Khyber Pakhtunkhwa (KP) is Pakistan’s third largest province by population, home to over 40 million people, with a challenging geography that includes remote mountainous districts, border regions, and a high dependence on public sector health services. These structural realities make healthcare governance not only a social necessity but a core measure of state capacity in the province.
Despite repeated electoral mandates and sustained control over provincial governance, the KP government today faces growing public dissatisfaction over healthcare delivery. This discontent is not rooted in a lack of spending or rhetoric, but in the widening gap between policy claims and lived patient experience. While the provincial leadership continues to defend its health reforms as progressive and people centric, hospitals across KP tell a different story, one marked by overcrowding, staff shortages, and declining trust in public facilities.
High Spending, Low Visibility of Improvement
In 2024, the KP government allocated a record Rs232 billion to the health sector, one of the highest provincial health budgets in Pakistan’s history. Yet, despite this fiscal commitment, major public hospitals continued to report limited ICU capacity, overwhelmed emergency wards, and shortages of doctors and nurses, particularly in peripheral districts. For the public, this disconnect between budget announcements and service delivery has become a central source of frustration.
From an analytical standpoint, this reflects a governance failure where input based policymaking has not been matched by outcome based accountability. Increased allocations have not translated into proportional improvements in hospital capacity, bed to population ratios, or emergency response readiness. KP’s public hospitals still operate with one of the lowest ICU bed to population ratios in the country, a reality that becomes especially visible during health emergencies and seasonal disease outbreaks.
The Medical Teaching Institutions Controversy
A major reason for declining public confidence lies in the government’s persistent defence of the Medical Teaching Institutions model. The MTI reforms were introduced to grant autonomy to teaching hospitals, improve efficiency, and reduce bureaucratic delays. However, in practice, many patients and healthcare workers perceive MTIs as having weakened public healthcare delivery rather than strengthened it.
Critics argue that MTIs have shifted hospitals away from a welfare oriented model toward a semi commercial logic, where cost recovery and administrative autonomy have diluted the state’s responsibility to ensure affordable and universal access. Fee structures, outsourcing of services, and contractual hiring have generated insecurity among staff and confusion among patients, particularly the poor, who rely almost entirely on public hospitals. The government’s insistence on defending MTIs, without adequately addressing these concerns, has reinforced perceptions of policy rigidity and disconnect from ground realities.
Sehat Card Plus and the Limits of Insurance Based Reform
The Sehat Card Plus program remains the KP government’s flagship healthcare initiative and is often cited as evidence of pro poor governance. With Rs37 billion in annual spending, the program has enabled hundreds of thousands of residents to receive treatment, including nearly 300,000 patients seeking care outside the province. While this reflects expanded financial access, it simultaneously exposes a deeper structural weakness.
From a policy analysis perspective, Sehat Card Plus has addressed the demand side of healthcare but largely ignored the supply side. Insurance coverage without parallel investment in public hospitals has resulted in a system where patients can pay for treatment but cannot always find timely care within KP. The increasing reliance on out of province hospitals is not a success indicator. It is evidence of insufficient tertiary and specialized care capacity within the province.
Moreover, by channelling substantial public funds into treatment reimbursements rather than infrastructure, staffing, and preventive care, the government has prioritized short term political visibility over long term system strengthening. For ordinary citizens, this translates into continued suffering in overcrowded hospitals despite being insured on paper.
Why Public Sentiment Has Shifted
The growing lack of public support for the KP government’s healthcare agenda is therefore not irrational or purely political. It is grounded in three observable failures.
First, there is a mismatch between spending and outcomes, where record budgets have not improved everyday hospital experiences. Second, institutional reforms have been pursued without broad social consensus, particularly the MTI model, which many view as exclusionary rather than empowering. Third, an insurance heavy approach has expanded access in theory but left structural bottlenecks unresolved in practice.
KP’s healthcare strategy reflects a fragmented reform model, where financing, governance, and service delivery have not been integrated into a coherent system. The absence of rigorous impact evaluation and transparent performance metrics has further weakened public trust.
Conclusion
The KP government’s healthcare challenge is not one of intent but of execution and prioritization. While policy innovation and fiscal effort are evident, the failure to strengthen hospital capacity, retain medical staff, and align reforms with public expectations has turned healthcare into a political vulnerability rather than an achievement. Until the province moves beyond headline reforms and addresses the structural foundations of public healthcare, public dissatisfaction is likely to persist regardless of how ambitious future budgets may appear.
