Healthcare Delivery Changing the paradigm
Contribution of the Indus Hospital & Health Network to Pakistan's Primary Care System
The healthcare crisis in Pakistan affects more than 220 million people in the country. The health system of Pakistan faces numerous challenges including a lack of healthcare facilities in rural areas, an acute shortage of trained medical professionals, and the unavailability of affordable quality healthcare facilities across the nation. The leading cause of the fragility of the healthcare system is that millions of Pakistanis have little or no access to affordable and quality primary care services.
Quality in healthcare is and has been a topic of discussion around the world for decades now. While developed nations have contributed towards standardising healthcare guidelines, developing countries like Pakistan are still struggling to provide the bare minimum to their people. Pakistan is the fifth most populous country in the world and yet only 0.9 per cent of the total GDP is spent on the healthcare sector. According to estimates, only 0.6 beds are available per 1,000 people with only 9.6 doctors for 10,000 people in Pakistan.
To overcome these challenges, the Indus Hospital & Health Network (IHHN) stepped up to improve the healthcare scenario throughout Pakistan. IHHN is providing quality healthcare absolutely free of cost to every Pakistani in need, irrespective of age, gender, caste, creed, or financial stability.
In 2007, The Indus Hospital was established in Korangi, Karachi, which soon became a prototypical hospital throughout Pakistan. In 2021, the hospital evolved into Indus Hospital & Health Network, managing 12 hospitals under public-private partnerships, four regional blood centres, four physical rehabilitation centres, one of Pakistan's largest paediatric oncology units, primary care centres, and multiple innovative public health programmes.
IHHN partnered with International Research & Development (IRD) Pakistan, to create the Global Health Directorate (GHD) to improve the primary care level services and the delivery of public health programmes across Pakistan. The majority of healthcare services in Pakistan are located in major urban centres, which makes healthcare inaccessible to the rural population. In most cases, people have to sell everything they own to be able to afford transportation to travel to an operational hospital. This creates an additional barrier for marginalized communities, especially women; who are then deprived of this basic necessity. Therefore, IHHN decided to bring free-of-cost integrated quality primary care services to the communities' doorsteps through container-based community health centres, mobile clinic vans, and Pakistan's first-ever Boat Clinic; under its Primary Care Program.
The Primary Care Program (PCP) was initiated in 2017 to address the growing need for high-quality care at first-contact for the Pakistani population. The programme integrates family medicine with public health initiatives and raises preventive awareness through a strong network of community-based workers. PCP works as the first point of contact where continuous, comprehensive, and coordinated care is provided to distant populations undifferentiated by gender, disease, or age. Services provided at each PCP facility are customised based on the healthcare needs of the population to improve the overall health indicators of Pakistan. Currently, PCP manages 25 different primary care facilities including 12 hospital-based facilities through the family medicine clinic at The Indus Hospital, Karachi, and in Badin, Muzaffargarh, Multan, and Lahore. IHHN also operates 12 standalone clinics in the districts of Tharparkar, Jamshoro, Muzaffargarh, Kashmir, Rahimyar Khan, and Karachi. In 2019-20 alone, PCP has impacted more than 1 million lives.
PCP set up two container-based community health centres in Khorwah Chowk and Shadi Large in Badin in the province of Sindh, Pakistan. These prefabricated containers are standardised to include services found in tertiary care hospitals including a reception, a waiting area, a room for vital examination, a pharmacy, full-size consultation clinics, lab collection points, and patient wards. Over 60,000 beneficiaries have been served as of January 2021, including 20,684 children and 31,107 women. Moreover, adapting to the current pandemic situation, Covid-19 screening and testing have also been integrated as part to control the national healthcare emergency. These community health centres, mobile clinic vans, and the boat clinic allow patients from distant populations to reach IHHN's consultants through telehealth.
In 2020, IHHN introduced Pakistan's first-ever mobile Boat-Clinic in South Punjab to reduce access-based healthcare challenges for distant communities. The riverine area of the famous Indus River in district Rajanpur, South Punjab has been neglected over the years since it could only be reached by boat. On average, patients needing medical help would travel for more than two hours to be able to reach the nearest docking point, from where they would further travel an hour to reach a healthcare facility. This often resulted in the loss of money, time, and precious lives. As a solution, IHHN launched a mobile Boat Clinic in the Rajanpur district, which is home to approximately 105,000 people who would otherwise remain deprived of affordable healthcare.
The Boat Clinic provides essential preventive care services that integrate both the clinical and public health initiatives identified by the community. At present, the clinic provides immunisation, nutrition, family planning sessions, breastfeeding awareness sessions, deworming, Hepatitis C treatment, mental health screening, and counselling services. The Boat Clinic has been able to reach an area where no doctor has ever set foot since the formation of Pakistan and has benefitted over 4,000 people so far.
IHHN's 'mobile boat clinic and community health centres' were also recognised by the International Humanitarian City (IHC) in the MGM Awards 2021. IHHN won the 'Best Innovation Solutions' Award for humanity throughout the year 2020. This promising initiative aims to change thousands of lives by bringing primary healthcare facilities to distant communities' doorsteps and addressing the health needs of shifting and migratory rural populations.
- Zaidi, S. Akbar, and Shamim A. Sahibzada. "Issues in Pakistan's Health Sector [with Comments]." The Pakistan Development Review, vol. 25, no. 4, 1986, pp. 671-682. JSTOR, www.jstor.org/stable/41258785. Accessed 10 Mar. 2021.
- Challenges Faced by Pakistani Healthcare System: Clinician's Perspective Faran Khalid1 and Ahmed Nadeem Abbasi2
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