Higher and More Effective Spending on Education and Health Figure 26.1: Distribution of Total Health Expenditure 2017-18 TOTAL 9% Households OOP Payment 1206 billion Rs * Federal, Provincial 39% 52% Government* and Local Governments Others** **NGOs, Social Security Funds, Autonomous Bodies, Private health insurance Source: NHA, PBS The expenditure on provision of health services by all three levels of government has a share of 39 percent. The underdeveloped nature of the health sector is highlighted by the only 9 percent share of social security funds, private health insurance and NGOs. However, the announcement in the Federal Budget of 2021-22 of a nationwide health insurance scheme is very welcome. A health (‘sehat’) card scheme has already been operating in Khyber-Pakhtunkhwa and will be introduced shortly in Punjab. The trend and distribution of public sector spending on health is given in Table 26.11. Total Government spending has increased from Rs 94 billion in 2009-10 to Rs 422 billion by 2018-19, with an annual growth rate of almost 17 percent. Since health is primarily the responsibility of Provincial government, the growth has been facilitated by the jump in transfers following the 7 th NFC Award of 2010. The largest share in government expenditure on health is on curative services of hospitals and clinics. However, the share has declined from 69 percent in 2009-10 to 51 percent in 2018-19. As required, the priority is shifting to preventive health measures, with the share rising to 29 percent. Other health services, especially training institutions, have also seen an increase in share to 18 percent. Table 26.11: Health Public Sector Spending by Type General Hospitals and Clinics Share (%) Mother& Child Health Share (%) Health Preventive Measures 2009-10 65 69.1-- 19 2014-15 168 72.7 1- 19 2018-19 217 51.4 9 2.1 121 Source: MOF, PRSP progress reports. Share (%) 20.2 5.9 28.6 (Rs in Billion) Others Share Total (%) 10 10.6 94 43 18.6 231 74 17.5 422 A worrying development is the declining share on expansion of coverage of public health services. The share of capital expenditure has declined from 30 percent in 2009-10 to 273