Pakistan’s health sector is not merely underperforming – it is steadily eroding under the weight of neglect, underinvestment, and weak governance. In a country of over 240 million people, public health spending remains below 1 per cent of GDP, while a significant share of healthcare costs is borne out-of-pocket. The result is a system where illness often translates into financial catastrophe, and where preventable deaths – particularly among 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 remain inadequate in both number and quality, particularly in rural areas, while preventive care continues to receive minimal attention. Although programmes such as the Lady Health Worker initiative have expanded outreach, they remain underfunded and poorly coordinated. Meanwhile, Pakistan’s 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 over preventive and community-based strategies. This mismatch reflects a system 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 recent case at the Pakistan Institute of Medical Sciences (PIMS) in Islamabad starkly illustrates the depth of the problem. In early 2026, a woman reportedly died following a biopsy procedure in which doctors allegedly extracted tissue from the wrong organ – the liver instead of the lungs – pointing to a grave lapse in clinical judgment and procedural safeguards. Such incidents are not isolated; rather, they expose systemic deficiencies in oversight, accountability, and professional standards.
Following the 18th Amendment, health became a provincial subject, leading to greater decentralisation but also increased fragmentation.
Similarly, hospitals in Lahore have recently come under scrutiny after videos circulating on social media appeared to show instances of patient mistreatment and unprofessional conduct by medical staff. While such cases must be verified through formal inquiry, their viral nature reflects a growing public perception of institutional indifference and declining ethical standards. The erosion of trust between patients and healthcare providers is, in itself, a critical dimension of the crisis.
However, it is important to situate these failures within a broader systemic context. Doctors and medical staff in public hospitals often operate under extreme pressure, facing overwhelming patient loads, inadequate infrastructure, and chronic shortages of support personnel. 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 reform that addresses the root causes of institutional dysfunction.
Pakistan today faces a dual burden of disease: communicable diseases and maternal and neonatal health challenges persist, even as non-communicable diseases rise sharply. Yet the health system remains ill-equipped to manage this transition. Resource allocation continues to favour curative, hospital-based care, while preventive services – the most cost-effective means of reducing disease burden – remain neglected. This misalignment is not merely inefficient; it is ethically indefensible in a context where thousands of preventable deaths occur each year.
Governance challenges further exacerbate the crisis. Following the 18th Amendment, health became a provincial subject, leading to greater decentralisation but also increased fragmentation. Initiatives such as the Sehat Card in Khyber Pakhtunkhwa and the Sehat Sahulat Programme in Punjab have expanded access to healthcare, yet concerns regarding financial sustainability, regulatory oversight, and potential misuse persist. In the absence of strong federal-provincial coordination, such programmes risk functioning in silos rather than as components of a coherent national health strategy.
Meaningful reform, therefore, requires more than incremental adjustments; it demands a fundamental reorientation of priorities. First, public spending must be significantly increased and redirected toward primary and preventive healthcare, where the highest returns in population health can be achieved. Second, governance structures must be strengthened through merit-based appointments, transparent procurement, and independent regulatory oversight to ensure accountability in cases of negligence. Third, Pakistan must invest in its health workforce by expanding recruitment, improving working conditions, and standardising professional training to reduce systemic strain on doctors and paramedical staff. Finally, stronger federal-provincial coordination is essential to integrate fragmented initiatives into a coherent national health framework.
Rebuilding trust in the healthcare system is equally critical. This requires institutionalising patient rights, ensuring ethical conduct, and fostering a culture of dignity and responsiveness within public hospitals. Ultimately, Pakistan’s health crisis is not merely a technical failure but a reflection of political choices. A state that fails to safeguard the health of its citizens undermines its own legitimacy. Preventive care is not only economically rational but morally imperative – and without decisive reform, the cost of inaction will continue to rise, measured not just in economic terms but in human lives.
The writer is a researcher and columnist based in Islamabad. He can be reached at zakiir9669 @gmail.com