Adeela Khan
Honesty, credibility, accountability, sincerity, modesty, rationality, creativity, and commitment are the characteristics of a nation poised to rise. History shows that Muslims of early ages were far better than their contemporaneous nations in upholding these qualities. They established institutions to serve humanity in realms of science, technology, medicine, business and welfare. All of their endeavours were focused on the beneficence of a common man. At this point the whole nation is hoping that these long-lost qualities and characteristics will be revived by the newly elected government. There is an expectation that the newly elected government will not fall prey to obsession with optics as was the case in previous governments. Priorities will be streamlined to ensure growth in all sectors including health, education and technology thereby enabling Pakistan to outperform others and grow in leaps and bounds.
The Constitution of Pakistan (1973) does not explicitly recognize health as a basic human right rather it is a privilege given to the people of Pakistan by the state. However, the right to life is recognized as a fundamental right. The state is duty-bound to provide safeguards and an enabling environment to allow an individual to lead a secure and healthful life. Protection from diseases that cause death and disability is therefore an obligation of the state.After the 18th Constitutional amendment of 2011, health care is mainly the responsibility of Provincial Governments, except in the territories administered by Federal Government. The planning and formulation of health policies is dealt by Federal Government and the Provincial Governments have the responsibility to ensure proper implementation of the policies. The absence of a clear policy in health is one of the main reason for the staggering health of the nation.
Unfortunately health has never been a priority for the previous governments in 70 odd years of Pakistan’s history. It is a painful fact that cosmetic measures were taken merely for optics with no impact what so ever. Dialogue about issues pertaining to health has never enjoyed primary importance in the political agendas and has always had a considerably lesser priority during the reins of two main conventional political parties of the country that have governed the country most of the period when civilian dispensations were in place in the country.This lack of realization regarding health’s role in overall growth of the nation has been linked to lower allocations of public funds for healthcare. Since the inception the healthcare sector in Pakistan has received financial allocations which were way lesser than the WHO recommendation of 2-5% of the GDP.
While examining the challenges in the health sector, we see overcrowded tertiary hospitals, under-utilized primary healthcare units, atrocious quality compromises in the services provided, shortages in healthcare workers, corruption and collusion in regulatory agencies, governance challenges, and tenuous relationships between Federal-Provincial health agencies. Unfortunately, the heath sector mirrors the overall state of governance in Pakistan. Country’s social development and health sector go side by side. The social determinants have a major impact on the health of the nation. The main issues relevant to health in Pakistan are population explosion, poor education, unemployment leading to low socioeconomic status of people, poor access to nutrition, lack of safe water supply and poor sanitation which have a direct effect on the health of the people. The effect of these social determinants are compounded by a weak and unresponsive health system giving rise to poor health indicators of the people of Pakistan. The major reason for the weakness of the health system is lack of financial resources, limited access to the primary health care, poor management capacity, corruption and absence of accountability.
The results of this situation are dreadful. According to the statistics, the infant death rate is 66/1000 live births as compared to that of 38 in India and 8 in Sri Lanka; at the same time, maternal mortality ratio is around 178/100,000 live births; Pakistan has the third highest number of children with stunted growth.A vast majority of women in the country suffer from anaemia and malnutrition which is quite dangerous during pregnancy. Malnutrition is widespread among all ages, and progress to address social determinants over the last several decades had been very slow. According to the National Nutrition Survey 2011, one-third of all children are underweight, nearly 44 % are stunted, 15 % are wasted, half of them are anaemic and almost one-third of these children have iron deficiency anaemia. Behind these depressing figures, there are a number of heart wrenching facts that have ruined lives of hundreds of people due to unavailability and unaffordability of health care services. It is also pointed out by the health indicators that there is a considerable lack of healthcare facilities and where these facilities are available, they are not accessible to the most vulnerable groups like women due to social, cultural and economic barriers. Pakistan ranks sixth among the 22 high TB burden countries. About half of TB patients remain undetected due to flaws in the systematic screening. Pakistan has an ever-increasing cases of drug resistant TB with estimated annual cases of around 14,000 among notified pulmonary TB cases again pointing out flaws in regulation and standardization of diagnostics and services. TB has been put on the agenda of 73rd United Nation General Assembly due in October this year. The deliberations in the General Assembly meeting will set the course of response against TB in developing countries. Pakistan is one of three countries where polio is still endemic, however very recently significant successes have been achieved with only three cases this year, all from the same district. Communicable disease outbreaks are rampant and non-communicable diseases are on the rise. All this is due to absence of an integrated disease surveillance and response mechanism. Individual surveillance mechanisms are there for the vertical programs but an integrated system is a dire need for effective disease control and decision making. Another shocking fact is that the previous regimen has been spending only 0.9% of its net GDP on health.
The ‘health vision’ of the new Prime Minister includes a strong commitment towards health. During his five-year tenure the aim should be a 100 per cent improvement in coverage by the public sector, a paradigm shift towards preventive healthcare, reduction in the burden of communicable and non-communicable diseases through sustained preventive programmes, increasedhealth allocations to at least 3% of the GDP, decentralized and depoliticized health governance, prioritized primary healthcare and development of a robust and reliable health information system for evidence-informed planning and decision-making.The ‘health vision’ must be aimed at achieving the sustainable development goals relating to maternal, neonatal, infant and child mortality, a fully devolved national health governance system with solid links to the community.It will sustain a robust primary healthcare network in rural areas and ensure availability of safe drinking water and sanitation facilities across rural and urban Pakistan.The new vision must also envisage strengthening the regulatory authorities with regard to medical services and provision of quality and affordable medicines to the masses. Health protection and promotion through behavioural change communication and adequate environmental safeguards need to be a priority. There is an urgent need to expand the health insurance net to include the entire country and efforts are neededon a fast track basis.
A starting point would be recognition that being an agrarian population, Pakistan’s nutrition indicators and progress towards improving maternal and childhood nutrition is way behind others in the region. This is related to lack of focus on implementing quality programs and addressing disparities. Bringing health and nutrition services closer to women and children and addressing social determinants, such as poverty and women empowerment would make the difference.The foremost task for the new government should be to introduce good governance, transparency and across the board accountability, the most fundamental prerequisites for any reform effort to succeed. Without fundamental freedoms -political, social, and economic – the people of Pakistan could hardly attain their full potential. Pakistanis require political freedoms, economic facilities, social opportunities, transparency guarantees, and protective security to break the cycle of corruption and underdevelopment. Unadulterated democracy coupled with a credible investment in the social sector, are essential steps if the country is to move forward.
At the helm of affairs at the Ministry of National Health Services, Regulations and Coordination we have new leadershipwhich is dynamic, committed, zealous, determined and resolute to bring a positive change in the health of people of Pakistan. They are in line with the vision of the new Prime Minister and have the experience of years of struggle for the rights of the masses. One can hope that given these credentials the new leadership will make an all-out endeavour to realize the vision of the new Prime Minister as passionately elaborated by him in his maiden address to the nation.
The writer is a Public Health Specialist, Anthropologist and Human Rights Activist based in Islamabad.
