Quality health for all
In Pakistan, the road to universal healthcare will be long and complex
The writer is a Howard Hughes Medical Institute professor of biomedical engineering, international health and medicine at Boston University. He tweets @mhzaman
On Saturday, April 6th, 2018 the World Health Organisation celebrated its 70th birthday and international health day. The slogan and aspiration was captured in a single bold statement, “Health for All” — or universal healthcare. The goal is ambitious, worthy and timely. Too many people around the globe have no access to healthcare. Many have to choose between paying for medicines or having food at the table. Some are forced to sell their most-prized possessions because they or their loved ones fall sick. None of this is just, fair or right and needs to change.
In Pakistan, the road to universal healthcare will be long and complex. While there are many hurdles, three primary issues need to be resolved if there is any chance of us achieving the dream of health for all people.
The first challenge, and perhaps the existential one, is answering the question what “all” in “all people” mean. Divided on the basis of ethnicity or religion, not all are equal in the land. This remains our existential challenge and fans the flames of exclusion, hate and bigotry. There is no health for all, if we do not have a sense that all people are equal citizens of the country. If you do not think that all people in Pakistan have equal rights, regardless of who they are, where they live, what they look like or what they believe (or not), you should stop reading here.
The second challenge, and one that was recently discussed by Pakistan’s prominent health scholar, Sania Nishtar, was the issue of corruption. Rampant wasteful spending, redundancies, cronyism and kickbacks will continue to haemorrhage our resources making the aspiration of universal healthcare a pipe dream. No amount of suo-motu cases by the chief justice or action by the chief of army staff can wipe out corruption. This is a problem we have to own, from our small clinics to large hospitals, and collectively work towards resolving.
The third issue is that of quality. The concept of universal healthcare is hollow and useless unless quality care is delivered. This includes not just quality of diagnosis and treatment but also quality of medicines and medical devices used for treatment and care management. The issue of poor quality, substandard and counterfeit drugs has never been adequately addressed and the efforts from the Drug Regulatory Authority of Pakistan (DRAP) leave much to be desired. While those with deeper pockets often have access to better quality care, efforts to ensure drug quality, particularly in large public hospitals, as well as in peri-urban or rural locations are lacking both in vision and in implementation. There are some efforts to improve drug quality by using smartphones but those solutions are a band-aid solution, not a comprehensive strategy. Furthermore, looking towards the future the risk of influx of poor quality medical products, due to increased trade with China, is also not insignificant.
Quality in care requires three things. The incentive to provide quality care, the strategy to maintain quality and the penalty against poor quality. This means that there have to be economic incentives and advantages for those who create quality products and deliver quality care. This also means that strict standards have to be set, which are not only enforced by the government but also demanded by the people. And finally, the action against those who fail to maintain the standard has to be swift and just.
Leaving all to those in power, and expecting them to deliver is neither realistic nor pragmatic. We, the people, have to demand the quality that we expect them to supply. And we have to demand it not for us, but also for all others in the nation. When it comes to universal healthcare, there should be no discrimination against anyone, no tolerance for corruption and no compromise on quality.
Published in The Express Tribune, April 10th, 2018.
In Pakistan, the road to universal healthcare will be long and complex. While there are many hurdles, three primary issues need to be resolved if there is any chance of us achieving the dream of health for all people.
The first challenge, and perhaps the existential one, is answering the question what “all” in “all people” mean. Divided on the basis of ethnicity or religion, not all are equal in the land. This remains our existential challenge and fans the flames of exclusion, hate and bigotry. There is no health for all, if we do not have a sense that all people are equal citizens of the country. If you do not think that all people in Pakistan have equal rights, regardless of who they are, where they live, what they look like or what they believe (or not), you should stop reading here.
The second challenge, and one that was recently discussed by Pakistan’s prominent health scholar, Sania Nishtar, was the issue of corruption. Rampant wasteful spending, redundancies, cronyism and kickbacks will continue to haemorrhage our resources making the aspiration of universal healthcare a pipe dream. No amount of suo-motu cases by the chief justice or action by the chief of army staff can wipe out corruption. This is a problem we have to own, from our small clinics to large hospitals, and collectively work towards resolving.
The third issue is that of quality. The concept of universal healthcare is hollow and useless unless quality care is delivered. This includes not just quality of diagnosis and treatment but also quality of medicines and medical devices used for treatment and care management. The issue of poor quality, substandard and counterfeit drugs has never been adequately addressed and the efforts from the Drug Regulatory Authority of Pakistan (DRAP) leave much to be desired. While those with deeper pockets often have access to better quality care, efforts to ensure drug quality, particularly in large public hospitals, as well as in peri-urban or rural locations are lacking both in vision and in implementation. There are some efforts to improve drug quality by using smartphones but those solutions are a band-aid solution, not a comprehensive strategy. Furthermore, looking towards the future the risk of influx of poor quality medical products, due to increased trade with China, is also not insignificant.
Quality in care requires three things. The incentive to provide quality care, the strategy to maintain quality and the penalty against poor quality. This means that there have to be economic incentives and advantages for those who create quality products and deliver quality care. This also means that strict standards have to be set, which are not only enforced by the government but also demanded by the people. And finally, the action against those who fail to maintain the standard has to be swift and just.
Leaving all to those in power, and expecting them to deliver is neither realistic nor pragmatic. We, the people, have to demand the quality that we expect them to supply. And we have to demand it not for us, but also for all others in the nation. When it comes to universal healthcare, there should be no discrimination against anyone, no tolerance for corruption and no compromise on quality.
Published in The Express Tribune, April 10th, 2018.