INTRODUCTION:
In Pakistan, informal health markets play a major role in delivering healthcare, particularly for marginalized populations. Informal providers such as unlicensed practitioners and drug sellers are often the first point of care because they are accessible, affordable and trusted within communities. However, the largely unregulated nature of informal care contributes to poor quality of services, delayed treatment, weak referral pathways, and high out-of-pocket spending. In this study, we examine how reforming informal health markets can support more equitable health systems in Pakistan.

METHODS:
We conducted a policy and health systems analysis using peer-reviewed literature, national health policies, and grey literature related to informal healthcare provision in Pakistan. We searched for major bibliographic databases including PubMed, Scopus, and web of science, and screened relevant reports. The analysis was guided by an equity-focused health systems governance framework, focusing on access to care, quality of services, financial protection, and system accountability. We synthesized evidence to identify how informality contributes to inequities and to assess reform strategies

RESULTS:
We found that informal providers remain a primary source of care for low-income and rural populations due to limited availability and responsiveness of public health services. Disadvantaged groups are more likely to experience poor quality care, inappropriate treatment, and financial hardship as a result of reliance on informal providers. Current regulatory approaches are fragmented, which limits their effectiveness and sustainability. Evidence suggests that inclusive reforms, such as regulation, supervision, formal referral linkages with public facilities and involvement of informal providers in disease reporting, can improve quality, continuity of care, and equity without reducing access for vulnerable populations.

CONCLUSIONS:
Reforming informal health markets is essential for addressing persistent health inequities in Pakistan. Integrating informal providers into regulated and accountable health systems can strengthen primary health care. Such reforms support equitable progress toward universal health coverage.