A few days ago, I found myself rushing a relative to a public hospital in Islamabad.
It was an emergency. We waited for over fifteen minutes, trying to get the attention of a doctor busy attending to more critical patients with various issues. Patients kept flowing in and the staff were doing their best to manage the chaos. They were doing what they could, no doubt, but it wasn’t nearly enough.
The situation only grew worse. From the emergency ward, we were sent to cardiology for an ECG, then asked to move to neurology for a secondary assessment. Blood tests and a CT scan were recommended. We were moving the patient through crowded corridors and security guards at each ward asked us to leave, citing rules that only one attendant per patient is allowed. Doctors—mostly postgraduate trainees—did their best, but experienced specialists were nowhere to be found. I remember a scene where four anxious families crowded around a single doctor, each pleading for him to check their loved one first.
As I stood there, helpless and frustrated, I couldn’t help but think of private hospitals that, although not perfect, manage affairs better at a substantial cost. They are functional and provide better care, with high fees charged for each service. There the patients are treated quickly with clean spaces and consultants who, though expensive, are available. The pattern feels familiar, almost identical to what we’ve seen in education. Like parents choosing private schools despite a lack of grounds or facilities, simply because the teaching is better. The shift is happening in the health sector as well.
This transition from public to private healthcare isn’t random. It’s driven by years of underfunding and mismanagement. Public hospitals lack necessary human resources and supporting equipment and sometimes doctors and staff are overworked. They’re trying to serve too many people with too little. No one should be surprised when patients—rich or poor—start avoiding these facilities, even if it means borrowing money to afford a private clinic.
Pakistan’s healthcare budget consistently falls short of what’s needed for a population of over 240 million. While the World Health Organization recommends that at least 5% of a nation’s GDP be allocated to healthcare, Pakistan hovers around 1.2–1.5%. That results in broken beds, non-functional machinery, long wait times and, perhaps most critically, the brain drain of medical professionals seeking better pay and working conditions abroad. As public institutions become more dysfunctional, the private sector continues to grow by expanding facilities, importing state-of-the-art technology and marketing itself as the best centers for treatment. They offer higher-quality care, but only the wealthy can consistently access it.
It’s also evident that in private setups, the line between treatment and business is becoming blurred. Some doctors, under pressure from pharmaceutical reps or simply chasing commissions, prescribe unnecessary tests. A simple check-up turns into a series of scans, consultations and prescriptions: all at the expense of the hard-earned money of the individual citizen. The patient becomes a client generating revenue for these private providers.
Even worse, private hospitals operate without proper accountability or regulatory oversight. Prices for various services vary widely and even basic procedures can cost three times as much from one facility to another, with no one to hold them accountable. Many patients don’t know what they’re paying for. Complaints often go unheard. The market decides critical care decisions: the more you pay, the better the service you receive. Unfortunately, the market isn’t kind to the poor, who make up the majority of the population. Some families sell valuables, take loans or delay treatment altogether because they fear the financial burden more than the illness itself.
It’s clear that healthcare in Pakistan is increasingly becoming a wealth-based system. Access to quality healthcare depends on purchasing power. Those who can afford it are seen quickly, treated respectfully and sent home confident. If healthcare is to be recognized as a human right, we must invest decisively in its public health infrastructure.
This isn’t just about increasing budgets but improving healthcare management to ensure proper services at all public hospitals. We also need to take steps to prevent talented doctors from leaving the country. There’s an urgent need to reform our healthcare system, which is currently widening the gap between the rich and the poor. This divide continues to grow and hospitals are reflecting that disparity.
— The writer is Director, Higher Education Commission, Islamabad.
