Pakistan's path to universal health coverage: national and regional insights

Universal Health Coverage (UHC) is a common health policy objective outlined in the Sustainable Development Goals. With provincial governments taking the initiative, Pakistan has implemented and extended UHC program amid a complex public health landscape. In this context, we assess Pakistan's p...

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Bibliographic Details
Published in:	International journal for equity in health Vol. 23; no. 1; pp. 162 - 14
Main Authors:	Yang, Di, Nikoloski, Zlatko, Khalid, Ghazna, Mossialos, Elias
Format:	Journal Article
Language:	English
Published:	England BioMed Central Ltd 15-08-2024 BioMed Central BMC
Subjects:	Analysis BCG BCG vaccines Catastrophic health expenditure Children Development policy Diarrhea Economic aspects Economic development Economic underdevelopment Expenditures Forecasts and trends Health aspects Health care expenditures Health care policy Health Expenditures - statistics & numerical data Health Policy Health services Health Services Accessibility Healthcare Disparities - statistics & numerical data Healthcare Disparities - trends Households Humans Immunization Indexes International comparisons International organizations Medical care, Cost of Medical policy Medical screening Mortality National health insurance Pakistan Personal income Physicians Poliomyelitis Poverty Prenatal care Prevention Provinces Public health Purchasing power parity Regional development Regression models Socioeconomic Factors Socioeconomic status Socioeconomics Subnational analysis Surveys Sustainable development Universal health coverage index Universal Health Insurance Vaccination Vaccines Womens health Pakistan India Bangladesh Universal health coverage index Pakistan Catastrophic health expenditure Subnational analysis
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Summary:	Universal Health Coverage (UHC) is a common health policy objective outlined in the Sustainable Development Goals. With provincial governments taking the initiative, Pakistan has implemented and extended UHC program amid a complex public health landscape. In this context, we assess Pakistan's progress toward achieving UHC at the national and subnational level. We use data from the Demographic and Health Surveys and the Household Integrated Economic Survey to construct a UHC index at the national and subnational level for 2007, 2013, and 2018. Furthermore, we use Concentration Index (CI) and CI decomposition methodologies to assess the primary drivers of inequality in accessing medical services. Logistic regression and Sartori's two-step model are applied to examine the key determinants of catastrophic health expenditure (CHE). Our analysis underscores Pakistan's steady progress toward UHC, while revealing significant provincial disparities in UHC progress. Provinces with lower poverty rate achieve higher UHC index, which highlights the synergy of poverty alleviation and UHC expansion. Among the examined indicators, child immunization remains a key weakness that one third of the children are not fully vaccinated and one sixth of these not-fully-vaccinated children have never received any vaccination. Socioeconomic status emerges as a main contributor to disparities in accessing medical services, albeit with a declining trend over time. Household socioeconomic status is negatively correlated with CHE incidence, indicating that wealthier households are less susceptible to CHE. For individuals experiencing CHE, medicine expenditure takes the highest share of their health spending, registering a staggering 70% in 2018. Pakistan's progress toward UHC aligns closely with its economic development trajectory and policy efforts in expanding UHC program. However, economic underdevelopment and provincial disparities persist as significant hurdles on Pakistan's journey toward UHC. We suggest continued efforts in UHC program expansion with a focus on policy consistency and fiscal support, combined with targeted interventions to alleviate poverty in the underdeveloped provinces.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1475-9276 1475-9276
DOI:	10.1186/s12939-024-02232-1