State of Healthcare in Pakistan – Part 3 – Asrar Qureshi’s Blog Post #786

State of Healthcare in Pakistan – Part 3 – Asrar Qureshi’s Blog Post #786

Dear Colleagues!  This is Asrar Qureshi’s Blog Post #786 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.

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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.

National Health Vision 2016 - 2025

“To improve the health of all Pakistanis, particularly women and children by providing universal access to affordable, quality, essential health services which are delivered through a resilient and responsive health system, capable of attaining the Sustainable Development Goals and fulfilling its other global health responsibilities”

National Health Vision 2016-2025

Pakistan was among the first few countries that showed commitment towards the 2030 agenda of SDGs – Sustainable Development Goals outlined by WHO in consultations internationally. After 18th amendment in 2010, the subject of health was devolved to provinces who were ill-prepared to take on the responsibility. The relevant policies and rules of business were also missing. For example, drug registration was done by the ministry of health at the federal government who also fixed drug prices. The questions rose after the devolution whether each province shall register a drug separately? Will the prices be same? Will the names be same? Will the same drugs be available in all provinces? What if one province refuses to register a particular drug while others do? Amid this confusion, it was decided to keep the drug registration as a federal subject. DRAP – Drug Regulatory Authority was formed in 2012, but it is federal government agency.

National Health Vision 2016-2025 also carries a ten-point priority agenda.

1. Improving the access and quality of RMNCAH (Reproductive, Maternal, Newborn, Child, Adolescent Health) primary care community-based services ensuring continuum of care including newborn care in rural districts and urban slums.

2. Improved quality of care in district facilities including rural health centers and district hospitals.

3. Overcoming financial barriers to care seeking and uptake of interventions

4. Increased funding and allocation for RMNCAH

5. Reproductive health and family planning

6. Investing in nutrition of adolescent girls, mothers, and children

7. Investing in addressing social determinants of health

8. Measurement and action at district level

9. National accountability and oversight

10. Generation of the political will to support RMNCAH as a key priority within the Sustainable Development Goals. 

The vision for action plan was endorsed by all the provinces and development partners on 13 May 2015, in a gathering chaired by the Minister of State for Health Mrs. Saira Afzal Tarar. Technical experts from all provinces gathered to translate the vision into national action plans which were to be costed and shared with all relevant stakeholders.

Each of the ten points above has a detailed roadmap, which if copied here would take too many pages. Generally, some major actions may be reproduced here.

• Primary care services in rural areas are critically dependent upon the Lady Health Workers program, and more community midwives. LHWs and Midwives shall be recruited and trained.

• Urban slums in larger cities shall be covered with community volunteer health workers who would be trained in prevention and promotion strategies.

• Extra training and education shall be provided to community workers to support pregnant women during pregnancy for positive outcomes and thereby preventing stillbirths and neonatal deaths.

• Provision of essential commodities shall be ensured.

• Administrative and legal steps to develop linkages between medical colleges/ universities with district health systems can act as a game changer.

• Capacity building for monitoring of quality of service at district and provincial level including maternal, newborn, and child death audits, with adequate focus on civic registration and vital statistics.

• Health insurance schemes for the identified poorest and marginalized groups for priority illnesses which lead to catastrophic illnesses funded by government; third party contract with providers on behalf of insured population and reimbursement based on outputs. (This was later converted into action by PTI government as Sehat Sahulat Card.)

• A realistic and robust plan for phased increase in health spending at PHC level (RMNCAH & Nutrition) for the next 5 years to be prepared jointly by federal and provincial government along with line ministries, based on equity and contextual needs. Including building upon Pakistan’s costed 2014- 2018 comprehensive Multi-year plans (cMYPs) for Routine Immunization. The targets set by the WHO for health expenditures to be seen as guiding principles. n 

• Timely approval of PC1s and release of allocated funds

• These should be coupled with innovative ways of generating finances e.g. imposition of health tax on luxury items, sin tax on tobacco or nutrition levies on soft drinks, tapping private sector resources etc.

• There is also an urgent need for declaring population emergency.

• Closing the gap between FP knowledge and practice through comprehensive service that encompasses family planning awareness, options, commodity security with focus on modern methods, as well as innovations, keeping in mind the diversity in the country. 

• Focus on sexual & reproductive health education among adolescents, both boys and girls in school and out of school, is an important step that needs to be taken in a culturally sensitive manner.

• Fortification of food with micro nutrients by involving industry especially flour and ghee.

• Biofortification of staple foods, nutrition education, food safety and control of mycotoxins are actions that can improve the nutritional impact of agricultural practices and programs.

• Women and girls empowerment through skill development, women focused micro-financing schemes, creation of job opportunities, and investing in cottage industry.

• Increased alignment and support behind a single national plan and monitoring framework for RMNCAH and nutrition using appropriate logistics and technology

• Institution of key performance indicators and health regulatory measures at provincial & district level aiming to improve governance & accountability mechanism.

• Engagements with key stakeholders like Religious scholars, media will be helpful in addressing myths and misconception on family planning etc.

• Capacity building of policy makers, parliamentarians, and Standing Committees on health & population issues, and media is mandatory to help them understand the linkages of health with development. Concrete actions in this are required.

We are almost in the middle of 2023 and the NVH completion is a year and half away. However, there is complete quietness on the progress vis-à-vis this vision. This is our biggest dilemma. We are quite capable of making beautifully worded plans, but commitment is missing at all levels. Even while the plans are being made, the stakeholders know inside that nothing much would happen. 

The most basic roadblock is allocation of funds for healthcare. With 1.2% of GDP, we shall never achieve much. Bangladesh has 3.2%, India has 2.4%, and Vietnam has 5.8%. The smaller budget becomes even smaller when money goes down the drain of corruption which is integral in government procurement, and expenses on unnecessary luxuries, such as vehicles, conferences, and participation in international conferences. 

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 Vision 2016-2025.pdf (unicef.org)

National Health Policy.PDF (nhsrc.pk)

The National Health Vision Pakistan (2016-2025) - Paradigm Shift

9789290222651-eng.pdf (who.int)