HIES 2024-25 (SOCIAL REPORT) 154
ICT
Region/Province HIES2024-25 Male Female Total Balochistan
Yes, Bank Account 17 4 11 Yes, Easy paisa, jazz cash, omni etc. 20 <1 11 Both (1 &2) 7 <1 4 None 55 96 75 Urban
Yes, Bank Account 23 5 14 Yes, Easy paisa, jazz cash, omni etc. 24 <1 12 Both (1 &2) 10 <1 5 None
44 95 69 Rural
Yes, Bank Account 15 3 9 Yes, Easy paisa, jazz cash, omni etc. 18 <1 10 Both (1 &2) 6 <1 3 None 61 97 78
NOTES: Population aged 18 years and older having physical account or digital account or both, in last three months as a percentage of the total population aged 18 years and older.
154
HEALTH
154
HIES 2024-25 (SOCIAL REPORT) 155
HEALTH
4 HEALTH
Introduction
Health plays a vital role in social and economic development of any country, as a healthy
population contributes to greater productivity, better education outcomes and reduced poverty.
High income or developed countries on average spend significantly more on health (both per
capita and as a share of GDP ), than lower income or developing countries. For example, many
high income economies devote over 9% of GDP to health expenditure, compared to around 2–4
% in many low and middle income countries.
Out-of-pocket health expenditure is extracted and published through a National Health Account
report. To support this requirement, relevant data is collected under this module, which also
enables the computation of SDG indicator 3.8.2. The national health expenditure is calculated
within the national accounts framework and serves as a key input for SDG reporting.
Recognizing its significance, this module has been made a permanent feature of HIES survey.
In Pakistan, improving public health is essential for sustainable development and achieving
national objectives aligning closely with URAAN Pakistan’s priorities and Sustainable
Development Goals (SDGs). URAAN Pakistan aims to ensure universal access to quality and
affordable healthcare and education service s. Pakistan’s healthcare system is managed through
a decentralized setup that includes federal, provincial, district and tehsil levels. Although this
system is designed to make health services more accessible to people, it still faces many long -
standing challenges. According to World Bank, public spending on health remains low around
1% of country’s GDP , which limits the number of doctors, nurses, medicines and prop erly
equipped health facilities (world bank). Because of these shortages, people do not have equal
access to quality healthcare and the difference between services available in cities and those in
rural areas remains wide.
HIES 2024-25 (SOCIAL REPORT) 156
HEALTH
In Pakistan, improving maternal and child health continues to be a national priority. While progress has been made, however, preventable illnesses such as diarrhoea, pneumonia, and malnutrition still pose serious threats to children’s health. Infant and ne onatal mortality rates have shown gradual decline but still remained at higher level than desired levels. Maternal education is recognized as a key factor in improving child survival, as educated mothers are more likely to ensure timely immunization, prope r nutrition and better hygiene practices. Continued investment in primary healthcare, clean water, sanitation and community awareness is essential to further reduce preventable diseases and achieve sustainable health outcomes across Pakistan. The devolution of health in Pakistan, initiated through the 18th Constitutional Amendment in 2010, transferred major responsibilities of health planning, financing, and service delivery from the federal to provincial governments. This reform aimed to enhance efficiency, accountability, and responsiveness to local health needs. However, it also introduced challenges related to coordination, capacity building and maintaining uniform health standards across provinces. Provincial health departments implement key health initiatives: Expanded Program on Immunization (EPI) protects children from vaccine- preventable diseases.
Health Expenditure (%) of GDP-Pakistan
HIES 2024-25 (SOCIAL REPORT) 157
HEALTH
Maternal, Neonatal and Child Health (MNCH) Program improving safe deliveries and postnatal care. National Program for Prevention and Control of Hepatitis addresses major infectious diseases. Data collection on health indicators constitutes a vital component of the Household Integrated Economic
Survey (HIES), serving as one of the primary sources of information on public health at both provincial and urban–rural levels. The survey provides reliable and comparable data that support evidence-based planning, policy formulation and monitoring of health outcomes. Through its regular implementation, HIES Survey series ensures the availability of up-to-date health statistics, enabling the assessment of progress in key health indicators and identifying gaps in service delivery across different regions. It provides the detailed comparison of health indicators covered in the current round of HIES (2024-25) with the previous round of Provincial Survey (2018-19). This helps to identify the loopholes present in health sector and helps government to identify the issues faced by health sector and hence to formulate data driven policies accordingly.
HIES 2024-25 (SOCIAL REPORT) 158
HEALTH
Immunization
Immunization remains a cornerstone of Pakistan’s public health strategy, playing a vital
role in reducing child morbidity and mortality from vaccine -preventable diseases. Through the
Expanded Programme on Immunization (EPI), Pakistan continues to work toward s achieving
universal immunization coverage by providing free vaccines against life -threatening diseases
such as Tuberculosis, Poliomyelitis, Diphtheria, Pertussis, Tetanus, Hepatitis B, Haemophilus
Influenzae Type B, and Measles. Supported by the Government of Pakistan in collaboration with
WHO, UNICEF, and other partners, immunization program strives to protect every child,
especially in remote and underserved areas. Immunization not only safeguards individual health
but also contributes to broader national commitments under URAAN Pakistan and the
Sustainable Development Goals (SDGs), aiming for a healthier and more resilient population.
Under its Equity & Empowerment pillar, URAAN Pakistan supports the Polio Eradication
Programme, including mobile vaccination teams targeting high-risk, nomadic children.
Pakistan’s childhood immunization schedule primarily included vaccines such as BCG
(for Tuberculosis), DPT (for Diphtheria, Pertussis, and Tetanus), Inactivated Polio Vaccine
(IPV), and the Measles Vaccine. However, in 2013, the national immunization program
underwent a major revision to strengthen protection against a broader range of vaccine-
preventable diseases. The updated schedule introduced the Pentavalent vaccine, a combination
of five antigens-diphtheria, pertussis, tetanus, Haemophilus influenzae type B, and Hepatitis -B
along with continued administration of BCG, IPV, and Measles vaccines. In addition, ROTA,
TYPHOID and Measles-2 vaccines were added, with the later administered at 15 months of age
to ensure sustained immunity. This expansion reflects Pakistan’s commitment to improving child
health outcomes through comprehensive immunization coverage and alignment with global best
practices and WHO recommendations, w hich are administered as per following Immunization
schedule:
HIES 2024-25 (SOCIAL REPORT) 159
HEALTH
Immunization Schedule
Age of Child
Previous Schedule (2018-19)
New Schedule (2024-25)
At birth
BCG (anti-TB) + Polio 0
BCG (anti-TB) + Polio 0
6-weeks
Pentavalent1+pneumococcal1+ Polio1
Pentavalent1+ Polio 1 +pneumococcal1+
ROTA1
10 weeks
Pentavalent2+pneumococcal 2 + Polio2
Pentavalent2+ Polio2 +pneumococcal 2 +
ROTA2
14 weeks
Pentavalent3+pneumococcal3 + Polio 3
Pentavalent3+ Polio 3 +pneumococcal3 + IPV1
9 months
Measles-1
Measles-1 + TYPHOID +IPV2
12-15 months
Measles-2
Measles-2
To assess accurate immunization coverage, one of the major challenges is the unavailability or
incomplete information on children’s health or immunization cards. In many cases, parents
are unable to present cards with complete vaccination details, making it difficult to verify doses
received. Therefore, in this HIES-(2024-25) survey, PBS estimates immunization coverage
using both “record-based” and “recall-based” approaches. The record-based measure relies
on written information from vaccination cards verified by enumerators or reported by parents,
which, although more reliable, may underestimate actual coverage due to missing or lost cards.
The recall-based measure depends on parents’ memory of the vaccines their child received; this
can lead to reporting errors or confusion about vaccine types and schedules. To minimize such
errors, enumerators are trained to carefully probe and verify responses to ensure the highest
possible accuracy. Despite these efforts, recall data remains less accurate for precise
measurement. Therefore, both methods are used in HIES survey series, providing a more
comprehensive picture of immunization coverage. Moreover, the findings highlight the need to
strengthen digital immunization records and parental awareness, ensuring more consistent
and verifiable data in future surveys.
Immunization Coverage: In Pakistan, Record-based immunization coverage for children aged 12-23 months stands at 73 percent in HIES 2024-25, indicating continued progress in routine vaccination uptake.
HIES 2024-25 (SOCIAL REPORT) 160
HEALTH
To assess changes and trends in immunization coverage across provinces and urban–rural areas,
comparison has been made between the
current Round of HIES (2024 -25) and
the previous Round HIES -(2018-19),
Record based immunization rates for
children aged 12 -23 months, has
increased to 73 percent in 2024 -25
from 68 percent in 2018-19 (Table 1b).
This increasing trend observed in rural
areas with 72 percent in 2024-25 from
63 percent in 2018 -19 whereas
showed minor decline in urban area
with 75 percent in 2024-25 from 76 percent in 2018-19 respectively (Figure 4.1). However, with
the inclusion of recall measures, immunization coverage (for all 8 recommended vaccines) has
shown an upward trend, rising from 76% in 2018–19 to 78% in 2024–25. (Table 1c).
In the current round of HIES 2024-25, immunization schedule has been revised by adding
Rota & Typhoid for the first time. Results for both record and recall measures shows an overall
increasing trend across all types of antigens (Table 3). Visible increase in every antigen (record
based) is observed. Punjab has shown highest coverage around 93 percent for every antigen
except Measles which is 80 percent followed by Khyber -Pakhtunkhwa in which every antigen
lies around 80 percent except Measles which is 72 percent respectively. This shows people tend
to forget their children vaccine against measles due to long gap between Penta 3 and Measles.
Immunisation coverage remains strong across most antigens, with only small differences
between age groups for example, PENTA1 is 86 percent among 12–23 months-old as compared
to 84 percent among 24–35 months-old and POLIO1 is observed 87 percent versus 85 percent.
This trend shows slightly higher coverage in younger group for most vaccines, reflecting early
uptake of routine immunisation. However, Measles displays the opposite pattern, rising from 74
percent in younger group to 80 percent in older group, indicating delays in timely vaccination.
Overall trend shows good vaccine coverage across most antigens but there is still a need to
improve timely completion of vaccinations especially Measles. (Figure 4.2)
0
10
20
30
40
50
60
70
80
Urban Rural Both
75 72 7376
63 68
2024-25 2018-19
Figure 4.1 :Children Aged 12-23 Months Based
on Record
HIES 2024-25 (SOCIAL REPORT) 161
HEALTH
Diarrhoea
Diarrhoea among children under five years of age remains a major public health iss ue worldwide, particularly in developing countries. It is one of the leading causes of childhood illness and death, primarily due to dehydration caused by excessive loss of fluids and electrolytes. The condition occurs when infections —often from contaminated food, water, or poor sanitation, disrupt normal intestinal function, leading to frequent loose or watery stools. Young children are especially vulnerable because of their lower immunity and greater risk of fluid loss. Despite being preventable and treat able, diarrhoea continues to pose a significant challenge to child health, emphasizing the need for improved access to clean drinking water, proper sanitation, hygiene practices, and timely treatment with oral rehydration salts (ORS) and zinc supplements. 85 84 83 83 84 83 83 85 85 85 80 87 86 84 83 85 84 83 87 86 85 74 0 10 20 30 40 50 60 70 80 90 100 24-35 MONTHS 12-23 MONTHS
Child Health Vulnerability to Diarrhoea Diarrhoea remains a significant public health concern, with young children particularly vulnerable to dehydration & related complications. Figure 4.2 Coverage of immunization by antigen record age 12-23 Months and 24-35 Months
HIES 2024-25 (SOCIAL REPORT) 162
HEALTH
As part of Pakistan’s National Development Agenda under Pakistan Vision 2025, the government has committed to halving the incidence of diarrhoea (alongside Hepatitis, Diabetes and Heart Disease) and to significantly improve access to Sanitation & Quality Health Care. Specifically, the plan sets a target to reduce the incidence of Diarrhoeal disease by 50 percent and increase the population’s access to improved sanitation from around 48 percent to 90 percent. This aligns with the broader goal of strengthening primary health -care services and ensuring that children under five receive timely and effective treatment and preventive interventions. For collection of data on this incidence mothers were asked to report whether a child under five years of age had Diarrhoea in 15 days prior to the survey. The current results are compared with earlier round of HIES 2018 –19 to assess changes in treatment seeking behaviour and service utilisation over time. If child reported to suffer with diarrhoea a series of questions were asked, to measure the prevalence and how it was managed. The overall percentage of children who have 0 20 40 60 80 100 Pakistan Punjab Sindh Kp Balochistan 78 84 71 73 7777 84 72 74 66 77 84 71 73 71 Male Female Both Figure 4.3: Diarrhoea cases where a practitioner was consulted by Region & Province
HIES 2024-25 (SOCIAL REPORT) 163
HEALTH
suffered from Diarrhoea in the past 15 days shows a significant increase, rising from 6 percent in
2018–19 to 10 percent in 2024-25. This upward trend highlights growing concerns regarding child
health and the need for effective policy intervention in Water, Sanitation and Health Care Services.
However, provincial situation shows that almost similar pattern is observed across all provinces.
Duration of Diarrhoea (Table 6) shows that almost 84 percent suffered for the period of 1 to 7
days. The trend shows that most diarrhoea cases last less than a week, indicating they are generally
acute rather than prolonged episodes (Table 5a ). The percentage of diarrhoea cases where a
practitioner of some kind was consulted (Table 5b), shows a decline, with 77 percent in 2024–25
compared to 84 percent in 2018 –19, indicating that people commonly treat diarrhoea at home by
using ORS rather than immediately visiting a practitioner. However provincial comparison shows
no significance difference in urban and rural areas except Sindh which is 76 percent in urban areas
and 69 percent in rural areas (Figure 4.3).
4.3.1 Trends in ORS Utilization for Childhood Diarrhea
The use of Oral Rehydration Salts (ORS) for treating Diarrh oea among children under five has
shown improvement at the
national level, rising from 53
percent in 2018-19 to 60 percent
in 2024 -25. An increase has
been observed across both urban
and rural areas, with ur ban
coverage improving from 57 to
64 percent and rural from 51 to
58 percent. This positive trend
reflects growing awareness
and better access to essential treatment for diarrheal diseases, as more people are able to manage
symptoms at home using ORS as a first step, reducing the need for immediate consultation with a
practitioner (Table 5c, Figure 4.4) .
0 10 20 30 40 50 60 70 80 Pakistan Punjab Sindh Kp Balochistan 59 53 71 52 6661 53 77 51 6160 53 74 52 63 Male Female Both Figure 4.4: Diarrhea Cases where ORS was given to Child
HIES 2024-25 (SOCIAL REPORT) 164
HEALTH
4.3.2 Consultation Patterns for Diarrhea Treatment
The preference for private consultation in diarrhoea treatment is observed marginally higher than
that for government facilities with 46 percent and 41 percent respectively. (Table 8,Figure 4.5).
This gives some indication of use of the
government primary health network for
these kinds of curative services. This
survey also collects information on
reason for not visiting government
facilities, which indicated the most cited
reason for not availing the government
facility was “Too far away” followed by
“No government facility” in all four
provinces. (Table 9) Main reason for
visiting
private
practitioners
for
diarrhoea
treatment
observed
is
convenient location with 39 percent followed by the availability of doctors with 23 percent. This
trend highlights that accessibility and immediate medical attention are the key factors influencing
care-seeking behaviour for diarrhoea treatment. (Table 11)
Communicable Diseases in Pakistan: Malaria, Dengue, Tuberculosis, and
Hepatitis
Communicable diseases such as Dengue, Hepatitis and Tuberculosis continue to pose a major
public health challenge in Pakistan with high case numbers and mortality each year. To effectively
reduce the burden of these diseases, strengthened surveillance systems, expanded vaccination and
diagnostic services, public awareness campaigns, improved sanitation and vector control measures
are essential. Furthermore, intersectoral collaboration and sustained investment in preventive
healthcare can significantly curb disease transmission and build long-term resilience against
infectious diseases in Pakistan.
46
6
41
1
5 1 1
Private practitioner
Chemist/Pharmacy
Govt hospital/dispensary
Figure 4.5:Type of Practitioner Consulted for
Diarrhoea Treatment