World Bank Flags Major Flaws in Pakistan’s Health Budgeting System

Pakistan’s Health Budgeting System Under Scrutiny: World Bank Calls for Urgent Reform

Outdated Budgeting Practices Undermine Healthcare Delivery A recent World Bank report titled Budget Execution in Health: From Bottlenecks to Solutions has exposed critical flaws in how Pakistan allocates and executes its health budgets. The report reveals that budget planning often relies on historical spending patterns rather than accurate cost estimates, leading to either overspending or underfunding of essential services.

Centralized Control Limits Local Responsiveness The budgeting process remains highly centralized, with minimal input from local health facilities. This disconnect results in unrealistic allocations that fail to reflect on-ground needs. Fiscal constraints and mid-year budget cuts further widen the gap between available resources and actual healthcare demands.

Delayed Fund Releases Disrupt Routine Operations Health facilities across Pakistan report frequent delays in receiving funds, affecting their ability to pay for basic expenses like utility bills. Even minor payments—sometimes as low as Rs200—are subjected to the same bureaucratic hurdles as million-rupee transactions, creating operational bottlenecks.

Limited Autonomy and Connectivity Challenges While the “Green Corridor” system was introduced to fast-track low-value transactions, broader reforms are still needed. Most hospitals lack financial autonomy and remain dependent on centralized approvals. Additionally, poor internet connectivity in rural areas hampers real-time financial reporting, weakening oversight and responsiveness.

A Call for Systemic Overhaul The World Bank urges Pakistan to modernize its health financing framework through:

• Decentralized budgeting
• Accurate costing methods
• Timely and predictable fund releases
• Improved digital infrastructure for reporting

Without these reforms, Pakistan’s healthcare system risks continued inefficiency, leaving millions without reliable access to essential services.