Frontiers in public health · 2026
Dementia service readiness in Pakistan: a provincial health systems assessment using a novel WHO-AIMS aligned framework.
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Bokhari Syed Ali, Qassem Tarik, Javaid Syed Fahad
Аннотация
BACKGROUND: Pakistan faces a rapidly growing dementia crisis with an estimated 374,060 cases, projected to rise substantially as the older adult population triples to 38.3 million by 2050. Yet no provincial-level assessment of service readiness has been published. To our knowledge, this study provides the first structured literature-based provincial assessment of dementia-relevant geriatric mental health infrastructure across Pakistan's four provinces and two administrative territories.
METHODS: We conducted an integrative review synthesizing peer-reviewed literature, grey literature, and government reports. Drawing on the conceptual structure of WHO-AIMS (2007), we developed a novel six-criteria framework to categorize provincial readiness across three dimensions: governance, infrastructure, and specialized care. Findings were contextualized through comparison with India, Bangladesh, and Sri Lanka.
RESULTS: Our framework stratified Pakistan into three tiers. Tier 1 provinces (Punjab, Sindh) demonstrated partial system maturity; Tier 2 provinces (Khyber Pakhtunkhwa, Balochistan) exhibited foundational but inactive governance structures; and Tier 3 territories (Gilgit-Baltistan, Azad Jammu and Kashmir) showed absent legislative frameworks and no identifiable dementia services. Validated Urdu screening instruments exist (MMSE-Urdu, 10/66 battery) but are not systematically used. Pakistan's psychiatric workforce (0.24 per 100,000) lags significantly behind regional comparators such as Sri Lanka (0.47) and India (0.30).
CONCLUSION: Dementia care in Pakistan remains structurally dependent on urban tertiary centers in Punjab and Sindh; four of six jurisdictions have no identifiable dedicated dementia-specific services. Post-18th Amendment devolution created coordination gaps without capacity transfer. We propose a tiered implementation roadmap and multi-channel service delivery model leveraging primary care, community health workers, and telemedicine to bridge the specialist gap.
METHODS: We conducted an integrative review synthesizing peer-reviewed literature, grey literature, and government reports. Drawing on the conceptual structure of WHO-AIMS (2007), we developed a novel six-criteria framework to categorize provincial readiness across three dimensions: governance, infrastructure, and specialized care. Findings were contextualized through comparison with India, Bangladesh, and Sri Lanka.
RESULTS: Our framework stratified Pakistan into three tiers. Tier 1 provinces (Punjab, Sindh) demonstrated partial system maturity; Tier 2 provinces (Khyber Pakhtunkhwa, Balochistan) exhibited foundational but inactive governance structures; and Tier 3 territories (Gilgit-Baltistan, Azad Jammu and Kashmir) showed absent legislative frameworks and no identifiable dementia services. Validated Urdu screening instruments exist (MMSE-Urdu, 10/66 battery) but are not systematically used. Pakistan's psychiatric workforce (0.24 per 100,000) lags significantly behind regional comparators such as Sri Lanka (0.47) and India (0.30).
CONCLUSION: Dementia care in Pakistan remains structurally dependent on urban tertiary centers in Punjab and Sindh; four of six jurisdictions have no identifiable dedicated dementia-specific services. Post-18th Amendment devolution created coordination gaps without capacity transfer. We propose a tiered implementation roadmap and multi-channel service delivery model leveraging primary care, community health workers, and telemedicine to bridge the specialist gap.