How To Improve The Current Healthcare Issues In Pakistan?

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Pakistan is the 6th most populous country in the world, with 64% of it residing in the rural areas. The requirement healthcare reformation has been persistent for decades and the healthcare industry is in need of revolution, if not evolution. Previously, the health service system was under the direct jurisdiction of Federal Government, however, after the 18th amendment issued on April 8, 2010, it was handed over to the provincial governments. In order to reform the sector and draw focus on both the policy-making and implementation of the projects except in the federally administered areas, this change was introduced. Presently, the burden of regulating and monitoring the delivery of healthcare services, research on health problems and their possible solutions, participating in international conventions fall under the umbrella of the Federal government. On the other hand, the provincial government is responsible for devising health policies, planning and implementation of the health services and drug control.

Spending in the health sector of Pakistan has long been debated and is the lowest proportion in comparison to other developmental sectors. As of 2014, the spending as percent of Gross Domestic Product was 2.61.[1]

Partly due to the lack of economic resources as well as the attention given to the industry by the government of Pakistan, the current healthcare issues in Pakistan are numerous and increasing with every day passing. Some of these issues have recently been highlighted and the efforts are being conducted to mitigate them. However, we have a long road ahead of us before the healthcare industry of Pakistan comes at par with the countries of the world.

Healthcare System of Pakistan

The healthcare system of Pakistan is a three-tiered system including primary, secondary and tertiary care delivery systems falling under the mixed public-private healthcare delivery system.[2] The responsibility of designing national health policies lies with the Federal Government. However, according to the Constitution of Pakistan's 18th amendment, healthcare came under the responsibility of provincial governments excluding the federally administered territories. Furthermore, the Ministry of Health is also responsible for introducing programs on the treatment of AIDS, malaria and immunization. According to recent statistics, there are 205,254 doctors in Pakistan, 7 million doctor-patient consultations per day and 112,775 patients visit per year to 1 doctor, highlight the growing demand and supply.[3] However, the problem lies in the medium of communication between the two groups and the lack of access riddling the present context. The description of the Pakistan's healthcare system below will be able to highlight further gaps in the information and the resources available.

Primary healthcare system

Primary healthcare refers to the routine low-cost and standardized healthcare services offered by any healthcare provider or institution e.g. community health centers which are sufficient to provide effective diagnoses and treatment of a large proportion of illnesses.[4] These services prove to be the platform for continuous medical services that may be provided to the patient till he/she requires specialist care or advanced medical facilities. General and nurse practitioners are some of the professionals involved in the provision of primary healthcare services.[5] The primary healthcare services are regulated through Basic Health Units (BHUs) and Rural Health Centers (RHCs).[2] Maternal and Child Health Centers (MCHCs) are part of overall health. The MCHCs, BHUs and RHCs are able to provide the healthcare services through the lady healthcare workers of the community outreach programs.[6]

Secondary Healthcare System

Secondary Healthcare system refers to the healthcare services that are specifically provided by medical specialists e.g. cardiologists, urologists, psychologists, dermatologists among others.[7] Often it includes the services that can be annotated under the broad category of hospital care or acute care. They refer to the required treatment to a serious illness, generally for a limited time period, and where the doctor has no prior contact with the patient (not necessarily). However, the services are not restricted to the hospitals and are offered at private clinics by physiotherapists, psychologists etc. In Pakistan, the secondary healthcare services are regulated through Tehsil Headquarter Hospitals (THQs) and District Headquarter Hospitals (DHQs), which are further supported by tertiary care normally through the channel of teaching hospitals.[2]

Tertiary Healthcare System

Tertiary healthcare services are defined to be consultative healthcare usually prescribed for inpatients or on referrals from primary or secondary health professionals. The tertiary delivery systems are equipped with personnel and facilities necessary for carrying out advanced medical investigation and treatment. The examples of tertiary care services include cardiac surgery, plastic surgery, treatment of burns, palliative and cancer management.

Current Health Issues of Pakistan

If you ask an average Pakistani, what is one thing without which their survival is impossible after food and shelter? Almost always they will chant without even a shred of thought, health. The one thing we seem to be in constant lack of owing to our social, political and economic instabilities. The healthcare industry lacks both infrastructure as well as a possible direction for development. Furthermore, there are a list of diseases over-powering the health status of Pakistan. According to Transparency International's National Corruption Perception Survey of 2009, it was the most corrupted sector of Pakistan and therefore the hope for development latches on to a very fine thread of hope and prayers.[8] Currently, Pakistan ranks with a score of 30 worldwide in overall corruption level.[9] Therefore, the current health issues of Pakistan are spread from the gaps in administrative health policies to the control of diseases and their possible effective prevention methodologies.

But then there is an Arabia proverb which says ‘He who has health, has hope; and he who has hope, has everything’. In the year 2015, Pakistan was unable to achieve its Millennium Development Goals (MDG4) with respect to the health sector due to constant occurrence of natural disasters, political instabilities and lack of persistent and sustainable initiatives from leadership and the private sector. The under-five child deaths were to be reduced to 46-per-1000 from 86-per-1000, however, which remain to be static.[10] These statistics represent the progressive development that can be attained in Pakistan after significant changes in both the healthcare policies and the organizations responsible for devising the policies.

The scope of the services of the primary healthcare system in Pakistan is yet to be defined. The functional capabilities of any primary healthcare system should include availability of recommended vaccination programs for the population and educating the common people around the health facility about the prevailing diseases, how to avoid them and what to do if you have been diagnosed.[11] These areas of medical facilities are missing from the majority of the primary healthcare facilities of Pakistan due to the lack of consistent pressure from the leadership and the policy-makers. Furthermore, the current population of Pakistan presents itself to be the one riddled with superstitious beliefs and superficial theories, preventing them from utilizing the complete benefits of the available basic health services.

Vaccination against polio/ measles and Jharru waley Amil Babas for epileptic and mentally disturbed people are two such controversial topics that are trending the narrow-minded thoughts of the populace of Pakistan. Prime Minister's Task Force, PM's Focus Group for Polio Eradication and the National Steering Committee are directly overseeing and reviewing the implementation of the National Emergency Action Plan (NEAP) 2015-16 eradication strategy. The strategic approach aims to increase the quality of all polio eradication activities, increase the access and reach of the general populace, tracking and vaccinating continuously missed children, expanding upon the existent community protected vaccinations, monitoring performance and accountability at all levels and implementing the outbreak response strategy.[12] The quarterly review published by National Emergency Operations Centre Islamabad in November last year reflected that there are now 4 epidemiological zones concentrated with the virus and they include Peshawar/Khyber corridor, Quetta, Karachi and Central Pakistan blocks. There have been 50 confirmed cases of wild polio virus in 2015, showing a decline of 84% compared to the preceding year. Furthermore, the number of infected districts have reduced from 40 to 21 in 2015 along with the number of inaccessible children from 57,000 to 35,000. With the decreasing prevalence of the polio virus, there have been decrease in the overall performance of the union councils, below the target set by NEAP. Therefore, great efforts have been initiated by the government of Pakistan in this regard, however, much needs to be still done in order to overcome the influence of the narrow-minded people and their conspiracies when it comes to the administration of polio vaccines and other possible hurdles.

Furthermore, there is a lack of awareness in the general population regarding the availability of doctors and specialists in various areas of the country. At numerous occasions, media and other sources have been able to identify that there are two extremes of the magnitude of the traffic present at the doctors. Either the doctors are booked with appointments for months on end, or they are unable to advertise themselves for gaining more attention of the patients requiring their services. An alternative to approach this problem using technology has been proposed by a start-up, Marham – Find a Doctor, working for social cause at this point in time. The patients are able to locate doctors relating to a particular specialty in the vicinity using the application. They can further book an appointment using the platform and provide their feedback about the services of the doctors after their visit.

In cases of floods and droughts, little relief services are available to cater to the health needs of the people in crisis. Besides, the awareness of the general population is also a burden the Pakistan healthcare industry needs to cater to. Pakistan Red Crescent Society caters to the relief activities during calamities[13] and Health and Education Development Organization is an NGO which works on providing services of health and education for the poor and needy people in Pakistan.[14] Furthermore, due to recent outbreaks of cholera and polio, numerous non-governmental organizations have arose to cater to the healthcare services and promote eradication movement through the areas of Pakistan.

All in all, in order to overcome the plethora of current healthcare issues faced by Pakistan, a holistic approach is needed to mitigate the risks at each hierarchy of the healthcare industry catering to all the emblems of the system. Promise has been made by the government to provide for the missing links in the system and to institutionalize the missing departments for implementation of the healthcare policies devised to date.[15] However, we as local citizens of the country must be bent on solving the routine health issues that we come into contact with, while the government remains to focus on strengthening the policy basis of healthcare industry.

References

  1. "Pakistan Health spending as percent of GDP - data, chart | TheGlobalEconomy.com". http://www.theglobaleconomy.com/Pakistan/Health_spending_as_percent_of_GDP/. 
  2. 2.0 2.1 2.2 "Pakistan Home". http://www.worldbank.org.pk/WBSITE/EXTERNAL/COUNTRIES/SOUTHASIAEXT/PAKISTANEXTN/0,,content%20MDK:20131431~menuPK:293059~pagePK:141137~piPK:141127~theSitePK:293052,00.html. 
  3. "Pakistan Medical & Dental Council > Statistics". http://www.pmdc.org.pk/Statistics/tabid/103/Default.aspx. 
  4. Waheed, Mr. Shahzad. "WHO EMRO | Health system strengthening | Programmes | Pakistan". http://www.emro.who.int/pak/programmes/health-system-strengthening-hss.html. 
  5. "PSQCA -Pakistan Standards Quality and Control Authority". http://psqca.com.pk/test2/index.html. 
  6. "She may reach a facility but will still die! An analysis of quality of public sector maternal health services, District Multan, Pakistan". http://jpma.org.pk/full_article_text.php?article_id=654. 
  7. "Dictionary and Thesaurus | Merriam-Webster". http://www.merriam-webster.com/dictionary/secondary%2520care. 
  8. "National Corruption Perception Survey TI 2009". Transparency International - Pakistan. 2009. http://www.transparency.org.pk/documents/NCPS%202009/NCPS%202009%20%20Report.pdf. 
  9. e.V., Transparency International. "Transparency International - Country Profiles". http://www.transparency.org/country/#PAK. 
  10. "Millennium Development Goals". http://www.pk.undp.org/content/pakistan/en/home/post-2015/mdgoverview.html. 
  11. "Primary Health Care Services Concept , Situation and problems in Pakistan - Health Care System - Medicine Pakistan". http://medpk.com/index.php?topic=258.0. 
  12. "Eradication Strategy" (in en-US). http://www.endpolio.com.pk/polioin-pakistan/eradication-strategy. 
  13. "Pakistan Red Cresent". http://prcs.org.pk/prcs/. 
  14. "Health and Education Development Organization". http://www.haedo.org/. 
  15. "‘Primary, secondary healthcare being improved’". https://www.thenews.com.pk/print/126655-Primary-secondary-healthcare-being-improved. 
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