Pakistan's Health Budget 2026-27: 20 Paisa and the 18th Amendment
What the federal government spends on health, and the devolution caveat that frames it
By the ISN Media desk • June 2026 • Approx. 7-min read
Health is the second-smallest of Pakistan's named federal sectors, and like education it must be read alongside the eighteenth amendment to be understood. This explainer sets out what the federal government allocates to health in 2026-27, what it covers, and how to read the figure honestly. The figures are Budget Estimates from the Government of Pakistan, in billions of rupees. It sits under the pillar education, health and the smallest shares of Pakistan's budget.
How much does Pakistan spend on health in 2026-27?
At the federal level, health receives about Rs 37 billion in 2026-27, roughly 0.2 percent of the budget, or 20 paisa in every 100 rupees. The current health line rose about 17 percent this year, from about Rs 32.0 billion, one of the larger percentage gains among the social sectors, though from a very low base. As with education, most hospitals and clinics are funded by the provinces under the eighteenth amendment, so the federal figure understates national health spending.
That is the figure and its essential qualification. The detail follows.
What the federal health figure covers
The federal health allocation of about Rs 37 billion is small, but it did rise about 17 percent on the year, from roughly Rs 32 billion. The increase is real, but because the starting point is so low, the rupee effect on a hospital is modest.
The federal lines mainly fund national health programmes, regulatory bodies, federal hospitals and health services in the territories the federation administers directly. The day-to-day running of the public hospital and clinic network across the four provinces, the part of the system most citizens actually use, is funded from the provincial budgets, not this federal line.
Why the federal figure understates spending
The eighteenth amendment, passed in 2010, devolved most responsibility for health to the provinces. They fund their hospitals and clinics from the share of national revenue the centre transfers to them, about Rs 8,848 billion in 2026-27. A large part of the country's health spending therefore appears in the provincial budgets rather than the federal one.
This means the small federal health line is not, on its own, evidence that the country neglects health; much of the money sits in the provincial accounts. The mechanism is set out in the 18th amendment, why these figures understate spending. The honest question is what the provinces add to the federal figure.
The national picture
Allowing for devolution, Pakistan's combined federal and provincial public health spending has nonetheless stayed low as a share of the economy, well below the levels seen in many comparable countries and below the levels health bodies recommend. The consequences are visible in the indicators most often cited: a high rate of stunting among young children, gaps in immunisation and maternal care in poorer districts, and households that fall into debt to pay for treatment a public system does not provide.
As with education, two things are true at once. The federal figure understates national spending because of devolution, and the national figure still shows a low overall commitment. Both belong in an honest reading.
How federal and provincial health spending fit together
Because health is devolved, the federal and provincial roles are meant to be complementary. The federation retains responsibility for functions that cross provincial boundaries, such as national disease programmes, drug regulation, and coordination during health emergencies, while the provinces run the bulk of service delivery. In practice, critics argue the division has produced gaps and duplication, with the centre maintaining health structures in areas formally devolved, while supporters argue some functions are genuinely national and must sit at the centre. This tension is part of the wider debate over the eighteenth amendment.
Pakistan's health indicators in context
The consequences of low health spending show up most clearly in outcomes rather than allocations. Pakistan has one of the higher rates of child stunting in the region, a measure of chronic malnutrition that reflects both health and nutrition systems. Immunisation coverage, though improved, remains uneven across districts, and Pakistan is one of the last countries where polio remains endemic. Maternal and infant mortality, while falling, stay high relative to comparable economies.
These indicators have many causes beyond the budget, including the quality of provincial delivery, the availability of trained staff, water and sanitation, and household income. But they are the reason the size of public health spending matters: a system that is thinly funded across both federal and provincial budgets struggles to close the gaps that these indicators measure.
Health insurance and out-of-pocket cost
A large share of health spending in Pakistan is paid directly by households at the point of care, rather than through public budgets or insurance. This out-of-pocket spending is one of the highest in the region as a share of total health expenditure, and it is a major reason families fall into debt when a member falls seriously ill.
In response, federal and provincial governments have run health-insurance schemes intended to cover hospital treatment for lower-income families, the best known being the Sehat Sahulat or Sehat Card programme. The reach and funding of these schemes have varied by province and over time, and they form part of the wider picture of how the state attempts to protect citizens from the cost of illness, alongside the small dedicated federal health line.
Frequently asked questions
How much does Pakistan spend on health in 2026-27? About Rs 37 billion at the federal level, or 0.2 percent of the budget, 20 paisa in every 100 rupees. It rose about 17 percent this year from a low base. Most hospital and clinic funding is provincial.
Why is the federal health figure so small? Because the eighteenth amendment devolved most health responsibility to the provinces in 2010. They fund hospitals and clinics from the roughly Rs 8,848 billion the centre transfers, so the federal line understates national spending.
Did health spending rise this year? Yes. The federal current health line rose about 17 percent, from roughly Rs 32 billion to Rs 37 billion, one of the larger percentage gains among the social sectors, though from a low base.
What does the federal health budget fund? Mainly national health programmes, regulatory bodies, federal hospitals, and health services in the territories the federation administers directly, rather than the provincial hospital and clinic network most citizens use.
Is Pakistan's overall health spending adequate? Combined federal and provincial public health spending has stayed low as a share of the economy, below the levels of many comparable countries. The effects are visible in indicators such as child stunting and out-of-pocket spending on treatment.
Who runs most of Pakistan's hospitals? The provinces, which fund and operate the bulk of the public hospital and clinic network from their share of national revenue, with the federation handling cross-provincial functions such as disease programmes and regulation.
Why do so many Pakistani families pay for healthcare out of pocket? Because a large share of health spending is paid directly at the point of care rather than through public budgets or insurance. Pakistan's out-of-pocket share is among the highest in the region, which is why illness often pushes families into debt.
What is the Sehat Card? The Sehat Sahulat or Sehat Card is a government health-insurance programme intended to cover hospital treatment for lower-income families. Its reach and funding have varied by province and over time, and it sits alongside the small dedicated federal health line.
What health indicators is Pakistan struggling with? Child stunting, uneven immunisation coverage, the continued presence of polio, and relatively high maternal and infant mortality. These reflect thin public health spending across federal and provincial budgets, alongside other factors.
Does Pakistan still have polio? Yes. Pakistan is one of the last countries in the world where wild poliovirus remains endemic, which is one reason national immunisation and disease-control programmes remain a federal priority despite devolution.
What does the national health programme funded federally cover? Functions that cross provincial boundaries, such as disease-control and immunisation campaigns, nutrition programmes, drug regulation and emergency coordination, rather than the day-to-day running of provincial hospitals and clinics.
How does Pakistan's health spending compare regionally? Combined federal and provincial public health spending is low as a share of the economy, below the levels seen in many comparable and neighbouring countries, which is reflected in outcomes such as stunting, immunisation gaps and high out-of-pocket costs.
Sources and notes
- Government of Pakistan, Federal Budget 2026-27: health figures are Budget Estimates in billions of rupees, rounded for readability.
- Health-outcome indicators reflect published estimates from national health surveys and international bodies.
ISN MEDIA