Very sick

Pakistan’s ranking of 149 out of 188 countries in the first assessment of the UN’s health-related Sustainable Development Goals should come as no surprise to anyone who is familiar with the state’s seeming indifference to the health sector. Our score of 38 out of hundred leaves us ahead of only war-ravaged Afghanistan in the region and tied with Bangladesh. A deeper analysis of the report shows that there have been improvements on some key metrics like infant mortality and access to family planning but we have fallen behind on childhood obesity, the spread of infectious diseases like Hepatitis B, violence and alcohol consumption. Certainly, some of our health-related problems can be blamed on the ongoing war against militancy, especially with regard to the return of polio and the poor health outcomes in Khyber-Pakhtunkhwa and the tribal areas. But the primary reason we are near the bottom of this UN list is because the health sector has been neglected for far too long and continues to be neglected to this day. Just earlier this month, the Supreme Court held a hearing into corruption in the public sector and found that many public hospitals do not have a permanent head and were woefully understaffed because laws for hiring had yet to be framed. Corruption, as in every other sector, has led to a lot of waste and fraud.

The one positive step taken recently by the government was to formulate the National Health Vision, which marked the first time a national health policy was laid out since the passage of the 18th Amendment to the constitution. With health being devolved to the provinces, there has been a lot of confusion about funding and responsibility. In theory at least, the National Health Vision will allow all the provinces to come together and discuss ideas to figure out the way forward. It has also taken the input of both public and private hospitals. The biggest problem, though, was left unanswered. The government, be it federal or provincial, does not spend enough money on health and relies far too much on donors. Those funds have been forthcoming for polio eradication and other issues which affect global public health but we cannot continue to expect much of our health sector to be taken care of by outside countries. As the UN report has shown all too clearly, our refusal to take responsibility has had dire consequences and left us with one of the worst health sectors in the world.