Reforming Pakistan’s health sector: A moral and strategic imperative

Pakistan’s health sector stands at a critical crossroads. Decades of underfunding, mismanagement, and systemic neglect have left the public healthcare system unable to meet the needs of a growing and increasingly urbanized population. While political manifestos often make lofty promises, genuine reforms remain elusive. Yet, if we are to build a healthier, more resilient Pakistan, health reform is not only a moral obligation but a strategic necessity. Pakistan’s public health sector remains under significant strain, facing challenges that range from chronic underfunding and inadequate infrastructure to governance gaps and regional disparities. Despite successive governments’ promises, the pace and depth of health reforms have not matched the urgency of the crisis. The time has come for a decisive, sustained effort to put health at the center of our national development agenda. Currently, Pakistan spends less than 2% of its GDP on health, one of the lowest ratios in South Asia. The implications of this are evident in our high maternal and infant mortality rates, persistent malnutrition, and limited access to even basic health services in rural and underserved urban areas. Public hospitals are overwhelmed, and primary healthcare, arguably the most critical tier of the system, is put aside in favor of hospital-based care. Public hospitals are overburdened, primary care remains neglected, and the rural-urban divide in healthcare access is stark. While the private sector fills many gaps, it often does so without sufficient regulation, leading to uneven quality of care and exploitative practices. The COVID-19 pandemic offered a painful reminder of our vulnerabilities and a unique opportunity to rethink our priorities.  It exposed the fragility of our health systems but also created an inflection point. It reinforced the understanding that health is not just a social sector concern; it is foundational to economic stability and national security. A healthy population underpins economic productivity, social cohesion, and state resilience. To seize this moment, reforms must be both ambitious and grounded in institutional realism. Pakistan must gradually increase health expenditure to 4% of GDP by 2030, with an emphasis on preventive care, mother-and-child health, and immunization, areas where Pakistan lags significantly behind global standards. We need structural reform in governance. Health is a devolved subject post-18th Amendment, but there is a dire need for stronger federal coordination, data sharing, and national standards. Provinces must be empowered, but they must also be held accountable for outcomes. Digital health solutions like the Sehat Sahulat Card program should be scaled and improved. These initiatives can expand access and transparency, but strong data systems and independent monitoring must underpin them. Health workforce development must be a priority. Pakistan has a severe shortage of trained medical professionals, especially in rural areas. Incentivizing service in underserved regions, expanding nursing and paramedical training, and cracking down on ghost workers are all critical steps. More fundamentally, our policy discourse must move from viewing health as a privilege to recognizing it as a right. This requires designing systems that prioritize equity, especially for women, children, and marginalized communities. Reforming the health sector requires political will, bureaucratic competence, and public engagement. Pakistan’s young population deserves better than a broken system that too often fails them in their hour of need. In a region beset by volatility and rapid change, a healthier population is not just a benefit — it is a bulwark. Health reform is not optional. It is urgent, essential, and long overdue. The reform of Pakistan’s health sector is not merely a technical task; it is a political, economic, and moral challenge. It requires courage, clarity, and commitment from our leadership and society. The path forward is not easy, but the cost of inaction is far higher.