THE state’s role in health and healthcare is as fundamental as health being a fundamental human right. The WHO, of which Pakistan has been a member since the beginning, says in its constitution: “Governments have a responsibility for the health of their peoples which can be fulfilled only by the provision of adequate health and social measures.” Governments are the stewards of the health sector. Health policymaking; financing; human resource development; laying health infrastructure; disease surveillance for prevention and control; setting quality standards; regulation; health information; addressing the social and environmental determinants of health; and health service provision are some of the established and exclusive responsibilities of governments in the health sector. However, health service provision is not governments’ exclusive responsibility.
Due to a number of reasons, there is a growing trend in low- and middle-income countries to loop in the private health sector in service provision. Most governments in L&MICs have not really spent enough on healthcare. Resultantly, healthcare provision through the public sector has been both inadequate and of low quality. Another major reason is that, of whatever little is being spent on health by governments, a major part goes on tertiary healthcare; very little is spent on primary healthcare where the bulk of healthcare is needed, where disease can be prevented and managed at an early stage, and which is much more cost-effective. PHC is the foundation of universal health coverage (UHC).
As a result of the short supply of healthcare services by governments, a parallel private health sector has evolved purely as........