Dr. Assai’s parting messages offer roadmap for better health in Pakistan

Islamabad : Financial sustainability of health programmes is a key challenge in Pakistan. Most health interventions are partially dependent on development funds, which are uncertain, suffer delays in release, and are fairly vulnerable to any austerity measures imposed by the government. To ensure sustainability of public health interventions, it is crucial for the new government to shift health costs from development budget to the regular budget. Preventive health interventions are more cost-effective for health systems; therefore, the share of promotive and preventive services out of total allocation to health needs to be increased.

This was one of the parting messages delivered by Dr. Mohammad Assai Ardakani, who has just left for his country Iran after serving as WHO Representative in Pakistan since January 11, 2017.

Dr. Assai has urged the new government in Pakistan to consider the upcoming nationwide measles campaign scheduled from October 15-27 as a top national priority to achieve at least 95% coverage so that future outbreaks and deaths due to measles can be prevented.

Dr. Assai also believes it is crucial for Pakistan to improve routine immunization so that the country can avoid the stigma of being one of the top five countries in the world with the highest number of unimmunized or partially immunized children. “Strengthening outreach team, covering deprived areas, and public-private partnerships along with engagement of all cadres of healthcare providers, and not just vaccinators, is among strategies to increase immunization coverage,” he stated.

With reference to efforts aimed at the prevention and control of AIDS, tuberculosis and malaria, Dr. Assai said, securing sufficient domestic financing for TB prevention and treatment is a major challenge in Pakistan, with 160,000 missed cases. A plan for strengthening active case detection for HIV/AIDS and enhancing access to ART clinics to above 80% by 2020 must also be looked into. Moreover, implementing community-based case detection and treatment programme may pay back with reference to control of malaria, which has bounced back with a three-fold increase in incidence.

Welcoming the government’s decision to develop a national plan to replicate the Sehat Sahulat Programme to cover all districts of Pakistan by end-2021, Dr. Assai suggested that a detailed plan of action must also be developed to produce 1 million health workers—an SDG target, with their equitable distribution, particularly covering remote rural areas.

“Pakistan has the highest newborn mortality rates in the world (55 per 1,000 Live Birth); hence, newborn health and survival should be a priority on the health agenda. There is a strong need for malnutrition to be announced as a National Emergency, with provincial and national multi-sectoral nutrition strategies being immediately operationalised,” Dr. Assai stated.

With reference to Non-communicable Diseases (NCDs), which are responsible for an estimated 57% deaths in Pakistan, Dr. Assai called for a multi-sectoral strategic plan to integrate NCDs into primary health care and to implement the highly cost-effective ‘WHO Best Buys,’ which are reduce tobacco use, reduce salt, excess fat and sugar intake, perform regular physical activity. With reference to the huge gaps in issues related to mental health in Pakistan, where over 24 million people need psychiatric help, Dr. Assai recommended integration of mental health into primary healthcare using a health systems perspective as a national strategy.

The new government’s vision, Dr. Assai stated, is well in line with the global commitment to Universal Health Coverage. “However, improving the health and nutritional status of the people requires the adoption of a strong multi-sectoral approach. Moreover, the media can play a role in increasing community awareness on preventive measures and encouraging development sectors to play their role in health and human development,” Dr. Assai concluded.