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Pakistan needs to fix its broken health system

On an assignment several years ago, I met a person in a remote village of Pakistan. He ran a convenience store in the village. He would conveniently treat people's ailments, as well, most often by injecting some single-cure medicine. He would use the needle of his syringe until it became blunt and reuse it after sharpening! He was not the only one indulging in such a scary practice.
Over the past two months, nearly 700 people - most of them children between 2 and 12 years old - have tested positive for HIV in a southeast Sindh province district, Ratodero. Even before this outbreak, Pakistan lagged far behind the United Nations' ambitious goal for HIV treatment and prevention globally. With cases among young people increasing by 29 per cent between 2010 and 2017, an estimated 163,000 adults and children are living with the disease in Pakistan, which can be spread primarily through transfusions of unscreened blood, unprotected sex, or injections. Although the authorities haven't conclusively determined the cause of the recent outbreak, considering the age of some of the affected children, health officials suspect the outbreak is linked to reused syringes and needles, a problem that stretches beyond Ratodero because people believe that injected drugs or drips work better than pills.
Such cases highlight the dire state of healthcare in Pakistan, a nation of 208 million where almost a third of the population lives on less than $3.20 a day and where many people cannot afford expensive medical tests or drugs in the absence of a sufficiently funded and equipped public healthcare system. Pakistan has signed and ratified more than a dozen conventions and treaties on public health. However, it lags behind the modern world in provision of healthcare to its people, especially the poor. Very few mechanisms exist to regulate the quality, standards, protocols, ethics, or prices within the private health sector, which is serving 70 per cent of the population.
Pakistan's poorest citizens and those living outside of major cities face the greatest challenge in accessing emergency and essential surgical and anesthesia care and the country, according to the World Journal of Surgery, has an annual deficit of 17 million surgeries. The country's National Health Vision 2016-2025 does recognise the need to address any inequalities and inequities in access to healthcare. Yet, it hasn't helped in achieving the country's public health goals.
And so, Pakistan ranks 164th in the world for its investments in healthcare and education, says a scientific study ranking countries for their levels of human capital. The country is placed just behind Rwanda (ranked 163rd) and is just ahead of Tanzania (ranked 165th), according to the study titled 'Measuring human capital: A systematic analysis of 195 countries and territories, 1990 to 2016'. To ensure sustainability of public health interventions, Dr Mohammad Assai Ardakani, a former WHO Representative in Pakistan, suggests that the government shift health costs from development budget to the regular budget.
According to him preventive health interventions and improving routine immunisation are more cost-effective for health systems; and so, the share of promotive and preventive services out of total allocation to health needs to be increased. Implementing community-based case detection and treatment programme may control malaria.
A national plan, the Sehat Sahulat Programme, aims at covering all districts of Pakistan by end-2021. Dr Assai suggests working out a plan to produce 1 million health workers - a Sustainable Development Goals target, with their equitable distribution, particularly covering remote rural areas. Pakistan, having the highest newborn mortality rates in the world (55 per 1,000 live birth), should make newborn health and survival a priority. It should declare malnutrition a national emergency. Non-communicable diseases (NCDs), responsible for about 57 per cent deaths in Pakistan, require a multi-sectoral strategic plan to be integrated into primary health care besides implementing the highly cost-effective 'WHO Best Buys' - reduce tobacco use, reduce salt, excess fat and sugar intake, perform regular physical activity. Dr Assai recommends integration of mental health into primary healthcare using a health systems perspective as a national strategy in Pakistan, where more than 24 million people need psychiatric help.
Improving the health and nutritional status of the people in Pakistan requires a strong multi-sectoral approach that also increases community awareness on preventive measures and confronting distrust in the country's health system and skepticism of its immunisation programmes. Pakistan needs to have a healthy human resource to prosper and progress. Earlier the better!
Waqar Mustafa is a multimedia journalist and commentator based in Lahore, Pakistan