A Rs 370 billion allocation has been made for the health sector in the Punjab for the forthcoming year. Rs 96 billion, out of this, is the developmental budget. Rs 78 billion has been allocated for specialised health services, medical care and tertiary care hospitals. Primary and secondary health have a share of Rs 17 billion. Finally, Rs 10.2 billion has been allocated for Covid-19 relief in Punjab. In addition, Rs 60 billion has been set aside for the health card scheme under the banner of universal health coverage. On Friday last week, the Khyber Pakhtunkhwa (KP) government announced its budget, with an allocation for health amounting to Rs 124 billion. An additional Rs 24 billion has been set aside for the Covid-19 relief fund. Sindh has set aside an amount of Rs 185 billion for its health budget with an expected 30 percent increase in this amount for the next fiscal year. There is also a Rs 2.3 billion fund for coronavirus emergency relief and a special grant of Rs 4.7 billion for its health department. Balochistan has set aside Rs 5.5 billion for health insurance in its budget.
The allocation for primary health care, particularly in the Punjab, is extremely inadequate. This sector covers services at district headquarters hospitals and hospitals in the periphery. The public dispensaries, basic health units, preventive medicine, communicable disease control, pre-natal health care and stunted growth are all included in the primary health care sector. The allocation for this sector in the FY 2016-17 was Rs 25, 799. Ever since the new government took over, the amount has been decreasing. In 2019, it was Rs 11 billion. Considering the high inflation, it was negligible compared to the amount set aside in 2018.
The priority, given the situation prevailing in the country, must have been primary health care. 38 percent of our children suffer from stunted growth. 53,000 children die in the first five years of their lives due to contaminated water. 5,000 women in Pakistan die every year due to obstetrical complications. Access to safe water supply remains a problem. The infant mortality rate in the country is the highest in the region at 55 deaths per thousand live births. 25 percent of the population lives below the poverty line earning - less than 2 dollars a day. Even in these circumstances the country’s spending on health is only 3.2 percent of the GDP ($43 per capita). It is the lowest in the region.
17 percent of the adult population (nearly 30 million people) suffers from diabetes mellitus type 2. 18 percent of the adult population suffers from hypertension. 6 percent of the adults in the country suffer from hepatitis. Almost 300,000 people are diagnosed with cancer every year. There must therefore be more spending on primary, secondary, and preventive health care. The focus should be not on building expensive hospitals with expensive health care. Population control is an imperative for a healthier population. Population growth rate in the Punjab remains alarmingly high (2.1 percent highest in the region). We have managed to increase our population nearly fivefold since 1950 when it was 25 million. With this kind of population growth rate no amount of allocations in the budget will be sufficient to overcome the increasing shortage of doctors, nurses and medical health facilities.
The health card programme is a good initiative in this situation. The Rs 60 billion allocation for this purpose and the promise of providing the entire population with this card by the end of December is a step in the right direction. This can enable the entire population to have access to primary and secondary care without increasing the pressure on public hospitals. A precursor of this scheme was launched in 2016 when similar cards were distributed in 11 districts home to largest low socio-economic indicator populations. The percent government has promised to provide the cards to all socio-economic backgrounds. This is a massive challenge. There is room however to question the desirability of including the upper socio-economic groups.
We have been unable to develop separate facilities to handle in-patient care for Covid patients. All big tertiary care hospitals were converted to Covid-19 hospitals, denying admission to all other patients and shutting down out-patient departments. Instead we should have developed smaller separate hospitals in cities like Lahore. Thousands of patients have lost their lives due to complications of cancer, lung diseases, abdominal diseases, and trauma cases in their homes after being denied timely treatment.
Our dependence on the Chinese Covid-19 vaccines has increased. The vaccines have not been approved in other parts of the world including Europe and Saudi Arabia. This can be a problem in the future for expatriate workers. The government should either invest in providing approved vaccines such as Pfizer and AstraZeneca or allow the private sectors to provide these vaccines.
The funds allocated are not being provided on schedule. This means that at the end of the fiscal year some of the budgetary initiatives will lapse. The government must focus on spending on on-going projects rather than beginning new projects. The MTI Act (Medical Teaching Institutions Act) and PMC (Pakistan Medial Commission) threaten to destroy the tertiary care hospitals and medical teaching institutions. The PMDC (Pakistan Medical and Dental Council) which was recognised and respected worldwide is being replaced by a PMC run by inefficient and nonprofessional people handpicked by the prime minister. Not a single vice chancellor of a medical university is in this council. All in all the health budget makes tall claims but speaks of wrong priorities.
The writer is an orthopedic surgeon and CEO of the OMC hospital in Lahore. He is a member of the Provincial Assembly of the Punjab and part of the standing committee on health