According to the Bank’s website, the proposed results-based lending (RBL) will support the government of Punjab in addressing the critical challenges facing Pakistan's nursing and health workforce sectors by focusing on the complex underlying issues and supporting a comprehensive reform approach. By improving the performance of the nursing sector and the governance and management of the health workforce, the RBL will improve the overall functioning of the health care system, ultimately leading to better health outcomes.

Health sector context. Pakistan faces persistent challenges in delivering equitable, efficient, and high-quality health services across its population of more than 240 million. The country's health system remains under resourced and underperforming, with public expenditure on health at just 1.0%1 of gross domestic product compared with global benchmarks of 5.0%,2 and significant disparities in-service provision between urban and rural areas. Punjab, which accounts for more than half of the national population, reflects this dual burden of limited access and uneven quality, particularly in the public sector. Health outcomes remain below desirable benchmarks: maternal mortality is 155 per 100,000 live births, and child malnutrition, stunting, and communicable disease prevalence remain high. 3 The province is undergoing an epidemiological transition, marked by a rising burden of noncommunicable diseases alongside continued outbreaks of vaccine-preventable and vector-borne diseases. These challenges are compounded by rapid urbanization; climate-induced health risks; and systemic weaknesses in health system governance, planning, and human resources. A major constraint on improving service delivery is the severe shortage and poor distribution of qualified health workers, particularly nurses, who form the backbone of frontline care but remain undervalued and structurally marginalized within Pakistan's health system.

The program has been classified category B for environment and involuntary resettlement, and category C for Indigenous Peoples under ADB’s Safeguard Policy Statement (2009).

Construction will be limited to state-owned land, with no major land acquisition anticipated. Any site-specific involuntary resettlement impacts from informal land use will be addressed through the resettlement framework. Environmental impacts from civil works are expected to be localized and reversible, mitigated through compliance with provincial environmental regulations, and the integration of green and climate-resilient design standards such as solar energy, rainwater harvesting, and natural ventilation.

The government has requested a concessional loan of $150 million from ADB’s ordinary capital resources to help finance the program. The loan will have a 25-year term, including a grace period of 5 years; an interest rate of 2.0% per year during the grace period and thereafter; and such other terms and conditions set forth in the draft loan and program agreements. The government will provide counterpart financing for the program from its development and non-development budget.

The RBL program expenditures are estimated to be $255 million from 2026 to 2030.

No contacts available at the time of disclosure.

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