The 18thAmendment to Pakistan’s Constitution, enacted in 2010, marked a significant shift by devolving substantial powers to the provinces—particularly in the sectors of health, education, and social welfare. This study aims to evaluate the status of health systems before and after the Amendment. The core purpose of the 18th Amendment was to promote decentralisation, enhance provincial autonomy, and strengthen federal–provincial collaboration. This analysis assesses the impact of this devolution on healthcare access, public health outcomes, and health policy management nationwide. Here, both the progress and challenges confronted by the healthcare system are assessed. Major health indicators are being examined under the new governance structure.
A significant number of reforms are taking place due to the 18th Amendment. Most importantly, provinces are now working with greater independence and autonomy. As a result, Federal powers were transferred to the provincial government. The responsibilities include formulating, implementing and most importantly, financing health policies and services. However, the primary objective is to improve the service delivery more efficiently and enhance responsiveness to local needs. The pre-and post 18th Amendment analyses here furnish the implications and assessments. The outcomes include the progress of various health indicators, primarily life expectancy, maternal and child health, immunisation outreach, and disease burden.
