World Bank Considering $258 Million for Health Sector Project in Pakistan

The World Bank’s Board of Executive Directors is likely to consider the National Health Support Programme (NHSP) of $258 million next month to strengthen equitable delivery and quality of essential health services at the primary health care level in support of Universal Health Coverage.

Official documents revealed that it is anticipated that the NHSP will be co-financed by grant resources amounting to approximately $130 million, $80 million of which will be from the Global Financing Facility (GFF). The credit and the grant will be mingled to finance the Disbursement-linked Indicators (DLIs) and the Insurance Premium Finance (IPF) component.

The proposed NHSP will be national in scope and will benefit Balochistan, Khyber Pakhtunkhwa (KP), Punjab, Sindh, and the Ministry of National Health Services, Regulations and Coordination (MoNHSR&C). It is aimed at supporting the Government of Pakistan’s (GoP) Universal Health Coverage (UHC) program which focuses on the implementation of the program benefits package at the primary and secondary care levels.

As health is a devolved subject, the proposed NHSP will support the provincial governments to improve the equitable delivery and quality of essential health services at the primary health care (PHC) level. While the government’s program comprises a set of services to be delivered at the primary and secondary care levels, the NHSP’s boundary is confined to the PHC defined in the Pakistan context as the services being delivered to Rural Health Centres and below, including at the community level.

As such, the Program for Results (PforR) financing will not directly support secondary or tertiary level care. Moreover, while the NHSP will be largely implemented by Pakistan’s provincial governments, the PforR is also aimed at supporting the MoNHSR&C in building its capacity for coordination, research, and reporting of the country’s progress toward the Universal Health Coverage (UHC).

The proposed Program Development Objectives (PDO) level results indicators are as follows:

  • An increase in UHC index (adjusted to reflect essential health services at PHC level) (disaggregated by province and lagging districts).
  • An increase in the use of modern contraceptives among married women aged 15 to 49 (disaggregated by province and lagging districts).
  • An increase in the effective coverage of antenatal care (disaggregated by province).
  • An increase in non-salary primary health care budget (disaggregated by province).

The documents revealed that Pakistan is the fifth-most populous country in the world with an estimated population of 227.5 million (2020), of which 48 million are women of childbearing age, and 32 million are children under the age of five. The Gross National Income (GNI) per capita was $1,410 in 2019. Periodic macroeconomic crises and a low human capital basis have constrained the country’s growth prospects. The annual economic growth (GDP) averaged around 4.3 percent between FY2019–FY2020, which is below the South Asian annual average of 6.2 percent.

Human capital also lags in Pakistan — a child born here is expected to be only 41 percent of his or her potential, given the risks of poor health and education prevalent today. This is lower than the average for the South Asia Region (0.50) and Lower-Middle Income countries (0.47). Moreover, the national level Human Capital Index (HCI) hides the vast provincial differences. Punjab is at 0.42, Khyber Pakhtunkhwa (KP) is at 0.39, Sindh is at 0.36, and Balochistan is at 0.32. Exacerbating the already low human capital accumulation, the pandemic has further weakened and strained the public health system.

Pakistan has had repeated waves of COVID-19 infections since the pandemic began. The infections and the containment measures impeded the delivery of essential health services due to supply chain disruptions and the redeployment of health care workers, and concurrently, restrictions on movement lost income and the fear of infection deterred people from seeking the care they needed. Based on global simulations for education and child mortality, the pandemic could well erase eight years of progress on human capacity (2 HCI points), possibly with greater implications for the poor and vulnerable.

The documents also showed that Pakistan has shown substantial improvement in its health outcomes over the last decade but it did not meet any of the 2015 health-related Millennium Development Goals (MDGs), and considering the current trends, it is unlikely to meet most of the 2030 health-related Sustainable Development Goals (SDGs).

Pakistan’s life expectancy increased from 60 years in 1990 to 67 years in 2019. However, it remains among the lowest in the South Asia Region. Progress on reproductive, maternal and child health has also been inadequate, as evidenced by a low contraceptive (modern methods) prevalence rate among married women (23 percent in 2019), a high level of stunting (38 percent in 2018), and neonatal mortality (41 deaths per 1,000 live births in 2019). Only 70 percent of children aged between 12 and 23 months in Pakistan have received a third dose of the DPT vaccination as compared to 90 percent for the South Asia Region, and it is 88 percent for lower-middle income countries.

Furthermore, disparities across socioeconomic groups and geography remain stark. The poor are being left behind. For example, the fourth wealth quintile has 34 neonatal deaths per 1,000 live births while the lowest quintile has 51 deaths per 1,000 live births.