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July 23, 2016



Healthcare and the census

We are a developing country whose healthcare system is in a deplorable condition; and the lack of updated census data makes it even worse. For accurate data we need to conduct a census – something that is also mandated by the constitution.

The last census in the country was conducted in 1998. As most of our resource allocations are being made using 18-year-old data, suffice it to say we must be solving the wrong problems in the wrong places. Healthcare decisions are directly proportional to the wellbeing of citizens and decisions based on guesstimates are going to affect them. Making critical decisions on unreliable data surely implies that the government is willingly adding to the suffering of its citizens.

We need to conduct a census so as to allocate resources effectively, make significant progress towards the Social Development Goals (universal set of goals, targets and indicators that nations have to pursue to make progress on poverty, health, education, hunger and the environment), report healthcare indicators more accurately, forecast healthcare trends, create better health-centred policies and also fairly distribute resources among provinces.

First, better resource allocation would efficiently address public healthcare needs in three prevention stages – primary, secondary and tertiary. Primary prevention is concerned with overall human wellbeing and health promotion activities. For example, if we know that people living in a certain region have a tendency toward diabetes, then funds can be allocated to educate people from that region on that condition.

Secondary prevention is about early detection and treatment of a disease so as to prevent its spread. For example, timely identification of high-risk groups can help us take measures to prevent it from spreading.

Tertiary prevention concerns itself with minimising the damage caused by a disease. For example, if we know that a certain demographic is affected by a disease then corrective measures can be taken to help minimise the damage.

All reliable remedies for these three prevention stages are only possible if we have access to updated data. How can we allocate resources efficiently when we do not know what sort of prevention resources a certain population needs most?

Second, in terms of the SDGs, no meaningful planning can be done without updated census data. This means that we cannot make significant progress towards health-related SDGs such as lowering mortality rates, ending preventable deaths of newborns, etc. Whatever progress we do make will definitely be slower in comparison to nations that have access to updated data.

Third, the health performance indicators currently presented by the authorities do not reflect the exact situation on the ground. Current performance indicators use outdated population data, and using up-to-date information can reflect a decline in otherwise satisfactory-looking performance indicators (potentially because updated data would yield a bigger number in the denominator).

So coverage levels reported in the Pakistan Demographic and Health Survey (PDHS), Multiple Indicator and Cluster Survey (MICS), and Pakistan Social and Living Standards Measurement (PSLM) are not significant because they are based on outdated data. Without a census, correct and transparent progress on health cannot be reported.

Fourth, an updated stream of data can help us predict trends. Forecasting helps us identify future trends and prepare for them in advance. That becomes difficult without data, not least because the baseline data changes due to growth in the population. So we need updated data to facilitate forecasting.

Fifth, health-centred policies cannot be made without current data. Let us assume a city has a lot of people suffering from partial achromatopsia, a cognitive vision disorder; people with this disorder usually cannot drive. Without access to data, how can we then reserve funds for alternatives in the city infrastructure that could help such people?

Lastly, the National Finance Commission is responsible for allocating resources based on a few factors. One of them is population and another is development indicators. Without access to updated data, allocations in the health sector cannot be accurately made.

It is unreasonable for any country to deprive people of access to basic healthcare due to reasons within its control. The government must allocate funds and resources for a timely census so that these problems can be addressed. Our healthcare is definitely poorer if there is uncertainty around actual performance indicators, resources are allocated inefficiently and no meaningful planning towards SDG goals is being done.

The writer gratefully acknowledges a conversation with Dr Shehla Zaidi of Aga Khan University Hospital.

Email: [email protected]