18th Amendment: Kamal concerned at incomplete implementation

ISLAMABAD: Federal Minister for National Health Services Mustafa Kamal has said that he does not oppose the 18th Constitutional Amendment but has concerns over its incomplete implementation. He said that while financial resources have been devolved from the federal government to the provinces, an effective mechanism for transferring funds from the provinces to district and local governments has yet to be established. He noted that approximately Rs8.848 trillion was transferred to the four provinces during the last fiscal year, but the absence of a strong local government system continues to hinder the effective utilization of these resources at the grassroots level. Kamal stated this while inaugurating the Phase-I of the upgradation of the Cardiac Centre at the Pakistan Institute of Medical Sciences (PIMS) on Tuesday. He said that PIMS serves as the largest referral hospital for patients not only from Islamabad but also from Azad Jammu & Kashmir, Gilgit-Baltistan, a large part of Khyber Pakhtunkhwa, and other remote areas of the country. He stated that PIMS receives approximately 7,000 to 9,000 patients every day, and when attendants and family members are included, between 30,000 and 40,000 people benefit from the hospital daily. “This is equivalent to the size of a major public gathering every single day, reflecting both the immense trust the people place in PIMS and the extraordinary burden on the institution,” he remarked. The Minister observed that the overwhelming patient load on Pakistan’s public teaching and tertiary care hospitals is largely due to the ineffective functioning of the country’s primary healthcare system. He noted that common ailments such as colds, flu, fever, minor pain, and routine antenatal check-ups should ideally be managed at Basic Health Units (BHUs) and dispensaries. The minister said that the government is revitalizing 28 Basic Health Units in Islamabad to strengthen primary healthcare, reduce the burden on tertiary hospitals, and ensure that quality healthcare services are available closer to people’s homes. He emphasised that without empowering local governments with adequate authority, financial resources, and effective administrative systems, quality governance and essential healthcare services cannot reach communities at the grassroots level. He said that once resources are transferred directly to neighborhoods and local governments, essential public services such as safe drinking water, sanitation, sewerage, and other basic civic facilities will improve significantly, leading to a substantial reduction in the burden of disease. He reiterated that the real solution to Pakistan’s health challenges lies not only in building hospitals but in preventing disease through a strong and effective local government system. Kamal further observed that the absence of an effective local government system has also created challenges in building public awareness and trust regarding polio and other immunization programmes. He remarked that the current administrative system relies on only a few hundred bureaucrats to manage the entire governance structure, whereas a robust local government system would significantly expand the reach of governance and public service delivery by engaging millions of people at the grassroots level. Copyright Business Recorder, 2026