A comparative look at healthcare systems from Pakistan to the West
By: A. Waseem Khattak
In the last hours of the night, when a patient’s family stands at a hospital’s emergency door, that building stops being brick, cement and machines for them. It becomes a center of hope, fear and prayer. This is the exact moment when the real test of any country’s health system begins: does it only treat the disease, or does it also treat the human being with dignity?
Pakistan spends less than one percent of its GDP on health, and the doctor-to-patient ratio here stands at roughly 1:1,300, while the World Health Organisation recommends at least 1:1,000 for developing nations. The gap is even wider in Khyber Pakhtunkhwa, where there are only about 0.76 doctors and 0.39 nurses per 1,000 people, against the WHO’s recommended 4.45 health workers per 1,000. Annual per-capita health spending in the province is close to just PKR 4,000, far below what is needed for adequate coverage. Institutions like Hayatabad Medical Complex, Lady Reading Hospital and Khyber Teaching Hospital carry the province’s entire burden despite this shortfall, across everything from trauma to cardiology. When a single doctor faces dozens of patients at once, the pressure falls not just on that one person but on the whole system.
Punjab’s story shows an equally stark divide within a single province. Lahore has close to 0.93 doctors per 1,000 people, while a district like Rajanpur falls to just 0.23 one province, two entirely different worlds. Research from public hospitals in southern Punjab found that patient satisfaction is most strongly tied to the behaviour of doctors and nurses, with waiting time mattering comparatively less, but chaos at the registration counter remains a wound the system has ignored for years.
In India, government institutions like AIIMS sit alongside private chains like Apollo and Fortis that have made the country a major name in medical tourism. Yet in India’s public sector, a study from Lucknow found that more than 62 percent of patients at major hospitals waited over 30 minutes, and in Kolkata, 64 percent of cardiac patients waited more than three hours. Interestingly, a survey from a Gujarat hospital found that 98 percent of patients were satisfied with staff behaviour despite short waits when a doctor addresses a patient by name, the bitterness of waiting fades.
Sri Lanka stands out as a different kind of example altogether. Despite not being an economically wealthy country, it guarantees every citizen free treatment from birth through major surgery. The result: 81 percent of patients in public hospitals were satisfied that they received the correct treatment, against 88 percent in the private sector a remarkably small gap. Sri Lankan patients’ biggest complaint is not their doctors’ competence but simply long queues. This proves that even a poor country can deliver dignified care when intent and management are right.
The picture in the West breaks the assumption that treatment there is instant. Britain’s National Health Service today has more than 7 million patients waiting for treatment; only 19 percent are treated within 18 weeks against a 92 percent target, and 22 percent of patients wait more than six weeks for a diagnostic test. Waits of 20 to 40 weeks for knee and hip replacements are common. In the United States, a new patient waits an average of 31 days for a first appointment, a figure that has risen 19 percent in just three years. The difference is that once an appointment is secured, the average wait in the waiting room is just 18 minutes; patients aren’t left in disorganised limbo but given a fixed date, privacy is a legal right, and a formal complaints process exists. The West hasn’t eliminated waiting it has changed its nature, so that patients retain their dignity even while they wait.
This brings us to a fundamental truth: a hospital’s real face is not its machines, but the people who work there. Doctors in Pakistan and India often work under conditions where life-or-death decisions must be made in minutes, and most carry out this duty with genuine dedication. But wherever low pay, excessive workload and weak oversight combine, curt behaviour and rushed care are not an accident — they are what the system produces. Sri Lanka’s lesson is that scarce resources are never an excuse for poor treatment; management priorities are what truly decide the outcome. Khyber Pakhtunkhwa’s medical teaching institution reforms aimed at exactly this: using autonomy and accountability to make the patient’s journey easier, and some hospitals have indeed introduced patient facilitation centres and similar improvements. But the real test isn’t in an office file it’s in the eyes of the patient who joins the queue at dawn and returns home exhausted by evening. Buildings can be built and machines can be imported, but until every member of staff, from doctor to ward attendant, understands that the person standing before them is a patient, not a criminal, one question will remain unanswered: is the right to treatment only for those who know how to wait, or for every human being?
The writer is a Communication Officer at HMC and can be reached @awaseemkhattak
