Ailing economy, aching jaws – Pakistan & Gulf Economist

• Federal and provincial governments should partner with Pakistan Dental Association to execute health policies

Economic narrative o Pakistan is dominated by the shadow of its public debt. As of 2024-25, the total public debt is estimated to be around 70%  of GDP, a figure that signals systemic fiscal stress. The most immediate consequence of this towering debt is that debt servicing becomes the single, non-negotiable budget priority, consuming a disproportionate share of federal revenues; upwards of 55% of total federal expenditure in FY 2024-25. This necessity creates a profound fiscal squeeze, leading to chronic under investment across social sectors. The orodental healthcare system, usually viewed as a non-critical component of public health, is a silent casualty of this austerity, a neglect that directly compromises public well-being and long-term economic productivity.

The sheer magnitude of the debt, which has surged past PKR 80 trillion and requires annual debt servicing expenditures that exceed the combined allocations for defense, subsidies, and development, represents a zero-sum game for the federal budget. This macroeconomic constraint forces policymakers into painful choices. Every rupee committed to paying interest on past borrowings is a rupee denied to future-oriented investments.

The most visible victim of this comprise is the Public Sector Development Program (PSDP), which faces successive cuts to accommodate rising interest payments. Since healthcare infrastructure, including the establishment and upgrading of dental departments in public hospitals, falls under development spending, it is one of the first sectors to be rationed. This environment of fiscal austerity ensures that public health funding remains alarmingly low.

Public health expenditure in the country, remains critically low, accounting for less than 1% of the GDP (approximately 0.9% in FY 2024). This figure is among the lowest in the world and falls drastically short of the World Health Organization recommendation of 5% of GDP.

Within this severely constrained health envelope, dental care faces a unique challenge of budgetary invisibility. Dental health is treated as an adjunct, typically receiving residual attention within provincial health departments, far removed from the primary focus on infectious diseases and maternal-child health.

The consequences of this systemic neglect are evident in the infrastructure of oral and dental health in the country. They include

Deteriorating Facilities: Public sector dental hospitals and departments struggle with outdated equipment. They can only offer services of tooth extraction. There is a persistent shortage of essential consumables like filling materials, endodontic treatment facilities and inadequate maintenance funding.

Human Resource Deficit: While the number of registered dentists has grown to around 40,000, the distribution is heavily tilted towards wealthy urban centers. Rural areas, where the majority of the population lives, suffer from a profound shortage, exacerbating the disparity between the rich and poor.

Preventive Care Void: Crucially, the fiscal squeeze prevents the establishment of widespread, low-cost, high-impact preventive programs, such as national fluoride application schemes, school dental health education and basic primary care services integrated into Basic Health Units.

Oral diseases are the fourth most expensive to treat globally, yet they are largely preventable. In Pakistan, the failure to allocate even modest debt-free funds for dentistry has resulted in an alarming public health crisis. Data indicates that the prevalence of tooth decay is tremendously high, estimated at over 60% of the population. In some major cities, like Karachi, this figure can reaches 70-80%. These are not isolated, minor ailments; untreated dental infections can lead to severe systemic health problems, including cardiovascular disease, diabetes complications and poor birth outcomes.

The complexity of dental neglect spill over from the patients’ suffering into broader economic and public health domains.

Lost Productivity: Chronic dental pain, infections requiring emergency treatment, and extended recovery from complicated extractions contribute significantly to missed work and school days. This constant drag on human capital severely hampers national productivity.

Out-of-Pocket Expenditure (OOP): With inadequate public facilities, the public is forced to rely on the private sector. Dental treatment becomes a luxury expense, leading to high OOP spending that pushes vulnerable families into the throes of health poverty. For most, the choice is either expensive treatment or delayed, painful extractions.

Brain Drain: The lack of funding for specialized public dental centers and competitive salaries drives highly skilled Pakistani dentists and specialists to seek better opportunities abroad, further depleting the domestic health talent pool.

The solution is to recognize that investment in oral health is not an expenditure but an economic investment. A healthy workforce is a productive workforce. The government must find a way to ring-fence essential social spending from the debt vortex, perhaps through specifically allocated grants or innovative financing models, to prioritize basic dental care. Until the fiscal squeeze of debt is eased and social investment is elevated above austerity, the silent suffering caused by neglected oral health will continue to undermine Pakistan aspirations for genuine, sustainable prosperity. The federal and provincial governments should actively partner with the Pakistan Dental Association (PDA), the country’s main professional body for dentists, to jointly plan, develop, and execute national and provincial oral health policies and initiatives.

The author is a Dean, Bhitai Dental  Medical College, Mirpurkhas