Health and nutrional economic growth in
Pakistan: A systematic review

A REPORT SUBMITTIED IN THE PARTIAL FULFILLMENT OF REQUIRMENT FOR THE POST GRADUATE DIPLOMA IN APPLIED ECONOMICS

Submitted by

Hafiza Sobia Ramzan
PGDAE-35

DEPARTMENT OF ECONOMICS
UNIVERSITY OF THE PUNJAB, LAHORE
2012-2013

We, the supervisory committee, certify that the contents and form of report submitted by Hafiza Sobia Ramzan, PGDAE-35 has been found satisfactory and recommend it for the evaluation by the examiner for the award of post graduate diploma in applied economics.

Supervisor: Dr. Azmat Hayat
Associate professor
Department of Economics
University of the Punjab, Lahore

ACKNOWLEDGEMENT

First of all we thank our ALLAH for establishment of this work. All praises for ALLAH, Who guides us from darkness to light and help us in all difficulties. All and every respect is for His Holy Prophet MOHAMMAD (P.B.U.H) for unique comprehensive and everlasting source of guidance and knowledge for humanity and enables us to recognize our creator. It is my foremost duty to express my heartiest and sincerest gratitude to my respected supervisor Dr. Azmat Hayat, for their kind guidance encouragement, continual guidance and simulate discussion on all aspects concerning this thesis during my studies. I would like to give my heartfelt appreciation to my parents, who brought me up with their love and encouragement me to pursue advanced degrees. Last but not least I am thankful to my whole family. I would like to give my heartfelt appreciation to my friends who accompanied me with their love, unlimited patience, understanding, helping and encouragement. Without their support, I would never be able to accomplish this work. And all the teachers in my university and my coworkers because without their prayers and help I could have never been able to do anything in my life.

Hafiza Sobia Ramzan

I Dedicated this Humble Effort

To

“MY LOVELY PARENTS”

Who introduced me to the joy of reading from birth, for their love, endless support and encouragement And
The only reason I am doing it because I know that it will mean alot to my parents

Introduction
Most people want to lead healthy lifestyles. There is much that people can do individually to protect their health including driving safely, wearing seatbelts, avoiding tobacco smoke and air pollution, exercising regularly, eating healthy food and having regular checkups. But many health risks are also influenced by community factors, including transportation and land use planning decisions. Health plays the key role in determining the human capital. Better health improves the efficiency and the productivity of the labor force, ultimately contributes the economic growth and leads to human welfare. Access to good health can contribute positively to the economic and social development of a country. Thus, key issues that impact the health status of people ought to be addressed through a diverse set of policy tools comprising short and long term measures to secure better health outcomes. The people of Pakistan have grown healthier over the past three decades. The vision for the health sector comprises a healthy population with sound health, enjoying good quality of life through the practice of a healthy life style. In order to achieve this vision, significant measures have been taken toward disease prevention, health promotion, and greater coverage of immunization, family planning, and provision of female health worker services. To attain better, more skillful, efficient and productive human capital resources, governments subsidies the health care facilities for its people. In this regard, the public sector pays whole or some part of the cost of utilising health care services. The size and distribution of these in-kind transfers to health sector differs from country to country but the fundamental question is how much these expenditures are productive and effective? It very much depends on the volume and the distribution of these expenditures among the people of different areas of the country. Besides the nature of the existing circumstances of the human resource, any marginal change in public sector spending on health services may have positive impact on the human capital and economic growth. Health generates positive externalities for the society as a whole, as well as the equity concerns that without public sector financial support only the wealthy segment of the population would be able to afford reasonable health care services. Lamiraud, et al. (2005) argued that social health protection is an important instrument aiming at fair burden sharing and reducing barrier underlining access to health care services. Another good reason for the government spending in delivering basic health care services is to reduce burden of the diseases (BOD) in the productive years of the life. The social rate of return and the BOD force the policy-makers to transfer the public resources towards basic health care facilities. According to the Economic Survey of Pakistan (2005-06), the government spent 0.75 percent of GDP on health sector in order to make its population more healthy and sturdy. In this regard, a number of vertical and horizontal programmes regarding health facilities are operative in Pakistan. The federally funded vertical programmes include: Lady Health Worker Programme; Malaria Control Programme; Tuberculosis and HIV/AIDS Control Programme; National Maternal and Child Health Programme; the Expanded Programme on Immunisation; Cancer Treatment Programme; Food and Nutrition Programme, and; the Prime Minister Programme for Preventive and Control of Hepatitis A & B. To effectively address the health problems facing Pakistan, a number of policies emphasis better health care services. These include: Health related Millennium Development Goals; Medium Term Development Framework; Poverty Reduction Strategy Papers; National Health Policy, and; Vision 2030. In spite of these policies, to overcome the health related problems in Pakistan seems suspicious and distrustful. The communicable diseases are still a challenge and the statistics reveal that the nutrition and reproductive health problem in communicable diseases are still liable for the 58 percent of the BOD in Pakistan. Non-communicable diseases (NCD), caused by sedentary life styles, environmental pollution, unhealthy dietary habits, smoking etc. account for almost 10 percent of the BOD in Pakistan. Social Policy Development Centre (SPDC), 2004, demonstrates that out of every 1,000 children who survive infancy, 123 die before reaching the age of five. A large proportion of those who surviving suffers from malnutrition, leading to impaired immunity and higher vulnerability to infections. Malnutrition is big problem in Pakistan. Human Conditions Report (2003) clearly points out that about 40 percent children under 5 year of age are malnutrited. About 50 percent of deaths of children under 5 years old children are due to malnutrition. POLICIES EMPHASISING HEALTH CARE SERVICES IN PAKISTAN

Pakistan is in the middle of epidemiological transition where almost 40 percent of total burden of disease (BOD) is accounted for by infectious/communicable diseases. These include diarrheal diseases, acute respiratory infections, malaria, tuberculosis, hepatitis B&C, and immunisable childhood diseases. Another 12 percent is due to reproductive health problems. Nutritional deficiencies particularly iron deficiency anemia, Vitamin-A deficiency, iodine deficiency disorders account for further 6 percent of the total BOD. Non-communicable diseases (NCD), caused by sedentary life styles, environmental pollution, unhealthy dietary habits, smoking etc. including cardio vascular diseases, cerebro-vascular accidents (hemiplegia), diabetes and cancers account for almost 10 percent of the BOD in Pakistan. With the increase in life- expectancy, diseases/disabilities of old age especially eye problems, paralysis and bone diseases are also on rise. The drug addiction problem is growing especially in the youth. There are approximately 5 million addicts out of which 50 percent are heroin addicts. The growing threat of injecting drug users poses a great challenge when one considers the hidden cases of HIV/AIDS and hepatitis-C amongst the addict population [MTDF (2005–10)]. In Pakistan, the probability of dying under-five child mortality is at 101 per 1,000 live births with a life expectancy of 62 years. It can be seen that child mortality remains the major problem facing Pakistan. In 2004, figures on immunisation of children under 12-months–age show that 33 percent did not get immunisation against measles and 20 percent did not receive immunisation against tuberculosis in Pakistan. The immunisation includes treatment against tuberculosis, diphtheria, pertussis, tetanus, polio and measles. Immunisation is the most cost-effective and highest-impact health intervention that reduces under-five child mortality and hospitalisation and treatment costs during childhood [Pakistan MDG Report (2006)].

REVIEW OF LITERATURE
A comprehensive review of literature, research materials, articles and evaluation reports is done to assess the existing situation and policy debate. This includes documents and reports available from World Health Organisation (WHO), United Nations Children’s Fund (UNICEF), Asian Development Bank (ADB), Centre for Poverty Reduction and Income Distribution (CRPRID), Poverty Reduction Strategy Papers (PRSP), Ministry of Health (Islamabad) and Mehbub ul Haq Human Development Centre. A large number of the studies have employed the Benefit Incidence Approach (BIA) on household data for their analysis. Findings reveal that public sector expenditures are either progressive or regressive and the share of the different income group differs depending upon the delivery of the benefits of the public expenditures across region, caste, religions, gender etc., see Christian (2002), Rasmus, et al. (2001), Younger (1999), Jorge (2001), Roberts (2003), Hyun (2006), David, et al. (2000), Gupta, et al. (1998, 2002), Lamiraud, et al. (2005), SPDC (2004), Norman (1985), Castro, et al. (2000), Hamid, et al. (2003), Sakellariou and Patrinos (2004) and Shahin (2001). The studies which exhibit public sector expenditures are progressive such as Younger (1999), in Ecuador used combination of benefit and behavioural approaches showed that public expenditures improves the health indicators in the developing countries. In cross country analysis, Gupta, et al. (2002) used 56 country data and concluded that the increase in public expenditures on health reduces the mortality rates in infants and children. Study by Toor and Butt (2005) shows...

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