These are the concluding remarks of the Essential Package of Health Services Report 2019. This inference is due to the fact that there is massive inequality in health care system in Balochistan. Based on the Pakistan Living and Standard Survey, an interesting study has been conducted in 2020.  The authors of this research study found that a cluster of districts that have highest level of inequalities are in the Balochistan province. Similar finding is also reflected in the universal health coverage essential package report in 2022. For example, Disease Control Priority (DCP3) recommended Essential Universal Health Services (EUHS) are available for more than 50% of the population at community level is only 7%. Moreover, if population level is considered, then there is 0% EUHS. The idea of inequality is closely linked to equality. Thus, it is essential to understand what equality means in the health care system. The idea of equality in health care is defined by World Health Organization is the access of resources and the choices available for the people to make the best decision regarding health care. Hence, the inequality in Balochistan is due to the socio-economic and infrastructural hurdles. And to remove this inequality, social economic and technological enablers are drastically required in Balochistan.

The very first hurdle that circumvent the health inequality in Balochistan is the socio-economic barriers. The illiteracy and severe lack of knowledge regarding healthy practices that makes seeking health care burdensome. For instance, Balochistan has the lowest literacy rate i.e. 54% that makes it difficult for many to read and understand simple communication material shared by health education cell.  In addition to that, the cost of good health care pushes masses out of health care system. The total expenditure on health never exceeded 0.86% of the GDP.  Similarly, the extremely poor had to spend more on health care considering the relative distance and non-availability of health care facilities. Morover, the 76% of the health sector is driven by private sector, it exacerbates the health inequality, because the poor population cannot afford private health care, which will be 41% of the households.

Another devastating issue regarding the health inequality is the abysmal state of health care infrastructure, i.e. building availability, functionality and accessibility whereas the human resources is the intrinsic aspect of health care infrastructure. According to the base line report by the World Health Organization in 2021, that 62% of all health care building are partially damage. Similarly, the 47% of the health facilities are partially functional; and only 16% are partially accessible in Balochistan. Besides, the skilled human resources that include technical paramedic staff are gravely under trained and under-utilized because of the lack of functional health care facilities.

Considering, these critical challenges faced by the health care system, there is an essential need to explore and implement social, economic and technological enablers for health care inequality. The very first social enabler is activated when education, nutrition and social welfare work together in collaboration rather than in agonistic manner. The school education must have an element of health care and hygiene. For example, implementing WASH initiative can significantly reduce the burden of Infectious disease, and can save up to 1.4 million lives annually.  The Economic cost is critical for removing health care inequality. There have been two critical suggestions by the WHO and EPHS: linking revenue raising to health financing strategy; conducting fiscal space analysis for additional funding. Both aspects can decrease the cost and add in the scarce financial resources.

Lastly, the technological enabler is the most important aspect for attaining universal health care especially with sporadic population and informal economy of Balochistan. There are three essential aspects for technological enabler. Primarily, it is the availably of up to date and timely data. Currently there is health information data management system at district to divisional level. But its effective utilization is questionable. Additionally, there is a need to normalize the concept of digital pharmacy and e-clinics, especially by indulging with female doctors and paramedics.  Lastly, the need for essential universal health system document to make a live document to have regular monitoring and proactive decision making.

Health is the fundamental universal right and an important sustainable development goal. Unfortunately, the health inequality in Balochistan is failing both aspects. The key hurdles faced by the health sector in Balochistan has social, economic and infrastructural problems in the form of lack of awareness in society, the low government spending and high cost of health care. Along with the partially functional infrastructure with serious deficiency of health care providers.

The inequality requires to be tackled by adopting social, economic and technological enablers, these enablers help the understanding of masses to understand the fact that health is the basic right and government is responsible for providing it to its masses. As Akbar Zaidi astutely inferred that “Health more than any other sector amongst the social services, requires holistic approach in order to understand the problems and constraints faced by the sector and to find effective solutions “. Hence, the understanding of the hurdles and enablers is a very good start to devise a more holistic approach for health care in Balochistan.