NHA-Pakistan-2021-22.pdf

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Table 31: OOP expenditures in Health Care Providers by categories 2021-22 in % OOP Expenditure categories Private Public Total Transportation costs 6.86 11.65 7.71 Parchi and admission fees 1.55 1.05 1.47 Doctors fee
15.14 2.98 12.97 Medicines/Vaccine
49.43 56.16 50.63 Medical Supplies
2.30 3.05 2.43 Diagnostic tests 7.70 10.60 8.22 Cost of surgery 7.84 3.68 7.10 Medical Durables 0.42 0.43 0.42 Food 1.67 3.85 2.05 Tips 0.15 0.57 0.23 Accompanying person cost 0.48 0.91 0.56 Other 6.46 5.07 6.21 Total Expenditure
100.00 100.00 100.00

Table 31 indicates that the percentage share of “Medicine/Vaccine” in private and public sector are 49.43% and 56.16% respectively. Private and Public OOP expenditures incurred on “Doctor’s fee” is around 15.14% and 2.98% respectively. The percentage shares of “Cost of surgery "Diagnostic tests" in the private and public sector are “7.84 & 3.68” and 7.70% and 10.60% respectively. While the percentage share of OOP expenditures as “Transportation Cost” is 6.86% and 11.65% in private and public sector respectively.
Table 32: OOP expenditures on the Type of health care provider accessed by the households 2021-22 Province Private Hospital Private Doctor clinics Homeo- path/ Ha- keem/ herbalist etc. Phar- macy/ shops Govt./THQ/D HQ/Tertiary/T eaching Hos- pitals Dispensary/Ma- ternal and child health cen- ter/BHU/RHC/L HV/LHW Military Hospital S.S, Railway & ABs Hospi- tals Labora- tory Oth- ers* Total Punjab 18.39 58.80 1.42 2.50 16.79 0.35 0.55 0.41 0.10 0.69 100.00 Sindh 41.23 45.38 0.40 1.59 9.88 0.12 0.40 0.23 0.23 0.54 100.00 KP 22.51 50.54 0.76 3.05 21.38 0.35 0.66 0.23 0.10 0.42 100.00 Baluchistan 34.18 45.92 0.64 1.38 13.71 0.87 0.05 2.59 0.04 0.62 100.00 Pakistan 23.50 54.43 1.08 2.44 16.55 0.33 0.54 0.41 0.12 0.60 100.00 The OOP health expenditure for access to government hospitals (16.55%) is lower than those for access to private hospitals (23.50%) because government hospitals provide services at lower rates. The High- est OOP expenditures are in the category of Private Doctor Clinics (54.43%) followed by private hospitals (23.50%) and Govt. Hosp./THQ/DHQ/Tertiary/Teaching Hospitals (16.55%) at national level. The percentage share of OOP spending on Private Doctor Clinics is highest in Punjab (58.80%) followed by KP, Baluchistan and Sindh and their respective percentage share of spending are 45.38%, 50.54%, and 45.92% respectively. The category of Pharmacy/shops have share of 2.44% in OOP health expenditures at the national level.

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Table 33: OOP health expenditures 2021-22 by kind of accessed sector (private and public) & by the province in % Province Private Sector Public Sector Total Punjab 82.18 17.82 100.00 Sindh 81.89 18.11 100.00 KP 89.37 10.63 100.00 Baluchistan 77.38 22.62 100.00 Pakistan 82.79 17.21 100.00

In Pakistan share of OOP health expenditures incurred in the private sector is significantly higher than public sector. The situation in the provinces is not much different, which indicates the provision of quality health care services in the private health sector across the country.

Table 34: Health expenditures by kind of illnesses/incident and by province 2021-22 in % Kind of Illness Pakistan Punjab Sindh KP Baluchistan Road Accidents
3.11 2.56 5.08 2.10 10.45 Fractures
2.01 2.41 1.88 1.20 1.05 Diarrheal disorder (including dysentery)
2.03 2.26 2.09 1.38 2.07 Pneumonia
0.55 0.70 0.39 0.26 0.45 Flu/Fever
9.55 9.52 11.86 8.10 8.14 Malaria
3.97 3.40 6.30 3.15 7.96 Typhoid
2.54 2.91 1.30 2.66 1.26 Chest infection
1.83 1.49 1.48 3.10 1.02 Asthma
1.94 2.18 1.82 1.44 1.57 Liver, Kidney Diseases
6.82 7.52 5.77 5.58 8.31 Measles, Polio (Immunizable diseases)
0.41 0.35 0.62 0.48 0.17 Stroke/Paralysis 1.86 2.25 1.36 1.35 0.88 Muscular Pain (Knee, Arm, Backbone etc.)
7.21 7.29 3.74 10.14 3.14 Depression/Hypertension
1.56 1.68 0.74 2.04 0.21 Eye infection/disorder (ENT)
1.98 1.75 2.11 2.59 1.17 Ulcer diseases
2.12 2.24 1.31 2.20 3.56 Hepatitis infections
4.86 6.09 4.87 1.85 3.56 Tuberculosis (TB)
1.29 1.75 0.63 0.61 0.95 Diabetes
7.09 8.28 5.14 5.92 3.57 Heart disease
9.73 7.65 17.75 8.49 15.01 High blood pressure
4.04 4.50 2.90 3.80 3.17 Gynae Issue
4.49 4.11 1.90 7.76 1.98

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Dog Bite/Snake bites
0.09 0.13 0.01 0.04 0.05 Dental Care
0.38 0.43 0.30 0.34 0.27 Burns
0.10 0.11 0.20 0.01 0.07 Brain hemorrhage 0.69 0.67 0.90 0.56 0.76 AIDS
0.03 0.05

0.00

Cancer 4.14 2.74 7.38 4.68 9.55 Don’t Know
0.23 0.23 0.09 0.36 0.11 Other, Specify _______
13.35 12.75 10.08 17.81 9.54 Total
100.00 100.00 100.00 100.00 100.00

Table 34 shows that the percentage shares of heart disease (9.73%), Flu/Fever (9.55%), Mus- cular Pain (Knee, Arm, and Backbone, etc.) (7.21%), and Diabetes (7.09%) are the highest among all other illnesses at the national level. Survey data also finds that liver, Kidney Diseases, Hepatitis infections, and Gynae issues are the second most common diseases that occur in all provinces. Heart disease is on the higher side in Sindh as compared to other provinces. AIDS percentage is very low in Pakistan. The occurrence of Road Accidents (10.45%), and Malaria (7.96%) are on the higher side in Baluchistan as compared to other provinces.

5. Census of Autonomous

Bodies/Corporations

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5.1 Why this census? The accounts of the public sector core government (federal, provincial & district) are maintained at the Accountant General Pakistan Revenues (AGPR) and respective Provincial Accountant Generals (AGs) offices. The final accounts of the respective governmen ts are compiled and published about a year after the end of the fiscal year in the document called appropriation accounts. The public sector health expenditures data of the core government, compiled in various appropria- tion accounts, have already been extr acted from the appropriation accounts of respective provinces, dis- tricts, and federal level obtained from the centralized accounting entities (AGPRs and AGs offices) and self- accounting entities. As far as ABs/C are concerned, they are not accounted for in the Government Budget Books issued by the finance division/finance department except for the grants, subsidies & write-off loans (A05). This means that some of the ABs/C have a “ one-line budget” in the Government Budget Books . Therefore, health expenditure data of the ABs/C have be en collected via a special survey/census. These expenditures are mainly made either through reimbursement of medical charges bills, health insurance, or through their own health care facilities. The expenditures incurred by healthcare facilities (Hospitals/Medical Centers/Dispensaries) run by ABs/C themselves have been collected separately.
5.2 Autonomous bodies/corporations and their kinds of expenditures ABs/C are set up in the public sector under an act of legislation or ordinance (subject to legislative approval) to perform regulatory, operational, corporate, promotional, research , and developmental func- tions15. These bodies carry different organizational titles such as corporations, boards, institutes, authori- ties, companies, and so on. These can generally be classified into (i) commercial, (ii) promotional, (iii) re- search, (iv) training and (v) regulation.
The primary distinction between a government department and an (ABs/C) lies in the fact that the latter enjoys a higher degree of autonomy in administrative and financial decision -making matters. The extent of autonomy that ABs/C enjoy is in effect granted to them under the acts, which provided for their creation. They are governed by their respective acts including the rules and regulations framed there under. However, the rules and regulations require the approval of the government.
The administration and management of the affairs of the ABs/C are vested in their respective Boards of Directors which are appointe d by the federal/provincial government. The government does not interfere in the day-to-day operational activities of ABs/C, but exercises oversight through its representa- tives on the Boards of Directors. The chief executive of the ABs/C is appointed by th e Government and is designated either as the chairman, or managing director, or director general or executive director.
Public corporations are established under special legislation of the Federal and Provincial Govern- ments or under the Companies Act 1913/Companies Ordinance 1984. These are usually holding corpora- tions of a number of public companies in the industrial sector. The Corporation holds all or majority equity in these companies on behalf of the government and administers them. These corporations or companies cannot be classified as autonomous bodies. According to publication published by Pakistan Public Adminis tration Research Centre (PPARC) Statistical Bulletin 2010-11, there are 207 ABs/C having 369,285 employees working under the administra-

15Report of the National Commission for Government Reforms on Reforming the Government in Pakistan, 2008
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tive control of the federal government. Similarly, according to Services & General Administrative Depart- ment (S&GAD) and the respective departments of the four provinces, there are 67, 40, 45 & 18 ABs/C under the administrative control of Punjab, Sindh, KP & Baluchistan governments respectively.
5.3 Autonomous bodies/corporations and their type of health services Data on public sector health expenditures are not collected through surveys (“primary” statistics). They are c ollected from administrative (“secondary”) sources. Therefore, it is imperative to deal with the set-up of public accounting in Pakistan and to differentiate among centralized accounting entities , self- accounting entities and exempt entities. The accounts of the public sector (core government) are maintained in the first two entities, whereas ABs/C are treated in accounting as exempt entities. Centralized accounting entities and self-ac- counting entities are defined as those which are under the Auditor General of Pakistan for accounting and reporting purposes. A centralized accounting entity is any a ccounting entity for which the AGs or AGPRs have the primary responsibility for the accounting and reportin g function of that entity. Data on health ex- penditures in respect of centralized accounting entities compiled in the appropriation accounts (Certified Document) have been obtained from the respective provincial AG offices and AGPR Islamabad . A self - accounting entity is any accounting entity for which the Principal Accounting Officer has the primary re- sponsibility for the accounting and reporting function. Self-accounting entities are separately preparing their appropriation accounts compiled in Volume II-X of their expenditures. Data on health expenditures of self-accounting entities have been obtained from the following self- accounting entities separately.
• National Savings Organization • Pakistan Mint • Food Wing of the Food and Agriculture Division • Pakistan Public Works Department • Ministry of Foreign Affairs • Pakistan Post Office Department • Geological Survey of Pakistan • Pakistan Railways • Forest Department • Ministry of Defense Exempt entities are defined as those which fall outside the responsibility of the Auditor General of Pakistan for accounting and reporting purposes. All ABs/C are treated as exempt entit ies. The terms cen- tralized accounting entities and self-accounting entities exclude exempt entities 16.The data on health ex- penditures incurred by the employees of Exempt entities ( ABs/C) have been obtained by conducting this census of ABs/C as these are required to maintain/prepare their accounts and reports by themselves.
It has been observed in the census that ABs/C are providing health services to their employees through at least one of the following mechanisms:

16Accounting Code for Self -Accounting Entities is available at: http://www.pifra.gov.pk/docs/nam/06-Ac- counting-Code-for-SAEs.pdf. Accessed on 30 April, 2011

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• Health care through their own health care facilities
• Provision of medical allowance to their employees • Health care through the reimbursement of medical charges bills • Health care through health insurance to their employees. Census data finds that some large ABs/C under the federal government provide health services to their employees and in some cases to the general public. For example, Pakistan International Airlines (PIA) has a medical wing, which mainly consists of curative facilities but some of preventive services such as immunization etc. are also provided. The medical wing runs medical centers at Karachi, Lahore, Multan, Peshawar, Rawalpindi/Islamabad providing comprehensive medical care to its employees and their de- pendents. Similarly, Water and Power Development Authority (WAPDA) is a large organization having a medical division having more than 1,200 employees providing predominantly curative services to the or- ganization. Currently, WAPDA is running 12 hospitals and 30 dispensaries (12 fortified and 18 basic dis- pensaries) across Pakistan.
5.4 Data sources As ABs/C working under the administrative control of federal/provincial governments of Pakistan are maintaining all their accounts/records by themselves, the only feasible way out to get their health ex- penditures data was to contact them officially and individually. The list of respondents was obtained from the following sources: • Annual Statistical Bulletin of the Employees of ABs/C under the control of Federal Government (2010-11), published by PPARC, Management Services Wing, Establishment Division, Islam- abad. • The list of ABs/C under the control of the Provincial Governments of Pakistan was obtained from the respective controlling department/Services & General Administration department of the four provinces. The postal addresses of ABs/C both at federal and provincial levels were obtained from the web- sites and controlling divisions/departments. Official letters along with the specially designed data specifica- tion form were dispatched to all ABs/C in order to get data on health expenditures of their employees. Table 35 and 36 show the number of federal bodies and their employees by Divisions of the Government of Pakistan and the number of provincial bodies and their employees by provinces, respectively.