Muhammad Bhuta, a domestic worker in Lahore, requires insulin injections every 10 days to manage his diabetes. But just one injection costs about a third of his meager monthly income.
Like millions of Pakistanis with health conditions, the only thing that keeps food on his table and a roof over his head is affordable prices he can't live without. unreliable charity aid that helps pay for drugs. His story is just one of many examples of Pakistan's serious health crisis, and the many reasons why the government needs to change direction to ensure the highest achievable standard of health for all Pakistanis. It's just one of the things.
According to Pakistan's non-governmental health organization Sehat Kahani, more than 50 percent of Pakistanis do not have access to basic primary health care services, and about 42 percent do not have access to health insurance. However, recent government policy changes are likely to make the situation even worse. In February, the Cabinet increased the prices of 146 essential medicines, making many of them even more unaffordable for people on low incomes.
One of the main reasons for the terrible state of healthcare in Pakistan is the lack of government funding. According to 2021 statistics, the Pakistani government spends just 0.84% of GDP on healthcare, down from 0.94% in 2019 and one-third of the average for other low- and middle-income countries (2.62%). It's less than that. . Public health spending is not a sufficient condition for securing the right to health, but adequate spending is a necessary condition.
In its recent report, Global Health Financing Failures, Human Rights Watch analyzed 20 years of global health spending data from the World Health Organization (WHO) and identified global and national trends. was analyzed. The researchers looked at how much both governments and households spend on health care, how out-of-pocket payments affect the right to health, and how countries can balance this balance to improve access to health care through increased funding. We focused on how we can change.
Human Rights Watch analysis found that in 2021, the most recent year for which data is available, most governments spent no more than 5.0 percent of GDP or 15 percent of national budgets on health care. These are two important and common criteria for assessing whether countries are on track to achieve universal health coverage. Universal health coverage is a goal that is distinct from, but is based on, the human right to universal access to health care, which is derived from the International Covenant on Economic, Social and Cultural Rights.
While the world is falling behind on these important spending targets, Pakistan is falling further behind. In 2021, Pakistan ranked 176th out of 189 countries in terms of the amount spent by the government on health compared to the size of its economy, and 170th compared to the size of its national budget. Simply put, the government has not made funding health care a priority.
Many of the countries that spent the most on health that year were high-income countries. However, many governments in less wealthy countries prioritized funding for health care. Cuba, for example, reported spending the equivalent of 12.6% of GDP on health care in 2021. Bolivia, a low-middle income country like Pakistan, met both spending criteria in 2021.
If governments do not fund health care, individuals and households will bear the burden. In 2021, more than 57 percent of Pakistan's health spending was borne by patients and their families through out-of-pocket payments, such as Bhuta's insulin bill. Instead of ensuring the availability, accessibility, and quality of health care, reliance on copayments can increase health care inequalities and widen gaps in quality of life and life expectancy.
Pakistan's current health crisis sits within a larger context of rising poverty, inflation and unemployment, as the country faces one of its worst economic crises in history. This situation puts the human rights of millions of people at risk, including the right to health, food and housing.
But well before this crisis, at least a quarter of Pakistan's population lived below the national poverty line. The World Food Program estimated that in 2018, 21 percent of Pakistan's population was undernourished and 44 percent of children under five were stunted. The Asian Development Bank reported that in 2020, 65 out of every 1,000 children born in Pakistan will die before their fifth birthday. In 2020, almost 25% of the population did not have access to electricity.
Pakistan is also one of the countries most vulnerable to climate change. We are facing rates of warming that are significantly higher than the global average, and we are likely to experience more frequent and intense extreme weather events. These events are a particular threat to economically and socially marginalized people, such as the elderly, people with disabilities, and people living in poverty and rural areas.
Pakistan's government has begun the latest round of negotiations with the International Monetary Fund (IMF) over a multibillion-dollar, three-year program to avert an economic meltdown. Last year's severe foreign currency shortage resulted in many imported goods, including essential medicines, being in short supply or unavailable.
Debt servicing is a major impediment to government investment in health care. Human Rights Watch found that Pakistan paid approximately seven times more in servicing its external public debt in 2021 than it did in healthcare costs. The IMF and credit rating agencies estimate that interest payments on Pakistan's debt will consume 50 to 60 percent of its population. Government revenues this year are at the worst rate among comparable economies in the world.
Creditor governments and institutions such as the IMF should assess the impact of debt payments on a government's ability to meet its human rights obligations, including the right to health, and provide debt restructuring and relief to help countries like Pakistan adequately protect their claims. This should be considered. right.
But funding alone is not enough. The lack of investment in health care in Pakistan reflects a lack of political will by authorities to address the issue. Pakistan does not have a constitutionally protected right to health care. The country's constitution provides for the state to provide “medical relief” in a chapter on “Policy Principles,” but these principles are not enforceable and are aspirational goals. Even the purpose of “medical relief” is limited to citizens who are unable to earn a living due to infirmity, illness, or unemployment.
Pakistan should urgently recognize the right to medical care in accordance with international standards. National authorities need to recognize that protecting citizens' right to health is not optional.
