Power, Policy, and Public Health in South Asia: A Narrative Review with Emphasis on Pakistan

Why It Matters

Political dysfunction directly limits Pakistan’s ability to deliver universal health coverage, affecting millions and signaling systemic risk for investors and donors.

Key Takeaways

• Governance gaps hinder Pakistan’s health system efficiency.
• Corruption and fragmented authority post‑18th Amendment reduce service delivery.
• Sehat Sahulat Program expands insurance but faces geographic inequities.
• Lady Health Worker Program improves outreach yet struggles with gender norms.
• Multi‑sectoral political commitment essential for achieving universal health coverage.

Pulse Analysis

The interplay between politics and public health has become a defining factor in South Asia’s quest for universal health coverage. Scholars increasingly recognize that health outcomes are not solely driven by medical technology or financing, but also by the quality of governance, democratic stability, and institutional capacity. In regions where policy volatility and weak state institutions prevail, even well‑funded health programs can falter. Understanding these political determinants provides a lens through which policymakers, investors, and development agencies can assess risk and design more resilient health systems.

In Pakistan, the 18th Constitutional Amendment of 2010 devolved significant health responsibilities to provinces, creating a fragmented governance landscape. While devolution promised localized decision‑making, it also exposed chronic issues such as corruption, limited fiscal autonomy, and uneven administrative expertise across provinces. Initiatives like the Sehat Sahulat Program—offering subsidized health insurance to low‑income families—and the Lady Health Worker Program have demonstrated tangible gains in coverage and maternal‑child health. Yet their impact is uneven, constrained by geographic disparities, gender norms, and budgetary shortfalls that reflect deeper political shortcomings.

Achieving universal health coverage in Pakistan and the broader South Asian context therefore hinges on coordinated political will and cross‑sector collaboration. Strengthening institutional capacity, enforcing anti‑corruption measures, and aligning provincial and federal health strategies are critical steps. For international donors and private investors, these reforms signal a more predictable environment for health‑related investments and public‑private partnerships. Ultimately, a sustained commitment to good governance can transform health policy from a series of isolated programs into an integrated system capable of delivering equitable care to all citizens.