FeaturedNationalVOLUME 18 ISSUE # 28

An unhealthy state of affairs

Though all sectors of our national life have problems, Pakistan’s healthcare system, which forms the bedrock of a strong nation and progressing economy, is in a particularly bad shape. With a growing population, decreasing budget allocations, rampant corruption and poor governance, the health delivery system has gone from bad to worse with the passage of time.

The grim health situation has many dimensions. Among others, there is a lack of skilled healthcare workforce, the doctor-patient ratio is dismal, hospital beds are far short of the need and medicine prices are out of reach of the common man. While the private sector hospitals are too expensive even for the rich, the public sector hospitals are chock-full, with multiple patients lying on the same bed. These hospitals have insufficient supplies of essential medicines and medical equipment.

According to Transparency International, the health care system in Pakistan is one of the most corrupt in the world, with the majority of people totally dissatisfied with the clinical services available in the public sector. The sector is riddled with numerous flaws, including poor governance, a lack of access and unequal distribution of health facilities, an inefficient delivery mechanism and a shortage of qualified professionals.

According to a survey, every year there are 500,000 new tuberculosis cases, making Pakistan the 5th  highest sick country in this category. Around 12 million people suffer from hepatitis B and C, making Pakistan the worst affected country in the Eastern Mediterranean region. More than 250,000 children die in their first 28 days of life, with more children dying in Pakistan than in Afghanistan, Somalia, South Sudan, Mali and Chad. We also have one of the highest maternal mortality rates in the region. In 2022, Pakistan reported more than 3.4 million malaria cases. Malnutrition is widespread. Four children out of ten are stunted. The stunted kids have low cognitive development, leading to a loss in economic productivity.

There are many factors behind this sad state of affairs, but one major reason is low budgetary allocations for the health sector. Pakistan is even behind many African countries in its spending on healthcare. Worse still, a major portion of the meagre health budget is consumed by corruption.

It is not just a health issue we are facing. In a broader context it also affects our future survival as a nation. A sick or unhealthy Pakistan cannot claim its rightful place in the comity of nations. Taking a long-term view of the situation, we need to control the runaway growth in our population which nullifies much of our development gains we make every year.

As per expert medical opinion, by providing clean drinking water and improving sanitation, we can reduce the burden of infectious diseases by up to 70 percent. At the same time there is an urgent need to address malnourishment issues so as to raise a more healthy generation.

Above all, we need to improve the quality of our public hospitals – where the bulk of poor people go – in terms of staffing, medical equipment and supplies. The need is to improve their functionality so that they comply with the international quality standards of clinical governance and patient care and safety. In this connection a comprehensive plan should be developed to meet the shortage of skilled and qualified healthcare workforce, health informatics experts, and healthcare economists.

For lack of funds, little work has been done in the field of research and development. This gap should be filled without further delay. Simultaneously, steps should be taken to improve the infrastructure of the nationwide healthcare system for better delivery of clinical care.

A major weakness of the existing system is that millions of people living in rural areas have no access to public healthcare facilities. The tehsil and district headquarters hospitals are working in very poor conditions. Rural dispensaries are mostly dysfunctional, without medicines and staff.Because of the weak infrastructure of the Basic Health Units (BHUs) and Rural Health Centers (RHCs), the majority of people are unwilling to use their services. As a result, rural people mostly prefer to seek the help of hakims and quacks.

A new national health policy is the need of the hour. The formulation of a new policy must be preceded by a detailed audit of the present system so as to identify the problems and gaps needed to be filled. The body tasked with formulating the policy should make a detailed study of the healthcare system in the West as well as Japan and China which have set new quality standards in the health sector.

Among other things, the policy should focus more on preventative approaches by integrating the indigenous system and naturopathy which has been described as the future of medicine by a large number of medical experts and health scholars around the world.