Pakistan's healthcare system continues to face deep disparities between public and private medical facilities, limiting access to quality treatment for millions of people despite higher provincial health allocations. According to an analysis by Pakistan Today, the federal government allocated ₹46.10 billion to the Ministry of National Health Services, Regulations and Coordination in the 2025-26 Budget, lower than the ₹54.87 billion allocated in the previous fiscal year. Underfunded public hospitals, particularly in rural and underdeveloped areas, continue to struggle with shortages of staff, equipment and other essential resources, forcing many patients to travel to major cities for treatment and putting additional pressure on urban healthcare facilities. The report cited World Bank data to show that poorer households in Pakistan spend, on average, around 20 per cent of their income on healthcare, leaving many families to choose between medical treatment and other essential household expenses.
According to the World Bank's Strengthening Fiscal Federalism report, cited by The Express Tribune, years of fiscal decentralisation have failed to narrow Pakistan's regional spending disparities. Quetta recorded the widest spending gap among provincial capitals, with per capita expenditure at ₹57,000 compared with just ₹12,000 in the rest of Balochistan, representing a gap of around 475%. Lahore recorded the second-largest disparity, with per capita spending of ₹31,000 compared with ₹7,000 in other districts of Punjab. In Khyber Pakhtunkhwa, Peshawar received about ₹35,000 per person while the rest of the province got around ₹10,000 per person. Even Karachi showed the smallest gap, but still received 178% higher per capita spending than other districts.
The World Bank noted that while spending disparities have narrowed since 2009, provincial capitals continue to receive a disproportionately large share of development funding. According to the report, there was no clear link between district-level funding and poverty rates or social indicators such as education, healthcare and infrastructure needs. The findings were particularly significant for Balochistan, where longstanding underdevelopment and limited employment opportunities have frequently been cited as factors contributing to unrest. Despite the province recording budget surpluses, Quetta continued to receive substantially higher public spending than other districts, highlighting the persistent nature of these disparities.
The report highlighted significant weaknesses in local governance, noting that provincial finance commissions remain largely inactive and local governments receive only a limited share of provincial resources. As cited by The Express Tribune, the share of total government expenditure managed by local governments has fallen from around 10% in 2005 to 4.7% in 2024, despite constitutional provisions intended to strengthen decentralisation. This decline in local government autonomy has contributed to the persistent regional spending disparities, with wealthier districts regularly receiving larger budget allocations while poorer regions remain trapped in a cycle of underinvestment.
The healthcare report comes amid mounting economic challenges, with annual inflation in Pakistan rising to 11.7 per cent in May 2026, up from 10.9 per cent in April and 7.3 per cent in March, according to Assahifa reports. This inflation rate significantly exceeds the State Bank of Pakistan's target range of 5 per cent to 7 per cent. Economists warn that the country risks slipping into a cycle of weak growth, rising prices and financial strain. The combination of healthcare inequalities and broader economic pressures highlights the urgent need for comprehensive reforms to improve public healthcare quality, ensure affordable access to private medical facilities, and strengthen community-based health initiatives.
