By Abdul Samad Channa
Health care is an essential pillar of human survival, dignity, and development. Without access to timely and affordable medical services, individuals and families are pushed into cycles of poverty, suffering, and social exclusion. In Pakistan, however, health care remains both expensive and, for many citizens, largely inaccessible. The situation presents a troubling paradox: while the province hosts some of the country’s finest tertiary-care hospitals in major cities, vast rural and peri-urban populations continue to struggle for even basic medical attention. The crisis of health care access is rooted in two interlinked realities. On the one hand, weaknesses in governance and public sector management have undermined the efficiency and credibility of government hospitals and primary health facilities.
On the other, an uneven distribution of medical professionals particularly doctors has deepened the urban-rural divide, leaving smaller towns and remote districts underserved. Public sector health facilities are intended to provide affordable and equitable services to all citizens, especially the poor. Yet, in many parts of the country, basic health units and rural health centers suffer from chronic shortages of medicines, equipment, and trained staff. Infrastructure is often dilapidated, diagnostic services limited, and accountability mechanisms weak. Patients frequently face absenteeism of doctors, lack of female medical staff in conservative rural areas, and long waiting times even for minor ailments. As a result, public confidence in the system erodes, pushing those who can afford it toward private clinics and hospitals.
However, private health care particularly in large urban centers is often expensive for the common person. Consultation fees, diagnostic tests, surgical procedures, and medicines collectively impose a heavy financial burden. For low-income families, a single serious illness can wipe out years of savings or force them into debt. Thus, health care becomes not only a medical issue but also a profound socio-economic challenge. A central factor aggravating this disparity is the migration of medical professionals from rural to urban areas. Many doctors, after receiving subsidized medical education often funded by the public exchequer choose to establish their careers in big cities where opportunities for specialization, private practice, better schooling for children, and improved living standards are available.
While such choices are understandable at a personal level, they have significant public consequences. Smaller towns and far-flung districts are left without qualified specialists, and in some cases, even without general practitioners. This imbalance creates a widening gap in the availability and quality of health services between commercial hubs and peripheral regions. Urban centers boast advanced diagnostic laboratories, specialized cardiac and cancer hospitals, and intensive care facilities. Meanwhile, patients belonging to far flung areas must travel long distances for routine procedures or emergency care. For a pregnant woman in a remote village, or a child suffering from acute infection, the delay caused by distance and lack of transport can mean the difference between life and death.
Moreover, the absence of medical professionals in remote areas weakens preventive health care. Immunization drives, maternal and child health counseling, nutrition awareness, and early disease detection programs require consistent community-level engagement. Without stable staffing and supervision, these programs lose momentum, leading to higher rates of preventable diseases and maternal and infant mortality. Addressing this crisis demands both structural reform and ethical reflection. Governance reforms must prioritize transparency, performance-based monitoring, and strict accountability for absenteeism and misuse of resources. Digital attendance systems, regular third-party audits, and citizen feedback mechanisms can help restore trust in public health institutions. Equally important is investment in infrastructure, modern equipment, telemedicine facilities, and reliable medicine supply chains.
At the same time, policies must incentivize doctors to serve in remote and underserved areas. Financial incentives, career advancement credits, housing facilities, hardship allowances, and opportunities for continuing medical education can make remote postings more attractive. Mandatory service periods tied to publicly funded medical education may also be considered, provided they are implemented fairly and transparently. Telemedicine presents another promising avenue. By connecting rural health centers with specialists in major cities, patients can receive expert consultation without the burden of travel. Mobile health units can further extend outreach to isolated communities. Ultimately, health care is not merely a service; it is a social contract between the state and its citizens.
The Constitution of Pakistan recognizes the welfare of the people as a fundamental responsibility of the government. Ensuring equitable access to health care is therefore not an act of charity, but a matter of justice. The path forward requires political will, administrative integrity, and collective responsibility. Doctors, policymakers, civil society, and communities must work together to bridge the divide between urban privilege and rural neglect. Only then can we move toward a health care system that is affordable, accessible, and dignified for all regardless of geography or income.
(The writer is former faculty member of National Institute of Management, Karachi and keen observer of national and international healthcare sector policies. He can be reached at editorial@metro-morning.com)
