Primary Health Care Financing in Pakistan: Bridging Policy and Practice

Noor Jehan

Noor Jehan

Keywords: Primary Health Care, Health Financing, Pakistan, Universal Health Coverage, Out-of-Pocket Expenditure, Fiscal Policy, Health Policy Reform

Abstract

Background: Primary Health Care (PHC) remains the cornerstone of Universal Health Coverage (UHC), yet financing in low- and middle-income countries, including Pakistan, faces systemic challenges. Despite policy commitments, financing gaps and implementation inefficiencies undermine PHC access.

Objective: This study analyzes the financing structure of PHC in Pakistan, exploring the disconnect between policy frameworks and practice, and quantifies the relationship between financing and access outcomes.

Methods: A quantitative design was adopted using secondary panel data (2000–2022) from World Bank, WHO, and Pakistan Bureau of Statistics. Descriptive statistics traced trends in PHC financing. Regression analysis examined the effects of public health expenditure (% of GDP), donor contributions, and OOP expenditures on access indicators (immunization rates, maternal health coverage, and PHC utilization).

Results: The findings indicate that Pakistan’s PHC financing is heavily reliant on OOP expenditures (62%), while public health spending remains below 1% of GDP. Regression analysis confirmed a positive and significant association between public health expenditure and PHC utilization, whereas high OOPs negatively influenced equitable access. Provincial disparities in PHC allocations were also evident.

Discussion: The results underscore a persistent gap between financing policy and practice, reflecting inefficiencies in governance, fragmented resource flows, and inadequate fiscal prioritization. While donor funds contribute substantially, their vertical nature undermines sustainability and integration.

Conclusion: Bridging policy and practice in PHC financing requires scaling up domestic revenues, instituting equity-based fiscal transfers, reducing OOP expenditures, and enhancing accountability mechanisms.

Policy Implications: The study recommends performance-based financing, integration of donor contributions into pooled systems, community participation in budgeting, and prioritization of PHC workforce. These measures are essential to align Pakistan’s financing practices with its UHC commitments.