Pakistan
The worked example in this register. The design playbook applies the six questions to a proposed palliative care training program here.
9 domains reviewed · 6 high-confidence · 3 dated estimates · 6 material gaps
WHO region: Eastern Mediterranean. World Bank income group: Income group not yet retrieved.
- Domains reviewed
- 9 of 9
- Hospice: 4 of 4
- Backed by a primary document
- 0 of 9
- Open questions
- 8
- Sources behind this dossier
- 24
- Newest source 2026
Lessons from Pakistan
- A charitable hospice for poor families can cover food and medicines for both the patient and family caregivers, which lowers the cost barrier to admission.275
- Where strong opioids are scarce, patients rely on tramadol and codeine, so pain services need opioid access as well as religious and philanthropic support.381,380
- Drug control enforcement and price caps should be checked for their effect on licit morphine supply, since in Pakistan they are linked to hospital morphine scarcity.551
Palliative care
Is morphine available in Pakistan?
Opioid supply. Is a therapeutic opioid physically available in the wards that need it? Every country on this question
- 3.71 MME per 1,000 people per daySOURCE-CHECKED · 2019 DATA
Opioid analgesic consumption, Pakistan, 20193
Method: IQVIA MIDAS pharmaceutical sales data for opioid analgesics, in morphine milligram equivalents per 1,000 inhabitants per day (Ju et al. 2022; abstract read September 2026). A sales-based proxy for availability, not a measure of palliative access. Last checked 2026-09-25.
Cite this figure: - 4.88 MME per 1,000 people per daySOURCE-CHECKED · 2015 DATA
Opioid analgesic consumption, Pakistan, 20153
Method: IQVIA MIDAS pharmaceutical sales data for opioid analgesics, in morphine milligram equivalents per 1,000 inhabitants per day (Ju et al. 2022; abstract read September 2026). A sales-based proxy for availability, not a measure of palliative access. Last checked 2026-09-25.
Cite this figure:
How does Pakistan regulate opioids for pain?
Narcotics regulation. What licensing regime governs stocking and dispensing, and when did it last change? Every country on this question
Which specific licensing clauses, in which provincial rules, produce the stocking bottleneck?
Help answer it:Search PubMedWho can prescribe morphine in Pakistan?
Prescriber authority. Who is legally allowed to prescribe, and can that group be widened? Every country on this question
- Unknown peopleILLUSTRATIVE ONLY
Practicing palliative specialists nationally, Pakistan, current25
Last checked 2026-08-03.
No published count located.
Cite this figure:
Is any nurse or clinical officer prescribing authority available under current law?
Help answer it:Search PubMedHow does palliative care reach patients in Pakistan?
Service delivery. Through what structure does care actually reach a patient at home? Every country on this question
Specialized palliative care in Pakistan is offered by only a few institutions. At Aga Khan University Hospital in Karachi, a program started in 2017 delivers inpatient, outpatient and home-based care and served 3747 patients in 2017 to 2019, and its outpatient clinic is described as the first in Karachi (self-reported, single institution).278,279,280
How is palliative care delivered outside large private tertiary hospitals, for example in public hospitals and rural districts?
Help answer it:Search PubMedWho pays for palliative care in Pakistan?
Financing. Who pays for the drug, the visit and the workforce? Every country on this question
How are palliative care clinicians trained in Pakistan?
Training and recognition. What credential exists, who awards it, and does anyone recognize it? Every country on this question
A postgraduate certificate in palliative care exists at National University of Medical Sciences with the Shaheen Palliative Care Project.7
How does Pakistan prevent opioid misuse without blocking pain relief?
Opioid safeguards. How are misuse and diversion controlled, and are treatment and naloxone available, without blocking pain relief? Every country on this question
An anthropological study argues that narcotics enforcement aimed at illicit supply and unviably low price ceilings make morphine scarce in Pakistani hospitals while heroin circulates illicitly. In a national survey of 2,838 hospital health professionals, only 27.7% knew patients must sign an opioid agreement and 22.2% knew of the drug monitoring program. A mystery-shopper study found 95% of 200 sampled Punjab pharmacies were run by non-qualified staff and sold controlled drugs without prescription.551,552,553
Is opioid agonist treatment (methadone or buprenorphine) available in Pakistan outside pilot HIV programs, and is naloxone stocked in hospitals and pharmacies?
Help answer it:Search PubMedHow do children get palliative care in Pakistan?
Children's palliative care. How do children with life-limiting conditions get palliative care and the medicines they need? Every country on this question
A palliative team at a Peshawar cancer hospital reviewed notes for 150 referred children and found psychological and family challenges, financial constraints and limited resources. Bereaved parents at a Karachi hospital reported no institutional bereavement practices and barriers to psychological care, including stigma and cost. Caregivers of children with blood cancers receiving specialist palliative care in Karachi valued its holistic approach and better communication.556,557,558
How many children in Pakistan are reached by pediatric palliative care each year, and are oral morphine formulations for children available at those centers?
Help answer it:Search PubMedHospice care in Pakistan
How the hospice model works here, who can use it, who pays and who it reaches. Covered 4 of 4.
What does hospice care look like in Pakistan?
Hospice model. What does hospice mean here, who runs it, and in what settings? Every country on this question
Hospice care is not well established in Pakistan, and most end-of-life care happens in acute hospitals or at home. The hospice described in the literature is a charitable non-profit inpatient cancer hospice in Karachi, linked to a philanthropist-funded cancer hospital that also gives palliative care.275,276
When was the Karachi hospice founded, and do any hospices or home hospice teams exist outside Karachi?
Help answer it:Search PubMedWho can get hospice care in Pakistan?
Hospice eligibility. Who can enter hospice, on what criteria, and how late do patients arrive? Every country on this question
The Karachi hospice admits patients with terminal cancer who are expected to die within six months, and it serves poor families. In a case study at the linked cancer and hospice hospital, all patients presented at a late stage of disease (single site).275,276
Who pays for hospice care in Pakistan?
Hospice funding. Who pays for hospice care: a public benefit, insurance, charity or families? Every country on this question
The Karachi hospice is a charitable non-profit that gives food and medications to patients and their families during the stay. The linked cancer hospital is funded by philanthropists for people who cannot pay, while personal spending makes up around 58% of total health spending in Pakistan.275,276
How many people reach hospice in Pakistan?
Hospice reach. How many dying people use hospice, and who is left out? Every country on this question
At the time of one study, Karachi, a city of 16 million, had only one hospice. In a survey of 522 dialysis patients in seven units, only 5% reported knowledge of hospice services.275,277
How many hospices exist in Pakistan today, and what share of people who die use them?
Help answer it:Search PubMedWhat fills the gap in Pakistan
How people get care outside formal services: families, faith communities, volunteers, health workers, healers, other medicines and charity. Described, not scored.
- Faith communities
Family caregivers at a Karachi hospice described seeking God's kindness and grace, family honor and selfless service as sources of strength while caring for a dying relative. Spirituality was a major coping resource amid limited resources.378
Single-site evidence- Traditional and complementary healers
Adults on hemodialysis at two units attributed their illness to supernatural causes and chose traditional medicine for kidney disease. Families at first tried to dissuade patients from dialysis, and patients seemed reluctant to discuss end-of-life care.379
Subnational evidence- Substitute and informal pain relief
At one Islamabad hospital, tramadol (69%) and codeine with paracetamol (68%) were the most prescribed cancer pain drugs and no strong opioids were used. The author links this to restrictive regulation, cost and limited availability.381
Single-site evidence- Charity, religious giving and mutual aid
At Indus Hospital in Karachi, which treats patients free of cost, zakat made up 34% of all philanthropic donations between 2007 and 2012, and 98% of donations were raised locally. The data concern surgical care and come from the hospital's own researchers.380
Single-site evidenceSelf-reported
Sources cited here
- 3Ju C, Wei L, Man KKC, et al.
Global, regional and national trends in opioid analgesic consumption, 2015 to 2019. Lancet Public Health 2022;7:e335-46. DOI 10.1016/S2468-2667(22)00013-5.
- 21Business Recorder,
2025, on hardship-category drug shortages including oral morphine for palliative care, and delayed approval of recommended price revisions.
- 25Letter: palliative care needs assessment for Pakistan.
Journal of Palliative Medicine, 2022. PMC9248331. Cites nine palliative and pain fellowship programs on CPSP listings.
- 278Jabeen I, Qureshi A, Waqar MA
Development of Palliative Care Services at a Tertiary Care Teaching Hospital in Pakistan: Retrospective Analysis of Existing Palliative Care Program. J Pain Symptom Manage 2022;64(2):178-185. Retrospective review of the Aga Khan University Hospital palliative care program 2017-2019 with inpatient, outpatient and home care; self-evaluation by program staff, single institution; a corrigendum was published (PMID 38219084). Abstract read.
- 279Rafaqat W, Syed AR, Ahmed IM, et al.
Impact of an outpatient palliative care consultation and symptom clusters in terminal patients at a tertiary care center in Pakistan. BMC Palliat Care 2023;22(1):75. Before-after symptom study of 78 outpatients at the first outpatient palliative care center in Karachi; single institution, includes program staff as authors. Abstract read.
- 280Saeed S, Tousif K, Fatir CA, et al.
Impact of COVID-19 on palliative care of cancer patients: Perspectives from Pakistan. Ann Med Surg (Lond) 2022;78:103705. Short commentary stating that only a few institutions provide specialized palliative care in Pakistan; opinion piece, not primary data. Abstract read.
- 19WHO Global Health Expenditure Database.
Out-of-pocket spending 54.3 percent of current health expenditure, 2020.
- 29Commonwealth Fund,
International Health Policy Center, Pakistan country profile. Sehat Sahulat coverage near PKR 460,000 per family; approximately 44.6 million households by 2022.
- 7National University of Medical Sciences.
Postgraduate Certificate in Palliative Care, with the Shaheen Palliative Care Project. Admissions materials and national press coverage, 2021 and 2025.
- 551Hayat Z
Regimes of pain: The geopolitics of cancer palliation in Pakistan. Med Anthropol Q 2024;38(3):271-284. Anthropological analysis of how narcotics control and price control shape morphine scarcity for cancer pain in Pakistan; interpretive, not a measurement study. Abstract read.
- 552Arshad H, Gillani AH, Rehman JU, et al.
Awareness about opioids crisis, policies and regulation of opioid stewardship at hospitals settings: a nationwide cross-sectional study among healthcare professionals from Pakistan. Subst Abuse Treat Prev Policy 2026;21(1). Nationwide survey of 2,838 health professionals in 59 Pakistani hospitals on opioid stewardship awareness and practice. Abstract read.
- 553Bashir I, Ahmad M, Jamshaid M, et al.
Illicit sale of controlled drugs at community pharmacy/medical stores of Punjab, Pakistan: A road to demolition of public health. Heliyon 2021;7(5):e07031. Mystery-shopper study of 200 community pharmacies in Punjab, Pakistan, on sale of controlled drugs without prescription. Abstract read.
- 554Kamal M, Khan A, Athar S, et al.
Prevalence of Anxiety and Depression among Primary Caregivers of Oncologic Patients: A Cross-Sectional Study from a Tertiary Care Hospital of Karachi, Pakistan. Semin Oncol Nurs 2026;42(4):152295. Cross-sectional study of anxiety and depression among 326 caregivers of oncology patients at one Karachi hospital. Abstract read.
- 555Jabeen S, Zakar R, Zakar MZ, et al.
Experiences of family caregivers in dealing with cases of advanced breast cancer: a qualitative study of the sociocultural context in Punjab, Pakistan. BMC Public Health 2024;24(1):1030. Qualitative study of 15 family caregivers of women with advanced breast cancer in Punjab, Pakistan. Abstract read.
- 556Khurshid S, Saleem A, Khanzada ZS
Barriers to Palliative Care for Terminally Ill Children in a Developing Country Cancer Hospital: A Qualitative Study. J Cancer Allied Spec 2026;12(1):24-29. Retrospective qualitative analysis of palliative team notes for 150 children at Shaukat Khanum Memorial Cancer Hospital, Peshawar; single site, authors are the service's own staff. Abstract read.
- 557Hussain H, Altaf S, Khalid A, et al.
Exploring challenges and opportunities in paediatric bereavement care: a qualitative study from a tertiary care hospital in Pakistan. BMC Palliat Care 2026;25(1). Qualitative study of 19 bereaved parents at Aga Khan University Hospital, Karachi, on bereavement care gaps; single site. Abstract read.
- 558Shariq S, Sultan A, Bukhari SI, et al.
Navigating the landscape of paediatric haematological malignancies: a qualitative exploration of caregivers' experiences and palliative care integration in Pakistan. BMC Palliat Care 2026;25(1). Qualitative study of 13 caregivers of children with blood cancers receiving integrated palliative care at a private Karachi hospital; single site. Abstract read.
- 275Lalani NS, Duggleby W, Olson J
"I Need Presence and a Listening Ear": Perspectives of Spirituality and Spiritual Care Among Healthcare Providers in a Hospice Setting in Pakistan. J Relig Health 2021;60(4):2862-2877. Qualitative interview study of hospice staff whose study-context section describes the only hospice in Karachi (45-bed, charitable, cancer-only, six-month prognosis rule, free food and medicines); single site. Full text read.
- 276Rattani SA, Dahlke S, Cameron B
Cancer Care in Pakistan: A Descriptive Case Study. Glob Qual Nurs Res 2022;9:23333936221080988. Qualitative case study (12 participants) at a philanthropist-funded cancer and hospice hospital in Karachi describing late presentation, poverty and lack of morphine; single site. Full text read.
- 277Saeed F, Sardar M, Rasheed K, et al.
Dialysis Decision Making and Preferences for End-of-Life Care: Perspectives of Pakistani Patients Receiving Maintenance Dialysis. J Pain Symptom Manage 2020;60(2):336-345. Survey of 522 patients in seven dialysis units showing very low awareness of hospice and palliative care; convenience sample. Abstract read.
- 381Sami SHA
Assessment of analgesics and alternative approaches in cancer pain management: A cross-sectional study. J Oncol Pharm Pract 2025. Prescription review of 203 cancer patients at PIMS, Islamabad, showing reliance on weak opioids and absence of strong opioids; single hospital. Abstract read.
- 380Samad L, Iqbal M, Tariq A, et al.
Equitable access to comprehensive surgical care: the potential of indigenous private philanthropy in low-income settings. World J Surg 2015;39(1):21-8. Five-year financial review of free care at Indus Hospital, Karachi, funded largely by local donations including zakat; surgical care rather than palliative care, and authors are from the hospital's own research center (self-evaluation). Abstract read.
- 378Lalani N, Duggleby W, Olson J
Rise Above: Experiences of Spirituality Among Family Caregivers Caring for Their Dying Family Member in a Hospice Setting in Pakistan. J Hosp Palliat Nurs 2019;21(5):422-429. Interpretive descriptive study of 18 family caregivers at one hospice in Karachi on spiritual coping. Abstract read.
- 379Malik S, Allen RJ, Vachharajani TJ, et al.
Dialysis Decision Making, Dialysis Experiences, and Illness Perceptions: A Qualitative Study of Pakistani Patients Receiving Maintenance Hemodialysis. Kidney Med 2022;4(11):100550. Interviews with 20 adults at 2 dialysis units covering traditional medicine use, family roles, costs and end-of-life talk; two hospitals in neighboring cities. Abstract read.