Pakistan’s Rs1.37 trillion health promise: Will patients feel the difference?

Pakistan’s federal and four provincial governments have collectively announced more than Rs1. 37 trillion in health-sector allocations for the financial year 2026–27, a figure large enough to suggest that healthcare has moved closer to the centre of public policy. But behind the headline amount lies a more difficult question: how much of this money will translate into medicines on hospital shelves, trained staff in emergency departments, functioning equipment, vaccination in underserved communities and affordable treatment for families? The combined figure is not a single national health budget administered from Islamabad. It is the sum of separately announced federal and provincial allocations, prepared under different classifications and containing varying combinations of current expenditure, development funding, hospital grants and programme spending. It should therefore be read as an approximate picture of public-sector commitments—not as one fully consolidated and directly comparable account. The distinction matters because, following the devolution of health responsibilities, provinces carry much of the responsibility for delivering healthcare. The federal government, however, continues to oversee national regulation, coordination, disease-control programmes, health security and services within the federal territory. For 2026–27, the federal government has announced approximately Rs53. 3 billion for different health projects and programmes. Punjab has allocated Rs500. 62 billion, Sindh Rs393. 16 billion, Khyber Pakhtunkhwa Rs334 billion, and Balochistan Rs96 billion. Together, these announced amounts total about Rs1. 377 trillion. A large number with several different meanings The size of an allocation alone does not explain what a government intends to achieve or what patients will eventually receive. Every health budget broadly contains two financial streams. Current or non-development expenditure keeps the existing system running. It pays salaries, utilities, medicines, routine supplies, hospital operations and administrative costs. Development expenditure is generally used for new hospitals, additional wards, laboratories, equipment, rehabilitation projects and the expansion of services. Current expenditure is not inherently unproductive. Hospitals cannot function without doctors, nurses, technicians, medicines, electricity or maintenance. The concern arises when the wage and administrative bill grows without corresponding improvements in attendance, drug availability, diagnostic capacity, referral systems and the quality of patient care. Development spending carries its own risks. New buildings and equipment produce visible evidence of government activity, but facilities may remain underused when staffing, maintenance, medicines, utilities and recurring operating costs are not secured. A hospital building is only a healthcare service when it is staffed, supplied and accessible. The federal allocation and the prevention deficit At the federal level, around Rs24. 3 billion has been proposed for health and nutrition under the Public Sector Development Programme, while approximately Rs22 billion has been earmarked for the Ministry of National Health Services, including foreign assistance. Health and nutrition represent about 2. 2 per cent of the federal social-sector development allocation of Rs187. 2 billion. The federal programme includes investment in cardiac research, specialised treatment facilities and the early stages of proposed medical infrastructure in Islamabad and Rawalpindi. These projects may expand tertiary care, but the Pakistan Medical Association has questioned whether the balance of expenditure adequately addresses nutrition, disease control, surveillance and primary healthcare. Responding to the federal proposals, PMA Secretary General Dr Abdul Ghafoor Shoro described the condition of national health security as a “full-blown public health emergency. ” The association argued that the allocation favoured visible infrastructure while essential systems for maternal and child nutrition, infectious-disease control and public-health preparedness remained underfunded. The PMA specifically highlighted limited allocations for health-workforce development, the federal unit dealing with tuberculosis, HIV/AIDS and malaria, and drug-control functions. It also warned that large liabilities attached to ongoing projects could lock future budgets into completing physical infrastructure while leaving less fiscal room for prevention and frontline services. This debate reflects a long-standing fault line in Pakistan’s health policy: governments frequently invest in the point at which disease becomes most expensive-the tertiary hospital-rather than the point at which illness can be prevented or detected early. A patient with uncontrolled hypertension may eventually require emergency treatment, intensive care or cardiac surgery. A child suffering from chronic malnutrition may later need repeated hospitalisation. A tuberculosis case missed at community level can produce additional infections and more expensive treatment. Primary care, screening and prevention rarely attract the same public visibility as major hospitals, but they often deliver greater health gains for each rupee spent. Sindh’s budget and the debate over outsourcing Sindh’s health allocation has risen to Rs393. 16 billion, supporting a system that includes government hospitals, autonomous institutions, specialised centres, grants and public-private partnerships. The province is home to several nationally significant treatment institutions that serve patients beyond Sindh and frequently provide complex care without direct charges. Yet the PMA’s assessment of Sindh’s budget was particularly critical. It said disease prevention and primary healthcare had been “completely neglected”, arguing that too much funding was being absorbed by recurring administration, salaries, centralised treatment and major grants to specialised organisations. The association acknowledged the essential services provided by specialised and charitable institutions but questioned the wider strategy of treating advanced disease after patients reach costly tertiary facilities. It called for stronger investment in basic health units, vaccination, nutrition, maternal monitoring, control of waterborne disease, tuberculosis, polio and other preventable conditions. Public-private partnerships and grants should not automatically be treated as a weakness. Institutions such as the Sindh Institute of Urology and Transplantation, Indus Hospital and other not-for-profit providers have expanded access to highly specialised care. The policy question is whether such funding forms part of a balanced provincial network or substitutes for the government’s responsibility to build reliable district-level and preventive services. Effective partnerships require transparent service agreements, measurable targets, independent audits and public reporting on the number of patients treated, geographic reach, cost per patient and health outcomes. Without such evaluation, large grants reveal how much was transferred but not necessarily what the public received. Punjab, KP and Balochistan: scale versus access Punjab has announced the country’s largest provincial health allocation in absolute terms. Its Rs500. 62 billion package includes support for hospital infrastructure and programmes involving rural health centres, basic health units, mobile services, dialysis, transplantation, cardiac surgery and free medicines. Its challenge is scale. With the country’s largest population, even a substantial allocation must serve millions of people across major cities, small towns and rural districts. High aggregate spending does not automatically mean high spending per resident, nor does it guarantee equal access between Lahore and more distant districts. Khyber Pakhtunkhwa has allocated approximately Rs334 billion to health. Its headline figure is lower than Punjab’s but becomes more significant when considered against its smaller population. The province’s priorities include the broader health system as well as financial-protection programmes, though the long-term test will be whether spending strengthens public facilities in addition to paying for treatment through insurance or purchasing arrangements. Balochistan’s Rs96 billion allocation represents an increase of roughly 30 per cent over the preceding year’s Rs71 billion. The increase is notable, but the province faces a particularly difficult service-delivery environment: a geographically dispersed population, long travel distances, shortages of specialists and uneven availability of functioning facilities. In such settings, the effectiveness of spending depends heavily on rural staffing, transport, referral systems, telemedicine, maternal services and dependable district hospitals. A simple ranking of provincial allocations can therefore be misleading. Punjab spends the most in absolute terms, but population size, geographic spread, disease burden, existing infrastructure and the cost of reaching remote communities differ sharply across provinces. Pakistan still spends less than one per cent of GDP on public health The broader fiscal picture remains concerning. The Pakistan Economic Survey reported public health expenditure of Rs924. 9 billion in FY2023–24, equivalent to approximately 0. 8 per cent of GDP. The latest survey continues to acknowledge that health expenditure as a share of national output remains very low. This percentage provides a better measure of national priority than a trillion-rupee headline alone. Budget figures rise naturally as the economy, population, salaries and prices grow. Inflation can make an allocation appear larger even when it buys only the same—or fewer—medicines, laboratory supplies and services. For patients, the consequences of insufficient public financing often appear as out-of-pocket payments: purchasing medicines unavailable at government hospitals, paying privately for tests, travelling to urban centres, or borrowing money for treatment. A health system cannot be judged only by whether a service technically exists. It must also be judged by whether people can reach it without being pushed into financial hardship. Progress is visible, but much remains to be done Pakistan’s health indicators present a mixed picture. According to the Pakistan Economic Survey 2025–26, childhood immunisation increased from 68 per cent in 2018–19 to 73 per cent in 2024–25. Neonatal mortality declined from 41 to 35 deaths per 1, 000 live births, while infant mortality fell from 60 to 47 deaths per 1, 000 live births. These improvements are praiseworthy, but the remaining burden is still high. The country has also improved its Universal Health Coverage Service Coverage Index from 40 in 2015 to 56 in 2023. The index assesses access to essential services across areas such as reproductive, maternal and child health, infectious diseases and non-communicable diseases. However, Pakistan remains well below the global benchmark of 80 targeted for 2030. These gains demonstrate that progress is possible. They also underline why health financing must be linked to outcomes rather than announcements. A province may report that billions of rupees were released, but the more important indicators are whether immunisation increased, maternal deaths declined, tuberculosis cases were detected earlier, emergency waiting times improved and medicine shortages decreased. The overlooked front line Pakistan’s most urgent health needs are not confined to major hospitals. Primary-care facilities should manage pregnancy monitoring, immunisation, nutrition, family planning, diabetes, hypertension, respiratory illness and early signs of infectious disease. When this layer functions, fewer patients reach tertiary hospitals with preventable complications. The country also requires a stronger and more equitably distributed workforce. Increasing the number of medical graduates alone will not resolve shortages if doctors, nurses, midwives and technicians remain concentrated in urban centres or leave public service because of poor working conditions, insecurity, delayed promotions or limited professional development. Budget policy must therefore address recruitment, rural retention, safe workplaces, accommodation, continuing education and functioning referral links—not only sanctioned positions. Public health surveillance is equally important. Dengue, measles, polio, tuberculosis and emerging infections cannot be managed through hospital expansion alone. They require laboratories, data systems, field epidemiology, rapid reporting and coordinated responses across human, animal and environmental health. From allocation to execution The greatest vulnerability in public budgeting often appears after the assembly has approved the numbers. Funds must be released by finance departments, distributed to implementing agencies, assigned to approved spending heads, spent under procurement rules and documented through treasury and audit systems. Delayed releases can leave hospitals unable to procure supplies during critical periods, while weak planning may result in rushed expenditure near the end of the financial year. Pakistan’s health debate should therefore distinguish among three separate figures: • Allocation is what the government approves. • Release is what the finance authority makes available. • Utilisation is what the department or institution actually spends. Even utilisation does not prove success. Money can be spent according to procedure without producing the intended result. The final stage must be an assessment of outcomes, quality and equity. Hospitals and departments should publish accessible information on medicine availability, workforce vacancies, equipment functionality, patient volumes, infection rates, procurement, waiting times and district-wise expenditure. Such transparency would allow citizens and policymakers to see whether spending is concentrated where the disease burden is greatest. What a successful health budget should achieve The 2026–27 allocations provide an opportunity to move beyond the annual debate over whether the total has risen or fallen. A credible health budget should guarantee essential medicines at frontline facilities, strengthen vaccination and nutrition services, improve maternal and newborn care, retain trained professionals in underserved districts and ensure that equipment remains functional after purchase. It should also protect hospitals from overcrowding by treating illness earlier, closer to patients’ homes. Specialised institutions must continue to receive support, but not at the expense of basic healthcare, prevention and district-level capacity. The government’s success will not ultimately be measured by the number of projects inaugurated or the size of the figure announced in parliament. It will be measured in quieter but more consequential outcomes: a woman surviving childbirth, a tuberculosis patient diagnosed before infecting others, a child completing vaccination, a rural family receiving care without travelling hundreds of kilometres, and a household avoiding debt because medicines were available in the public system. Pakistan has placed more than Rs1. 37 trillion worth of health commitments on paper. The central question for the coming financial year is whether those commitments will become functioning services—or remain impressive numbers that patients cannot feel. A health budget is not merely an accounting statement. It is a public promise, and its true value is determined at the bedside. Stay informed, stay alert! pk/10-Jul-2026/pakistan-health-budget-2026-27-analysis” target=”_blank” rel=”nofollow noopener noreferrer”>Read full story on Dental News