C ommo nwe a l t h memb e r c o u n t r i e s Pakistan has a small but growing pharmaceutical industry, which sold around US$1.8 billion worth of products in 2010. The industry is split between domestic and multinational companies, with large multinationals having specific Pakistani divisions operating in the country. The Pakistan Mental Health Ordinance 2001 is the most recent revision of legislation relating to mental health issues, replacing the 1912 Lunacy Act. Health MDGs: The Millennium Development Goals (MDGs) mature in 2015, but monitoring of progress is ongoing due to the time it takes to collect and analyse data from each country. For Pakistan to achieve its targets for the reduction of child mortality, which forms MDG 4, it should have reduced under-five deaths per 1,000 live births to 46 and increased measles immunisation to 100 per cent when the 2015 data is analysed. In 2013 under-five mortality stood at 86 deaths per 1,000 live births and measles immunisation at 61 per cent, which makes Pakistan unlikely to meet these targets. The global MDG 5 target for maternal health is to reduce the number of women who die in pregnancy and childbirth by threequarters between 1990 and 2015. For Pakistan, the maternal mortality should fall to 123 cases per 100,000 live births. In 2013 Pakistan had an adjusted maternal mortality ratio of 170 deaths per 100,000 live births (this figure was estimated at 260 deaths per 100,000 by UN agencies/World Bank in 2010). Based on the data reported by the country, Pakistan’s maternal mortality target is unlikely to be achieved. Part of the goal also stipulates that 100 per cent of births must be attended by a skilled health professional. In 2013 this figure stood at 52 per cent, so this target is also unlikely to be met. MDG 6 aims for a reduction in the prevalence of HIV, malaria and other communicable diseases. The prevalence of HIV/AIDS is very low, standing at less than 0.1 per cent of the population in 2013; however, it has shown no improvement since the MDGs came into action. Meanwhile, estimated mortality from TB (when mortality data excludes cases comorbid with HIV) has shown noticeable improvement – it has almost halved since 1990. Some work on HIV prevalence is still required if the country is to achieve MDG 6. For definitions, sources and explanations on the Millennium Development Goals see page 314. Universal health coverage Less than a third of health care in Pakistan (31 per cent) was government funded in 2012. The remaining 69 per cent was paid for by patients or funded by other non-governmental entities, such as private insurers, charities or employers. Total health expenditure constituted 3.1 per cent of GDP in 2012. Expenditure by government amounts to US$12 per capita. Pakistan has a multi-tiered and mixed health care delivery system, which is administered mainly by the private sector. Public health facilities are adequate in urban sectors of society, but lacking in more rural areas. Following a consultative process with a consortium of civil service organisations, development experts and marginalised people, a Post-2015 Development Framework Report on Pakistan was compiled. The report, conducted by Global Call to Action Against Poverty and Beyond 2015, looked at specific priority areas for the country in the years following the MDGs. Access to health care facilities in Pakistan was highlighted in the report as being of particular concern and it was suggested that efforts are needed to improve availability of health care, in particular maternal and neonatal facilities, in rural areas. Pakistan has signed and ratified the International Covenant on Economic, Social and Cultural Rights, which includes ‘the right of everyone to the enjoyment of the highest attainable standard of physical and mental health’. The covenant commits signees to providing healthy and hygienic environmental conditions, controlling epidemic diseases, improving child health and facilitating access to health services without discrimination. Care of the elderly: Around eight million people in Pakistan are over the age of 65 – four per cent of the total population (2013). At the age of 60 a person in Pakistan can be expected to live for an additional 17 years, on average (2013). Overall, public pension spending is equivalent to 0.5 per cent of the country’s total economic output (2012). There are more than 15 non-governmental organisations (NGOs) working to provide housing and medical care services to the elderly in Pakistan, including shelter and residential care, medical care, home visits and activity provision. The Edhi Foundation Old Homes, Gills Shelter Old Age Home and Old Age Happy Homes are just a few providers of residential care. Further information Ministry of National Health Services Regulation and Coordination: www.pakistan.gov.pk Commonwealth Health Online: www.commonwealthhealth.org/health/asia/pakistan 236 Commonwealth Health Partnerships 2015 Population over 65 4%
Commonwealth Health Partnerships 2015
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