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At 9am at a rural health center. The waiting room is full. The shelves are naked. And the generator is silent. There was no budget for fuel this quarter. A refrigerator has been closed for several days to store the vaccine. Anywhere in government accounts, there is money for fuel and medicine, but it is confused with approval, codes and forms. Steps for the patient, this is not an accounting problem. This is the difference between treating and getting sick at home.
This is a hidden crisis in Pakistan’s healthcare system: not only the money we spend but how – even if – this money reaches the frontline. The public financial administration may feel like a bureaucratic term, but it is a bridge between budget and care in health. If the bridge is weak, there will be no number of policies, benefits package or shiny infrastructure that they need most.
Why? PFM MAtters
PFM is often hidden until it fails. A clinic that cannot repair broken goods because the budget transfer is stuck or the vaccination drive that begins for months because the funds are released in the last quarter is not just the result of poor policy design. These are the signs of the financial management system that struggle to put into practice the allocation.
Throughout Pakistan, health budgets are trapped in forecasts. Development funds arrive too late to be fully used, forcing frustrated costs at the end of the year. The salaries swallow the lion’s share in the expense without any performance management procedure, which is very low for medicines, utility or recovery. Budgets have been prepared from last year’s data, which is the least input from the factory facilities.
For patients, stakes are easy: Better PFM means walking to the clinic and finding medicines on the shelf. Poor PFM means to leave empty -handed.
Beyond JayAsgun
In fact, PFM is not complicated in health. It boils on planning a realistic budget based on the original service needs. Performing these budgets by issuing funds on time and purchasing goods without endless red tape; Maintain basic records so that resources do not lose. And to track down what was spent against what happened.
Think about PFM like a patient’s prescription. The name tells you who is for it. The medicine tells you what is being purchased. The diagnosis explains why it needs it. Pharmacy is a source of funding. No part is wrong and the patient is not treated.
The way forward
Finding solutions is not rocket science but it requires commitment. Pakistan needs to develop PFM skills in frontline, training facility managers and district teams to plan, cost and track resources while giving them easy tools for it. Even a basic Excel register can change the way to convert the budget into services.
A broken financial system leaks resources, delays services and eliminates confidence. Strengthening PFM is not supplementary reforms. This is the difference between practical paper and care promises.
Further, the budget should be compatible with service plans rather than historical spending samples. This means merging the service supply projects into the budget process and creating a place for local sounds. The flow of the fund should be predicted and timely to prevent the chaos of the annual spending, which disrupts the delivery of service.
The actual progress will come from connecting every rupee with the service target, whether it be vaccinated, pre -birth care or emergency transport. Compliance with this changes the focus of the results. From paperwork to patients.
PFM should be part of every health reform. Universal Health Coverage Schemes, Insurance Program and New Infrastructure will only succeed when they are planned, ongoing and effectively spent.
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Pakistan’s original shift is cultural. For a long time, PFM is considered as a practice of paperwork to satisfy auditors. It should be a service supply function where financing is seen as part of the maintenance provider, not separate from it.
Imagine a system where a basic health unit manager, in real time, can spend the cost of services, which they provide, and track each rupee on a solid output. Imagine that the provincial budget published with the goals of service so that citizens can see what their taxes are buying. This is what the working UHC financing system looks like.
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Pakistan will not only get the UHC by increasing the health budget. It has to fix the pipes through which the money flows. A broken financial system leaks resources, delays services and eliminates confidence. Strengthening PFM is not supplementary reforms. This is the difference between practical paper and care promises.
The question is not whether Pakistan can afford to invest in a better PFM for health but can not be able to afford it.
The author is a Flbright Scholar who is a master in international development studies. He is a technical adviser to an international organization working on health financing and stabilizing the health system. This can be reached by Okhan1@gwu.edu.
