Barriers to Universal Health Coverage in Pakistan: A Health System Perspective

Muhammad Hamza Muzammil; Muhammad Uzair; Faiza Iqrar; Muhammad Talha; Sara Alam; Aatqa Khan; Sehrish Muhammad; Arsalan Khan; Kainat Ashraf; Noor Fatima

doi:10.61919/a408s076

Authors

Muhammad Hamza Muzammil Health Services Academy, Islamabad, Pakistan Author
Muhammad Uzair Health Services Academy, Islamabad, Pakistan Author
Faiza Iqrar Health Services Academy, Islamabad, Pakistan Author
Muhammad Talha Health Services Academy, Islamabad, Pakistan Author
Sara Alam Health Services Academy, Islamabad, Pakistan Author
Aatqa Khan Health Services Academy, Islamabad, Pakistan Author
Sehrish Muhammad Health Services Academy, Islamabad, Pakistan Author
Arsalan Khan Health Services Academy, Islamabad, Pakistan Author
Kainat Ashraf Health Services Academy, Islamabad, Pakistan Author
Noor Fatima Riphah International University, Islamabad, Pakistan Author

DOI:

https://doi.org/10.61919/a408s076

Keywords:

Universal Health Coverage, Pakistan, Health Systems, Qualitative Research, Healthcare Access, Health Policy

Abstract

Background: Universal Health Coverage (UHC) aims to ensure equitable access to essential health services without financial hardship; however, progress in Pakistan remains constrained by systemic challenges. Qualitative inquiry is needed to understand how these barriers are experienced and interpreted within the health system. Objective: To explore stakeholder perceptions of structural barriers to UHC in Pakistan from a health systems perspective. Methods: A qualitative descriptive study was conducted between January and March 2025 using semi-structured interviews with 25 stakeholders, including policymakers, public health experts, physicians, and hospital administrators. Participants were selected through purposive sampling. Data were analyzed using Braun and Clarke’s reflexive thematic analysis. Results: Five major themes were identified: insufficient health financing, workforce shortages and maldistribution, weak governance and policy implementation, inequitable healthcare access, and high out-of-pocket expenditure. Participants described these barriers as interconnected, with financing and governance influencing workforce distribution and service accessibility, while financial burden directly affected healthcare utilization. Conclusion: Achieving UHC in Pakistan requires integrated health system reforms focusing on financing, governance, workforce distribution, and financial protection. Strengthening implementation mechanisms and addressing contextual barriers will be critical for improving equitable healthcare access.

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