State of Healthcare in Pakistan – Part 2 – Asrar Qureshi’s Blog Post #785

State of Healthcare in Pakistan – Part 2 – Asrar Qureshi’s Blog Post #785

Dear Colleagues!  This is Asrar Qureshi’s Blog Post #785 for Pharma Veterans. Pharma Veterans welcome sharing of knowledge and wisdom by Veterans for the benefit of Community at large. Pharma Veterans Blog is published by Asrar Qureshi on  WordPress, the top blog site. Please email to asrar@asrarqureshi.com for publishing your contributions here.

Photo Credit: Alvaro Camacho

Photo Credit: Joshua Mcknight

Photo Credit: Mikhail Nilov

Healthcare stands on three pillars: Healthcare related policies; Public and private health infrastructure; and availability of diagnostic and treatment tools, the last one also includes easy access to drugs. We shall review each of these in some detail to understand the entire healthcare landscape. The information is gathered from several sources, and references are given at the bottom.

Healthcare related Policies – 1947 - 2009

The WHO defines health policies as decisions, plans, and actions that are undertaken to achieve specific healthcare goals within a society. A well-defined health policy provides a vision for the future with reference points for short and medium term goals. 

Pakistan did not have a health policy during the period 1947 – 1990. Although Pakistan signed Alma-Ata declaration in September 1978 which expressed the need for urgent action from all governments, all health and development workers, and the world community to protect and promote the health of all people.

The first policy was developed in 1990 with its focus on school health, family planning, malaria control, communicable diseases, and WASH – WAter, Sanitation, Hygiene. It was followed by the 2nd National Health Policy in 1997 which also focused on health promotion and education. The 3rd version of the National Health Policy, which was presented in 2001, adopted ‘Health for All’ approach and focused on ten key areas. The policy also set targets against each of the above key areas with a time frame, which are shown below under them. General status of achievement is also shown.

1. To reduce the widespread prevalence of communicable diseases – childhood diseases, TB, malaria, hepatitis B, and HIV/AIDS

a. Immunization coverage to increase to 80% by 2005; 100% by 2010 – partially achieved.

b. Polio cases to be reduced to less than 100 by 2001; polio-free by 2005 – partially achieved. Polio cases are rising.

c. Hepatitis B coverage in 70% districts by 2002; 100% by 2003 – partially achieved.

d. Full DOTs coverage of TB by 2005. TB prevalence reduced by 50% by 2010 – partially achieved.

e. Malaria cases reduction by 50% by 2010 – partially achieved.

2. To address inadequacies in primary/secondary healthcare services

a. 100,000 family health workers to be recruited and trained by 2005 to cover the entire population – partially achieved.

b. Rationalization study of Rural Health Centers/Basic Health Units to be completed by 2002 – partially achieved.

c. 58 districts and 137 tehsil hospitals to be upgraded in the next 5 years – partially achieved.

3. To remove professional and managerial deficiencies in district health system

a. No specific, measurable targets set

4. To promote greater gender equity in the health sector

a. 100,000 LHWs to be recruited by 2005; and 55,000 female nurses by 2010 – even now we have 104,000 including nurses, LHVs, and LHWs.

5. To bridge the basic nutrition gaps in the target population i.e., children, women, and vulnerable population groups

a. Reduce low birth weight babies from 15% to 15% by 2010 – malnutrition has increased with every passing year causing more LBW infants.

b. Vitamin A supplementation to approx. 30 million children a year – partially achieved.

6. To correct urban bias in the health sector implementation modalities

a. No specific, measurable target set

7. To introduce required regulation in the private medical sector

a. No specific, measurable target set

8. To create mass awareness in public health matters

a. No specific, measurable target set

9. To affect improvement in the drug sector with a view to ensuring the availability, affordability, and quality of drugs in the country

a. No specific, measurable target set

10. Capacity building for health policy monitoring in the ministry of health

11. No specific, measurable target set

As you see, for 6 out of 10 key areas, no measurable target was set; only some implementation modalities were proposed. The achievement status is unknown. Of the 4 key points where targets were set, none was achieved.

Why is the performance of government so dismal in the health sector, despite rhetoric about it? The first reason is lack of seriousness; the rhetoric is empty. Secondly, the budget allocation is not in line with the requirement. Thirdly, and even more seriously, portions of allocated health budgets are diverted to other sectors on the sole discretion of the powers that be. Laptop schemes, green cabs, sasti roti, metro bus, orange train, are the kind of projects which are not part of the original budget, are started during the year, and at the cost of other sectors. 

Please also note that 18th amendment was adopted in 2010, under which health was devolved to provinces, along with education. Since then, it is the responsibility of the provinces to take care of the health sector. Chief Ministers thereby got control over additional budgets with which they played recklessly. The devolution was not bad per se, but the preparation to devolve was totally inadequate. You will notice that all CMs got entangled in mega projects and wasted much needed public money. It is also interesting to note that the opposition, whosoever sits in there, never raises voice against budget usurpation by the chief executives, no one goes to court with a public interest petition, and no court initiates suo moto proceedings. 

Budget allocation

1995 – 1996 0.8% of GDP

1996 – 1997 0.5%

1997 – 1998 0.7%

1998 – 1999 0.9

1999 – 2000 0.7

2000 – 2001 0.7

Present 1.2% which is not available fully due to funds shortage

In the next post, we shall review the new National Health Vision 2016 – 2025.

To be Concluded……

Disclaimer: Most pictures in these blogs are taken from Google Images and Pexels. Credit is given where known; some do not show copyright ownership. However, if a claim is lodged at any stage, we shall either mention the ownership clearly, or remove the picture with suitable regrets.

References.

National Health Policy.PDF (nhsrc.pk)

Success stories National Health Vision 2016-25.pdf (nhsrc.pk)

9789290222651-eng.pdf (who.int)