Despite a modest increase, the health sector's share in Pakistan's overall social sector development budget stands at only 2.2 per cent for the current fiscal year. The country's health outcomes continue to underperform against regional benchmarks. Life expectancy hovers just over 67 years, nearly five years below the South Asian average. Maternal and child mortality rates remain considerably higher than those of several neighbouring countries.
Decades of Underinvestment
Such outcomes are not surprising given decades of underinvestment, weak governance, and poor policy choices. The public health system is ill-equipped to serve a growing population, the majority of which cannot afford private healthcare. Pakistan spends less than 3 per cent of GDP on healthcare, far below the global average of 6.74 per cent based on data from 185 countries.
Role of Official Development Assistance
Against this backdrop, Official Development Assistance (ODA) has become far more important to Pakistan's health sector than its modest share of GDP would suggest. A recent report by Tabadlab, titled Understanding the Impact of ODA Cuts on Pakistan's Health System, estimates that Pakistan has received under $5 billion annually in development assistance over the past decade. The significance lies not merely in its size, but in what this aid finances.
With much of the country's annual budget dedicated to military spending and debt repayments, international aid provides vital support to the public health system. Internationally-funded initiatives such as Gavi have helped finance the country's immunisation programme. The Global Fund finances prevention, diagnosis, and treatment efforts for major diseases such as tuberculosis, malaria, and HIV/AIDS.
Domestic Budget Limitations
Pakistan's domestic health budgets are largely committed to meeting fixed and recurring costs such as salaries, hospital operations, administration, and procurement of routine medicines. The Pakistan Medical Association has criticised this year's health budget for again prioritising infrastructure projects while underfunding essential public health functions such as primary healthcare, disease prevention, and workforce development.
Overseas aid, by contrast, has been funding critical functions such as providing vaccines, diagnostic kits, improving supply chains, outreach, surveillance, and technical support.
Impact of Aid Cuts
However, this reliance on international aid has become a major problem. Traditional donors, including the United States, several European countries, and Japan, are cutting aid simultaneously, creating sudden disruptions in health programmes. Countries like Pakistan are already experiencing the fallout of this broader phenomenon.
Tabadlab notes how cuts to USAID funding have led to the closure or suspension of over 60 health facilities, disrupting services for nearly 1.7 million people. In Sindh's Shikarpur district, a tuberculosis control programme serving about 1,500 families monthly was halted, leaving more than 100 health workers unemployed. TB monitoring in Punjab and Khyber-Pakhtunkhwa has also been affected, while treatment for over 42,000 HIV positive patients is reportedly at risk.
Structural Reforms Needed
Given how much Pakistan's health service delivery has become dependent on external financing, this sudden aid contraction is undermining the operational backbone of disease control, immunisation, and preventive healthcare systems that millions of vulnerable citizens rely upon. Managing this transition will require far more than temporary stopgap financing.
Pakistan must adopt broader structural reforms aimed at rebuilding domestic health financing capacity, strengthening provincial delivery systems, and reducing donor dependence. Pakistan does not depend on international aid to sustain its defence expenditures or to pay the salaries of its officials. It should not have to rely on loans and external assistance to ensure basic healthcare for its citizens either.
