Pakistan must work in cooperation with its global partners to improve healthcare
Our flawed healthcare system has been unable to deliver services that are methodically effective, acceptable, equitable and, above all, responsive to the ever-changing needs of the people
For dummies, having an efficient and up-to-date healthcare system is pivotal to a country’s future prospects. Subpar health impairs the human capital of a nation i.e. the availability and quality of the workforce (à la lack of education impairs skilled human capital). The WHO has declared worldwide universal healthcare (where financial inadequacy never hinders healthcare delivery) its ultimate objective. But are we even close to that chimerical state? Nigh, we have peaks to scale before we are even at par with the world in this sector. Our flawed healthcare system has been unable to deliver services that are methodically effective, acceptable, equitable and, above all, responsive to the ever-changing needs of the people. The success of any master plan to improve the situation depends solely on the priority that the government places on healthcare.
Before we begin, let’s proceed to some healthcare indictors. For reference, we have the relevant statistics for Turkey, a long-running socioeconomic partner that is steadily moving towards universal health coverage.
Comparing the health indicators of Pakistan and Turkey
| Pakistan | Turkey | |
| Expenditure on health (% of GDP) |
2.6 |
5.4 |
| Life Expectancy | 66.4 yrs | 75.8 yrs |
| Infant mortality rate (expiries per 1000 births before 5 yrs) |
55.67 |
18.8 |
| Maternal mortality (expiries per 100,000 births) |
260 |
20 |
| People per doctor | 400 | 750 |
| People per hospital bed | 1667 | 400 |
| WHO healthcare rank | 122 | 70 |
Pakistan lags behind Turkey in all indicators except the number of doctors. The terrifyingly high infant and maternal mortality rates are one of highest in the world, and demonstrate the dismal quality of health services provided in obstetrics and paediatrics. The relative abundance of doctors shows that medical education is relatively more popular in Pakistan. However, the reasons for this trend are mostly the prospective job security and financial returns medicine offers, rather than any true concern for social welfare. This notion is supported by the increasing commercialisation of doctors, who set up private practice to take advantage of the poor patients rushing to public hospitals. Using public hospitals as effective marketing platforms, such doctors refer these patients to their clinics/hospitals with the promise of speedy treatment. In private practice, they charge extravagantly for their services. This case is particularly common in primary and secondary healthcare, where doctors impair their professional integrity for all things shiny. Despite the large number of health personnel that are available, there is a need for more health professionals due to absenteeism and ghost health workers (especially common in the public sector). Besides this, there is a general imbalance in the health workforce (insufficient health managers, paramedics, nurses and skilled birth attendants), as well as a growing disparity in the quality of medical healthcare provided in urban and rural areas. Health professionals generally prefer practice in cities where better job descriptions are available. There is a lack of highly specialised and competent health professionals as many of them leave to start practice abroad, contributing to the growing brain drain (Pakistan is the 4th highest source of foreign doctors in the US).
The lack of specialised facilities for specific cancers is hardly noticed by the general unaffected public because of all the publicity that SKMH has received in this regard. There are 21 cancer hospitals in Pakistan, which appears sufficient
Pakistan has a strong primary healthcare infrastructure that consists of Basic Health Units (BHUs), Rural Health Centres (RHCs) and dispensaries, with the lady health worker program providing home delivery of services. However, this system is highly mismanaged, and corruption is rampant. There is also a lack of specialised clinics for particular diseases e.g. TB, dengue, diarrhoea, hepatitis, malaria, etc. Community oriented medical education is provided at too small a scale to enhance collaboration between the healthcare system and the populace. This, along with unsatisfactory funding from provincial health departments (only 2.6pc of GDP in total, compared with the 9.94pc global average), has resulted in our healthcare system being ranked 122nd by the WHO. Successive governments fail to understand that the cost of poor healthcare delivery far outweighs the cost of establishing an improved system. The subpar public sector means that more than 80pc of outpatient visits are handled by the private sector, which charges patients extravagantly.
Healthcare in every case has two dimensions: prevention and treatment. An important aspect that improves preventive healthcare programs is inter-sectoral collaboration, for example the development of community oriented medical education with the cooperation of the education ministry to improve disease-related awareness, making welfare activities compulsory at all levels, encouraging a holistic admissions approach with emphasis on community work and empowering women to curb sedentary domestic lifestyles, etc. In Pakistan, inter-sectoral cooperation for improved healthcare is limited to textbook illustrations, small-scale programs and occasional use of the media. Other preventive measures are non-existent.
As a result of the lack of preventive measures and specialised healthcare professionals, there is a growing epidemic of non-communicable diseases such as hypertension, diabetes, cardiovascular diseases, cancer, etc. Pakistan ranks high in terms of obesity rates: 22.2pc of 15+ population is obese (BMI> 25.7). Pakistan also has the highest rate of diabetes in South Asia. According to the Obesity Task Force, misplaced concepts of health and beauty, reliance on fatty and nutrient deficient food, decrease in activity and increase in stress levels associated with today’s competitive environment are the major factors leading to individuals being overweight, obese and finally patients of cardiovascular diseases. Pakistanis are at an even higher risk of suffering from CVD than others. As per a study conducted way back in 2011 at the McMaster University, South Asians find fat more dangerous as fat tends to be more visceral rather than subcutaneous. The lack of specialised endocrinologists is slowly turning diabetes into a universal disease in Pakistan. The country also ranks high with regards to the number of people who smoke. 46pc of men and 5.7pc of women smoke regularly. This has led to a high incidence of lung cancer, chronic obstructive lung disease and asthma. As much as 100,000 people expire annually due to lung cancer alone. Strong legislative measures are in place to deter smokers, but these are rarely enforced.
The lack of specialised facilities for specific cancers is hardly noticed by the general unaffected public because of all the publicity that SKMH has received in this regard. There are 21 cancer hospitals in Pakistan, which appears sufficient. However, most are general cancer hospitals, which lack the scale to treat a growing body of cancer patients. Pakistan has high mortality rates from breast and cervical/ovarian cancers. Breast cancer claims approximately 40,000 lives annually, while cervical cancer took 7,300 lives in 2015. While steps are being taken to develop a strong early detection network for breast cancer under the banner of various NGOs (the Pink Ribbon Campaign is working on the first specialised cancer hospital in Lahore), there are next to no steps being taken for ovarian/cervical cancers and lung cancer. In most cases, a survival rate of more than 90pc can be achieved through early detection and intervention, which will also reduce treatment costs. Specialised cancer clinics with attached hospitals are the need of the hour.
Pakistan must work in cooperation with its global partners to improve healthcare. The recent steps taken to benefit from the Turkish healthcare model through training of health professionals bodes well for the situation. Measures are needed to collaborate with international medical associations and medical schools to train professionals along international standards. There is also a need to reform medical education to make it more viable for Pakistani medical graduates, who otherwise prefer practicing abroad. NGOs have to take steps to complement the government. The dearth of institutionalised social security measures has greatly hindered the ability of the common man to afford qualitative treatment. Our feeble economic situation and tax evasion practices are greatly to blame for this, but recent steps taken by the government, with the introduction of the Prime Minister’s National Health Programme, show a genuine will to go down that lane. At the moment, only eight classes of diseases are covered by priority interventions. There needs to be a gradual increment, both in the range of interventions covered and the scale of this programme. The ultimate goal should be complete independence of treatment from financial factors.
The writer is a freelance journalist