Health of the IDPs

Government needs to create robust structures to ensure that our gains in battle are not lost by petty decisions.

Whatever the intentions may have been, there is little doubt that Pakistan’s health system and structure has suffered substantially due to the Eighteenth Amendment. With health now managed at the provincial level, and not all provinces having the same capacity or even interest in managing health and health-related challenges, our system is now more vulnerable to fracture and failure. The challenges associated with polio, the emergence of measles and rubella and the lack of a clear strategy in managing the supply chain or the quality of medicines have further weakened the system. Provincial level incompetence manifests itself in resource management and cronyism. In the backdrop of these long-standing challenges, poor strategy or lack of a clear policy in management of health of our internal refugees, whose numbers are predicted to be in several hundred thousand, can become a major national crisis with long term social and economic consequences.

There are two main issues that need to be kept in mind given the health issues of the IDPs. First, displacement can often lead to exposure to new climate and new diseases. This problem grows exponentially when the displaced people may have underlying medical conditions or health related vulnerabilities. With the national awareness and vaccination campaigns against high impact diseases almost non-existent in the home base of the IDPs, the chances of spread of diseases, including polio, are much higher than normal. The second issue revolves around management of disease in both the short and the long term. While we may have limited capacity to manage health crises that need immediate attention and outbreaks of disease in the short term, the long-term impact needs attention as well. High density populations are particularly vulnerable to sanitation issues and can lead to the spread of the disease as well as development of drug resistant strains that can impact the population at large.

My point here is not to create a sense of panic. Nor do I intend to create a feeling of suspicion around those who are now essentially homeless and displaced in their own country. I feel strongly for the IDPs and want to highlight that careful thought and a clear policy is needed to manage both the short-term and the long-term challenges that need immediate attention. As we think about creating a dignified base for those who are displaced, we need to think more than just about shelter, safety and immediate security. We also need to think about their health in a holistic way that provides them comfort and a sense of security in these trying times.

Whether we like it or not, we have to agree that our health system is far from integrated and is, at best, fragmented. A consequence of this fragmentation is that people from different parts of the country, when brought closer to each other, create new health challenges. Yet, I also believe that this is an opportunity for us to take a hard look at our existing system and create policies that are structured for the national well being, and not political point-scoring. Here is an opportunity to think about disease management, improvement of maternal and child health, improving access to basic health services, access to quality medicines and above all, creation of a system that gives confidence to the consumer and where those in charge are held accountable.

A comprehensive battle for the soul of the nation is taking place in Pakistan. It needs to be fought with a steely resolve at all levels, including in the domain of policy. Those in the government need to create robust support structures for our citizens who are deeply affected with a strong commitment in order to ensure that our gains in the battlefield are not lost by incoherent, illogical, petty and short-sided policy decisions.

Published in The Express Tribune, June 24^th, 2014.

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