The government has been spending 0.5-0.8 percent of its GDP on health but Ministry of Health and the provincial health departments do not take into account other public and private sector health services, say Health Indicators of Pakistan 2007.
If these ignored sectors are taken into account, the total expenditure roughly ranges between 2.3-3.7percent of the GDP. The government's spending on health has ranged between 2.6-4 percent which currently stands at 3.2percent, it said.
However, besides utilisation issues, the total government health spending has increased 5.5 times over the last decade and a half, increasing from Rs 7.7 billion in 1990 to Rs 50 billion now. Unfortunately this figure has not been adjusted towards inflation and population growth.
Statistics show that private sector spending on health as a total percentage of the expenditure on health has ranged above 67 percent over the last several years, 98 percent of this is out of pocket budget. This is clearly a significant burden for a greater chunk of the country's population, which lives below poverty line.
The ratio between the development and non-development budgets, a comparison of the federal and provincial development and non-development financial plan shows dominance of non-development budget in the provinces; this gap appears to have widened over the last 10 years.
An analysis of the government expenditure on health reflects that spending has ranged between 63 percent to the current 80 percent over the last five years.
It is difficult to estimate the expenditure on health in the districts because development allocations are made all at once. Data on government spending on health must also be contextualised to its appropriate share of health financing, giving the realisation that public sector contributions are just one of the sources of financing health within the country. The government's spending on health as a percentage of the total spending has ranged below 35 percent over the last several years.
As a contribution to public sector health expenditure, foreign aid is officially quoted as having ranged from 4-16%percent over the last several years.
A major part of the donor contributions is not reflected in the Public Sector Development Programme (PSDP) and other than the contributors like the World Bank and Asian Development Bank. Most of the international departments, however, remained unaccounted for.
World Health Organisation (WHO) has reflected this in a form of sizeable chunk in its recent publications. Considering this, a system for tracking contributions made by donors and development agencies is a prerequisite. There is a dire need to put in place a system for National Health Accounts to enhance efficiency and promote greater transparency in health system.
In line with the Fiscal Responsibility Act 2005, the government has committed to increase health allocations by 1percent of the GDP by 2015. However, even this is far below the internationally recommended level for any government's spending on health, which should be $34 for essential health interventions by the year 2015 to achieve MDGs.
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