According to The Agricultural Economist, the doctor-to-patient ratio in rural areas remains frighteningly low, with one physician serving 3,500 people compared to one per 1,000 in urban areas. “Oh yes, in serious cases we’re told time cannot be wasted,” said a 41-year-old man from Masu Bhurgri, recalling the rush to get his mother into emergency cardiac care. “And yet, here we are, gathering money at the last minute to arrange transport and medicines” (translated from Sindhi).
There isn’t a single root cause responsible for these statistics. From poor medical infrastructure to unskilled home births, Pakistan ranks 124th among 195 countries in terms of the Healthcare Access and Quality Index.
The rise of herbal healing practices
Areas like rural Balochistan, Gilgit-Baltistan, and Tharparkar have the poorest accessible healthcare. Desperate for relief, the local population resorts to traditional healers and home remedies, promoting the spread of herbal quackery. Faced with the burden of costly, hours-long travel to reach the nearest hospital, many patients turn to unprofessional consultations. These unregistered herbalists not only generalise their practice by claiming to treat everything from chronic pain to liver diseases, but they also prescribe formulas filled with heavy metals and steroids, often on the basis of wild guesses, eventually worsening their patients’ conditions.
Though some argue that these non-professionals themselves are merely victims of limited medical knowledge, their repeated unauthorised prescribing reveals profit-driven practice, as they charge implausible fees for each visit.
Severity of faith healers
Equally troubling are spiritual healers who psychologically manipulate patients into believing that their conditions originate from evil spirits or black magic, causing medical neglect and false reassurance, trapping patients in a cycle of exploitation.
A study from rural Pakistan published in PubMed indicated how these entrenched practices mislead people into neglecting mental health problems by convincing them that their symptoms stem from spiritual apparitions. Beyond persuading patients that fatal diseases are God’s curse, they even promise changes in an unborn child’s gender, promoting patriarchal bias in childbirth.
The crisis is multifaceted: home births carry high risks due to unsterile conditions, antibiotic resistance is fueled by unregulated use in poultry and humans, and snakebite victims arrive at clinics too late after consulting local charmers
As reported by BBC in February 2022, a pregnant woman arrived at a hospital with a 5-cm nail embedded in her skull, later confessing that a faith healer instructed her to do so in hopes of delivering a baby boy. While this case emerged from Peshawar, countless rural women suffer similar abuse, often unseen and undocumented, as these dangerous practices run deep in rural areas, overpowering medical reasoning.
Home birth and unsafe practices
While rural women often develop apprehension toward hospital care due to medical illiteracy and geographical isolation, many arbitrary decisions stem from resource scarcity. With transport unavailable, costs high, and deep mistrust of the formal medical system, many pregnant women prefer dais (traditional birth attendants) over modern healthcare.
What they often fail to realise is that home births carry a higher risk of infant mortality and severe complications. A 2022 study from rural Sindh by the NIH found that 27.7% of women delivered at home, and these women were more likely to be illiterate, have high parity, and lack access to antenatal care (ANC), with an adjusted odds ratio of 14.8 for no ANC visits.
The problem is worsened by unsafe practices. For instance, boiled water is often used to sterilise equipment for wound care or home births, which is not a reliable technique to ensure sterilisation and often leads to infection and cross-contamination. These unsafe methods are compounded by the absence of basic first aid supplies in rural households and everyday hazards such as hard water, which repeatedly make children ill.
“We’ve gotten 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. “But by the time our children’s bodies adjust, we will keep having to come here again and again.” (translated from Urdu/Sindhi)
Socio-economic triggers: Antibacterial resistance and farming hazards
While some villages rely on a single pharmacy for ointments, disinfectants, and bandages, these pharmacies often bring their own crises. Black marketing thrives on people’s desperation, and untrained staff hand out antibiotics and advanced medicines without prescriptions.
Antibiotic resistance affects both humans and poultry. A study of poultry farmers in rural Punjab published in Frontiers in Public health found that most used antibiotics such as colistin and amoxicillin as growth promoters or prophylactics without veterinary guidance. Nearly all antibiotics were purchased from local agents.
Since many rural people work in agriculture, they are also prone to snake bites, insect stings, and exposure to harmful chemicals. Yet access to ointments, antivenoms, and medication remains out of reach. A study of 5,737 snakebite cases done by PAFMJ at a rural health center in Khairpur, Sindh found that more than 87% of patients arrived after 24 hours, often because they first sought treatment from local charmers or untrained healers.
Telemedicine and poor network infrastructure
Despite these challenges, some meaningful improvements have begun to emerge. Initiatives like Sehat Khana and eShifa are making modern healthcare accessible by providing online consultations. Though it is a promising solution, it faces drawbacks such as lack of internet infrastructure, frequent load-shedding, low digital literacy, and limited smartphone ownership.
It’s an optimistic solution waiting for socio-economic conditions to catch up. Until then, many preventable deaths, drug misuse, cross-contamination, maternal mortality, and rising antibiotic resistance will persist. This is why urgent investments are needed, because healthcare is not just about science; it is also about access.
Author’s note on methodology and sources: This article is based on publicly available data, including national and international health reports (NIH, PAFMJ, BBC, and PubMed). In addition, I conducted 20 in-person interviews with rural residents in Sindh between August and September 2025. Two of these are directly cited as evidence in this piece, while the rest helped me identify crucial issues such as reliance on faith healers, limited access to medical facilities for pregnant women, and the effect of the healthcare system on farmers. All interviews were recorded on paper and most of these were conducted during my volunteering experience at Civil Hospital Hyderabad.