Can Pakistan achieve Sri Lanka’s life expectancy?

According to the Human Development Report, Pakistan has an average life expectancy at birth of 67.1 years (2018 figures), much below the average for South Asia (69.5), let alone the star performer, Sri Lanka (76.8), or even Bangladesh (72.3), Bhutan (71.5), Nepal (70.5), or India (69.4). Sri Lanka has achieved this impressive health outcome close to the industrialized West despite civil war and terrorism. How has Sri Lanka done it? By focusing on primary care, preventive care, maternal and child health, and universal health coverage – all tenets of healthcare also practiced in the West. Pakistan can certainly do better and one area in which it can is building out its primary care capacity and skills.

Conference on Primary Care

On March 4-5, 2020 Pakistan’s Higher Education Commission (HEC) and USA/Canada’s Association of Physicians of Pakistani-descent of North America (APPNA) are holding a joint conference on “Building Primary Care Capacity: Pakistan’s Critical Need.” The ultimate goal is to mobilize advice on actions needed to enhance life expectancy and health outcomes in the country. These include the fostering of training programs and policies for comprehensive development of Family Medicine, investing in public health and health systems, and initiating a crash program for training nurses.

The conference is also consistent with the steps taken recently by the HEC to enhance the quality and relevance of the system of education in the country.

Family Medicine Role & Training

Family Medicine physicians should be a key component of making Pakistan’s healthcare system more effective, including under new health insurance card schemes. Family Medicine doctors are a backbone of primary care in US and Canada. They are often the primary doctors for the family. They diagnose and treat most routine illnesses, provide preventive care and counseling on a healthy lifestyle. They also co-manage chronic illness, referring their patients to specialists when needed and then coordinating care with those specialists.

US Family Medicine Residency training is for 3 years after medical school and is designed to develop a broad set of skills by rotating trainee-doctors through internal medicine, pediatrics, obstetrics-gynecology, psychiatry, surgery, emergency medicine, geriatrics, and various electives. In UK and European countries this type of broad-based post-graduate training and this field is called General Practice (GP).

International & Pakistan Participants

APPNA experts attending the conference will include Family Medicine faculty from US/Canada training programs, including Residency program directors. They will present the curriculum and structure of Family Medicine training in US/Canada and participate in design workshops to help Pakistan’s participating teaching institutions develop primary care training. APPNA can also offer training curriculum for Pakistan, online training modules and visiting faculty volunteers who can serve onsite for development of Family Medicine training.

Pakistani attendees include Vice Chancellors and faculty members of medical universities and colleges, leaders from federal and provincial health ministries, HEC officials, representatives of regulatory bodies, and other stakeholders. Family Medicine programs already established in Pakistan, such as at Aga Khan University will also share their experience, so it can inform the development of training at other institutions.

Building Capacity: Family Medicine & Nursing

There are multiple tiers of training: from comprehensive multi-year training for FCPS-certified faculty at major tertiary-care teaching institutions, to shorter training for certified Family Medicine practitioners for local and district-level healthcare facilities, and continuing-medical-education training courses for MBBS doctors already in practice. However, an important issue is to ensure that physicians with Family Medicine training receive appropriate recognition in their careers. This will involve policy changes especially with regard to appointments and promotions.

Another critical issue for strengthening of Pakistan's health care system is the development of the nursing profession. Pakistan has only about 10% of the required number of nurses expected for this size population. APPNA has already indicated its willingness to be a bridge between nursing schools in Pakistan and US/Canada to assist in the development of nursing faculty in Pakistan.

APPNA Pakistan Initiatives

APPNA, which represents 18,000 physicians of Pakistani origin in US/Canada, undertakes volunteer work across Pakistan in healthcare, education, philanthropy and disaster relief. APPNA MERIT, APPNA’s committee for transfer of medical education and research expertise to Pakistan, beams live weekly lectures on the latest medical advances in various fields to 30-plus Pakistani medical universities and colleges. MERIT has also helped develop new specialties in Emergency Medicine/Critical Care, Pediatric Oncology, and Child Psychiatry by assisting CPSP (College of Physicians and Surgeons Pakistan), with curriculum, requirements, and visiting faculty. MERIT has specific initiatives in Neurology and ICU at Khyber medical university, and online and onsite teaching on Movement Disorders with medical societies. APPNA physicians also fund hundreds of need-based scholarships for medical students in Pakistan, provide medicines to indigent patients, send corneas to restore sight to the blind, hold free medical camps, volunteer during disasters like earthquakes and floods, fund water and school projects, and have provided mobile units and telemedicine services to deliver medical services in underserved areas.

This conference is another volunteer effort by APPNA to help Pakistan transform its healthcare. If successful, the development of Family Medicine could improve healthcare for all Pakistanis. It might even raise life expectancy to rival that of Sri Lanka’s!

Dr. Naheed Usmani is APPNA President 2020 and Professor of Pediatrics Hematology/Oncology at University of Massachusetts Medical Center. She established the children’s cancer department at Shaukat Khanum Cancer Hospital as a member of its commissioning team from 1994-99.