According to The Agricultural Economist, the doctor-to-patient ratio in rural Pakistan remains alarmingly low, with one physician serving approximately 3,500 people compared to roughly one per 1,000 in urban areas. “Oh yes, in serious cases we are told that time cannot be wasted,” said a 41-year-old man from Masu Bhurgri, recalling the frantic effort to get his mother into emergency cardiac care. “And yet, here we are, gathering money at the last minute to arrange transport and medicines,” he added (translated from Sindhi).
There is no single root cause behind these statistics. From poor medical infrastructure to unskilled home births, Pakistan ranks 124th out of 195 countries on the Healthcare Access and Quality Index.
Areas such as rural Balochistan, Gilgit-Baltistan, and Tharparkar endure the poorest healthcare access. In search of relief, local populations increasingly rely on traditional healers and home remedies, which has contributed to the spread of herbal quackery. With costly, time-consuming travel often required to reach the nearest hospital, many resort to unqualified practitioners who prescribe unregulated mixtures containing heavy metals and steroids. These healers typically claim to treat a wide range of illnesses using guesswork, worsening patients’ conditions. Although some argue that these practitioners are themselves trapped by limited medical knowledge, the persistent patterns of unauthorised prescribing and inflated fees reveal profit-driven motives.
Equally troubling are spiritual healers who manipulate patients into believing that their illnesses are caused by evil spirits or black magic. This leads to dangerous neglect of treatable medical conditions. A study from rural Pakistan published in PubMed highlighted how such deeply entrenched beliefs distort understandings of mental health, persuading individuals that their symptoms arise from supernatural forces.
Healthcare is not only a matter of scientific advancement; it is fundamentally a matter of access
Some faith healers also reinforce patriarchal biases in childbirth, promising parents the ability to influence the gender of an unborn child. In February 2022, the BBC reported the case of a pregnant woman who arrived at a hospital with a 5 cm nail embedded in her skull. She later admitted that a faith healer had instructed her to do so in the hope of giving birth to a boy. Though this incident occurred in Peshawar, countless similar cases in rural areas remain unseen and undocumented.
Rural women often develop mistrust of hospitals due to geographical isolation, medical illiteracy, and lack of resources. Many, therefore, rely on traditional birth attendants (dais). However, home births carry significantly higher risks of infant mortality and maternal complications. A 2022 NIH study from rural Sindh found that 27.7 per cent of women delivered at home, and these women were more likely to be illiterate, have multiple previous pregnancies, and lack antenatal care. The adjusted odds ratio for having no antenatal visits was 14.8.
Unsafe caregiving practices further compound these risks. For example, boiled water is frequently used to sterilise equipment, yet this does not ensure complete sterilisation and often leads to infection. Basic first-aid supplies are often absent in rural homes, and environmental factors such as hard water also contribute to recurring illnesses.
“We have become used to this hard water,” said a 25-year-old woman at Civil Hospital Hyderabad, waiting for her four-year-old son to be discharged after his kidneys were affected. “By the time our children’s bodies adjust, we will keep having to come here again and again,” she said (translated from Urdu/Sindhi).
In many villages, access to medicines is limited to a single pharmacy. These pharmacies often contribute to medical crises by distributing antibiotics and advanced drugs without prescriptions. Antibiotic resistance is affecting both human health and livestock. A study in Frontiers in Public Health found that poultry farmers in rural Punjab frequently used antibiotics such as colistin and amoxicillin as growth promoters, without veterinary guidance. Most purchased these medicines from local agents.
Agricultural workers also face exposure to snake bites, insect stings and hazardous chemicals. A PAFMJ study of 5,737 snakebite cases at a rural health centre in Khairpur, Sindh, reported that more than 87 per cent of patients arrived after 24 hours, having first sought help from traditional healers.
Some promising solutions have begun to emerge. Initiatives such as Sehat Khana and eShifa are providing online medical consultations to rural communities. However, limited internet infrastructure, frequent power outages, low digital literacy and restricted smartphone access hinder these programmes. Telemedicine remains a hopeful approach, yet it requires broader socio-economic improvements to become widely effective.
Until then, preventable deaths, drug misuse, cross-contamination, rising maternal mortality and increasing antibiotic resistance will continue. Healthcare is not only a matter of scientific advancement; it is fundamentally a matter of access.