Confusion and healthcare

Frequent changes of policy can play havoc with the already derelict healthcare system

The whole world is battling with a deadly coronavirus and seeking ways to protect the health workers who are on the forefront of this battle. In Pakistan, however, the political leadership is not on the same page with regard to tackling the pandemic.

The federal government has taken many turns and U-turns on the enforcement of strict social distancing, including through a general lockdown. Led by Sindh, the provincial governments have been more proactive within their meager resources.

The pandemic has once again exposed the inherent flaws in the utilisation of resources in times of emergency, a dilapidated healthcare system, and above all, the confusing decision-making.

According to health experts, confusion is a symptom that a person cannot think clearly and take timely decisions. Such a person feels disoriented and has a hard time focusing and making decisions. It is also called a state of disorientation. In extreme cases, it takes the form of delirium.

Sometimes, it is not merely a matter of individual confusion or disorientation. Instead it is on account of certain leaders avoiding making tough calls in an effort not to upset others or lose their status. In the latter case, such leaders and their supporters come up with many explanations for delaying hard decisions without fully appreciating the repercussions of the delay. Delayed decision-making may cause more harm to people than whatever outcome they were trying to avoid.

In their bestselling book, Rising to Power: The Journey of Exceptional Executives, Ron Carucci and Eric Hansen, say, some leaders spend most of their time teaching their subordinates to avoid mistakes at all cost. Thus when there is a critical situation, they are afraid of the challenge and more eager to “look right” than “do right”. As a result, they end up making sub-optimal decisions.

History tells us that great leaders were all great decision-makers.

It is frustrating to work under leaders who fail to provide directional focus and guidance and courage to tackle time-sensitive problems with vigour and perseverance. A confused leadership creates uncertainty and fear among its followers. This has far-reaching consequences for the society.

In Pakistan’s context, confused decision-making at the top can aggravate the sufferings of the people and damage the already dilapidated healthcare system. It cause difficulties in managing scarce resources and further burden the common man. The Pakistan Association of Mental Health (PAMH) has warned about the “neurotic symptoms” in the population resulting from mixed messages about the lockdown.

According to the World Health Organization, Pakistan is ranked 66th amongst high-burden-of-disease countries. Forty percent of the overall disease burden is in the form of malaria and tuberculosis. The communicable, perinatal, maternal, and nutrition-related deaths make up 38 percent of all deaths, followed by cardiovascular (19 percent) and other non-communicable diseases (15 percent). Diabetes causes 3 percent of all deaths.

According to the National Diabetes Survey (2016-17), diabetes has emerged as another significant risk to society; the prevalence rate of diabetes is alarmingly high (26.1 percent). Inactivity, obesity and being overweight are contributing to the high burden of diabetes in Pakistan. As for reproductive and sexual healthcare is concerned, only 46 percent of women have access to modern contraceptive methods. As many as 78 children under five years of age die per 1,000.

Pakistan also stands out with 146 polio cases in 2019, out of which Khyber Pakhtunkhwa reported 92. The data on injuries caused by accidents, coverage of essential health services, and national health insurance is not available officially.

According to the Economic Survey 2017-18, despite its heavy burden of communicable as well as non-communicable diseases, Pakistan’s expenditure on public health is only 0.91 percent of its Gross Domestic Product. The country has one doctor for 957 people and one hospital bed for 1,580.

The government-run hospitals are capable of catering to medical needs of only 30 percent of the population. Private hospitals take care of the rest. Since people are more dependent on the private sector for their healthcare, out of pocket expenditures are 63-70 percent.

The government has implemented many healthcare programmes at the district level. For example, a partnership of public and private (PPP) health care system is helping to meet the burgeoning demand for medical care, particularly for maternal and child health. However, the programme itself is unable to meet the challenges of the increasing burden of both communicable and non-communicable diseases in Pakistan.

This is due to limited coverage and scope, unavailability of equipment and training. The lady health workers who were trained to provide essential maternal and child healthcare services under the auspice of the PPP, covering 60 percent of the population, are not capable of dealing with NCDs due to lack of needed skills. The minimal government support in providing clean water, adequate sanitation facilities, and medical research also add to the burden of preventable diseases in Pakistan.

The basic principle of any healthcare delivery system (HCDS) is to value human life, reinstate, and maintain the health of the population.

Frequent changes of policy, indicating confused decision-making, can play havoc with the already derelict healthcare system.

The writer is an assistant professor at the Department of Economics, University of Karachi. She can be reached at

Confusion and healthcare: Frequent changes of policy can play havoc with the already derelict healthcare system