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\title{Health and Nutrional Economic Growth in Pakistan: A Systematic Review}
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             \author[1]{Hafiza Sobia  Ramzan}

             \affil[1]{  University of the Punjab}

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\date{\small \em Received: 6 December 2013 Accepted: 3 January 2014 Published: 15 January 2014}

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\begin{abstract}
        


In this  short  report  I  want  to  explain  about  the  economic  growth  in  Pakistan.  Here  I  explain  the  health  and  nutritional economic growth in Pakistan almost last ten years.  Government  of  Pakistan  made  different  policies  for  the  development of nation. These policies include health policies,  medical  treatment,  HIV  control  programmes  etc.  These  all  policies helps for the prosperity of Pakistan.

\end{abstract}


\keywords{HIV, malaria, development, policies.}

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\let\tabcellsep& 	 	 		 \par
ost people want to lead healthy lifestyles. There is much that people can do individually to protect their health including driving safely, wearing seatbelts, avoiding tobacco smoke and air pollution, exercising regularly, eating healthy food and having regular checkups. But many health risks are also influenced by community factors, including transportation and land use planning decisions. Health plays the key role in determining the human capital. Better health improves the efficiency and the productivity of the labor force, ultimately contributes the economic growth and leads to human welfare.\par
Access to good health can contribute positively to the economic and social development of a country. Thus, key issues that impact the health status of people ought to be addressed through a diverse set of policy tools comprising short and long term measures to secure better health outcomes. The people of Pakistan have grown healthier over the past three decades. The vision for the health sector comprises a healthy population with sound health, enjoying good quality of life through the practice of a healthy life style. In order to achieve this vision, significant measures have been taken toward disease prevention, health promotion, and greater coverage of immunization, family planning, and provision of female health worker services.\par
To attain better, more skillful, efficient and productive human capital resources, governments subsidies the health care facilities for its people. In this regard, the public sector pays whole or some part of the cost of utilising health care services. The size and distribution of these in-kind transfers to health sector differs from country to country but the fundamental question is how much these expenditures are productive and effective? It very much depends on the volume and the distribution of these expenditures among the people of different areas of the country.\par
Lamiraud, et al.  {\ref (2005)} argued that social health protection is an important instrument aiming at fair burden sharing and reducing barrier underlining access to health care services. Another good reason for the government spending in delivering basic health care services is to reduce burden of the diseases (BOD) in the productive years of the life. The social rate of return and the BOD force the policy-makers to transfer the public resources towards basic health care facilities.\par
According to the Economic Survey of Pakistan (2005-06), the government spent 0.75 percent of GDP on health sector in order to make its population more healthy and sturdy.   {\ref (Islamabad)} and Mehbub ul Haq Human Development Centre. A large number of the studies have employed the Benefit Incidence Approach (BIA) on household data for their analysis. Findings reveal that public sector expenditures are either progressive or regressive and the share of the different income group differs depending upon the delivery of the benefits of the public expenditures across region, caste, religions, gender etc., see Christian (  {\ref 2002} The studies which exhibit public sector expenditures are progressive such as \hyperref[b11]{Younger (1999)}, in Ecuador used combination of benefit and behavioural approaches showed that public expenditures improves the health indicators in the developing countries. In cross country analysis, Gupta, et al. (  {\ref 2002}) used 56 country data and concluded that the increase in public expenditures on health reduces the mortality rates in infants and children. Study by  {\ref Toor and Butt (2005)} shows that socio-economic factors play an important role in determining the health care expenditure in Pakistan.\par
The share of health expenditure in total public sector expenditure is the most significant variable affecting health status in a country. Moreover, literacy rate and GDP growth are also essential variables, which illustrate a positive relationship with health care expenditure. Other set of studies that establish the regressiveness of incidence of public sector spending such as Norman  {\ref (1985)} concluded that increased government expenditure on health services eventually benefits more to the upper income than the lower income groups.\par
Castro-Leal, et al.  {\ref (2000)} analysed the public spending on curative care in several African countries and found that the public sector spending favours mostly the better-off rather than the poor. Hamid, et al. (  {\ref 2003}) study covers 56 countries analysis from the period 1960-2000 in which benefit incidence approach (BIA) was used, resulted in, on average spending on health is pro rich particularly in sub-Saharan Africa but is well targeted and progressive only in the western hemisphere. Some points need further consideration; the first point about the impact of the level of public expenditures on human capabilities is a debated point, because not all studies have found an empirical link between the two. The connection between lucratively addressing poverty issues and spending is not first and foremost a function of the percent of GDP that is committed to total spending on health and, but depends on the intra-sectoral allocation to health spending. Evidence shows that infant and child mortality rates become lowest in countries with high shares of health care spending devoted to primary (preventive) health care facilities. Second, the fiscal policy-makers meet head-on the nature and magnitude of fiscal incidence.\par
The policy choices necessitate the knowledge about which groups are prone to pay for and which groups are expected to benefit more from public sector expenditure. Policy-makers have many questions concerning how to alleviate the burden of taxation for the poor and about how to increase the efficiency and efficacy of the public sector spending on health? How to target public spending in order to improve the conditions of the poor? The incidence analysis provides some critical information to facilitate policy-makers regarding equal distribution of income and improvement of efficiency and efficacy of the public policy.\par
Ample literature is available to understand the questions regarding the nature of incidence of the public sector expenditure in developing as well as developed countries. Most of the studies have been conducted on old data-sets taken from household surveys which have not been updated. These studies are deficient in comparisons of incidence among the cross countries on one hand and in-comparability of the cross country results on the other hand. Moreover, the impact on different groups such as gender and region has not been taken into consideration in the case of Pakistan, as emphasised by Seldon and Wasylenko (1992).\par
Nevertheless, the literature considering the incidence of the public sector expenditure and its distribution in Pakistan is scarcely available. The current study is being initiated to explore the nature of incidence of public sector expenditures in Pakistan on health sector by using the primary data of the Pakistan Social and Living Standards Measurement Survey (PSLM), 2004-05, collected and published by the Federal Bureau of Statistics, Pakistan.\par
By using current data, the current research highlights the present scenario of incidence of the public spending on health and indirectly provide the guideline to what extent health policy targets have been successfully achieved, who benefit how much, which kind of inequalities exist in distribution of benefits of government expenditure on health, region and income wise. Additionally, by calculating the inequalities in the distribution of the benefits of expenditures, the study provides policy recommendations to enhance the effectiveness and efficacy. 
\section[{a) Health Indicators}]{a) Health Indicators}\par
The most recent data on health performance of other South Asian countries suggest that Pakistan lags behind in infant mortality rate (at 63 per 1000 live births) and the under 5 year's mortality rate (at 86.5 per 1000 live births). These indicators continue to remain high mainly on account of un-healthy dietary habits, water borne diseases, malnutrition and rapid population growth. However, the average life expectancy at 66 years compares well with India, Nepal and Bangladesh.\par
Pakistan is committed towards achieving the millennium development goals.  
\section[{Source: Planning \& Development Division c) Targets and Achievements during 2011-12}]{Source: Planning \& Development Division c) Targets and Achievements during 2011-12}\par
The targets for the health sector during 2011-12 included establishment of 10 rural health centres (RHC), 50 basic health units (BHUs) and renovation of 20 existing RHCs and 50 BHUs. The manpower targets include the addition of 5,000 doctors, 500 dentists, 4,000 nurses, 5,000 paramedics and 550 traditional birth attendants. Under the preventive program, about 7.5 million children were targeted to be immunized and 22 million packets of oral rehydration salt (ORS) were to be distributed during 2011-12.\par
The achievements in the health sector during 2011-12 included the establishment of 7 rural health centers (RHCs), 30 basic health units (BHUs) and renovation of \hyperref[b7]{15}    
\section[{d) Health Programs}]{d) Health Programs}\par
In pursuance of the 18th amendment to the constitution of Pakistan, the health sector has been devolved to the provinces and the federal Ministry of Health has been abolished. However, national planning in the health sector and cooperation with the provinces and international development partners is vested with the Planning and Development Division. All the vertical health programs have also been devolved to the provinces. However, upon request of the provinces, the Council of Common Interests (CCI) in its meeting held on 28th April 2011 decided that the federal government (Planning and Development Division) shall fund these programs till currency of the 7th NFC award at a predefined share. Accordingly, the following national health programmes continue to be financed by the federal government in the post devolution scenario till 2014-15. 
\section[{e) Food and Nutrition}]{e) Food and Nutrition}\par
The links between malnutrition, ill health and poverty are well known. Disease contributes to poverty due to the costs of illness and reduces earning capacity during and after illness. Good health is a first step towards prosperity and reduction of poverty. It is therefore, critical to move towards a system which will address health challenges and prevent households from falling into poverty due to poor health. In Pakistan, health sector investments are viewed as part of the government's poverty alleviation endeavors. This chapter discussed the state of health and nutrition in Pakistan. An overview of the National Health Policy and its primary objectives are presented, followed by a discussion of the state of health indicators, expenditures, and facilities in Pakistan. The targets and accomplishments for the 2011-12 are described, followed by a special focus on cancer treatment and the government's response to dengue outbreaks. The chapter highlights the challenges of narcotics trafficking and growing incidence of drug addiction in Pakistani society.  
\section[{Chris}]{Chris}\begin{figure}[htbp]
\noindent\textbf{}\includegraphics[]{image-2.png}
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\noindent\textbf{} \par 
\begin{longtable}{P{0.8374580818242789\textwidth}P{0.001710261569416499\textwidth}P{0.004560697518443997\textwidth}P{0.005130784708249497\textwidth}P{0.0011401743796109992\textwidth}}
Ministry of Health\tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
\multicolumn{5}{l}{Malaria Control Programme; Tuberculosis and HIV/AIDS}\\
\multicolumn{5}{l}{Control Programme; National Maternal and Child Health}\\
Programme;\tabcellsep the\tabcellsep Expanded\tabcellsep Programme\tabcellsep on\\
\multicolumn{5}{l}{Immunisation; Cancer Treatment Programme; Food and}\\
\multicolumn{5}{l}{Nutrition Programme, and; the Prime Minister}\\
\multicolumn{5}{l}{Programme for Preventive and Control of Hepatitis A \&}\\
\multicolumn{5}{l}{B. To effectively address the health problems facing}\\
\multicolumn{5}{l}{Pakistan, a number of policies emphasis better health}\\
\multicolumn{5}{l}{care services. These include: Health related Millennium}\\
\multicolumn{5}{l}{Development Goals; Medium Term Development}\\
\multicolumn{5}{l}{Framework; Poverty Reduction Strategy Papers;}\\
\multicolumn{5}{l}{National Health Policy, and; Vision 2030. In spite of}\\
\multicolumn{5}{l}{these policies, to overcome the health related problems}\\
\multicolumn{4}{l}{in Pakistan seems suspicious and distrustful.}\tabcellsep \\
\multicolumn{5}{l}{The communicable diseases are still a}\\
\multicolumn{5}{l}{challenge and the statistics reveal that the nutrition and}\\
\multicolumn{5}{l}{reproductive health problem in communicable diseases}\\
\multicolumn{5}{l}{are still liable for the 58 percent of the BOD in Pakistan.}\\
\multicolumn{5}{l}{Non-communicable diseases (NCD), caused by}\\
\multicolumn{5}{l}{sedentary life styles, environmental pollution, unhealthy}\\
\multicolumn{5}{l}{dietary habits, smoking etc. account for almost 10}\\
\multicolumn{3}{l}{percent of the BOD in Pakistan.}\tabcellsep \tabcellsep \\
\multicolumn{5}{l}{A comprehensive review of literature, research}\\
\multicolumn{5}{l}{materials, articles and evaluation reports is done to}\\
\multicolumn{5}{l}{assess the existing situation and policy debate. This}\\
\multicolumn{5}{l}{includes documents and reports available from World}\\
\multicolumn{5}{l}{Health Organisation (WHO), United Nations Children's}\\
\multicolumn{5}{l}{Fund (UNICEF), Asian Development Bank (ADB), Centre}\\
\multicolumn{5}{l}{for Poverty Reduction and Income Distribution}\\
\multicolumn{5}{l}{(CRPRID), Poverty Reduction Strategy Papers (PRSP),}\end{longtable} \par
 
\caption{\label{tab_0}}\end{figure}
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\noindent\textbf{0} \par 
\begin{longtable}{P{0.29934782608695654\textwidth}P{0.17\textwidth}P{0.06652173913043478\textwidth}P{0.020942028985507247\textwidth}P{0.12934782608695652\textwidth}P{0.14289855072463767\textwidth}P{0.020942028985507247\textwidth}}
Country\tabcellsep Life expectancy 2011\tabcellsep \multicolumn{2}{l}{Mortality rate}\tabcellsep \multicolumn{2}{l}{Infant mortality rate}\tabcellsep Population growth\\
\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep rate (\%)\\
Pakistan\tabcellsep 65.99\tabcellsep 86.5\tabcellsep \tabcellsep 63.26\tabcellsep 2.03\\
India\tabcellsep 66.80\tabcellsep 62.7\tabcellsep \tabcellsep 47.57\tabcellsep 1.34\\
China\tabcellsep 74.68\tabcellsep 18.4\tabcellsep \tabcellsep 16.06\tabcellsep 0.49\\
Indonesia\tabcellsep 71.33\tabcellsep 35.3\tabcellsep \tabcellsep 27.95\tabcellsep 1.07\\
Bangladesh\tabcellsep 69.75\tabcellsep 47.8\tabcellsep \tabcellsep 50.73\tabcellsep 1.57\\
Sri-lanka\tabcellsep 75.33\tabcellsep 16.5\tabcellsep \tabcellsep 9.70\tabcellsep 0.93\\
Malaysia\tabcellsep 73.79\tabcellsep 6.3\tabcellsep \tabcellsep 15.02\tabcellsep 1.58\\
Nepal\tabcellsep 66.16\tabcellsep 49.5\tabcellsep \tabcellsep 44.54\tabcellsep 1.60\\
\multicolumn{2}{l}{Source: World development report 2011}\tabcellsep \tabcellsep \tabcellsep \\
b) Health Expenditure\tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
\tabcellsep \tabcellsep Table 0 2\tabcellsep \tabcellsep \\
Fiscal year\tabcellsep \multicolumn{2}{l}{Public expenditure}\tabcellsep \multicolumn{2}{l}{Percentage change}\tabcellsep Health expenditure \% of\\
\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep GDP\\
2000-2001\tabcellsep 24.28\tabcellsep \tabcellsep \tabcellsep 9.9\tabcellsep 0.72\\
2001-2002\tabcellsep 25.41\tabcellsep \tabcellsep \tabcellsep 4.7\tabcellsep 0.59\\
2002-2003\tabcellsep 28.81\tabcellsep \tabcellsep \tabcellsep 13.4\tabcellsep 0.58\\
2003-2004\tabcellsep 32.81\tabcellsep \tabcellsep \tabcellsep 13.58\tabcellsep 0.58\\
2004-2005\tabcellsep 38.00\tabcellsep \tabcellsep \tabcellsep 15.8\tabcellsep 0.57\\
2005-2006\tabcellsep 40.00\tabcellsep \tabcellsep \tabcellsep 5.3\tabcellsep 0.51\\
2006-2007\tabcellsep 50.00\tabcellsep \tabcellsep \tabcellsep 25.0\tabcellsep 0.57\\
2007-2008\tabcellsep 60.00\tabcellsep \tabcellsep \tabcellsep 20.0\tabcellsep 0.57\\
2008-2009\tabcellsep 74.00\tabcellsep \tabcellsep \tabcellsep 23.0\tabcellsep 0.56\\
2009-2010\tabcellsep 79.00\tabcellsep \tabcellsep \tabcellsep 7.0\tabcellsep 0.54\\
2010-2011\tabcellsep 42.00\tabcellsep \tabcellsep \tabcellsep -47\tabcellsep 0.23\\
2011-2012\tabcellsep 55.12\tabcellsep \tabcellsep \tabcellsep 31.24\tabcellsep 0.27\end{longtable} \par
 
\caption{\label{tab_1}Table 0 1}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{0} \par 
\begin{longtable}{P{0.48983050847457626\textwidth}P{0.16464891041162227\textwidth}P{0.1152542372881356\textwidth}P{0.08026634382566586\textwidth}}
\tabcellsep \multicolumn{2}{l}{3 : Physical achievements 2011-2012}\tabcellsep \\
Sub-sectors\tabcellsep Targets\tabcellsep Estimated achievements\tabcellsep Achievements \%\\
A. Rural Health Programme\tabcellsep \tabcellsep \tabcellsep \\
New BHUs\tabcellsep 50\tabcellsep 30\tabcellsep 60\\
New RHCs\tabcellsep 10\tabcellsep 7\tabcellsep 70\\
Strengthening/\tabcellsep 50\tabcellsep 35\tabcellsep 70\\
Improvement of BHUs\tabcellsep \tabcellsep \tabcellsep \\
Strengthening/\tabcellsep 20\tabcellsep 15\tabcellsep 75\\
Improvement of RHCs\tabcellsep \tabcellsep \tabcellsep \\
B. Hospital Beds\tabcellsep 5000\tabcellsep 4000\tabcellsep 80\\
C. Health Manpower\tabcellsep \tabcellsep \tabcellsep \\
Doctors\tabcellsep 5000\tabcellsep 4300\tabcellsep 86\\
Dentists\tabcellsep 500\tabcellsep 450\tabcellsep 90\\
Nurses\tabcellsep 4000\tabcellsep 3000\tabcellsep 75\\
Paramedics\tabcellsep 5000\tabcellsep 4500\tabcellsep 90\\
TBAs\tabcellsep 550\tabcellsep 500\tabcellsep 91\\
Training of LHWs\tabcellsep 10000\tabcellsep 9500\tabcellsep 95\\
D. Preventive Programme\tabcellsep 7.5\tabcellsep 7\tabcellsep 93\\
Immunization\tabcellsep \tabcellsep \tabcellsep \end{longtable} \par
 
\caption{\label{tab_2}Table 0}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{} \par 
\begin{longtable}{}
\end{longtable} \par
 
\caption{\label{tab_3}}\end{figure}
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