Healthcare Landscape in Pakistan – General Information – Asrar Qureshi’s Blog Post 976

Healthcare Landscape in Pakistan – General Information – Asrar Qureshi’s Blog Post 976

Dear Colleagues! This is Asrar Qureshi’s Blog Post 976 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.

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Healthcare is among the basic rights granted by the constitution. UHC – Universal Health Care is among the Sustainable Development Goals of United Nations, and Pakistan is also a signatory to the SDGs. Successive governments have had a lukewarm attitude towards healthcare and did not go beyond announcing few new projects for public consumption. The most recent and successful effort was Sehat Sahulat Program by the last government. Please ignore politics for a moment. The program, in its design and spirit, was excellent but did have issues in execution, mainly related to corruption at individual and institutional level.

I shall write in some detail about the major aspects of healthcare and its key players. Each blog post shall be complete in its content but linked with the main topic of healthcare. This post gives basic information about healthcare in Pakistan.

Pakistan population now stands at over 240 million. According to Institute of Health Metrics and Evaluation, the population shall keep rising till 2060 and shall reach 310 million. It will then start declining (reasons not given) and shall stand at 248 million in the year 2100. This is what the statistical model predicts.

Life expectancy shall keep rising steadily with average of 75 years for males and 75.4 years for females.

Fertility rate was somehow at its highest in the year 1990: it was 5.9%; in 2021, it came down to 3.2% and in the year 2100, it is forecasted to be 1.2%. This is the reason of decline in population after the year 2060. 

Spending on healthcare is US$45 (12,500 rupees) per capita per year. Out of this, 7,250 rupees are spent by the patients from their pocket while 3,500 rupees are spent by the government. Please do not get deceived by the per capita spending statistics. In reality, a major portion of government healthcare budget is consumed by the VIPs and another major portion is consumed by corruption. Stats about future spending are presently irrelevant because of extreme economic turmoil of present times. The government is hellbent on providing extraordinary benefits to its allies, cronies, and plunder-sharers while the public is being fleeced for the last drop of blood. 

The number of registered medical practitioners (doctors) is around 270,000 which is one doctor for about 900 people. There are about 30,000 dental surgeons which is one dental surgeon for 8,000 people. Even these figures are misleading because the concentration of doctors is much higher in the urban areas as compared to rural areas. So, if one doctor is available for 300 people in a major city, the ratio maybe one doctor for 2,000 people in the rural areas. 

In addition, there are thousands of unqualified, unregistered practitioners who run full time clinics in all cities, including the major cities. They are illegal but they are a great help to common people who can get healthcare at low cost through them. They treat common ailments and quite successfully. One such practitioner once made a claim to me which is worth quoting. He said, “80% diseases are such which will go away with nominal or minimum treatment. It does not matter whether we treat them, or a qualified doctor does so. 20% diseases are untreatable and qualified doctors or us will not be able to treat those. So, what’s the fuss about?” 

There are about 5,600 Basic Health Units (BHUs), 750 Rural Health Centers (RHCs), and 1,280 hospitals run by the government. Private sector is running over 700 hospitals.

Pakistan has also seen rapid rise in private medical colleges, along with their hospitals as a mandatory requirement. Around 32,000 medical graduates are being produced every year, but it is not helping the healthcare system to that extent because many opt to go abroad, and majority of the female doctors do not practice medicine.

The private hospital market in Pakistan is forecasted to achieve a revenue of US$ 5.7 billion in 2024 – 1,600 billion rupees. Compared globally, the US hospitals are expected to generate US$1,500 billion in 2024. The projected annual growth rate from 2024 – 29 is 4.33%, which will result in a market volume of US$7.07 billion – 1,970 billion rupees. The hospital market is experiencing a surge in demand for specialized healthcare services due to aging population.

There is one hospital bed for about 1,200 people in Pakistan, considering that 200,000 beds are available. The nurses work for 8 hours a day and that means 600,000 beds allocation over 24 hours. 2024 US Guide for the State of California states the following nurse-to-patient ratios in hospitals:

• Critical care unit – 1:2

• Labor and delivery – 1:2 

• Post-delivery area – 1:4

• ICU Newborn – 1:1

• Emergency department – 1:4

• Critical trauma – 1:1

• Psychiatric units – 1:6

The list goes on, but the fact is that we are nowhere near this requirement. Private hospitals are worse than government hospitals in nursing area. They do not hire fully qualified nurses and never in enough number.

Nursing, even otherwise, is facing acute shortage due to expansion in hospitals, there are just about 125,000 nurses which is half that of doctors. New nursing schools have not opened at the same rate. Demand for nurses is high worldwide and many nurses leave for abroad. In Pakistan, the nurses profession has not yet gained acceptance as a regular profession for all tiers of society. 

The same is true for midwives and lady heath workers, who are also in short supply. The government hired hundreds of leady health workers temporarily for vaccinations, polio campaigns etc. but they do not have any job structure or advanced training.

The way the patients are treated at the hospital, both medically and personally, is another heartbreaking story. Some health indicators are given below to make the point.

• Maternal Mortality Ratio (per 100,000 births) – 186

• Neonatal Mortality Ratio (per 1,000 live births) – 40

• Under-5 Mortality Rate (per 1,000) – 65

• Births attended by skilled staff – 69%

Healthcare is a complex field for every country. Growing needs due to new diseases, evolving treatments, and rising population are just some of the major variables. In addition, we have insufficient funding, corruption, inadequate workforce and infrastructure. Lack of government funding, focus, and support are further aggravating factors. 

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.healthdata.org/research-analysis/health-by-location/profiles/pakistan

https://www.pbs.gov.pk/content/national-health-accounts

https://data.worldbank.org/indicator/SH.MED.PHYS.ZS?locations=PK

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

https://www.statista.com/outlook/hmo/hospitals/pakistan