Health policy reforms 

  • The right way 

Health is a state of complete physical, mental, and social well being, and not merely the absence of disease or infirmity. Health starts from daily routines to medical facilities, the health standards are often deemed and attributed to heavy lofty fees charged by the medical practitioners. Actually health policy is a set of values and commitments that are formulated keeping in view the scenarios from the past in order to overcome future challenges. Article 24(3-a)(e-i) of constitution discuss public health and medical aid. Unlike 115 countries of the world, the Constitution of Pakistan does not explicitly recognise the right to health. The preamble to the Constitution and its Principles of Policy refer to  socio-economic rights but courts cannot enforce these. However, courts in Pakistan have previously handed down progressive decisions in public interest through the application of an expansive definition of ‘right to life’.

Keeping in mind the policies from 1950s to the present day many  goals could not be achieved. The reasons behind the failure of making effective health policies is that the policies are being formulated at the apex and are then being asked to be executed at grass root level. It is a principle of change that whenever any change is settled to be brought up, the major stake holders are taken on board and grass root level is indulged otherwise that change is supposed to fail. In fact the policies should be made from the grass root level as norms and cultures vary from place to place and area to area.

Pakistan had committed to achieve health for all, reduction in infant mortality rate and maternal mortality ratio that still linger to the present date. The reason behind this is that there are many areas of reforms that never get fulfilled for example incidence of prevalence, incidence includes new cases in one year whilst prevalence includes the previous cases. Taking into account the communicable infectious diseases, such diseases were supposed to be reduced down but that also could not be attained. Pakistan is ranked 7th out of 50 countries with 7,311 cervical cancer deaths. There is lack of equalities both at primary and secondary health care services that still need to be addressed.

Managerial deficiencies alsi need a lot of thought; obviously a physician cannot perform surgery. In the same way public health needs consideration the public health departments and projects must be headed by public health specialists. Government has the responsibility that awareness should spread about public health by constituting health care boards as in developed countries.

In Pakistan, all these factors – demographic, epidemiological, economic, political and systemic – stress the need for health sector reforms

Poverty reduction strategy paper states firstly to shift expenditure from tertiary care to primary and secondary level in field of health. Secondly shift from curative to the side of promotion and prevention is needed. Thirdly priority focus should be on backward and underdeveloped areas particularly in rural areas. The deaths of neonates and early neonates in Thar are linked directly to the poor health policies and strategies along with reluctance in their execution by the government.

Pakistan has a very good infrastructure there are more than 5000 basic health units, local doctors and clinics are present in the local vicinities but unfortunately due to poor management and lack of interest they are not functional. The health sector can improve a lot if only these local basic health units are properly systemised. This can not only reduce the work load at the hospitals but can also bring speedy reforms in the field. Consider a doctor checking and diagnosing 200 patients a day in working hours at a tertiary government hospital. If the doctor gives five minutes to a single patient which actually is below average time checking pulse, taking history the total time for 200 patients comes beyond the working hours. Under such circumstances it is not the facility but perplexity towards the patient. If basic health units are made functional a lot of load can be put down from the referral hospitals.

If the government is keen to improve health and its indicators health houses should be improved. Lady health workers can play a pivotal role in improving the health at grass root level as they have knowledge of the local area and individual houses. In 2009 a term was coined by then E.D.O Health Dr. Aqeel Khan (UNFPA nominee), district Muzaffargarh using scraped ambulances as “Health Mobile Units” granting door to door health facility.  Later 22 wheeler trucks were used by PML-N which became static instead of mobile and were of no use as their access was limited, expensive and did not fulfill the required task.

Behavioural factors at the hospital and other health facilities is another main concern to be addressed while formulating health policies. The patients are mostly humiliated at the hands of para medical staff, doctors and vice versa. The security must be ensured at both sides. Regulation has always played an important role, complaint boxes must be set up at all the levels of the health facilities which should be monitored by district health administrations.

If the goals of health sector reforms are to be achieved the technical and allocative efficiency of the health care system be dealt accordingly, enhancement of the quality of services be ensured and the systems should be made more equitable. It has numerous dimensions – from financing to organisation of services to the package of services to be delivered. Depending on the circumstances, health sector reform may encompass one or more of these dimensions or all of them simultaneously. In Pakistan, all these factors – demographic, epidemiological, economic, political and systemic – stress the need for health sector reforms.