Background: Maternal and child health is an important component of the Sustainable Development Goals. Pakistan has one of the worst maternal and neonatal health outcomes in the world. This is despite significant health system investments across the country. Aims: The objectives of this study are twofold. First, the study estimates the technical efficiency of the public healthcare facilities in Pakistan, defined as the number of obstetric deliveries compared to the number of medical specialists, nurses, and other health and non-health staff members.Second, the study evaluates the relationship between efficiency and quality of care; the latter is measured in terms of maternal and neonatal mortality. Materials & Methods:The data were taken from the Pakistan Health Facility Assessment Survey. Efficiency score was calculated for 843 public healthcare facilities, using Stochastic Frontier Analysis. We then used two-stage residual inclusion approach with bootstrapping to evaluate the relationship between efficiency and quality.Results and Discussion: The average efficiency score was 0.48 (range: 0-1) and none of the public healthcare facilities were on the frontier, implying that efficiency gains can be made across the board. The relationship between efficiency and quality is found to be positive and statistically signif-

BackgroundThe lack of reliable tobacco healthcare and economic cost estimates leaves the tobacco industry undertaxed and thriving in Pakistan and makes the country as one of the top tobacco-consuming nations. To facilitate effective tobacco tax policymaking, this study estimates the economic cost of smoking-attributable diseases and deaths in Pakistan.MethodsA nationally representative sample survey of 13 000 households was administered to gather the data required to estimate different cost components of smoking-attributable diseases through the prevalence-based approach.FindingsThe total smoking-attributable economic cost of all diseases and deaths in Pakistan in the year 2018–2019 for persons aged 35 years or older is 615.07 billion ($3.85 billion). Similarly, three major diseases, namely cancer, cardiovascular disease and respiratory disease, along with associated deaths, cost the nation PKR437.8 billion ($2.7 billion) of which 77% is the indirect cost. The three major diseases make 71% of the total estimated cost, nearly two-thirds of which is borne by rural residents, nine-tenth by males and more than four-fifths by the citizens in the 35–64 years age group.ConclusionThe total annual economic costs of all smoking-attributable diseases and deaths and those of the three major diseases equal 1.6% and 1.15% of Pakistan’s gross domestic product, respectively. The tax contribution of tobacco sector is merely 20% of the total estimated cost. The finding of huge economic and health costs of smoking makes a convincing case for policymakers to realise the true value of the industry’s contribution and raise tobacco taxes to the level of full cost recovery.

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Langya viral human-to-human transmission collocation has been poorly understood and urgently needs global attention and extensive investigation.