newly created state continued with the lunacy act of 1912, which had been in place in british india. the focus of the act was more on detention than on treatment and with advances in treatment, especially the introduction of psychotropic medication, updated legislation was needed but it was not until 2001 that the lunacy act of 1912 was replaced by the mental health ordinance of 2001. following the 18th amendment in the constitution of pakistan, health was made a provincial subject rather than a federal one. on 8 april 2010, the federal mental health authority was dissolved and responsibilities were devolved to the provinces, and it became their task to pass appropriate mental health legislation through their respective assemblies. only the provinces of sindh and punjab have a mental health act in place and there is an urgent need for similar legislative frameworks in other provinces to protect the rights of those with mental illness. pakistan's mental health policy was last revised in 2003.the disaster/emergency preparedness plan for mental health was last revised in 2006. there is no policy that protects the rights of people who get convicted but are mentally ill. recently, pakistan's top court has ruled that schizophrenia does not fall within its legal definition of mental disorders, clearing the way for the execution of a mentally ill man convicted of murder. mental health care services the allocated mental health budget is 0.4% of total health care expenditures. estimated mental health spending per capita is (us$) $0.01. there are only 5 mental hospitals in pakistan. number of mental health outpatient facility 4,356 and number of mental health day-treatment facility is 14. there are 18 ngos in the country involved in individual assistance activities such as counselling, housing or support groups. the total number of human resources working in mental health facilities or private practices per 100,000 people is 87.023, among which 342 are psychiatrists, meaning that there is roughly one psychiatrist available per 500,000 people. of these, 45% work for government-run mental health facilities and 51% work with non-governmental organisations and other private institutions, while 4% work in both sectors. disease burden of mental health burden of mental disorders in terms of disability-adjusted life years (per 100,000 population) is 2,430. common mental health problems have been identified in both the rural and urban population which seems to have a positive association with socioeconomic adversities, relationship problems and lack of social support. depressive and anxiety disorders appear to be highest, followed by bipolar disorder, schizophrenia, psychosomatic disorders, obsessive compulsive disorder and post-traumatic stress disorder. percentage of dalys of common mental disorders in pakistan mental disorders dalys schizophrenia 0.36% alcohol use disorders 0.47% drug use disorders 0.70% depressive disorders 1.28% bipolar disorders 0.27% anxiety disorders 0.89% eating disorders 0.06% autistic spectrum 0.33% adhd 0.01% conduct disorder 0.26% intellectual disability 0.21% other mental disorders. 0.32% depression often starts at a young age and affects women more commonly than men. one or two mothers out of 10 have depression after childbirth. depression also limits a mother's capacity to care for her child, and can seriously affect the child's growth and development. a study showed that exposure to maternal mental distress is associated with malnutrition in 9‐month infants in urban pakistan. pakistan is one of those countries where the mental health of children is not taken seriously by parents. as per recent stats published by one news website, almost 36% of people in pakistan are suffering from anxiety and depression. the major reason for these mental illnesses is bad relationship with friends & family. moreover, due to the recent pandemic, poverty and unemployment also increases the depression, anxiety, and suicide rate. almost 18,000 people in pakistan commit suicide annually while the number of suicide attempts is almost four times greater than these figures. suicide prevalence in pakistan is 9.3 people per 100,000 persons. according to united nations office on drugs and crime (unodc) technical summary report 2012 on drug use in pakistan, annual prevalence is estimated to be 5.8 per cent, or 6.45 million of the population in pakistan aged between 15 and 64 used drugs in 2012. cannabis is the most commonly used drug with an annual prevalence of 3.6 per cent or approximately four million people. cannabis is followed by sedatives and tranquillisers, such as benzodiazepines, heroin, opium and other opiates. mental health awareness challenges and necessary actions the stigma against mental illness is rampant in pakistan. it is sustained by a popular belief in spiritual cures — exorcising evil spirits, experimenting with herbal cures — and a lack of awareness about mental illness's causes, symptoms, and cures. even when patients recognize their symptoms, overcome the stigma, gain the support of their families and start looking for medical help, there are insufficient mental healthcare facilities. it is concluded that the health care system's response in pakistan is not adequate to meet the current challenges and that changes in policy are needed. mental health care needs to be incorporated as a core service in primary care and supported by specialist services. political commitment, adequate human and financial resources, and advocacy are needed for the integration of mental health into phc in pakistan. there is a strong need to provide adequate training for general practitioners and postgraduate training for mental health professionals to meet the current demands. a collaborative network between stakeholders in the public and private sector, as well as non-governmental organizations are required that promotes mental health care and advocates for changes in mental health policy. ongoing programs a number of innovative programmes to develop indigenous models of care like the 'community mental health programme' and 'schools mental health programme' have been developed by the pakistan government. these programmes have been found effective in reducing stigma and increase awareness of mental illness amongst the adults and children living in rural areas. recently, who launched a mental health gap action program (mhgap). it will call for improving political commitments and help develop policies, and legislative infrastructure, to provide integrated health care. the british basicneeds program, mental health focused international ngo with a global reach spanning 14 countries, began forming partnerships with pakistani nonprofits in 2013, has already served 12,000 people in need of psychiatric attention. in addition to setting up camps where patients can see doctors, receive prescriptions for medicines and engage in therapy, the program trains citizens to recognise symptoms and side effects of mental illnesses. resources doctors (pmc-2022)274,135 dentists (pmc-2022)32,237 nurses (2022)121,245 midwives (2022)44,693 lady health workers (2022)22,408 registered vets10,600 health facilities in 2022 (njm) total health facilities14,568146,053 beds hospitals1,276105,592 beds dispensaries5,8022,845 beds rural health centers7369,612 beds tuberculosis centers416184 beds basic health units5,5586,555 beds m.c.h. centers906256 beds personnel according dr nasir javed malik, there are 274,135 doctors (2022 statistics from pakistan medical commission) and 14,568 health care facilities in 2021-22 to cater for over 229 million people. overall, pakistan’s sdgs index score has increased from 53.11 in 2015 to 63.5 in 2020 i.e. 19.5 percent up from the baseline of 2015. this is a composite score. there are sectoral achievements at different levels. infant mortality rate (imr) in pakistan is 54.2 deaths per 1,000 live births in 2020, while neonatal mortality rate is 40.4 deaths per 1,000 live births in 2020 from 41.2 in 2019.maternal mortality ratio is 186 maternal deaths per 100,000 births (pakistan economic survey-2021) many pakistani doctors and medical professionals choose to migrate to other countries, contributing to a brain drain and chronic skills shortage in the country. in the united states alone, there are over 20,000 doctors of pakistani origin. challenge of covid-19 outbreak in pakistan : to date, pakistan has experienced five waves of the pandemic. the pti government under prime minister imran khan successfully contained covid-19 through various initiatives taken under pakistan preparedness and response plan (pprp) 2021-22, which is a continuation of the first pprp, launched on 23 april 2020 in response to the detection of covid-19 in pakistan on 26 february 2020. the pprp 2020, was worth us$595 million. the pprp 2021-22 highlights the achievements in the implementation of pprp 2020, the challenges and lessons learned, and the proposed priority intervention to be implemented from june 2021 to july 2022. this plan has been developed by the m/o nhsr&c in consultation with all provinces. facilities list of hospitals in pakistan professional institutes as of 2007, there were 48 medical colleges and 21 dental colleges in the country. list of schools of medicine in pakistan list of schools of dentistry in pakistan list of schools of pharmacy in pakistan list of schools of nursing in pakistan list of schools of veterinary medicine in pakistan services nursing according to dr.shaikh tanveer ahmed nursing is a major component of health care in pakistan. the topic has been the subject of extensive historical studies, is as of 2009 a major issue in that country, and has been the subject of much scholarly discussion amongst academics and practitioners. in 2009, pakistan's government stated its intent to improve the country's nursing care. dentistry main article: dentistry in pakistan at present there are upwards of 70 dental schools (public and private) throughout pakistan, according to the pakistan medical and dental council the state regulatory body has upwards of 11500 registered dentists. the four-year training culminates in achieving a bachelor of dental surgery (bds) degree, which requires a further one year compulsory internship to be a registered dentist in pakistan. pharmacy the pharmaceutical industry in pakistan has grown during the past recent decades. at the time of the independence of pakistan in 1947, there were few production units in the country. currently pakistan has more than 800 large volume pharmaceutical formulation units, including those operated by 25 multinationals present in the country. almost all the raw materials used in making of medicine are sourced from abroad. about 50 percent of them are imported from india. the pakistan pharmaceutical industry meets around 90% of the country's demand of finished dosage forms and 4% of active ingredients. specialized finished dosage forms such as soft gelatin capsules, parenteral fat emulsions and metered-dose inhalers continue to be imported. there are only a few bulk drug active ingredient producers and pakistan mainly depends on imports of bulk drugs for its formulation needs resulting in frequent drug shortages. political disturbances and allegations of under-invoicing add to the uncertainty of imports and clashes with the customs and tax authorities are common. the national pharma industry has shown growth over the years, particularly over the last decade. the industry is trying to upgrade itself and today the majority industry is following local good manufacturing practices (gmp) laws, with a few in accordance with international guidance. currently the industry has the capacity to manufacture a variety of traditional products ranging from simple pills to capsules, ointments and syrups. in 2017, world health organization accredit first-ever pakistani drug formulated by getz pharma. medical tourism main article: medical tourism in pakistan medical tourism in pakistan is viewed as an untapped market that could be turned into a huge opportunity if the government "focuses on key issues". according to pakistani medical experts, pakistan has a "huge potential" in becoming a regional medical tourism hub, comparable to many other countries in its neighbourhood. medical tourism in pakistan has been arranging potential trips for many medical health and care procedures. a number of modern hospital facilities exist in major cities such as islamabad, karachi and lahore that are fully equipped and facilitated with the latest medical technologies. many doctors and surgeons in pakistani hospitals tend to be foreign qualified. however, security issues and an overall below-par health infrastructure have challenged the growth of the industry. veterinary medicine veterinary medicine is widely practiced, both with and without professional supervision. professional care is most often led by a veterinary physician (also known as a vet, veterinary surgeon or veterinarian), but also by paraveterinary workers such as veterinary nurses or technicians. this can be augmented by other paraprofessionals with specific specialisms such as animal physiotherapy or dentistry, and species relevant roles such as farriers. community medicine pakistan's government has committed to the goal of making its population healthier, as evidenced by its support for the social action programme (sap) and by the new vision for health, nutrition, and population outlined in the national health policy guidelines. the national health policy provides guidelines to provinces for