The role of state capacity and socio-economic determinants on health quality and its access in Pakistan (1990–2019).

Quality of Healthcare and accessibility is one of the vital Sustainable Development Goals (SDGs). For achieving this goal, the United Nations focuses on state capacity development and associated determinants in emerging and developing countries. By focusing on this objective, this study evaluates and examines the liaison of state capacity, socio-economic conditions, private health expenditures, and demographic pressure to the quality of health and its accessibility in Pakistan from 1990 to 2019. This study investigates the policy implications and their consequences on Pakistan's health conditions during the last three decades. Moreover, during COVID-19, pandemic health governs policies in the year 2020 have also been considered by using the Health Containment Index and analyzed policy implication on combating COVID-19. By applied Ordinary Least Square and Fixed Effect estimations, results show that Pakistan's health conditions have been showing sluggish improvement in the last three decades. Prudent policy-making and adequate health spending have a strong significant impact on health quality and accessibility, while institutional corruption and demographic pressure have adversely affected Pakistan's health outcomes. This proposed study analyzed that policy enforcement has been fragile in Pakistan from 1990 to 2010. Furthermore, this study concludes that from the year 2010 to date with the 18th constitutional amendment to administration and public policies have fractionally improved Pakistan's health conditions. However, Pakistan still lacks the International standards and minimum criteria of health measures a far behind Sustainable Development. The present study concludes that a sound and effective policy enforcement by enhancing resource capacity, quality of institutional practices, and controlling socio-economic conditions will promote SDG of health quality in Pakistan. • HQAI has been fractionally improved in Pakistan in the last three decades. • Policy decision-making inconsistent with achieving Sustainable Health development. • Socio-economic risk factors have been significantly affected the HQAI. • 2010, 18th Constitutional Amendment has positively impacted the HQAI in Pakistan. • Out-of Pocket expenditure & health budget have a significant impact on HAQI. [ABSTRACT FROM AUTHOR]