The poor in Pakistan get very poor healthcare, says the World Health Organisation (WHO). "Out-of-pocket" health expenditure in the country stands at a whopping 71 per cent.
The figure is the highest in the Eastern Mediterranean region. Evidently it is the poor who are hit hard in a scenario where the government's role in healthcare delivery is minimal.
The rural poor, particularly, who cannot afford to pay for their healthcare have to necessarily fall back on the government sector which, anyway is plagued by severe under-funding.
The rural poor visit private doctors as a last resort, and sometimes because of a referral made by the government doctor, reveals the report.
The WHO report also says that the idea of handing over basic health units to non-governmental organizations could be worth exploring. Whether that would address the problem of lack of access to healthcare for the poor is another issue altogether. Only the NGOs with expertise could try and fill some gaps in public health.
Indicators of inequality in health and social status are only a starting point for assessing inequity, Dawn reports. The link between women's status in society and her condition explains why there is high mortality and morbidity in women in Pakistan.
It is associated with delay in access to health services, restrictions on women's mobility, domestic violence, mental stress emanating from male unemployment, armed conflict and deaths due to armed conflict, and the high workload placed on women.
When customary practices place serious restrictions on women, and they live in a near perpetual state of insecurity, and when lawgivers have no sense of people's rights, the challenge is to capture these deeply entrenched realities as determinants of the inequities that prevail.
With regard to rural-urban inequalities, rural areas where three-quarters of the people live are poorer and have far fewer health and educational facilities than urban areas. In rural areas, health indicators such as infant mortality and maternal mortality are higher, the report says.
A focus on urban-rural differences is not enough. It is important that inequities within the rural and urban sectors are also highlighted.
For example, nearly 50 per cent of population of Karachi lives in squatter settlements, the report reveals.
Literacy for women is a key to the health of her family, but the gap in gross primary school enrolment for girls (77 per cent) and for boys (94 per cent) is the largest such gender differential in the region. Dropout rates in public primary schools are much higher among girls and increasing compared to those of the boys.
The WHO report says a portrait of the "average" Pakistani woman indicates that she is illiterate and has five children, of whom those under three years old are malnourished. She works 15 hours a day and is anaemic and gives birth to low-weight babies.
Although its position has improved somewhat, the low rank of Pakistan on the gender-related development index (ranked 105 of 136 countries) and the gender empowerment measure (ranked 66 of 75 countries) indicates the extent of gender disparity in Pakistan.