KARACHI: Pakistan’s public-health system is confronting a complex combination of underinvestment, limited access to healthcare, weak regulation, rising non-communicable diseases, infectious illnesses, malnutrition and stark disparities between urban and remote communities, health experts warned at an international conference at the University of Karachi.
The warnings came as the University of Karachi (KU), in collaboration with Al-Kawthar University, inaugurated the three-day first international conference on Public Health Governance and Sustainable Health Systems 2026 at the HEJ Research Institute Auditorium on Wednesday.
Held under the theme “Governing for Health: Equity, Resilience, and Innovation Towards a Sustainable Public Health Future,” the conference brought together senior health professionals, academics, policymakers and public-health experts to examine how Pakistan can strengthen its health system through prevention, effective governance, evidence-based policymaking and more equitable access to care.
The opening session placed particular emphasis on the scale of the country’s health challenges and the need to move beyond a system primarily focused on treating disease after it occurs.
Pakistan’s health system faces structural constraints
Vice Chancellor Health Services Academy Islamabad Professor Dr Shehzad Ali Khan said Pakistan’s health system has evolved into a mixed model comprising both public and private sectors, but limited financial resources, inadequate access to health facilities, weak regulatory mechanisms and the growing burden of disease continue to place significant pressure on the system.
He said Pakistan has approximately 290,000 doctors, 130,000 hospital beds, 108,000 community health workers and 16,000 health facilities, yet public-sector coverage remains restricted.
The private healthcare sector is extensive but, according to Dr Shehzad, largely lacks effective regulation.
He said government expenditure accounts for nearly 34 percent of total health spending, while the private sector contributes 64.4 percent. Out-of-pocket payments by citizens account for 89.9 percent, compared with only 1.7 percent from donors.
The figures point to a health system in which households continue to carry a substantial share of healthcare costs, while public investment remains limited.
Health spending remains low
Dr Shehzad said Pakistan’s per capita health expenditure is approximately US$45, compared with US$75 in India, US$127 in Sri Lanka and US$50 in Afghanistan.
Pakistan spends only around 0.7 to 1 percent of its GDP on health, according to the figures presented at the conference. By comparison, the corresponding figures cited were 9.7 percent for Afghanistan, 3.8 percent for Sri Lanka, 3.6 percent for India and 2.4 percent for Bangladesh.
He also noted that Pakistan ranks 150th among 189 countries on the Human Development Index.
Against this backdrop, Dr Shehzad said the country faces the simultaneous burden of communicable and non-communicable diseases, compounded by severe nutritional deficiencies.
Diabetes, hypertension and tobacco add to disease burden
More than 17 percent of Pakistan’s population suffers from diabetes, while more than 25 percent of adults aged over 18 have hypertension, according to figures shared by Dr Shehzad.
He said nearly 36 percent of people above 40 are affected by high blood pressure, while cholesterol prevalence among people aged 15 to 40 is around 30 percent.
Tobacco use also remains a major concern. Dr Shehzad said 38 percent of men and 9 percent of women use tobacco in some form.
The dietary and physical-activity indicators he presented added another layer to the country’s non-communicable disease challenge.
In urban areas, 65 percent of the population consumes less than one full serving of fruit a day, while the proportion rises to 79 percent in rural areas.
Nearly 90 percent of the population consumes fewer than two servings of vegetables a day, while a similar proportion lacks recreational physical activity, he said.
Children face a parallel burden of infection and malnutrition
The conference also highlighted significant health risks among children.
Among children under five, the prevalence of diarrhoea was cited at 11 percent and pneumonia at 6 percent.
Dr Shehzad said around 9 percent of the population is affected by Hepatitis C and 4 percent by Hepatitis B.
Malnutrition remains another major challenge. Stunting affects 42.7 percent of children, which Dr Shehzad described as the second-highest rate globally after Afghanistan.
He said 17.7 percent of children suffer from wasting, 28.9 percent are underweight and 9.5 percent are overweight, reflecting the coexistence of different forms of malnutrition within the population.
Micronutrient deficiencies remain widespread
The nutritional picture extends beyond childhood growth indicators.
According to the figures presented by Dr Shehzad, iron deficiency affects 28.6 percent of the population and zinc deficiency 18.6 percent.
Anaemia affects 54 percent of women, while 79.7 percent of the population has vitamin D deficiency and 27.3 percent has vitamin A deficiency.
Among women, nearly 18 percent are underweight and 26 percent are overweight, highlighting the coexistence of undernutrition and excess weight within the population.
Together, the figures presented at the conference underscored the breadth of Pakistan’s public-health challenge, spanning infectious disease, chronic disease, nutrition and lifestyle-related risks.
Maternal, neonatal and child mortality remain major concerns
Dr Shehzad warned that Pakistan continues to face one of the highest neonatal mortality rates globally, the third-highest maternal mortality and the fourth-highest child mortality.
He also said Pakistan ranks fifth worldwide in tuberculosis burden and remains one of only two countries where polio persists.
He argued that the figures demonstrate the gravity of the challenges facing Pakistan’s health system and require a comprehensive response rather than isolated interventions.
That response, he said, should include the expansion of primary healthcare facilities, stronger disease prevention, effective regulation, elimination of malnutrition, greater public investment and coordinated strategies between the public and private sectors.
From treating disease to preventing it
Dr Shehzad stressed the need to shift the health system’s focus from treatment alone towards prevention and upstream approaches tailored to local needs and realities.
He called for equitable access to basic healthcare, a clean environment, protection from health risks and quality medical services for all citizens.
The emphasis on prevention was echoed by other speakers, who argued that a sustainable health system cannot be built solely through additional hospitals, medicines and sophisticated equipment.
Chairperson of the Sindh Higher Education Commission, Dr Tariq Rafi, said hospitals, medicines and modern equipment alone cannot guarantee a strong health system.
Skilled human resources, robust administrative leadership and evidence-based policymaking are equally indispensable, he said.
Universities have a wider health-system role
Dr Rafi underlined the role of universities in preparing not only doctors but also nurses, pathologists, healthcare administrators, researchers and policymakers.
He called for quality education and training in public health, medical systems management, governance and health policy.
He also expressed concern over regional disparities, noting that health facilities in remote areas lag significantly behind those available in major cities.
Policymakers, he said, must base decisions on ground realities and evidence, stressing that effective management is as important as funding and physical infrastructure.
He concluded that Pakistan must invest adequately in education and health because sustainable progress is impossible without substantial investment in both sectors.
Surveillance should become the health system’s early-warning network
Principal Secretary to the Governor of Sindh Dr Saif-ur-Rehman placed particular emphasis on surveillance and early detection.
He described environmental surveillance, sewage monitoring, vaccination coverage and rapid laboratory testing as the “eyes and ears” of a modern health system.
Dr Saif-ur-Rehman cautioned against reducing public-health challenges to statistics alone, noting that every figure represents human lives and families.
He cited Singapore, Thailand and Rwanda as examples of countries where effective surveillance, prevention, public participation, technology and strong primary healthcare systems have helped address major public-health challenges.
A sustainable health system, he said, must therefore be built around prevention, surveillance, vaccination, clean water, environmental protection, public awareness and strengthened primary health centres.
Hospitals also need stronger quality systems
Executive Director of NICVD Karachi, Professor Dr Tariq Saghir, said a Quality Assurance Department is being established at the institution, describing it as an urgent necessity.
He noted that hospitals generally lack effective quality-assurance systems, although their fundamental purpose should be the continuous monitoring and improvement of patient care and treatment standards.
Professor Dr Tariq Saghir stressed that meaningful improvement in hospitals can only be achieved through effective governance.
For that to happen, he said, all concerned individuals must fulfil their responsibilities and play their respective roles meaningfully and efficiently.
Public health extends far beyond hospitals
Consultant Cardiologist and newly elected President of the Pakistan Islamic Medical Association Pakistan, Dr Ahmed Salman Ghori, described public health as a broad and multidimensional field that cannot be confined to hospitals, medicines and doctors.
Public health, he said, is directly connected to Pakistan’s health, dignity and future.
Its core purpose should be to create a society in which people receive effective care and treatment before they fall prey to serious illness, he added.
Renowned psychiatrist Professor Dr Iqbal Afridi also highlighted the importance of mental health, describing it as indispensable for a healthy society.
KU calls for public health to become a national priority
Earlier, KU Director ICCBS Professor Dr Muhammad Raza Shah delivered the inaugural address, outlining the objectives of the conference and stressing that prioritising public health is essential to steering society towards progress.
Taken together, the discussions at the conference presented a health-system challenge that extends far beyond the number of hospitals or doctors available.
Pakistan’s burden spans chronic diseases, infectious illnesses, maternal and child mortality, malnutrition, micronutrient deficiencies, tobacco use, unhealthy diets, inadequate physical activity and mental-health needs, while limited public financing, high out-of-pocket spending, regulatory gaps and regional disparities add further complexity.
The central message emerging from the opening session was therefore clear: building a sustainable health system will require Pakistan to invest not only in treatment infrastructure, but also in prevention, primary care, surveillance, human resources, regulation, evidence-based governance and healthier environments.
As the three-day conference continues, its focus on equity, resilience and innovation places a broader question before policymakers and health institutions: can Pakistan transform a health system that often responds to illness into one that prevents it before the burden reaches hospitals?
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