As important as it is, health sector has never received the priority it deserved in a country with deteriorating health and nutrition statistics. While the indicators in the latest Economic Survey (2017-18) show improvement – be it healthcare facilities, number of doctors or other manpower – having one doctor for 957 people, or one dentist for 9,730 people or one bed for 1,580 citizens paints a daunting picture of the health sector.
Nonetheless, health expenditure has increased to 0.91 percent during fiscal year 2016-17 and to 1.21 percent based on budgeted estimates of 2017-18. For the actual period July-February 2018, it increased to 0.49 percent from 0.38 percent recorded in the same period of fiscal year 2016-17. A look at the overall health expenditure of Rs384.57 billion that includes federal and provincial expenditure shows that the budgeted amounts were set over 31.75 percent higher than the actual expenditure of 2016-17.
However, since these estimates include both provincial and federal allocations, one cannot say how much the actual expenditure has been with most of the provinces still to announce their budget estimates for FY19 and actual expenditure for FY18. But a look at the federal allocations recently in the Federal Budget 2018-19 can give direction of where the federal government is headed.
Of the recent budgetary allocations, the health sector again lacks behind, amid staggeringly high estimates for debt servicing, interest payments and defence. Despite Mifta Ismail earlier statement on the prevalence of stunting in 30 percent of children in Pakistan, Budget 2018-19 seems a non-event for the health sector.
Total federal government’s health sector allocation for 2018-19 stands at Rs43.896 billion, which includes both the development and current expenditure. Of this, the current expenditure has seen around 7 percent increased allocation to Rs13.897 billion for the coming fiscal over the revised estimated for FY18. Allocation for Hospital Services is a major component for current expenditure and has seen allocations amounting to Rs11.657 billion, up by 7 percent from the actual expenditure in FY18. On the other hand, the development side has seen a 4 percent increase to Rs29.999 billion over the revised estimates. However, what is important to note here is that the development expenditure has been slashed back by 41 percent in FY19 Budget when compared with FY18 budgeted amounts as only Rs28.7 billion were actually spent on the health sector out of the total Rs51.05 billion budgeted under the development expenditure head for health in 2017-18.
For completion of 20 ongoing and 37 new projects in health sector under the Public Sector Development Programme (PSDP), Rs25.034 billion have been allocated by the federal government in 2018-19, which is also quite less than previous year’s allocation of Rs48.701 (49 percent lower year-on-year in National Health Services, Regulations & Coordination Division).
Besides the continuation of the existing programs, nothing new has been announced for the health sector in the latest budget. Of the relief measures to the health sector, the federal government has shown interest in addressing child stunting and malnourishment with fortification programs in collaboration with international partners. It has exempted drugs from customs duties at import stage to provide relief for cancer treatment in the country.
It is argued that the federal government has a restricted focus on health because health is a provincial subject after the devolution process post 18th Amendment. It makes more sense to look at how provinces tackle this menace. So far, only Sindh has announced its Provincial Budget, which appears to be a non-event as well. It has allocated Rs96.38 billion for the health sector in 2018-19 budget, an increase of 13.6 per cent against last year’s Rs84.4 percent. The Annual Development Programme (ADP) of health is allocated Rs12.5 billion, which includes amount of Rs6.5 billion for hospitals, and Rs3 billion for preventive programs. Apart from ADP, Rs2.3 billion has been set for foreign-funded projects for the health department. How these allocations fare against last year, and against other provinces is something that will be taken up later in this section.
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Federal Government Health Spending-Rs (mn)
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Development Current Total Health
Expenditure Expenditure Expenditure
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FY16 25,874 12,108 37,982
FY17 25,324 12,379 37,703
FY18 (Budgeted) 51,051 12,847 63,898
FY18 (Revised) 28,728 12,944 41,672
FY19 (Budgeted) 29,999 13,897 43,896
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YOY Change
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FY17 -2% 2% -1%
FY18 (Budgeted) 102% 4% 69%
FY18 (Revised) 13% 5% 11%
FY19 (budgeted) -41% 8% -31%
FY19 (revised) 4% 7% 5%
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Source: ESOP 2017-18, Budget 2018-19
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Health & Nutrition Expenditure-Rs (bn)
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Public Sector Expenditure
(Federal and Provincial)
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Health
Total Health Development Current Percentage Expenditure
Expenditure Expenditure Expenditure Change as % of GDP
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FY13 125.96 33.47 92.49 128.51 0.56
FY14 173.42 58.74 114.68 37.68 0.69
FY15 199.32 69.13 130.19 14.94 0.73
FY16 225.87 78.5 147.37 13.92 0.77
FY17 291.9 101.73 190.17 29.54 0.91
FY18 384.57 130.19 254.38 31.75 1.12
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Source: ESOP 2017-18
