Pakistan is a country comprising four provinces: Punjab, Sind, Northwest Frontier Province and Baluchistan, in addition to the federally administered tribal areas and the federal capital territory of Islamabad. It is bordered by China, Afghanistan, Iran and India. It has a population of 152 million (excluding an estimated 3–4 million Afghan and Bangladeshi immigrants) and an area of 796 095 km.

The per capita gross national product (GNP) is $483 and the budget of the Ministry of Health is 5% of the national budget, or 0.7% of the GNP (1997 figures). The annual per capita expenditure on health by the Ministry of Health is $3.5, compared with the national expenditure of $31. The ratios of beds, doctors, dentists and nurses to 10 000 population work out at 6.9, 6.0, 0.25 and 4.1, respectively. The mental health budget is 0.4% of the overall health budget.

From a modest beginning in 1947, when there were only three mental hospitals, at Lahore, Hyderabad and Peshawar, and a psychiatric unit at the Military Hospital in Rawalpindi, psychiatric units were gradually established in all the medical colleges of the country, especially during the 1970s.

Training

At the undergraduate level, behavioural sciences have been incorporated in the curricula of all the medical schools in Pakistan. An indigenous behavioural sciences teaching module has been developed for medical students and a demonstration project of community-oriented medical education with an emphasis on behavioural sciences was established in 1998 in four of the public sector medical colleges in all the provinces of the country.

At the postgraduate level, fellowship (FCSP), MD and diploma courses are available. The College of Physicians and Surgeons Pakistan (CPSP) is the main certifying body for postgraduate training in psychiatry; a four-year training programme leads to a fellowship in psychiatry. This training is carried out at specified institutions under the supervision of certified trainers. The training involves exposure to adult, forensic, child and adolescent, geriatric and liaison psychiatry patients in a graded manner that is monitored by the CPSP through regular reports from the supervisors, trainees and its own inspectors. The trainee has to com-plete a research project and submit a dissertation during this training period, besides attending workshops (organised by the CPSP) on research methods, biostatistics and communication skills.