Healing healthcare

Honesty, credibility, accountability, sincerity, modesty, rationality, creativity and commitment are some of the characteristics of a nation poised to rise. History shows that in the past Muslims were far better in upholding these qualities. They established institutions to serve humanity in the realm of science, technology, medicine, business and welfare. Their endeavours focused on ensuring the people’s benefit. At this point, the entire nation is hoping that these long-lost qualities and characteristics will be revived by the new government. There is an expectation that the PTI government will not fall prey to an obsession with optics like previous governments did.

The constitution doesn’t explicitly recognise health as a basic human right. However, the right to life is recognised as a fundamental right. The state is duty-bound to provide safeguards and an enabling environment to allow an individual to lead a secure and healthy life. Protection from diseases that cause death and disability is, therefore, a state obligation. After the 18th Amendment, healthcare is primarily the responsibility of provincial governments, except in the territories administered by the federal government. Planning and formulating health policies falls within the federal government’s domain and provincial governments are responsible for ensuring the proper implementation of these policies.

Unfortunately, health has never been a priority for successive governments over the seven decades of Pakistan’s history. It is a distressing fact that cosmetic measures were taken only for optics and had no tangible impact whatsoever. Dialogue about issues pertaining to health has never enjoyed primary importance in various political agendas and has always received considerably less priority during the tenures of two of the country’s main political parties.

This lack of realisation regarding the role of health in the overall growth of the nation has been linked to the limited allocation of public funds for healthcare. Since its inception, our healthcare sector has received financial allocations that fell short of the WHO’s recommendations of between two percent and five percent of a country’s GDP. If we examine the challenges in the health sector, overcrowded tertiary hospitals; underutilised primary healthcare units; atrocious quality compromises in the services provided; shortages in healthcare workers; corruption and collusion in regulatory agencies; governance challenges; and tenuous relations between the federal-provincial health agencies are some facets that come to mind.

The heath sector mirrors the overall state of governance in Pakistan. The country’s social development and health sector go hand-in-hand. Various social determinants have a major impact on the health of the nation. The issues relevant to health in Pakistan are the population explosion; poor education; unemployment, which impacts people’s socioeconomic status; poor access to nutrition; and lack of safe water supply and poor sanitation, which have a direct effect on people’s health.

The effects of these social determinants are compounded by a weak and unresponsive health system, giving rise to poor health indicators. The major reasons for the weaknesses in our health system are the lack of financial resources, limited access to the primary healthcare, poor management capacity, corruption, and the absence of accountability. The results of this situation are dreadful. According to statistics, the infant mortality rate is 66 per 1,000 live births as compared with that of India (38 per 1,000 live births) and Sri Lanka (eight per 1,000 live births). Meanwhile, the maternal mortality ratio is around 178/100,000 live births.

Pakistan has the third largest number of children who suffer from stunted growth. A vast majority of women in the country suffer from anaemia and malnutrition, which is especially dangerous during pregnancy. Malnutrition is widespread among all ages and progress has been quite slow to address its social determinants over several decades. According to the National Nutrition Survey 2011, one-third of all children are underweight, nearly 44 percent are stunted, and 15 percent are wasted.

These depressing figures represent how hundreds of lives have been ruined due to unaffordable healthcare services. There is a considerable lack of healthcare facilities. Where these facilities are available, they are not accessible to the most vulnerable groups, such as women, due to social, cultural and economic barriers.

Almost 50 percent of TB cases remain undetected due to flaws in the screening process. Pakistan has an increasing number drug-resistant TB cases, with the estimated annual cases of around 14,000 among notified pulmonary TB cases. This indicates the flaws in regulation, and the standardisation of diagnostics and services. Pakistan is one of three countries where polio is still endemic. Communicable disease outbreaks are rampant and non-communicable diseases are on the rise. This is due to the absence of an integrated disease surveillance and response mechanism. Another shocking fact is that the previous regime has been spending only 0.9 percent of its net GDP on health. During the present government’s tenure, the aim should be to introduce improvements in coverage by the public sector; a paradigm shift towards preventive healthcare; a reduction in the burden of communicable and non-communicable diseases through sustained preventative programmes; and increased health allocations that amount to at least three percent of the GDP.

Decentralised and depoliticised health governance, prioritised primary healthcare, and the development of a robust and reliable health information system for evidence-informed planning and decision-making should also be prioritised. The country’s ‘health vision’ must be aimed at achieving sustainable development goals related to maternal, neonatal, infant and child mortality. We also need a fully devolved national health governance system with solid links to the community.

We must recognise that, as an agrarian country, Pakistan’s nutrition indicators and progress towards improving maternal and childhood nutrition is way behind other countries in the region. This is related to a lack of focus on implementing quality programmes and addressing disparities. Bringing health and nutrition services closer to women and children and addressing social determinants, such as poverty and women’s empowerment, will make a difference.

The foremost task for the new government should be to introduce good governance, transparency, and across-the-board accountability – the most fundamental prerequisites for any reform effort to succeed. We now have new leadership at the helm of affairs in the Ministry of National Health Services, Regulations and Coordination that is dynamic, committed and determined to introduce positive change. Given its credentials, the new leadership will make an all-out endeavour to realise the vision that the new PM passionately highlighted in his maiden address to the nation.

The writer is a public health specialist, anthropologist, and human rights activist based in Islamabad.