Curing Pakistan’s ailing healthcare system

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    Frank Islam (Washington): Pakistan’s healthcare system is sick. Successive governments have neglected this critical area for the past 70 years. Urgent measures need to be taken to improve this ailing system.

    The government of Prime Minister Imran Khan is aware of the needs and importance of Pakistan’s health care sector and appears poised to act on them. In its election manifesto, Khan’s Pakistan Tehreek e Insaaf promised to revamp the health care system completely. Speaking to senior journalists recently, the Prime Minister reiterated his pledge to provide quality health care facilities for every Pakistani.

    There are multiple challenges that must be overcome to accomplish this, however.

    First, the most important issue hurting Pakistan’s health is a lack of adequate funding. The country’s meagre budgetary allocation for the healthcare sector does not allow it to address the needs of over 200 million people in a satisfactory manner.

    According to the Economic Survey 2017-18, the cumulative health expenditures of the central government and provinces was a mere Rs 384.57 billion in the last fiscal year. This is less than one percent of the country’s Gross Domestic Product (GDP).

    Small allocation significantly constrains the scope of public sector health-care which is used by a majority of Pakistanis.

    The country currently has 1211 public sector hospitals along with 5508 basic health units and 676 rural health centres. There is one doctor for 957 people and one bed for 1,580 citizens. The government-run hospitals are not only overcrowded, understaffed and poorly equipped but also lack proper supervision and oversight by the relevant authorities.

    Second, private sector health care is very expensive and of variable quality. Most of the country’s rich and middle class rely on private hospitals for their health needs. However, in the absence of any regulatory mechanism, the healthcare provided in these facilities leaves much to be desired.

    Pakistan does not have adequate health care data or a system for collecting it. A global investigation conducted by the International Consortium of Investigative Journalists reported that faulty implants in the human body have caused many patients worldwide to suffer and to die

    Third, Pakistan does an abysmal job in providing preventive health care services. Pakistan is one of the five countries in the world with the highest number of unimmunized or partially immunised children. While the rest of the world is free from polio, the country is still struggling to contain the disease. Pakistan also has the highest newborn mortality rate in the world (55 per 1,000 live births).

    Fourth, the absence of an effective regulatory mechanism puts millions of lives in danger. Recent investigative reports have revealed that faulty health equipment such as stents have been used in Pakistan without the approval of the concerned authorities. This has occurred despite efforts by the Supreme Court of Pakistan to curb the practice. The apex court has observed that the Pakistan Medical and Dental Council (PMDC) the body that regulates doctors and dentists and the Drug Regulatory Authority of Pakistan (DRAP), which regulates drugs and medical equipment have failed to perform their duties to ensure quality of health care throughout the country.

    Given these conditions, it is imperative that, the newly formed government develop a comprehensive plan and take immediate action on these issues in order to improve the standards for and provision of healthcare for the entire population. Key measures that must be taken by the federal government in conjunction with the respective provincial governments because of the nature of Pakistan’s heath care delivery system include the following.

    Increase the health care budget and expand coverage

    The federal government and provincial administrations need to enhance budget allocations for the health sector. The extra funding should be used to build new hospitals especially in rural areas and semi-urban centres and upgrade existing health facilities with modern equipment. According to media reports, some of the hospitals in rural and remote areas do not even have proper X-Ray machines. Laboratories need to be upgraded to offer proper testing services. Investing at the local level will address the issue of over-crowding in public hospitals in major cities. The federal government also needs to invest in preventive care to ensure the necessary vaccinations for every child.

    Ensure universal access to healthcare

    Access to health is the major issue for millions of poor Pakistanis who can’t afford private healthcare. The Khan government has promised to provide health cards to ensure government-subsidised health insurance for poor and needy families across the country. The project has been introduced in Khyber Pakhtunkhwa and some parts of Islamabad but it has yet to reach every deserving Pakistani family. It needs to be implemented quickly and uniformly to provide much-needed relief to poor Pakistanis in all provinces.

    Improve regulatory bodies

    In the past, political meddling and poor oversight has resulted in extremely poor performance of regulatory bodies like DRAP and PM and DC. The government must make these bodies autonomous and accountable because they are pivotal to improving healthcare standards across the country. In addition, the growing private health sector needs proper regulation to reduce the complaints of malpractice in its hospitals. There should be a grading system for doctors and private clinics based on their competency and quality of service to facilitate patient choice and decision-making A-grading system would also encourage healthy competition among private hospitals and medical professionals. Finally, there must be strict accountability for those found involved in medical negligence and malpractice.

    Promote appropriate and timely data collection

    Pakistan does not have adequate health care data or a system for collecting it. A global investigation conducted by the International Consortium of Investigative Journalists (ICIJ) reported that faulty implants in the human body have caused many patients worldwide to suffer and to die. According to ICIJ’s local partner, data on such adverse events is not available in Pakistan due to its weak regulatory system and strong doctor-medical distributor relationships. The government and regulatory bodies need to work together to ensure that the necessary data is properly organized and collected in a timely manner. This will promote both the effectiveness and efficiency of medical professionals and institutions and the efficacy of medicines and medical equipment.

    By initiating and implementing these measures, the government will put Pakistan on the right track to cure its ailing health care system. This will not only improve the health of 200 million people it will also contribute to the growth and development of Pakistan’s overall economy because a healthy nation will be a more productive nation.

    The writer is an Entrepreneur, Civic Leader, and Thought Leader based in Washington DC