National health policy
In 1978 Pakistan endorsed the World Health Organization's (WHO) strategy of 'Health for All (HFA) by the year 2000'. The government declared its first National Health Policy (NHP) in January 1990, which aimed to provide universal health coverage in accordance with the HFA 2000 strategy (Ministry of Health, 1990). In 1997 the NHP was renewed and upgraded in line with modern health standards (Ministry of Health, 1997). In the third version of the NHP, in 2001, the government accepted the need for a more comprehensive policy. In 2008 a Health Policy Task Force (HPTF) was constituted to formulate a new health policy aspiring to universal health coverage along the lines of the National Health Service (NHS) in the UK (Government of Pakistan, 2010a). The draft version of this policy set new targets in terms of financing, planning and delivery. The NHP 2010 proposed universal social health insurance for the small formal sector and encouragement of micro-health insurance plans for the poor (Nishtar, 2010b). Progress on this agenda will require enhanced financial protection against private out-of-pocket expenditure and, in particular, medicine costs, which constitute a major share of private health expenditure.
The WHO in 2006 recommended health expenditures of US$34 per capita in developing countries. In that year, Pakistan spent US$18 per capita, of which the total government contribution was US$4 (Akram and Khan, 2007). Funding from international sources contributed to only about 7 per cent of total health expenditure. The average for low-income countries is above 14 per cent, and for Bangladesh it is more than 22 per cent (Federal Bureau of Statistics, 2009).
The healthcare system comprises a public sector, private for-profit, and private not-for-profit providers, and an informal sector. Some hakims— traditional unani (Greco-Arab) medical experts and homeopaths—are private practitioners, while others operate within the public sector. Until 2011 the public sector was made up of the national federal Ministry of Health and provincial and district health departments. The federal ministry was responsible for legislation and national health policy, including standards for medical education, medical equipment and manufacturing of pharmaceuticals. Other responsibilities included coordination with international agencies, management of federally run hospitals and planning, and management of national programmes for AIDS, malaria, tuberculosis and family planning (Akram and Khan, 2007; Mezzera, Aftab and Yusuf, 2010). Several federal ministry responsibilities have recently been decentralized. The provinces are now responsible for the delivery of health services, including the provision of resources to the districts for implementation of health programmes and supervision of their performance (Mezzera et al., 2010).