Analysis & Expansion of Fiscal Space for Health of Pakistan

Abstract

This report encompasses Pakistan's efforts to achieve Universal Health Coverage (UHC) through financing reform initiatives. The focus is on two significant initiatives: the development of a national UHC Blueprint and the implementation of district-level Essential Package of Health Services (EPHS) programs. However, the projected costs of these programs exceed the available fiscal space, necessitating an improved health financing trajectory. The report presents the DRUM framework, which highlights four areas of policy action to create fiscal space for health: macro-economic growth, reprioritization towards health, raising sector-specific revenues, and improving efficiency within the health sector. It emphasizes that increased budgetary reprioritization for health, earmarked revenues, and efficiency improvements are essential levers for unlocking additional resources. There is an essential need for a combination of policy measures rather than relying on a single lever to generate sufficient resources. Advocating for increased budget allocation to health, introducing pro-health taxes, and prioritizing efficiency gains. The goal is to achieve the minimum targets for UHC financing while addressing other health-related challenges. Budget reprioritization is highlighted as the primary lever for immediate resource increase, while sector-specific revenues can provide additional short-term funding. Efficiency gains are crucial for sustaining fiscal space and convincing finance departments of the value of health expenditures. The report emphasizes that all avenues for resource mobilization must be explored to achieve improved health financing for UHC. It is concluded that reprioritization and efficiency improvements offer good prospects for increasing fiscal space at both the national and sub-national levels. However, raising health-specific revenues and relying on macro growth and development assistance have limited prospects. The researchers acknowledge the need for more programmatic research to aid policy implementation and provide strategic health financing guidance. In summary, the text underscores the importance of strategic policy levers, such as reprioritization, sector-specific revenues, and efficiency gains, to enhance fiscal space for UHC in Pakistan. The implementation of these measures, along with the new national EPHS program, can contribute to sustainable health financing and accelerate progress towards UHC.