Ladies and Gentlemen,
Pakistan recognizes that investment in health sector is of utmost importance, in order to achieve the targets we have set for coming years. We would like to ensure that our population is healthy and has equitable access to health. The relation of health with economic growth and security environment is very clear and in order to achieve optimal growth, emphasis on improving social sector indicators is a must.
Inadequate resources for social services and the fact that over half of all “New poors” added to the pool every year, are resulting from catastrophic health related expenditures thus laying a fertile ground for extremist groups to embed themselves throughout society.
It has been recognized in the government’s 10-year development strategy, Vision 2025, that current demographic trends pose real threats to Pakistan’s future including:
– High population growth rates exert negative pressure on economic growth as investment funds have to be concentrated in meeting the needs of the growing population (education, health, housing, police, and other infrastructure), rather than productivity growth.
– The potential demographic dividend cannot be realized unless there is adequate investment in human development, especially education, training, and health.
– The growing population in Pakistan poses a significant threat to food security, Pakistan’s development and social indicators and stability. With almost 50% of women and children being malnourished, these nutritional inadequacies hinder the development of the intellectual faculties of school-going children and young adults consigned to such diets, and could thus perpetuate intergenerational inequalities of opportunity and income. Given the prospect of climate change and depleting water resource, this will constitute one of the major challenges faced by the country.
– Total health expenditure in Pakistan is estimated at $5.4 billion USD per year, of which 36% is funded by public sector. Approximately 62% of the health expenditures are funded through private sector, out of which 88% is out of pocket (OOP) by households. Currently development partners / donors organizations cover only 2% of total health expenditures.
– There is a continued need for increased donor assistance through the “Economic Transition in Health” when GDP per capita is over $1,400 and total health expenditure per capita reaches ~$70/capita. As evidenced globally, even when these thresholds are met, there is continued need for donor assistance to ensure adequate funding for the ‘best value for money’ with prioritizing primary health and prevention instead of more attractive infrastructure and tertiary healthcare.
– With the 18th constitutional amendment devolving health to the provincial governments, the federal government as the main interlocutor with major development partners prioritizes issues and donor assistance request to subjects which are squarely within the federal government’s mandate. In addition, immediate concerns with security and short-term drivers of economic growth (energy, infrastructure…) currently take precedence despite the opportunity cost of not addressing the more insidious threats to long-term security and economic development.
– Despite all adversities Pakistan has taken tangible steps to ensure improvement of health in the country both in terms of enhancing financial resources as well as developing robust policy environment.
· Since 2012, provincial governments increased health allocation to 7-8% of provincial budgets – at par with regional average. Although inflation and growth in population has eroded corresponding increases and impact.
· Population programs have allocated progressively increasing resources for securing Family Planning commodities in their own budgets to the tune of approximately 60 million USD over next 5 years, showing a true commitment for this vital area.
– The recently launched Prime Minister National Health Insurance Program is a flagship initiative to support the poor through catastrophic health expenditures and Federal government has allocated 90 million USD this year from its own resources. The provincial governments have allocated similar amounts in their budgets. The program is a clear indication of the present government to social sector development in Pakistan.
– The Prime Minister of Pakistan, noting slow progress in MNCH and nutrition, directed national leadership to develop a comprehensive action plan to address challenges. A 10-Point priority Agenda has been developed by the federal and provincial governments, in consultation with development partners, which includes:
– Improving access and quality of primary care services for MNCH in rural districts and urban slums through revitalization and refocusing scope of LHW program.
– Improving quality of care through linkages between medical colleges with district health systems, engaging private and not-for-profit sector in the provision of priority services, addressing staffing gaps in rural districts (especially female health workers) and availability of essential supplies. “Respectful Maternity Care” is an idea where we would like to invest further.
– Overcoming financial barrier to care through targeted conditional cash transfers, vouchers and health insurance schemes.
– Increasing funding and allocation for MNCH over the next decade.
– Improving family planning through synergies between population and health departments, developing commodity security strategy, mobilizing religious and traditional leaders, and focusing on culturally sensitive reproductive health education among adolescents thus ensuring “Positive Development Assets” concept for younger population.
– Ensuring operationalization of multi-sectoral nutritional strategies with a focus on enforcement of laws such as breastfeeding protection law and food fortification.
– Addressing social determinants of health through integration of health and development messages and linking MNCH to education, prevention of child marriage and gender empowerment.
– Strengthening measurement and district-level action by strengthening the District Health Information System (DHIS), developing link between existing information systems and a national Health Information System to track core indicators.
– Increasing national accountability and oversight by establishing a national oversight body linked to respective provincial structures and a high-level “Inter-ministerial forum for health and population” and an “Inter-agency coordination forum” at the national level.
– Generating political will to support reproductive health, MNCH, and nutrition as a priority within the Sustainable Development Goals
Pakistan plans to meet the National Vision 2025 commitment of increasing allocation to health to 3% of GDP in next decade however this should also include a similar commitment for partners including the US government to enhance the development assistance for social sector in particular health sector for us to achieve the desired impact. Domestically we are committed to developing realistic plans for phased increase in health spending, and exploring innovative ways of generating domestic financing such as imposition of taxes on luxury items, nutrition levies on soft drinks and tobacco products. The federal government is also creating incentive/matching fund programs to augment provincial budgets to address primary health priorities similar to the nascent Prime Minister’s insurance scheme to address catastrophic health costs which is co-funded by the federal and provincial governments.
The battle against Polio is another avenue which clearly shows government’s pledge to health and its international responsibilities. Last year saw enhanced ownership and political commitment at all levels of the Government. The formation of the Prime Minister’s Focus Group on Polio Eradication reflects strong political commitment of the highest leadership. Based on the decision of the Prime Minister’s Focus Group a cabinet committee on Immunizations was formed to include Ministry of Defense. These steps have had a major impact in coordinating security efforts with the Provinces and in improving the overall security planning of the Program. Resultantly the number of cases has dropped to less than 80% as compared to last year however we are still cognizant of the ongoing transmission and have prepared a robust plan to be implemented in next six months focusing on continuously missed children as well as quality of campaign. In last 3 years Pakistan contributed the entire cost through a loan arrangement, in the coming period of 2016-18 Pakistan will continue to fund the Polio program and we are negotiating a balanced mix of domestic and international resources to cover the cost of 337 million USD for this period. [AR(1]
We keep on reminding ourselves that we need to reach every mother, newborn and child to reduce inequities and harness the power of parents, families and communities.
Let me emphasize in the end that our government is fully aware of the importance of investing in health and social sector and we would like to explore along with partners like US government and others to mobilize more resources for our shared vison and bring health sector to play its due role in economic development and global security.
Thank you and Pakistan Zindabaad
Embassy of Pakistan
September 9, 2015