Pakistan Bureau of Statistics National Health Accounts
36
2.7 NHA Indicators with regard to National Accounts 2021-22 The annual per capita Current Health Expenditures (CHE) for Pakistan as per NHA 2021- 22 are (48.05US$) Rs. 8,526 while in NHA 20 19-20 it was (40.7US$) Rs. 6,432. According to NHA-2021-22 report, the ratio of CHE to Gross Domestic Product (GDP) is 2.9 1%, while the ratio of general government health expenditures to total general government final consumption expenditure is 13. 2%. The ratio of private sector hea lth expenditures according to NHA over total household final consumption expenditure is 1.8%.
❖ Total health expenditures are 2.91% of GDP (at market price) in 2021-22.10 ❖ General government health expenditures are 13.2% of general government final consumption expenditures in 2021-22 as according to national accounts.11 ❖ Private health expenditures are 1.8% of Household final consumption expenditure as accord- ing to national accounts.12
10Pakistan Bureau of Statistics, National Accounts main aggregates (at market price) 11 Pakistan Bureau of Statistics, National Accounts, Expenditure on the Gross domestic product at current prices, general govern- ment final consumption expenditure 12 Pakistan Bureau of Statistics, National Accounts, Expenditure on the Gross domestic product at current prices, Household final consumption expenditure
Pakistan Bureau of Statistics National Health Accounts
37
- Provincial Health Accounts
Pakistan Bureau of Statistics National Health Accounts
Pakistan Bureau of Statistics National Health Accounts
39
3.1 Health expenditure at provincial level
The province wise breakdown of heal th expenditures in the literature is called Re-
gional Health Accounts13 or Provincial Health Accounts14. Matrices 3-6 show the total health
expenditures for each Province.
Provincial Health Accounts are sub-accounts of the NHA and track expenditures on
health for a specific regional section of the health system. Similar to NHA, the sub-accounts
measure the expenditures by financing sources, financing agents, health care providers
and functions which show the flow of resources through the construction of matrices. But it
is imperative to understand the criterion of regionalization. The expenditures are allocated
to the regions according to the location where the health care has been provided. The res-
idency of the patient is not a criterion, at all. The expend itures of a resident of Punjab in a
clinic at Peshawar would be recorded as expenditure in KP. Accordingly, the military health
expenses are allocated to the location of the military health facilities. Nevertheless, it can
be assumed that the figures widely reflect the regional distribution of benefits by residency
of the patients.
In Punjab, the current expenditures made by provincial government in its capacity
as financial agent are (27.92%). The share of social security is 1.19%. OOP expenditures
of private households as agents account for 5 1.38% of overall health expenditures made
in Punjab.
In Sindh, current expenditures made by its government were 28.88% of overall ex-
penditures. The share of social security is only 1.31%. The share of private households’
OOP expenditure is 55.44%.
In KP, the current expenditures made by the provincial government were 31. 84%.
In KP and Baluchistan, the share of social security expenditures is 0.34% and 0.28% re-
spectively which are lower than Punjab and Sindh. In KP, the share of OOP in KP is around
51.74%. The share of donor in overall health expenditures in KP is 1.26%.
In Baluchistan, the share of expenditures of the provincial government is 36.7 2%
(including districts government expenditure), while the share o f OOP health expenditures
was 58.90%.
13See WHO, Workshop on Health Financing in Pakistan, 2007,http://www.who.int/nha/events/en/.
14 See ADB, Technical Assistance Completion Report, 1997, http://www.adb.org/Documents/TACRs/PNG/tacr-png-2772.pdf.
Pakistan Bureau of Statistics National Health Accounts
40
Matrix 3: Financing Sources by Financing Agents - Punjab Current Health Expenditures 2021-22 (Million Rs.)
Financing Agents
Financing sources
FS.1 Public funds
FS.2 Private funds
FS.3 ROW
Total
%
FS.1.1 Government Funds
FS.1.2
Autono-
mous Bod-
ies
FS.2.1
Em-
ployer
funds
FS.2.2
House-
hold
funds
FS.2.3
Local
NGO’s
FS.3.1 Of-
ficial do-
nor agen-
cies
FS.1.1.1
Federal Gov.
FS.1.1.
2 Prov.
Gov.
FS.1.1.3
District /
Tehsil
bodies
HF.1 Gen-
eral Gov-
ernment
HF.1.1 Ter-
ritorial
Govt.
HF.1.1.1
Federal Gov-
ernment
Federal Gov. (civil)
Military health
expenditures
39,194
39,194
4.06
HF.1.1.2
Provincial
Government
Dept.
of:
Health
243,269
243,269 25.20 other
18,701
18,701 1.94 Population Welfare
7,524
7,524
0.78
HF.1.1.3
District
Bodies
District Government
98,716
98,716 10.23 Cantonment Boards
766
766 0.08 HF.1.2 Social se- curity funds HF.1.2.1 Social secu- rity funds through Government ESSI
9,946
9,946 1.03 Zakat Council
210
210 0.02 Bait-ul-Mal
1,297
1,297 0.13 HF.1.3 Autonomous Bodies / Corporations
398
398 0.04 HF.2 Priv. Sector HF.2.3 Private households' out-of-pocket payment
495,999
495,999 51.38 HF.2.4Local Non-Government Organizations (NGO’s)
45,973
45,973 4.76 HF.3 ROW HF.3.1 Official donor agencies
3372 3,372 0.35 Total 39,194 269,494 99,482 398 9,946 497,506 45,973 3,372 965,365 100.00 % 4.06 27.92 10.31 0.04 1.03 51.54 4.72 0.35 100
Pakistan Bureau of Statistics National Health Accounts
41
Matrix 4: Financing Sources by Financing Agents – Sindh Current Health Expenditures 2021-22 (Million Rs.)
Financing Agents
Financing Sources
FS.1 Public funds
FS.2 Private funds
FS.3 ROW
Total
%
FS.1.1 Government Funds
FS.1.2
Autono-
mous Bod-
ies
FS.2.1
Em-
ployer
funds
FS.2.2
House-
hold
funds
FS.2.3
Local
NGO’s
FS.3.1 Of-
ficial do-
nor agen-
cies
FS.1.1.1
Federal
Gov.
FS.1.1.
2 Prov.
Gov.
FS.1.1.3
District /
Tehsil
bodies
HF.1 Gen-
eral Gov-
ernment
HF.1.1 Ter-
ritorial
Govt.
HF.1.1.1
Federal Gov-
ernment
Federal Govt. (civil)
Military health
expenditures
5,777
5,777
1.50
HF.1.1.2
Provincial
Government
Dept.
of:
Health
107,278
107,278 27.83 other
4,032
4,032 1.05 Population Welfare
0.00
HF.1.1.3
District
Bodies
District Government
0.00 Cantonment Boards
272
272 0.07 HF.1.2 Social se- curity funds HF.1.2.1 Social secu- rity funds through Government ESSI
4,426
4,426 1.15 Zakat Council
339
339 0.09 Bait-ul-Mal
294
294 0.07 HF.1.3 Autonomous Bodies / Corporations
910
910
0.24
HF.2
Private
Sector
HF.2.3 Private households' out-of-pocket payment
213,677
213,677 55.44 HF.2.4Local Non-Government Organizations (NGO’s)
47,972
47,972 12.45 HF.3 ROW HF.3.1 Official donor agencies
423 423 0.11 Total 5,777 111,310 272 910 4,426 214,358 47,972 423 385,400 100.00 % 1.5 28.9 0.1 0.2 1.1 55.6 12.5 0.1 100.00
Pakistan Bureau of Statistics National Health Accounts
42
Matrix 5: Financing Sources by Financing Agents – Khyber Pakhtunkhwa Current Health Expenditures 2021-22 (Million Rs.)
Financing Agents
Financing Sources
FS.1 Public funds
FS.2 Private funds
FS.3
ROW
Total
%
FS.1.1 Government Funds
FS.1.2
Autono-
mous Bod-
ies
FS.2.1
Em-
ployer
funds
FS.2.2
House-
hold
funds
FS.2.3
Local
NGO’s
FS.3.1 Of-
ficial do-
nor agen-
cies
FS.1.1.1
Federal
Gov.
FS.1.1.
2 Prov.
Gov.
FS.1.1.3
District /
Tehsil
bodies
11.71HF.1
Gen0.05er
al Gov-
ernment
HF.1.1
Territorial
Govt.
HF.1.1.1
Federal Gov-
ernment
Federal Gov. (civil)
Military health
expenditures
5,396
5,396
1.93
HF.1.1.2
Provincial
Government
Dept.
of:
Health
70,176
70,176 25.13 other
18,556
18,556 6.65 Population Welfare
218
218
0.08
HF.1.1.3
District
Bodies
District Government
32,629
32,629 11.68 Cantonment Boards
139
139 0.05 HF.1.2 Social se- curity funds HF.1.2.1 Social secu- rity funds through Government ESSI
541
541 0.2 Zakat Council
54
54 0.02 Bait-ul-Mal
359
359 0.13 HF.1.3 Autonomous Bodies / Corporations
225
225 0.08 HF.2 Priv. Sector HF.2.3 Private households' out-of-pocket payment
144,528
144,528 51.7 HF.2.4Local Non-Government Organizations (NGO’s)
2,998
2,998 1.08 HF.3 ROW HF.3.1 Official donor agencies
3,528 3,528 1.27 Total 5,396 88,950 32,768 225 541 144,941 2,998 3,528 279,347 100.00 % 1.93 31.84 11.73 0.08 0.19 51.89 1.08 1.26 100.00
Pakistan Bureau of Statistics National Health Accounts
43
Matrix 6: Financing Sources by Financing Agents –Baluchistan Current Health Expenditures 2021-22 (Million Rs.)
Financing Agents
Financing Sources
FS.1 Public funds
FS.2 Private funds
FS.3 ROW
Total
%
FS.1.1 Government Funds
FS.1.2
Autono-
mous Bod-
ies
FS.2.1
Em-
ployer
funds
FS.2.2
House-
hold
funds
FS.2.3
Local
NGO’s
FS.3.1 Of-
ficial do-
nor agen-
cies
FS.1.1.1
Federal Gov.
FS.1.1.
2 Prov.
Gov.
FS.1.1.3
District /
Tehsil
bodies
HF.1 Gen-
eral Gov-
ernment
HF.1.1 Ter-
ritorial
Govt.
HF.1.1.1
Federal Gov- ernment Federal Gov. (civil)
Military health
expenditures
2,713
2,713
2.88
HF.1.1.2
Provincial
Government
Dept.
of:
Health
33,175
33,175 35.21 other
1,422
1,422 1.51 Population Welfare
0
0.00
HF.1.1.3
District
Bodies
District Government
0 0.00 Cantonment Boards
23
23 0.02 HF.1.2 Social se- curity funds HF.1.2.1 Social secu- rity funds through Government ESSI
170
170 0.18 Zakat Council
22
22 0.02 Bait-ul-Mal
70
70 0.08 HF.1.3 Autonomous Bodies / Corporations
53
53 0.06 HF.2 Priv. Sector HF.2.3 Private households' out-of-pocket payment
55,492
55,492 58.90 HF.2.4Local Non-Government Organizations (NGO’s)
999
999 1.06 HF.3 ROW HF.3.1 Official donor agencies
76 76 0.08 Total 2,713 34,597 23 53 170 55,584 999 76 94,215 100.00 % 2.88 36.72 0.02 0.06 0.18 59.00 1.06 0.08 100.00
Pakistan Bureau of Statistics National Health Accounts
44 Overall, these results show that the shares of financing agents of the health expenditures are relatively heterogeneous between different provinces. Table 25 provides the data of the provinces plus those for Islamabad Capital Territory (ICT) and the un-regionalized part of Federal Government. Table 25: Current & development health expenditures by provinces and financing agents 2021-22 in million Rs. Agents Punjab Sindh KP Baluchistan ICT Gilgit Un-regionalized Pakistan Current Dev. Current Dev. Current Dev. Current Dev. Current Dev. Current Dev. Current Dev. Current Dev. Federal Govt. (Civil)
159,422 9,530 159,422 9,530 Military 39,194
5,777
5,396
2,713
1,323
6,157
60,560
Provincial Govt. 269,494 3,819 111,310 1,667 88,950 9,618 34,597 505
504,351 15,609 District Govt. 98,716 1,335
32,629 494
131,345 1,829 Cant. Boards 766 33 272
139 26 23 2
1,200 61 ESSI 9,946
4,426
541
170
15,083
Zakat Department 210
339
54
22
625
PBM 1,297
294
359
70
203
2,223
Fed. ABs/C
18,021
18,021
Prov. ABs/C 398
910
225
53
1,586
Private Insurance
16,260
16,260
OOP 495,999
213,677
144,528
55,492
9,494
(2,463)
916,727
NGOs 45,973
47,972
2,998
999
1,999
99,941
Donors
Organizations
3,372
423
3,528
76
625
75
8,099
Grand Total 965,365 5,187 385,400 1,667 279,347 10,138 94,216 507 13,643
3,769
193,703 9,530 1,935,443 27,029 % 49.19 0.26 19.64 0.08 14.23 0.52 4.80 0.03 0.70 0.00 0.19 0.00 9.87 0.49 1,962,472