healthcare in pakistan healthcare in pakistan the healthcare delivery system of pakistan (تحفّظ صحتِ عامّہ ، پاکستان) is complex because it includes healthcare subsystems by federal governments and provincial governments competing with formal and informal private sector healthcare systems. healthcare is delivered mainly through vertically managed disease-specific mechanisms. the different institutions that are responsible for this include: provincial and district health departments, parastatal organizations, social security institutions, non-governmental organizations (ngos) and private sector. the country's health sector is also marked by urban-rural disparities in healthcare delivery and an imbalance in the health workforce, with insufficient health managers, nurses, paramedics and skilled birth attendants in the peripheral areas. pakistan's gross national income per capita in 2021 was $4,990 and the total expenditure on health per capita in 2021 was rs 657.2 billions , constituting 1.4% of the country's gdp. the health care delivery system in pakistan consists of public and private sectors. under the constitution, health is primarily responsibility of the provincial government, except in the federally administrated areas. health care delivery has traditionally been jointly administered by the federal and provincial governments with districts mainly responsible for implementation. service delivery is being organized through preventive, promotive, curative and rehabilitative services. the curative and rehabilitative services are being provided mainly at the secondary and tertiary care facilities. preventive and promotive services, on the other hand, are mainly provided through various national programs; and community health workers’ interfacing with the communities through primary healthcare facilities and outreach activities. the state provides healthcare through a three-tiered healthcare delivery system and a range of public health interventions. some government/ semi government organizations like the armed forces, sui gas, wapda, railways, fauji foundation, employees social security institution and nust provide health service to their employees and their dependents through their own system, however, these collectively cover about 10% of the population. the private health sector constitutes a diverse group of doctors, nurses, pharmacists, traditional healers, drug vendors, as well as laboratory technicians, shopkeepers and unqualified practitioners. development of life expectancy in pakistan pakistani doctors operate on an injured woman in muzafarabad in 2005 healthcare delivery system of pakistan despite the increase in public health facilities, pakistan's population growth has generated an unmet need for healthcare. public healthcare institutions that address critical health issues are often only located in major towns and cities. due to the absence of these institutions and the cost associated with transportation, impoverished people living in rural and remote areas tend to consult private doctors. studies have shown that pakistan's private sector healthcare system is outperforming the public sector healthcare system in terms of service quality and patient satisfaction, with 70% of the population being served by the private health sector. the private health sector operates through a fee-for-service system of unregulated hospitals, medical practitioners, homeopathic doctors, hakeems, and other spiritual healers. in urban areas, some public-private partnerships exist for franchising private sector outlets and contributing to overall service delivery. very few mechanisms exist to regulate the quality, standards, protocols, ethics, or prices within the private health sector, that results in disparities in health services. even though nurses play a key role in any country's health care field, pakistan has only 121,245 nurses to service a population of 229 million people, leaving a shortfall of nurses as per world health organisation estimates. as per the economic survey of pakistan (2020-21), the country is spending 1.2% of the gdp on healthcare which is less than the healthcare expenditure recommended by who i.e. 5% of gdp. cancer care cancer information on pakistan approximately one in every 9 pakistani women is likely to suffer from breast cancer which is one of the highest incidence rates in asia. major cancer centers in pakistan include the shaukat khanum memorial cancer hospital and research center in karachi, lahore and peshawar, aga khan university hospital in karachi and the national institute of blood diseases (nibd) in karachi. obesity obesity in pakistan is a health issue that has effected moaz concern only in the past few years. urbanisation and an unhealthy, energy-dense diet (the high presence of oil and fats in pakistani cooking), as well as changing lifestyles, are among the root causes contributing to obesity in the country. according to a list of the world's "fattest countries" published on forbes, pakistan is ranked 165 (out of 194 countries) in terms of its overweight population, with 22.2% of individuals over the age of 15 crossing the threshold of obesity. this ratio roughly corresponds with other studies, which state one-in-four pakistani adults as being overweight. according to the research paper published on pubmed, in pakistan, 25% of people are either obese or overweight. moreover, according to the 2016 stats by world health organization (who), 3.3% of males and 6.4% of females in pakistan are suffering from obesity. research indicates that people living in large cities in pakistan are more exposed to the risks of obesity as compared to those in the rural countryside. women also naturally have higher rates of obesity as compared to men. pakistan also has the highest percentage of people with diabetes in south asia. according to one study, fat is more dangerous for south asians than for caucasians because the fat tends to cling to organs like the liver instead of the skin. malnutrition malnutrition is one of the most significant public health problems in pakistan, and especially among children. according to unicef, about half of children are chronically malnourished. national surveys show that for almost three decades, the rates of stunting and acute undernutrition in children under five years of age have remained stagnant, at 45 percent and 16 percent, respectively. additionally, at the “national level almost 40% of these children are underweight...and about 9% by wasting”, diseases where muscle and fat tissues degenerate as a result of malnutrition. similarly, women are also at risk, with about half suffering from anemia, which is commonly caused by iron deficiency. a significant contributing factor to this issue is food insecurity; the world food programme estimates that nearly one in two pakistanis are at risk of food insecurity. this in turn can be attributed in part to the rapid urbanisation and mass migrations caused by the great partition of india and pakistan, and the resulting issues with infrastructure and government, as well as other factors. for example, contamination of water sources affects water and food security, and also over a long time contribute to stunting and underweight measurements, caused by deficiencies of nutrients, lost through diarrhea, dysentery, and other water-born diseases. some limitations to interventions and aid are due to the limitations in peer-reviewed literature on this specific topic. according to the director of the nutritional science program at pakistan's dow university of health sciences (duhs), and president of the pakistan nutrition and dietetic society (pnds), dr. safdar, “only 99 papers of nutritional research were published in pakistan between 1965 and 2003”. smoking tobacco smoking in pakistan is legal, but under certain circumstances is banned. if calculated on per day basis, 177 million cigarettes per day were consumed in fy-14. according to the pakistan demographic health survey, 46 per cent men and 5.7 per cent women smoke tobacco. the habit is mostly found in the youth of pakistan and in farmers, and is thought to be responsible for various health problems and deaths in the country. smoking produces many health problems in smokers. pakistan has the highest consumption of tobacco in south asia. drug addiction in the last few decades, drug addiction has increased exponentially in pakistan. most of the illegal drugs come from the neighbouring afghanistan. according to the un estimate, 8.9 million people in the country are drug users. cannabis is the most used drug. the rate of injection drug abuse has also increased significantly in pakistan, sparking fears of an hiv epidemic. although, the increase in the problem has been alarming, the government response has been minimal at best. few programs are active in the country to help drug addicts and smuggling and availability of the drugs in the country has gone almost unchecked. anti-narcotics force is the government agency responsible for tackling drug smuggling and use within pakistan. suicide pakistan's suicide rate is below the worldwide average. the 2015 global rate was 6.1 per 100,000 people (in 2008, 11.6). suicides represent some 0.9% of all deaths. pakistan's death rate, as given by the world bank, is 7.28 per 1000 people in 2016 (the lowest rate in the 2006-2018 period). in 2015, the suicide rate in pakistan was approximately 1.4 deaths per 100,000 inhabitants, one seventh of the global average. similarly, suicides represent only ~.1.2% of all deaths. cancer among asian countries, pakistan has the highest rates of breast and ovarian cancer. the genetic findings show that brca mutation (brca1 and brca2) mutations account for a substantial proportion of hereditary breast/ovarian cancer and early-onset breast and ovarian cancer cases in pakistan. breast cancer is the most common cancer in pakistan as different studies show it kills nearly 40,000 women every year. according to world health organization (who), breast cancer rates are getting worse and it is not sparing even younger age group. reproductive health and rights introduction reproductive health being stigmatized through sociocultural norms remains one of the most poorly developed segments of health system in pakistan. according to the united nations population fund unmet access to sexual and reproductive health deprive women of the right to make crucial choices about their bodies and future and affect the family welfare. poor reproductive health of adolescents leads to early childbearing and parenthood, pregnancy complications, maternal deaths and disability. according to a study of population council, pakistan adolescents and youth in pakistan are at risk of experiencing poor reproductive health, which has a number of negative implications for adolescents and youth, and for society at large. knowledge of reproductive health and rights pakistan do not have concrete reproductive health educational programs targeted at young population. young boys and girls are more aware of their rights as youth but they do not know much about their reproductive health rights. adolescents and youth face barriers in accessing sexual and reproductive health services such as needing an elder family member to accompany them. further country's socio-cultural background discourages the discussion about reproductive health, making it difficult to provide sex education and awareness about sexually transmitted diseases. according to latest pakistan demographic and health survey 2017–18 the proportions of young married men and women who have heard about hiv/aids or have comprehensive knowledge about it are quite low. moreover, health facilities predominantly focus on treatment rather than a preventive approach. percentage of males and females who have heard about hiv/aids in pakistan (source) gender age percentage male15-19y22.3 female15-19y13.2 male20-24y51.8 female20-24y21.5 male25-29y63.3 female25-29y34.7 health of adolescent mothers and their children compared to older mothers, adolescent mothers in pakistan are three times more likely to be anemic and have a lower pre-pregnancy body mass index. as a result of this, their newborns are more prone to preterm birth and low birth weight and have a higher risk of neonatal death. pediatric intensive care units are available solely in large cities where the "cost of intensive care is high and affordable only by middle-high income groups." as of 2015, there didn't exist available data on pakistani critically ill children in picu. family planning although use of contraceptives and other modern contraceptive methods increases in recent years but still pakistan has a high fertility rate. level of family planning knowledge rises steadily with age, from about 91 percent of women in the 15 to 19 age group to nearly 99 percent among women of 25 to 29 years. but knowledge level varies greatly among different regions of the country where balochistan and sindh have the lowest proportion of women with knowledge of contraceptive methods and surprisingly in federally administered tribal areas a very high proportion of women even higher than the punjab and islamabad know about at least one contraceptive method. mental health introduction mental health is mostly neglected in pakistan, where 10- 16% of the population, more than 14 million, suffers from mild to moderate psychiatric illness. the figures probably do not include a large number of people who have never seen a psychiatrist and who strongly deny the need for psychiatric consultation. legislation and policy when pakistan was created in 1947, the