SPEAK Trust conducts a study on the Implementation of Universal Health Coverage (UHC) in Pakistan

Pakistan has been implementing Primary Healthcare since 1978 following the Alma Ata Declaration. But to date, 50 percent of the population does not have access to primary healthcare. Pakistan has been an International Heath Partnerships and related Initiatives (IHP+) signatory since 2010.

Pakistan has been implementing Primary Healthcare since 1978 following the Alma Ata Declaration. But to date, 50 percent of the population does not have access to primary healthcare. Pakistan has been an International Heath Partnerships and related Initiatives (IHP+) signatory since 2010.

With the introduction of sustainable development goals, IHP+ became Universal Health Coverage 2030 (UHC2030). In 2012, The United Nations urged all the countries to accelerate their efforts to achieve UHC. Pakistan signed UHC2030 in 2018. However, Pakistan has not assessed the implementation of the UHC2030 since then.

This research is conducted by SPEAK Trust, which is a member of the Centre for Action Research on AIDS and Mobility (CARAM Asia) in Pakistan. CARAM Asia works on AIDS-related issues of mobile populations. It spans 20 Asian countries with 42 members, actively conducting and utilizing action research to improve advocacy programming. This research highlights the implementation level of UHC in Pakistan and the inclusion of migrants in Pakistan’s UHC commitments. Due to its qualitative nature, the study dives deep into the need for, and hurdles in achieving UHC in Pakistan.

Through extensive study of available literature and primary data, it has been found that there is a lack of understanding of UHC. Every province has developed its own definition which is not comprehensive while the domain of UHC is much extended.

Secondly, there is no legislation in place at the national level. Pakistan is implementing PHC as UHC. To streamline UHC, legislation at the federal level is the need of the hour. Additionally, there is no roadmap to gauge the progress of UHC and Pakistan is using SDG indicator 3.8.1 to monitor its progress.

Another bottleneck is the lack of inter-sectoral policies and interventions. More than half of the burden of disease in Pakistan can be tackled through inter-sectoral coordination, but our health sector lacks the will to work in a coordinated manner.

The results also indicate that the budget allocation for UHC is insufficient. There is no budget allocation specifically meant for Pakistani emigrant laborers. Pakistan has “left out” overseas Pakistani emigrants from its health initiatives.

It is hoped that the findings of this study will facilitate the government and other shareholders to design interventions, strengthen inclusion and improve financing around UHC for migrant workers.

There is a dire need to create one single definition of UHC. As there is no consensus on the UHC definition, it creates problems in effective planning, implementation, and monitoring. In addition, the findings may also catalyze international government-level collaboration and action by international organizations for the recognition of migrants as a vulnerable group that desperately needs UHC coverage and social protection schemes. Out of 17 SDGs, 11 have indicators for migrant workers. However, the implementation of these indicators is limited.

This research will be utilized actively by CARAM Asia members and other related stakeholders to advocate for the inclusion of migrants in the key UHC advancements. It will impact the Asian continent which is the leading exporter of migrant workers, while Pakistan itself is the 2nd biggest exporter of migrant workers in the region with approximately 11 million international labor emigrants and 1.4 million refugees.

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