Health Care Financing
in Pakistan:
Trends and Issues
Dr. Rashid Jooma
Director General
Ministry of Health, Pakistan
Purpose of a Sound Health Care
Financing Policy
Beyond “how much should we spend…”
A sound HCF policy should look at:
• The Overall need and Available funds
• How money flows to ensure the system reaches
its objectives
• Creating incentives to enhance health care
delivery
• Provide social protection against routine and
catastrophic health care expenses
The Current Government Setup
Policy
Budget
Surveillance
M&E
Reporting
Oversight
Funds
Federal
Direct Oversight
M&E
District
Reporting
Oversight
Funds
Provincial
Direct Implementation
M&E
Current Health Care Spending
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Total: Rs 152 billion (2% of GDP)
Or about USD 17 per capita
Government contribution is about a quarter
Reflects only about a 50% increase over the
past 15 years (when adjusted for inflation and
population growth)
Where it goes
• Government: prevention, curative care and
infrastructure
• Private sector and NGOs: mostly curative care
Some current restraints
• Limited revenue collection (<15% of GDP)
• Limited revenue collection by provincial or
district governments
• Distinction between recurrent and
development budgets, sometimes with
management of each with different depts
• Within sub-units (eg hospitals) different things
are paid from different funding sources
• Under utilization of allocated funds
Is increased funding needed…
• Absolutely!
• However, this is not the final answer
• Health outcomes are not well correlated with
health spending
• In fact setting a total as a target may not be very
helpful
• Equally important to
1. prioritize funding
2. design technically sound interventions and
3. monitor results that are geared towards
effective and equitable targets
General Suggestions
• Need an overarching plan that looks at the overall
health needs to establish the funding envelope
(and also assigns deliverables and responsibilities
for different stakeholders)
• Making sub-units (for e.g. districts or even clinics)
accountable for their budgets and their
deliverables
• Definition of “minimum essential” packages
• Assign accountability and responsibility for
services
• Financial and budgetary implications (rewards or
otherwise) tied to quality of services provided
• M&E framework including results and finances
Raising Adequate funds
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Taxation
Earmarking
Approach external donors
Allowing provincial or local revenues to go
directly to health locally
• User fees
Pooling Risk
• Catastrophic health insurance is being
provided in Pakistan via the Rural Support
Networks
• Government leverages expenses related to
natural disasters
• Government increases coverage and
payments for expensive healthcare such as
hospitalization, esp when these payments are
pro-rated acc to incomes
Equitable Provision of Services
• Pro-rate user fees and other expenses acc to
income of clients
• Conditional Cash Transfers (CCT) to attract
clients to prevention services and as social
support for the poorest
• Support funds for indigent care (zakat)
• NGO and philanthropic support
Efficient Provision of Services
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Adequate funding for what is planned
Timely and efficient disbursement of funds
A results monitoring system
Pilot trials of Results based financing
Delegate control over budgets,
implementation as well as responsibility to
local implementers
• Local community involvement in planning and
then monitoring services
Role of non-state actors
• Providers of quality care (Rural Support
Networks, charitable hospitals/ clinics)
• Providers of essential services (Edhi)
• Providers of social safety nets (Edhi, other
NGOs)
• Providers of employment or employment/
income generation (include micro credit,
vocational training)
• Piloting new health care models (AKHS)
• Funding some care