National-Census-Report-2023-1.pdf

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FY2023, it recorded negative growth of 3.31%, due to a decline in the production of natural gas, crude oil, and exploration cost, following a sharp contraction of 6.66% in the previous year.
Another key component of the industrial sector, construction—which contributed 12.44% to industry and 2.29% to GDP—registered negative growth of 9.25% in FY2023. This decline was primarily attributed to conservative reporting of construction-related expenditures by both private and public sector enterprises, as well as an unusual increase in the relevant deflator, namely the Wholesale Price Index (WPI) for building materials. In contrast, the Electricity, Gas, and Water Supply sector, which accounts for 14.26% of industry and 2.63% of GDP, posted a growth of 9.95%. A key factor behind this positive trend was the 28.0% increase in Public Gross Fixed Capital Formation (GFCF) during FY2022 within this sector. The lag effect of this investment significantly contributed to the growth observed. Table 1.5 presents the gross value added for the years 2021-22 and 2022-23 at constant basic prices, the growth rates for 2022-23 over 2021-22, and the respective shares of industrial sub-sectors in the industry and total GDP of the country (a relative view of gross value added of the industrial sub- sectors is given in Figure 1.11). Table 1.5: GVA of Industry at Constant Basic Prices of 2015-16
(Rs. Million) S.No. Industrial Sectors 2021-22(F) 2022-23(R) Growth rate (%) 2022-23/ 2021-22 Share in Industry (%) Share in GDP (%) 1 Mining and Quarrying 651,208 629,670 -3.31 8.82 1.62 2 Manufacturing 4,864,350 4,606,868 -5.29 64.48 11.88 i. Large Scale 3,626,559 3,268,778 -9.87 45.75 8.43 ii. Small Scale 768,249 838,435 9.14 11.74 2.16 iii. Slaughtering 469,542 499,655 6.41 6.99 1.29 3 Electricity, Gas and Water Supply 926,804 1,019,017 9.95 14.26 2.63 4 Construction 979,221 888,670 -9.25 12.44 2.29 Total 7,421,583 7,144,225 -3.74

18.43 Note: F stands for final and R for revised estimates.

Figure 1.11: GVA Contribution of Industrial Sub-sectors

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1.7.3 Services Sector The services sector mantained the largest share of nearly 58% in GDP for the last several years. In FY2023, the sector recorded a slight contraction of 0.01%, with mixed performance across industries. The Wholesale and Retail Trade industry, accounting for 31.06% of services and 18.15% of GDP, declined by 3.99%, primarily due to a 1.03% drop in crop output and a 9.87% decline in large-scale manufacturing. On the contrary, Transportation and Storage, the second-largest services sector, and Accommodation and Food Services activities grew by 3.76% and 4.14%, respectively. However, Information and Communication contracted by 0.82%.

The Finance and Insurance industry shrank significantly by 9.42%, largely due to a high CPI- based deflator. Real estate activities grew by 3.66%, while Public Administration and Social Security saw a 7.02% decline, also attributed to the high deflator. Education witnessed a growth of 5.15% due to public sector expenditure, and Human Health and Social Work activities increased by 8.87%, due to the general government. Growth in other private services was 4.27%. Table 1.6 presents the gross value added for the years 2021-22 and 2022-23 at constant basic prices, the growth rates for 2022-23 over 2021-22, and the respective shares of services sub-sectors in the services sector and total GDP of the country (A relative view of gross value added of the services sub-sectors is given in Figure 1.12). 21 Table 1.6: GVA of Services Sector at Constant Basic Prices of 2015-16
(Rs. Million) S.No. Services Sectors 2021-22(F) 2022-23(R) Growth rate (%) 2022-23/ 2021-22 Share in Services (%) Share in GDP (%) 1 Wholesale and Retail Trade
7,325,882 7,033,762 -3.99 31.06 18.15 2 Transport and Storage
3,980,936 4,130,519 3.76 18.24 10.66 3 Accommodation and Food Services Activities (Hotels & Restaurants)
541,222 563,604 4.14 2.49 1.45 4 Information and Communication
1,125,119 1,115,886 -0.82 4.93 2.88 5 Finance and Insurance Activities
730,220 661,448 -9.42 2.92 1.71 6 Real Estate Activities
2,156,942 2,235,936 3.66 9.88 5.77 7 Public Administration and Social Security (General Government)
1,853,122 1,722,958 -7.02 7.61 4.44 8 Education
1,071,646 1,126,861 5.15 4.98 2.91 9 Human Health and Social Work Activities
600,835 654,153 8.87 2.89 1.69 10 Other Private Services
3,257,106 3,396,145 4.27 15.00 8.76 Total 22,643,030 22,641,272 -0.01

58.41 Note: F stands for final and R for revised estimates.

21 Additional data sources for the Economy section, beyond those mentioned in the text, include the Pakistan Economic Surveys for 2022-23 and 2023-24, as well as the National Accounts tables available on the PBS website: https://www.pbs.gov.pk/content/national-accounts.

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Figure 1.12: GVA Contribution in the Services Sector of the Economy 1.8 Health Healthcare is recognized as a basic human right in Pakistan’s Constitution, emphasizing the importance of a healthy population for economic productivity and national development. Pakistan is committed to providing equitable access to health and nutrition services for all, aligned with international standards and the country’s commitment to achieving the health and well-being targets of SDG 3. The National Health Vision 2016- 2025 outlines a reform agenda aimed at improving the public health delivery system t hrough carefully planned, needs-based interventions.
In Pakistan, approximately 53% of healthcare services are delivered by the private sector, while the public sector accounts for the remaining 47%. 22 Since the devolution of the health sector to the provinces under the 18th Constitutional Amendment, each province has been responsible for designing its own health strategies. Despite these efforts, significant gaps remain in meeting the healthcare needs of the population, and the quality of public healthcare services—where most low-income individuals seek care—is often inadequate. Some provincial efforts are underway to improve access to and quality of healthcare facilities. Additionally, the federal government implements programs such as the National Maternal and Child Health Programme and initiatives to control malaria, TB, and HIV/AIDS. However, Pakistan still faces challenges in advancing its healthcare system to reach standards seen in more

22 National Health Accounts, 2021-22, Pakistan Bureau of Statistics. Key Health/ RH Indicators • Infant Mortality Rate: 60 • Maternal Mortality Ratio: 186 • Life Expectancy: 67.3 years • Total Fertility Rate: 3.7 • Contraceptive Prevalence Rate: 34%

Source: HIES 2018-19 and Pakistan Demographic and Health Survey, 2019 in Pakistan Economic Survey 2022-23
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developed countries. As a low -income country, Pakistan allocated 1% of its GDP (federal and provincial health expenditures) to public healthcare expenditure in 2021-22.23 1.8.1 Healthcare System The healthcare system in Pakistan includes both public and private health facilities. Public sector services are offered at the federal, provincial, and district levels through a network of rural health centers, basic health units, dispensaries, and district/tehsil headquarters hospitals, supported by medical pr ofessionals. With growing population pressure on public health institutions, the private sector has increasingly helped meet the rising demand where public facilities are limited. The number of private hospitals, clinics, and diagnostic labs has grown significantly, especially in urban areas, contributing notably to healthcare services across the country.
Pakistan National Health Accounts 2021 -22 estimates total health expenditures in Pakistan at Rs. 1,962 billion, marking an increase of Rs. 496 billion, or about 34%, from the fiscal year 2019-20 in nominal terms. In 2021-22, financing sources show that the general government contributed 47% of the total health expenditures, while the private sector accounted for 52.6%. Of this private sector share, 89% was out-of-pocket (OOP) spending by households. Contributions from development partners or donor organizations represented a small share, making up 0.4% of total health expenditures. 1.8.2 Healthcare Delivery System I. Primary Healthcare Primary healthcare is the first point of contact for most patients, especially in rural areas, where it offers both preventive and curative services. Basic Health Units (BHUs), located at the Union Council level, serve a population of approximately 25,000 people. These facilities provide preventive, curative, and referral services and support Lady Health Workers (LHWs) with clinical, logistical, and managerial assistance. As of 2022, there are 5,520 BHUs operating across Pakistan. Rural Health Centres (RHCs) serve as a further level of care, catering to a catchment area of up to 100,000 people. 1.8.2.1 Secondary Healthcare This intermediate level of healthcare provides technical, therapeutic, and diagnostic services and functions as the first referral level, operating at the district and tehsil levels. It includes specialist consultations and hospital admissions. Tehsil Headquarter and District Headq uarter Hospitals serve populations ranging from 0.5 to 3 million people. These facilities offer a wide range of services, including basic and comprehensive emergency care, obstetric services, preventive and curative care,

23 PRSP Budgetary Expenditures (Finance Division) in Pakistan Economic Survey, 2023 -24.

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diagnostics, and inpatient services. They also handle referrals from Basic Health Units (BHUs), Rural Health Centres (RHCs), and the Lady Health Workers Programme. 1.8.2.2 Tertiary Healthcare Tertiary healthcare hospitals offer specialized inpatient care and provide advanced healthcare services, typically to inpatients and those referred by primary or secondary healthcare providers.

Tables 1.7 and 1.8 provide important information on healthcare access in Pakistan. Table 1.7 lists the number of healthcare institutions across the country, including hospitals, dispensaries, RHCs, TB clinics, BHUs, and Maternal and Child Health (MCH) Centers. Table 1.8 outlines the availability of healthcare personnel, such as doctors, dentists, and nurses, and their accessibility to the population. Table 1.7: Healthcare Institutions, 2018-22 Year Health Institutions Hospitals Dispensaries Rural Health Centres(RHCs) TB Clinics Basic Health Units (BHUs) Mother and Child Health Centres 2018 1279 5671 686 441 5527 747 2019 1282 5743 670 412 5472 752 2020 1289 5849 719 410 5561 752 2021 1276 5832 736 416 5559 781 2022 1284 5584 697 417 5520 798 Sources: PM&DC, Nursing Council, Provincial Health Directorates & PBS
Table 1.8: Healthcare Personnel, 2018-22 Manpower 2018 2019 2020 2021 2022 2023(P) Registered Doctors 220,829 233,261 245,987 266,430 282,383 299,113 Registered Dentists 22,595 24,930 27,360 30,501 33,156 36,032 Registered Nurses 108,474 112,123 116,659 121,245 127,855 127,855 Population per Doctor 964 936 911 862 834

Population per Dentist 9,426 8,760 8,186 7,530 7,104

Population per Bed 1,611 1,634 1,523 1,573 1,553

Sources: PM&DC, Nursing Council, Provincial Health Directorates & PBS
1.8.3 Family Planning and Primary Health Care

Under the Family Planning and Primary Health Care Programs, over 100,000 Lady Health Workers (LHWs) were recruited to improve rural health. Their services have positively impacted the health of women and children by promoting better sanitation, birth spacing, iron supplementation, expanded vaccination coverage, and prenatal and postnatal care. Despite the Population Welfare Program being in place since the 1960s, access to quality services