An estimated 4.4%—or 11 million Pakistanis—will experience impoverishment due to out-of-pocket spending for healthcare services in 2024. Substituting such expenditures by increasing government spending on health is crucial not just to reduce poverty, but to spur continued progress towards universal health coverage in Pakistan.
Yet, at a time when debt repayment burdens are ballooning across the Global South and macro-fiscal outlooks are unfavorable, increasing government spending on health is a complex challenge for countries like Pakistan. The options available in these circumstances tend to boil down to just two: (1) increasing health’s share of public expenditures, and (2) using public resources allocated to healthcare more efficiently, particularly through an increased emphasis on preventative and primary healthcare (PHC). But let us now ask the important follow-on questions: How are these two options supposed to be achieved? And, even more instrumentally, who will do it?
While policy dialogue at the top level can be instrumental for change, within government agencies, advocacy and policy advancement often depends on initiatives of middle-ranking officers. In the case of health financing reforms, what is needed is a well-capacitated health sector administrator who can combine public health and economic arguments during policy discussions, thereby creating the ground for senior officers to win changes in public budget allocations for health.
However, more than a decade after health sector devolution in Pakistan, provincial budget processes for health have remained dependent on historical inputs and are largely non-strategic. The lack of any specialized graduate programs in healthcare financing have led to limited availability of expertise. The conclusion: a critical link in the theory of change behind increasing public financing for health appears fractured in Pakistan, especially at the provincial level.
To help turn this around, the World Bank–supported by resources from the Global Financing Facility, ThinkWell Global, WHO, and GIZ–embarked on a journey to strengthen the health financing policy reform chain. This began with a series of intensive workshops in health financing fundamentals delivered to a targeted cohort of mid-level managers comprising of provincial health department officials, experts from finance, planning and development board from across the country. None of the health officials had prior health financing expertise despite their involvement in provincial health financing policymaking processes.
Over the course of 8 months, this cohort convened once each in Islamabad, Lahore, and Murree. The purpose was to develop an applied familiarity with the core functions of health financing and to create a cohort of champions capable of advocating for health budget reprioritization and more efficient health budget utilization as and when needed.
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