Current Legal Framework: Access to healthcare in Pakistan
Article 25 of the 1973 Constitution of Pakistan (hereinafter "Constitution") provides that there shall be no discrimination based on sex. Under this article, the state may enact affirmative action laws designed to protect women from unequal treatment. Const. Art. 38 provides that the state shall provide medical relief to all individuals, regardless of sex, to ensure the well-being of the population.
The majority of Pakistan's health facilities are state-run.1 Under Pakistan's National Health Policy, the state-run health care system is divided into three tiers: 1) Primary and secondary tiers, which constitute primary care, including materanal care; and 2) tertiary care, which consists of specialized surgical care.2 Primary and secondary tiers handle most maternal and female health care issues, such as complications due to pregnancy and gynecology. The federal government, through the Ministry of Health, provides funding and develops national health care initiatives for public health care facilities.3 Provincial and district governments, which are divided into basic health units (BHU), administer and regulate primary, secondary, and tertiary health care facilities within their respective BHUs.4
Pakistan's public health care system has failed to adequately address health care problems facing women. For example, as of 2009, approximately 30,000 women die from pregnancy-related complications each year, and approximately more than 400,000 women suffer from pregnancy-related complications per year.5 Moreover, as of 2009, more than fifty percent of women suffer from iron deficiency, which causes pregnancy complications, and women with diabetes are more likely than men with diabetes to suffer from heart attacks.6
One explanation for the public health care system's failure to adequately address women's health care issues is that neither the federal government, which formulates policy objectives for the system, nor the provincial governments have issued any laws that directly adddress these concerns. Since provincial and district governemnts, under the system's three-tier approach, are responsible for administering public health care, the federal government will probably not address women's health care issues through legal reform. In doing so, the federal government will effectively pass to local governments its constitutional duties under Articles 25 and 38 to provide adequate health care to women.
Another explanation is that neither the federal or provincial governments have provided women with adequate and sanitary health care facilities. Provincial governments allocate most health care funding into tertiary, or specialized, care instead of primary and secondary care facilities, where women mostly seek treatment for female and maternal health issues.7 Moreover, the federal government does not effectively oversee how provincial governments allocate funding, choosing instead to focus on national policy.8 As a result, many public health care facilities have fallen into disrepair and provide poor service.9 Therefore, the public health system provides poor service to women suffering from maternal and other health complications.
In March 2010, Parliament transferred public health policy-making and funding from the federal government to provincial and district governments by passing the 18th Amendment to the Constitution.10 Under the 18th Amendment Art. 48, which inserted Art. 140A into the Constitution, political, administrative, and financial authority is devolved to local government bodies. This effectively puts provincial governments in charge of managing BHUs within their respective provinces. Therefore, provincial governments, instead of the federal government, are responsible for ensuring that public health facilities provide adequate health care to women, in compliance with Articles 25 and 38 of the Constitution.
Decentralization under the 18th Amendment provides provincial governments to assess and fix their respective BHUs' shortcomings in addressing women's health issues, namely by allocating adequate funding into primary and secondary tiers and by conducting research on women's health issues. However, given provincial governments' reluctance to improve and fund primary and secondary tier structures, this is unlikely. Moreover, under Articles 25 and 38 of the Constitution, the state as a whole, not just provincial governments, must ensure that women receive adequate health care.
Neither the federal or provincial governments have enacted any relevant laws regulating private health care facilities.
- 1. Pakistan Ministry of Health, National Health Policy 2009: Stepping Towards Better Health, at 6 (February 9, 2009).
- 2. Human Rights Commission of Pakistan, State of Human Rights 2009, at 256 (2009).
- 3. Ministry of Health, National Health Policy 2009, at 6.
- 4. Id.
- 5. Human Rights Commission of Pakistan, State of Human Rights 2009, at 263.
- 6. Id.
- 7. Ministry of Health, National Health Program 2009, at 6.
- 8. Id.
- 9. See Human Rights Commission of Pakistan, State of Human Rights 2009, at 254-56.
- 10. Kristin Elisabeth Solberg, "New Laws Could Improve Women's Health in Pakistan," The Lancet (June 5, 2010), available at http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)60911-7/fulltext