Pakistan’s health and nutrition outcomes and service coverage lag behind those in
most other South Asian countries, despite slowly improving over the past decade. Key
issues include persistent inequities in health and nutrition outcomes and service use by
economic status, gender, and region; poor governance and weak and centralized
management; low public spending on health; and programmatic shortcomings in reducing
fertility and improving nutrition—areas with cross-cutting impacts on human
development and economic growth.
The adoption of the 18th Amendment to the constitution in 2010 and the
subsequent devolution of most federal responsibilities for health and population welfare to the
provinces provide opportunities for more responsive and accountable governance, but
they also pose severe challenges. Special attention will be required to ensure appropriate
institutional arrangements to house federal functions, a clear delineation of responsibilities,
and the building of capacities and structures at all levels. Actions to improve health
sector performance include improving health services targeting the poor; increasing health
spending; strengthening health sector management and accountability with a greater
focus on monitoring and information (in a context of devolution and contracting); and
expanding family planning and nutrition services.