The sum of our maladies

April 7, 2024

The burden of disease in Pakistan is rendered worse by an increasing population

The sum of our maladies

The growing burden of preventable diseases and deaths together with lack of adequate resources has been a major road block in paving the way to a robust health delivery system in Pakistan.

The current state of healthcare in Pakistan can only be described as bleak and depressing. Approximately 0.5 million children under the age of five succumb to preventable diseases and 14,000 women lose their lives due to avoidable complications related to pregnancy and childbirth, annually.

Pakistan’s annual health budget of 1.2 percent of the Gross Domestic Product is a fifth of the World Health Organisation’s recommended allocation of 6 percent for healthcare.

Ensuring that women and children receive adequate preventive care, access to family planning services, vaccinations, proper nutrition and essential treatment for diseases is not just a moral imperative but also a societal obligation. “Preventable deaths should be unacceptable in a society that aspires to progress. Pakistan’s health system needs a transition from a reactive healthcare approach to a proactive one,” says Dr Qaiser Sajjad, a former secretary general of the Pakistan Medical Association.

A growing population, 242,946,666 as of January 2024, makes Pakistan the fifth most populous country globally, with a healthcare ranking of 124th out of 169 countries.

The Pakistan Medical Association’s Health Report 2024 reveals that the number of public sector hospitals in Pakistan has increased to 1,282, Basic Health Units to 5,472, Rural Health Centres to 670 and dispensaries to 5,743. Together with 266,430 registered doctors, 30,501 registered dentists and 121,245 registered nurses, these facilities bring the current ratios to one doctor for 963 persons, 9,413 persons per dentist and availability of one hospital bed for 1,608 people.

Maternal deaths due to preventable causes, such as sepsis and haemorrhage are too frequent and neonatal mortality rates too high. In young children, diarrhoea and respiratory illnesses remain major killers. The estimated prevalence of various forms of malnutrition conditions in children under five years is: 31.6 percent underweight, 10.5 percent wasting, 3.3 percent severe wasting, 45.0 percent stunting and 4.8 percent overweight. Half the women of reproductive age are anaemic (50.42 percent). The burden of disease is rendered worse by a growing population. The growth rate is 1.9 percent per annum, contraceptive prevalence 35 percent and unmet need for birth spacing 25 percent.

Pakistan also faces a double burden of disease with hepatitis B and C, a prevalence of 7.6 percent and around 15 million affected people; the only country in the world still seeing a rapid rise in new HIV infections with 63,202 registered HIV cases; coronary heart disease claims 240,720 lives a year, making it the leading cause of death. Cancer, often a hereditary disease but also linked to environmental factors and poor dietary habits, claims around 148,000 new cases every year and is thus the second leading cause of death.

The International Diabetes Federation ranks Pakistan third in the world with a total of 33 million – one in four adults – living with Type-II diabetes, following China (141 million) and India (74 million). Diabetes, alone, is responsible for around 400,000 deaths in Pakistan. Pakistan has the fifth highest tuberculosis burden in the world with drug-resistant tuberculosis estimated at 4.3 percent among new cases and 19 percent among previously treated cases.

Seasonal outbreaks of dengue fever, chikungunya, Congo virus, Naegleria virus and the Corona virus are a relatively new challenge for healthcare delivery system of Pakistan.

Prof Dr Shahid Malik, a public health expert, says that immunisation/ vaccination is key to success in getting rid of preventable diseases. He says misconceptions regarding vaccines are a big hurdle in this regard.

Polio only exists only in Pakistan and Afghanistan. Pakistan has been unable to eliminate the virus despite more than 100 rounds of vaccination over the past decade. Iran, in contrast, was able to eradicate the polio virus with just three rounds of country-wide vaccination.

Mental disorders account for more than 4 percent of the total disease burden. The mental health burden is higher among women (57.5 percent) than men. According to WHO data, Pakistan has only 0.19 psychiatrists per 100,000 inhabitants, one of the lowest numbers in the WHO Eastern Mediterranean Region and worldwide.

Pakistan also ranks first in Asia for most deaths caused by traffic accidents. Injuries account for more than 11 percent of the total burden of disease.

Pakistan is currently the fifth most climate-vulnerable country in the world. As many as 33 million people were displaced and nearly 10,000 died in floods in 94 districts during the 2022 monsoon season.

Diseases caused by outdoor air pollution account for 22,000 premature adult deaths. Indoor pollution accounts for 40 million cases of acute respiratory infections and 28,000 deaths/ year. Enforcement of laws in this regard, including the Prohibition of No Smoking Law 2002, has been weak at best.

The resistance to antibiotics, especially for tuberculosis and typhoid, is a looming disaster. The factors contributing to this menace include quackery, irrational use of antibiotics, non-compliance, spurious drugs, over-the-counter purchases and self-medication as well as the pharmaceutical industry’s pressure on doctors for prescribing their products.

The unavailability of safe drinking water leads to several waterborne diseases and contributes to the highest number of deaths (40 percent) in Pakistan. Clean water, alone, can prevent 60 percent of gastrointestinal and infectious waterborne diseases.

Noor Mahar, pharmacist and drug lawyer, says that since 2018, successive governments have been raising the prices of 8,000 medicines. “The hike in drug prices, when health facilities are inadequate at public hospitals, adds to the people's woes,” he says.

Prof Dr Shahid Malik, a public health expert, says that immunisation/ vaccination is the key to success in getting rid of preventable diseases. He says misconceptions regarding vaccines are a big hurdle.

“Incorporating nutritional interventions, integrating family planning services into Universal Health Coverage packages is vital for ensuring maternal and child nutrition services,” he says.

Dr Malik says that most diseases, and resultant deaths, can be prevented through screening of blood transfusion, proper sterilization of invasive medical devices, safe injections and allocation of testing and treatment resources. He says risk factors for other diseases can be controlled through minor lifestyle adjustments, exercise and quitting smoking.

Dr Salman Kazmi, the Young Doctors’ Association general secretary, says the government should not be wasting billions of rupees on renovation of hospital buildings. Instead, he says, it should ensure availability of necessary equipment, medical supplies and diagnostic facilities at these hospitals. He also calls for ensuring transparency in the Health Card scheme.

Preventable diseases are not only taking precious lives but also consuming a major chunk of the health budget. It is counterproductive to invest in curative healthcare instead of preventing diseases.

The writer is an investigative journalist associated with The News International, Pakistan. He is an EWC and GIJN fellow. His X handle: @AmerMalik3

The sum of our maladies