Healthcare Landscape in Pakistan – Facilities for Disabled – Asrar Qureshi’s Blog Post 983

Healthcare Landscape in Pakistan – Facilities for Disabled – Asrar Qureshi’s Blog Post 983

Dear Colleagues! This is Asrar Qureshi’s Blog Post 983 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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World Health Organization – WHO – states that people with disabilities, throughout the life course, have unequal access to healthcare services, have greater unmet healthcare needs, and experience poorer levels of health compared with the general population. As a result, people with disabilities have poorer health outcomes than the general population. 

People with disabilities frequently experience preventable diseases and report high incidence of risk behavior such as obesity, smoking, and physical inactivity. It means a parent or spouse who could potentially be contributing income to the family is taken away from this role. It also means potential catastrophic health expenditures that can drive individuals and their families to poverty.

UN Convention on the Rights of Persons with Disabilities states, “Persons with disabilities include those who have long-term physical, mental, intellectual, or sensory impairments, which, in interaction with barriers, may hinder their full and effective participation in society on an equal basis with others”. More than 270 million – 15% of population in the Western Pacific Region – experience disability. 12% of US population are people with significant disabilities.

Who are the People with Disabilities?

An article published in American Journal of Public Health defines people with disabilities in this way. [Quote] Some people are born with a disabling condition (e.g., Down syndrome) or demonstrate a condition early in life (e.g., autism, bipolar disorder), whereas others acquire disabilities through injury (e.g., spinal cord injury) or a chronic condition (e.g., limb loss because of diabetes), and still others develop a disability in later stages of life (e.g., dementia, age-related mobility disability). The health needs of people with disabilities vary with the type of limitation (e.g., mobility or cognitive) and by the condition underlying the disability (e.g., spina bifida, Down syndrome). For some, such as people who acquire disability through injury, the nature of their disability can be differentiated more readily from their health status. For others, their health status may directly lead to their disability (e.g., diabetes leading to limb loss and vision loss). Race/ethnicity, age, language, sex or gender, poverty, and low education can compound the impact of disability, leading to even poorer health and quality of life. People with disabilities are a diverse group who share the experience of living with significant limitations in functioning and, as a result, often experience exclusion from full participation in their communities.

In 2001, the WHO published a framework that integrated previous models of disability. This framework, the International Classification of Functioning Disability and Health (ICF) for adults (2001) and for children and youth (2007) has been adopted internationally and is useful for many public health purposes. In the ICF framework, disability is used as an umbrella term to include bodily impairments, activity limitations, or participation restrictions that relate to a health condition. [Unquote]

Standards of Healthcare for Disabled

The Seventy-fourth World Health Assembly adopted resolution WHA74.8(2021) on the highest attainable standard of health for persons with disabilities, which aims to advance the agenda of disability inclusion in the health sector, focusing on three key areas: access to effective health services, protection during health emergencies, and access to cross-sectoral public health interventions. The resolution requested the Director General to submit a global report on this topic for consideration by the Seventy-sixth Assembly.

This report consists of four main chapters; the third chapter outlines 40 actions, across 10 strategic entry points, for governments to take to address health inequities, with a focus on strengthening health systems. Link under References..

I would like to copy here the list of 10 strategic entry points (areas); 40 targeted actions may be seen from the report. 

1. Political commitment, leadership and governance

2. Health financing

3. Engagement of stakeholders and private sector providers

4. Models of care

5. Health and care workforce

6. Physical infrastructure

7. Digital technologies for health

8. Quality of care

9. Monitoring and evaluation

10. Health policy and systems research

Where is Pakistan on this Subject?

Social Welfare & Bait-ul-Mall department, Government of Punjab, gives this information.

Council on Rights of Persons with Disabilities (CRPD) is established under section 19 of the “Punjab Empowerment of Persons with Disabilities Act 2022”. The CRPD is a 28-member body headed by the minister SW&BM as chairperson. 

Under Section 27 of the above Act, Districts/Tehsils Assessment Boards in all districts of Punjab to assess the nature and extent of disability, and to issue disability certificate. Any person residing I the territory of Punjab, having disability, may apply for assessment and issuance of disability certificate on “Disabled Person’s Management Information System” – DPMIS. In case of any difficulty, they may visit the office of Medical Social Officer at DHQ and THQ hospitals. 

Under Section 24 of the above Act, District Welfare & Rehabilitation Units have been established in each district headed by the concerned deputy commissioner. Any person with disabilities who is assessed by Assessment Board and declared as ‘Not Fit For Work’ and having no source of income is entitled to get financial assistance from the DW&R Unit. Following facilities are also being rendered by the DW&R Unit.

• Free medical treatment

• Provision of free artificial limbs

• Provision of free wheelchairs, hearing aids etc.

• Employment opportunities through private establishments etc.

It is not known how much and what has been achieved with these activities. My basic objection is that through this Act, only beggary is being promoted.

Bangladesh

A study published in 2022 states that several strategies and policies are being implemented in Bangladesh to address the healthcare needs of people with disabilities, who comprise about 10% of the population. However, these measures are not adequate to provide accessible or friendly healthcare to the people with disabilities.

India

An Indian study published in 2020 states that census India reported the disability rate at 2.2% across all ages. The world report on disability showed that the prevalence in India was 24.9% among ages > 18 years. Several other local studies find various rates of disabilities across regions and age groups.

People with disabilities in India face many difficulties to access either general or specialized healthcare or rehabilitation services. Only about 15% living in urban and 3% in rural areas avail any form of rehabilitation services. Most significant barriers are lack of awareness of services, if any, cost of transportation, inaccessible physical building, and poor fitting of hospital equipment. 

Sum Up

People with disabilities form a sizeable portion of population in Pakistan. Our infrastructure is not designed to accommodate them, our buildings are not designed for them, our transport system does not support them, our public hospital facilities are either not designed for them or do not function if available. Social problems besides, the healthcare was not designed to accommodate people with disabilities, nor it is being upgraded to make it disability-friendly.

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.

References:

https://iris.who.int/bitstream/handle/10665/279966/WPR-2017-DNH-005-facilitybooklet-eng.pdf?sequence=1

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4355692/

https://apps.who.int/gb/ebwha/pdf_files/EB152/B152_23-en.pdf

https://swd.punjab.gov.pk/disabled-assessment_and_rehabilitation

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9490997/ 

https://journals.lww.com/ijph/fulltext/2020/64010/addressing_the_health_needs_of_people_with.16.aspx