes, reduce health in-equalities, and lower overall healthcare costs.

Basic health units (BHUs), rural health centres (RHCs), vaccination programmes, maternal and child health services, nutrition interventions and disease prevention initiatives form an effective public healthcare system. When adequately funded and staffed, it can address most health needs at the community level, thereby reducing the burden on secondary and tertiary hospitals.

The growing incidence of communicable and non-communicable diseases in Sindh underscores the need to shift the focus from treatment to prevention. It not only improves access to essential services, but also contributes to healthier communities and a more efficient healthcare system.

Policymakers should consider re-balancing health-sector spending in favour of primary and secondary levels. A strong national healthcare system begins not in major urban hospitals, but in properly functioning community health facilities.

Dr Habib ur Rehman Soomro
Karachi

Published in Dawn, July 4th, 2026