According to naturegnosis, Pakistan faces numerous challenges in its social development, including the health sector. The country was unable to achieve the health-related Millennium Development Goals by the end of 2016. In the Human Development Index (HDI 2018), Pakistan ranks 150th out of 189 countries and thus does poorly in a regional comparison. The general life expectancy is according to the UNDP 66.6 years. Pakistan has a rapidly growing population. Around 35 percent of the population is under 15 years old – many young people have no prospect of a job. Another consequence of the population growth is the too intensive use of scarce natural resources, especially agricultural land and water. There are particular challenges in the areas of family planning, child mortality, mother-child health and nutritional status; combined with social problems such as the status of women, violence against women in Pakistani society and the lack of awareness of HIV / AIDS this situation contributes to inadequate health care, especially for women and children. The official HIV / AIDS rate for adults between the ages of 15 and 49 is 0.1% (Worldbank 2015).
The current government has increased government spending on health significantly, but it remains too low to guarantee universal coverage. Public health expenditure as a percentage of gross domestic product is 0.92% (Worldbank 2015). The quality and accessibility of public health services in Pakistan are comparatively low. As a result, many people still develop diseases such as poliot that are almost extinct elsewhere. The proportion of one-year-old children vaccinated against diphtheria, whooping cough or tetanus is 73% (Worldbank 2015). The maternal and child mortality rate is among the highest in the world. The number of children who die before the age of five is 81.1% per 1,000 live births (Worldbank 2015). The number of mothers who die during pregnancy or the birth of their children is also extremely high (178 women die per 100,000 live births; Worldbank 2015). The proportion of pregnant women who receive medical care is 73.1%. Alternative medical care offers are only available – if at all – from private providers who work for profit and are not subject to state control. Wealthy patients are available to clinics with international standards. As in other developing and transition countries, however, the majority of the population has poor medical care.
German development cooperation in the health sector
Germany will support Pakistan in improving basic medical care by 2020. The aim of the German commitment is to strengthen basic medical care and to define quality requirements for the commercial health sector. In addition, Germany is funding programs to combat tuberculosis, reproductive health and family planning, and the establishment of a nationwide system for safe blood transfusions. The German commitment includes, among other things, the development and introduction of a health insurance system, and the training of health managers and medical staff. In addition, Germany supports programs for reproductive health and family planning as well as for combating polio.
Attacks on vaccination centers
In mid-January 2016, at least 15 people, including twelve police officers, were killed in a suicide attack on a vaccination center in Quetta. Attacks against vaccination teams have been known in Pakistan for many years; in this case it was about polio vaccinations. Islamists and Taliban see actions by Western intelligence services in the vaccination program and fear that the vaccinations are in fact intended to sterilize children. The vaccination program has been suspended until further notice. In January 2016, Pakistan also launched a polio vaccination campaign for more than two million children under five.
There are no vaccination regulations for foreigners and travelers from Europe to Pakistan. The Federal Foreign Office provides information on travel and health and provides current travel medicine advice.
In general, careful food and drinking water hygiene should be observed. Basic medical care is insufficient in rural areas. Better medical care can only be found in larger cities. In principle, it is advisable to obtain comprehensive information about health risks in advance.
The Foreign Office (AA) regularly issues safety notices and partial travel warnings for Pakistan. Warnings are given against traveling to Khyber Pakhtunkhwa (formerly Northwest Frontier Province, NWFP), to the tribal areas on the border with Afghanistan (the so-called former Federally Administered Tribal Areas, Ex-FATA), which are now incorporated into the KP Province, and to Balochistan.
When planning trips to Pakistan, particular attention should be paid to security issues. Politically and religiously motivated acts of violence are the order of the day. Foreign travelers can be targeted victims of an attack or kidnapping, or they can just be in the wrong place at the wrong time and be harmed by attacks that are not explicitly applicable to them. Before and during the trip to Pakistan, travelers should seek local advice on the security situation at the destination. You should also ask the Pakistani authorities or travel agencies which areas are closed to tourists. Travel restrictions imposed at short notice and regular checks by security forces can also be expected. According to the security advice of the Foreign Office, there is an increased risk of attack and kidnapping in places where there are more and more foreigners. The more general advice includes avoiding crowds if possible and following instructions from local security authorities. It can also be very useful for travelers to monitor media coverage in order to better assess incidents, moods and trends.
Additional safety information can be obtained from the UK and US governments:
- UK Government Travel Advice
- 2019 Crime & Safety Report: Lahore
- 2019 Crime & Safety Report: Peshawar
- 2019 Crime & Safety Report: Karachi
- 2019 Crime & Safety Report: Islamabad
It goes without saying that you must follow the safety instructions issued by the Federal Foreign Office.