Our ill health sector

A Supreme Court hearing last week into corruption in the public health sector showed once again that even this vital sector is not spared the incompetence, adhocism and neglect that befall most government departments. The Supreme Court found that recruitment has slowed to a crawl because the applicable laws for hiring have yet to be framed. Many public-sector hospitals are even operating without a permanent head and confusion prevails in hospitals around the country. Speaking specifically for Islamabad, the joint secretary for the Capital Administration and Development Division, Ayesha Farooq, said that primary health care was being taken care of by the interior ministry, an assertion which drew a stinging rebuke from the judges who wondered what authority that ministry had in the health sector. Part of the problem is that the centre and the provinces have been unable to figure out the lines of responsibility after the passage of the 18thamendment and the devolution of the health sector. Rather than clarifying jurisdiction, they seem to be making up the rules as they go along. The SC has now asked the attorney general to supervise the formulation of rules for recruitment and given the government two weeks to submit a response.

The court intervention is timely because the health sector is in a state of paralysis. The new National Health Vision, launched recently, was the first such document since devolution and only the fifth in our history. It wisely chose not to dictate to the provinces and instead tried to be more strategic. It was also the product of intensive collaboration with the provinces and the public and private health sectors, giving it more weight than previous such proposals. But, as the court hearing showed, there is much that has been ignored. Chief among the unanswered questions is how we plan on funding the health sector. The centre seems to have assumed that international organisations will cover whatever shortfalls we have. While that may be true for issues like polio which affect the whole world, we cannot expect outside help for primary and preventive care. Despite taking on board the views of the provinces, the centre is still to institute a forum for the federating units to formulate joint strategies and compare their performances. Ideally, devolution would allow provinces to adopt each other’s best practices but in reality it has been a race to the bottom. The National Health Vision must not only be endorsed by parliament, it must be accompanied by efforts to ensure there are sufficient doctors and nurses and that each province is getting the resources it needs to spend on health. A document – or even a Supreme Court instruction – alone will not get us there.