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Pakistan's healthcare sector needs more attention

The prime minister's vision for universal health coverage has three components.

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People in Pakistan are expected to live fewer years than those in other countries of South Asia, notes the latest Human Development Index which is led by Sri Lanka with Bangladesh, Bhutan, Nepal and India trailing behind.

Mired in financial crunch, Pakistan spends only two per cent of its GDP on health. Under the constitution, except in the federal capital, Islamabad, the provincial governments are responsible for the healthcare of citizens. However, there is no coherent policy to maintain uniformity in service delivery across the provinces. Preventive, promotive, curative, and rehabilitative services are delivered through a primary, secondary, and tertiary system and a range of public health interventions. The prime minister's vision for universal health coverage has three components. Every citizen must have access to health services. The government should pay the expenses of those who are unable. And the quality of services should be increased.

However, high population growth, uneven distribution of health professionals, deficient workforce, insufficient funding, and limited access to quality healthcare services courtesy multidimensional poverty hamper an effective service delivery by the state health institutions in the sixth most populous country in the world. And so, about 70 per cent of Pakistan's 220 million people have to go for private healthcare, which is mostly unregulated and rarely monitored for standard.

A Pakistan Medical Association report, released last month, highlights the country's poor health indicators including its high maternal and infant mortality rates, slow progress on stunting and wasting, negligence towards mental health, weak healthcare system, and a growing rise in the burden of diseases mainly due to lack of basic facilities, such as supply of clean drinking water, sanitation, primary healthcare services, and environmental degradation.

National statistics show that more than half of Pakistani households suffered from food insecurity in 2019. The other half was found to be at potential risk. Across the country, 40.2 per cent of infants suffered from stunting. The maternity mortality rate is 140 by 100,000. Breastfeeding rate for mothers stood at 48.4 per cent and early lactation rate at 45.8 per cent. Nutritional protection was 63.1 per cent.

Titled the Health of the Nation, the report suggests the government to focus on preventive, effective vaccination and immunisation programmes, and provision of clean drinking water and cleanliness, and primary healthcare.

Towards this aim, the UAE has channelled $200 million (Dh734 million) into the UAE-Pakistan Assistance Programme (UAE-PAP) to pay for 40 projects covering health and water among other areas. The UAE has also made large donations to a campaign aiming to end polio in Pakistan - one of the two countries left in the world that haven't managed to eradicate the disease. The other country is Afghanistan, where polio virus cases still circulate. These donations are part of the UAE-PAP campaign. There are some UAE-funded healthcare facilities as well in Pakistan's different cities.

But a lot more is required to be done to focus on primary care, preventive care, maternal and child health, and universal health coverage. Pakistan needs to improve primary healthcare to improve health statistics, says Special Assistant to the Prime Minister on National Health Services Dr Zafar Mirza.

The country requires more than 400,000 doctors, 200,000 dentists and 1.6 million nurses to meet international standards. It faces a shortage of more than 200,000 doctors, 180,000 million dentists and 1.4 million nurses.

"The numbers need to be enhanced and the 'bulk of general practitioners' need additional training and incentives," Mirza said at a conference recently on family medicine titled Building Primary Care Capacity: Pakistan's Critical Need.

People need to be educated on how to avoid communicable diseases. Effective childcare medical facilities are needed to decrease the child mortality rate, which for children under five years of age is 69 by 1,000. Preventive and curative healthcare should be integrated. Effective local governance is needed to develop a family medicine framework, monitor its functionality and administer its needs.

The Universal Declaration of Human Rights acknowledges the right of every person to a living standard that ensures health and well-being. An integrated approach is needed towards investing in the healthcare system, including family health, tertiary care, environmental health, community health, and nursing. The healthcare system needs to reach the people, putting the people first instead of merely infrastructural growth. People deserve to have better health.

Waqar Mustafa is a Pakistan-based journalist