NAEEM A. JAFAREY
Located in southern Asia, Pakistan has a population estimated in 1990 at 122.6 million, of which about eighty million live in rural areas and forty million in urban areas ( UNICEF 1992). The country has a wide range of geographic features, climates, and cultures. Starting with a cluster of very high mountains and glaciers in the north, the terrain gradually changes to green valleys, and then to flat alluvial lands fed by the Indus River and its tributaries. The southeastern region of the country, bordering India, is a desert, while the western part is formed of arid mountains. The southern boundary is the Arabian Sea. The country has a largely agricultural economy: wheat, rice, cotton, and sugar cane are the main crops.
Pakistan has a federal administrative structure with four provinces. Health and education are provincial responsibilities, but policies and directions are given by the federal government. With the exception of some nominal user charges in a few institutions, all services provided by government health agencies are free. However, many people use both traditional (Hakim, homeopath, etc.) and modern health providers in the private sector. Workers in large industrial units are covered by social security services, but otherwise, there is no health insurance scheme available for those who wish to use private facilities. The government health services start with a Basic Health Unit (BHU) for every 10,000-15,000 population. BHUs provide both curative and preventive services and are staffed by one physician and seven auxiliaries. The BHUs are supported by a tier of secondary and tertiary care services at the provincial and district levels, backed up by specialized services available at hospitals attached to medical colleges. The utilization and referral facilities of the BHUs, provincial- and district- level facilities have not been evaluated in recent years.