Pakistan's Rural Health System: Addressing Inequalities

Rural communities in Pakistan continue to grapple with a multitude of health challenges, including infectious diseases, maternal and child health disparities, non-communicable diseases (NCDs), mental health concerns, and climate-induced health risks. These issues are intensified by limited healthcare infrastructure, financial barriers, low health literacy, and restricted access to quality medical services. With 62.7% of the population living in rural areas (Pakistan Bureau of Statistics, 2023), addressing these issues is central to achieving national health and development goals.

While programs like the Sehat Sahulat Program (SSP) and polio eradication campaigns mark important milestones, rural health indicators reveal ongoing systemic inequities. For instance, maternal mortality rates in rural areas are alarmingly high at 272 deaths per 100,000 live births, compared to 158 in urban settings (PDHS, 2023). Similarly, 40% of rural children under five are stunted (UNICEF, 2023), reflecting chronic undernutrition and poor maternal health services.

This paper evaluates the current rural health policy framework and identifies critical areas for reform. Strengthening primary healthcare (PHC) systems through investment in rural clinics, workforce training, and supply chain management is essential. Expanding the reach and capacity of the Lady Health Worker (LHW) Program can improve maternal and child health outcomes. Enhancing healthcare financing mechanisms, particularly through universal health coverage schemes, can ease the financial burden on low-income households.

Incorporating digital health technologies, such as telemedicine and mobile diagnostics, offers a scalable solution to bridge rural-urban health divides. Moreover, improving disaster preparedness and climate resilience in health systems is crucial given increasing environmental threats.

Ultimately, achieving equitable rural health outcomes requires a holistic, multi-sectoral approach that integrates governance, community participation, and cross-institutional collaboration. A resilient rural health system is not only a public health priority, but also a cornerstone of inclusive and sustainable national development.

Understanding Rural Health Challenges in Pakistan

Rural Pakistan is home to over 60% of the country’s population, yet it faces persistent and multifaceted health challenges that threaten the well-being of millions. From infectious diseases to non-communicable conditions and climate-induced health risks, the burden is disproportionately high in these underserved areas.

Infectious diseases such as tuberculosis (TB), malaria, and diarrheal illnesses remain widespread due to poor sanitation, inadequate clean water, and limited preventive healthcare services. Maternal and child health indicators are particularly alarming rural maternal mortality stands at 272 per 100,000 live births, and neonatal mortality is 42 per 1,000 live births (PDHS, 2023). These figures point to systemic gaps in antenatal care, delivery services, and postnatal follow-up. Meanwhile, non-communicable diseases (NCDs) such as diabetes and hypertension are rising at an alarming rate, with one in four rural adults affected (WHO, 2023).

Mental health is another neglected crisis. Cultural stigma, gender inequality, and lack of mental health infrastructure contribute to the silent suffering of thousands particularly rural women are facing depression and anxiety. The situation is further exacerbated by climate-related events; the 2022 floods, which affected 33 million people, led to increased malnutrition, vector-borne infections, and psychological trauma (NDMA, 2023).

Access to healthcare remains deeply unequal. Geographic isolation means that 28% of rural residents live over 10 km from the nearest health facility (World Bank, 2023). Healthcare worker shortages are stark, with just one doctor serving 5,000 people in rural areas, compared to one per 1,200 in cities (PMDC, 2023). Infrastructure is critically underfunded, only 15% of the national health budget is allocated to rural healthcare (Ministry of Health, 2023). Cultural barriers, including restrictive gender norms and vaccine hesitancy, further limit healthcare utilization.

From Fragmented Interventions to Integrated Care

Pakistan’s current rural health policy framework includes a range of initiatives addressing primary care, disease-specific responses, and community-based interventions. However, fragmented implementation, under-resourced systems, and limited rural outreach hinder their effectiveness.

Primary Healthcare (PHC) remains the cornerstone of rural service delivery through Basic Health Units (BHUs) and Rural Health Centers (RHCs), yet these facilities are plagued by chronic understaffing, medicine shortages, and poor infrastructure. The Sehat Sahulat Program (SSP), a flagship universal health insurance initiative, was expanded in 2023 to include 100 million low-income citizens. Despite its potential, rural enrollment is disproportionately low due to digital, linguistic, and awareness barriers (State Bank of Pakistan, 2023).

Disease-specific efforts show mixed progress. The Polio Eradication Initiative reduced wild poliovirus cases from 147 in 2019 to just 6 in 2023 (GPEI, 2024), but vaccine hesitancy continues to limit coverage. The Expanded Program on Immunization (EPI) has improved rural immunization rates to 75%, yet regional inequities persist (UNICEF, 2023). Community outreach through the Lady Health Worker (LHW) Program, now over 130,000 strong, offers vital maternal and child services, but faces logistical and financial constraints.

Learning from global examples is essential. Brazil’s Family Health Strategy demonstrates how community health teams can halve maternal mortality. Rwanda’s digitized health worker network shows how technology can revolutionize outreach, while India’s Ayushman Bharat scheme offers insights for scaling SSP coverage.

Policy reforms must prioritize strengthening PHC infrastructure through upgrades to BHUs with telemedicine capabilities and increased health budget allocations to meet WHO benchmarks. Incentivizing rural health postings, expanding LHW roles to include NCDs and mental health, and adopting mobile and GIS technologies will enhance service delivery. Furthermore, integrating climate resilience into disaster response planning and involving communities in health education and vaccination drives will foster trust and sustainable impact.

Conclusion

Pakistan’s rural health system stands at a crossroads. Despite commendable efforts such as the Sehat Sahulat Program, Lady Health Worker outreach, and progress in immunization, persistent inequalities and system inefficiencies continue to leave millions vulnerable to preventable illness, maternal mortality, and health-related poverty. With rural areas home to nearly two-thirds of the population, addressing health disparities is not just a social obligation but a national development imperative.

This article has highlighted both the pressing challenges ranging from infectious diseases and non-communicable conditions to climate-induced health risks and the systemic barriers that hinder effective care, including underfunded infrastructure, workforce shortages, and cultural constraints. It also proposes actionable pathways: strengthening primary healthcare, enhancing financing and outreach, digitizing rural health delivery, and improving community engagement and disaster preparedness.

Looking ahead, Pakistan must transition from fragmented interventions to a coordinated, equity-driven rural health policy that integrates public health with broader goals of education, gender equity, and environmental sustainability. Only through strategic investment, evidence-based policy, and inclusive governance can rural health be transformed into a pillar of national resilience. A healthier rural population will not only drive productivity and food security but also ensure a more just and thriving society for all Pakistanis.

References: Pakistan Bureau of Statistics; PDHS; WHO; UNICEF; NDMA; PMDC; Ministry of Health; World Bank; State Bank of Pakistan; GPEI

Please note that the views expressed in this article are of the author and do not necessarily reflect the views or policies of any organization.

The writer is affiliated with the Department of Epidemiology and Public Health, Faculty of Health and Pharmaceutical Sciences, University of Agriculture, Faisalabad, Pakistan.

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