Hadi, Qurat ul AinVerhaghe, JohanYunus, Hammad2025-07-152025-07-152025-07-15https://hdl.handle.net/10986/43460Pakistan’s overall national health budget had a high rate of execution from 2016 to 2019, averaging 95 percent. However, execution rates between provinces as well as between categories of spending varied significantly. At the health facility level, execution of spending is notably challenging, particularly for non-wage expenditure. Good practices that facilitated better budget execution included strong integration of payroll and personnel records in most provinces as well as the contracting out of the provision of primary healthcare services to the private sector in Sindh, Baluchistan, and Punjab Provinces. This approach has facilitated more consistent budget execution rates and evidence of resources reaching the facility level. There remain challenges, however, with ensuring the accountability of how these resources are used. The main bottlenecks holding back the quality of budget execution include an inability to track primary, secondary, and tertiary healthcare budgets and their execution; systematic over-estimation of resources by the provinces; weaknesses in budget preparation processes; inefficiency in spending control processes; lack of autonomy for primary healthcare facilities; insufficient integration of vertical programs in local health systems; and lack of a process for capturing spending arrears.en-USCC BY-NC 3.0 IGOGOOD HEALTHBUDGET EXECUTION CHALLENGESHEALTH FINANCING PERSPECTIVEPUBLIC FINANCIAL MANAGEMENTWorking PaperWorld Bankhttps://doi.org/10.1596/43460