Healthcare Landscape in Pakistan – Public Sector – Asrar Qureshi’s Blog Post 977

Healthcare Landscape in Pakistan – Public Sector – Asrar Qureshi’s Blog Post 977

Dear Colleagues! This is Asrar Qureshi’s Blog Post 977 for Pharma Veterans. Pharma Veterans Blogs are published by Asrar Qureshi on its dedicated site https://pharmaveterans.com. Please email to aq.pharmaveterans@gmail.com for publishing your contributions here.

Civil Hospital Karachi

Jinnah Postgraduate Medical Center Karachi

Mayo Hospital Lahore

Healthcare is among the basic rights granted by the constitution. UHC – Universal Health Coverage – is also among the UN Sustainable Development Goals – SDGs. 

Having said that, healthcare system in every country must keep evolving due to growing needs of people, constantly emerging new public health challenges, and the diversity of population demographics due to rural urban migration and other factors. Public Healthcare System – PHS, comprises of public and private sectors that cater to the huge population of over 240 million. Major challenges faced by PHS include inadequate funding, infrastructure limitations, inequitable resource allocation, corruption, brain drain of health professionals, excessive cost of healthcare in private sector, and limited focus on preventive healthcare. 

Government Budget Allocation 2024 – 2025

Let us first have a look at the budget allocation for health. It is a good time because the budgets have just been announced.

Federal Government

Pakistan population as per 2023 digital census – 249.5 million

After 18th amendment, health was devolved to provinces. Federal government now only caters for few institutions in Islamabad Capital Territory, and couple of other institutions elsewhere. ICT has recorded a population of 2.4 million in the latest census, and the health budget allocation is 27 billion rupees. 

Banner Project – Federal government has proposed to build a Quaid-e-Azam Tower at Pakistan Institute of Medical Sciences – PIMS, which will add to their infrastructure. 

Punjab Province

Population – 127 million

Health Budget – 539 billion, an increase of 24% over last year – per capital allocation: 4,244

410 billion for running the existing infrastructure; 129 billion for development. 

Personal Glory Project – 6 billion for Nawaz Sharif Institute of Cancer Treatment and Research Center – this is a random allocation for aggrandizement of Mr. Nawaz Sharif, without any feasibility for its establishment and long-term running.

Banner Projects – 55 billion for providing free medicines to outpatients at government hospitals, an activity of no-consequence. 1 billion for Nawaz Sharif Institute of Cardiology at Sargodha. 1.5 billion for emergency and trauma center at Jinnah Hospital Lahore. 200 million for a 100-bed Mother & Child hospital at Murree. 1 billon for PKLI – Punjab Kidney & Liver Institute. 1.3 billion for reconstruction of Lady Willingdon Hospital Lahore. 

Sindh Province

Population – 58 million

Health Budget – 290 billion, increase of 24% - per capita allocation: 5,000

General Hospital Services – 186 billion; Health Administration – 88 billion; Specialized Services – 16 billion

They have not yet announced any banner projects which they will certainly do later. Few weeks back, there was a news that Sindh government was going ahead with a high-tech purchase worth several billions despite resistance from all stakeholders; probably the other stakes were too high to ignore.

Khyber Pakhtunkhwa Province

Population – 40 million

Health Budget – 228 billion, increase of 13% - per capita allocation: 7,050

Sehat Sahulat Card – 39 billion; 11 billion for purchase of medicines related to SS Card.

Banner Projects – Rupee 1 treatment for entire population of KPK (read free treatment – impossible unless conditions are defined); Air ambulance service; Satellite centers of Peshawar Institute of Cardiology for southern districts.

Balochistan Province 

Population – 22 million

Health Budget – 67 billion, increase of 30% - per capita allocation: 3.045

Banner Projects – 5.5 billion for Balochistan Health Card; 582 million for cancer medicines; 2.8 billion for new machinery.

Government Purchases – Leakages and Wastages

Successive governments have experimented with various models of procurement to curb the menace of corruption (stated purpose) but have never achieved much. There was a time when the centralized purchase managers were happy with 5% under the table commission because it translated into enough money to keep all parties contented. But then greed got the better of them. 

There has been decentralization and recentralization, introduction of Public Procurement Authority, and detailed rules framed by them. However, as the number of stakeholders (read shareholders) increased, the percentage of commission went up. During Musharraf era of decentralized purchase, it went as high as 25-35%. Presently for bulk purchase, the cost is around 10%, while for individual institutions, it is between 15-25%. 

Purchase of medical equipment is an entirely different story. Due to various technical specification, the commission is calculated in number of rupees, not as percentage. 

You can safely assume that at least 15% of the budget is leaked into corruption and does not reach the patients and healthcare system.

Wastage is another serious issue. The institutions purchase some basic medicines, and many such medicines which are not for common use but offer good commission. Such products are purchased in big quantities and are later doled out lavishly to finish the stocks. No one is looking at it but the volume of medicines in institutions that expires every year is alarmingly large. 

Another form of leakage is stealing of medicines from the hospital stores by the staff and sold to the selective buyers in the market. Long time back, the government ordered that all hospital supplies shall be made in special packing, usually all green pack with Government Property printed in bold. It had some effect, but the ingenuity of our people finds ways. These medicines are now sold without covers, and only to dispensing doctors and unqualified practitioners in suburban and rural areas.

Sum Up

Governments at the center and provinces are trying to make bigger allocations and using other techniques to extend the benefits to the patients. The allocations are still very small as compared to other countries, but we understand our limitations, though we do not agree. Our biggest expense is government structure and its unbridled lavishness and luxury which must be reined in. Secondly, corruption is not limited to some officials, it encompasses all corners; top, right, left, center. Due to this fact, corruption shall never be rooted out, and certainly never by putting up banners and flexes on the roads and even in the offices. I have seen people taking bribe under the flex which says ‘Rishwat is Haram’. We have become immune to sermons and advice and threats of the Day of Judgment.

Healthcare is suffering and shall remain so, unless the change comes from the top. So far, no government had the courage or strength to do so.

Concluded.

Disclaimers: Pictures in these blogs are taken from free resources at Pexels, Pixabay, Unsplash, and Google. Credit is given where available. If a copyright claim is lodged, we shall remove the picture with appropriate regrets.

For most blogs, I research from several sources which are open to public. Their links are mentioned under references. There is no intention to infringe upon anyone’s copyrights. If, however, it happens unintentionally, I offer my sincere regrets.

Reference:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10548490/

https://www.dawn.com/news/1839731

https://finance.gos.pk/Home/Download?path=Budget%2FBudgetBooks%2FFY-24-25%2FVOLUME_I%2FVOLUME-I-%202024-25.pdf

https://www.quettavoice.com/2024/06/21/balochistan-budget-2024-major-boost-for-education-and-health-with-record-allocations/

https://www.samaa.tv/2087316369-budget-2024-25-rs-93-billion-allocated-for-education-sector

https://www.thenews.com.pk/latest/1192822-salient-features-of-kp-budget-fy25 

https://www.pakistantoday.com.pk/2023/05/22/pakistans-first-digital-census-records-249-5-million-population/