Old medicine in a new bottle?

Improved water and sanitation could decrease more than 70% of infectious diseases in Pakistan

Pakistan’s health problems are huge. As the Prime Minister mentioned in his inaugural speech, nearly half of our children are stunted. On the other side, over the years our sedentary lifestyle and increase in fast food consumption have increased diabetes, ischemic heart diseases and other chronic ailments. As a double whammy, our complete lack of sanitation and clean water in most places has caused the number of infectious diseases to skyrocket. This should not be surprising as we are on the top of the list of the countries with the most infectious diseases. We are further seeing extremely drug-resistant (XDR) diseases propping up in many places. We had XDR tuberculosis and now we have XDR typhoid raging in two cities with an estimated more than 40,000 cases. Pakistan was also one of the first ten countries which reported a highly resistant and fatal new fungal disease just a couple of years ago. With no visible effort on population growth and very little investment in addressing the underlying issues, no number of increases in beds can solve Pakistan’s health issues.

So why we are still struggling even when successive governments really want to improve the health system in the country? The answer is short and simple. We are not getting the right person for the right job. No, I am not talking about nepotism in hiring. We are just going to the wrong group of professionals for the remedy for our complex health issues. Clinical sciences and public health are two very different specialities. While the first focuses on a single patient, the latter focuses on population health as a whole. That requires different pieces of training, experiences and sets of minds with very different priorities. Unfortunately, public health in Pakistan has not received its due importance in the health hierarchy.

Decision-makers have personal contacts and developed trust over the years with their treating clinicians. That means when they assume power or a health crisis comes, they seek the advice of these clinicians. Unfortunately, they don’t understand how detrimental this is to the health of the people they want to serve. It is just like going to a neurosurgeon to extract your teeth. No matter how good a neurosurgeon maybe, he won’t be able to extract your teeth better than a dental surgeon.

So the problems Pakistan is facing are related to population and health, and we are coming up with solutions which are patient-focused like an increase in beds or better-managed hospitals. Just look at all the think tanks and Board of Governors (BoGs) in the health system and you will find them filled with eminent professionals of repute whose whole life’s work has been in personal medicine or hospital management. Health management is a very small part of our overall health crisis but we think that just better-managed hospitals will be the solution to the crisis while missing the bigger picture. We need to decrease the number of sick people in this country. We need to invest in better preventive health programmes and their leaderships. We need to invest in providing better sanitation and clean water (yes, that is a health issue and we could decrease more than 70% of our infectious diseases and even stunting by improving water and sanitation quality). Working on maternal education and reducing poverty will also improve the health of our population. Focusing on hospitals alone is just tinkering at the edges of the problem.

The current Federal Health Minister is an exception with a background in public health. As a public health professional, I hope he will be able to bring back the focus from curative to preventive strategies in health policies. This will not be an easy task but it’s a very critical need for us now. Our health indicators have become the worst in our region and in comparison to some much poorer African countries. This should be unacceptable in a country with so many resources and qualified human capital. The need is to redraw the whole health strategy again from scratch and move in a completely different direction focusing on disease prevention instead of care provision. No matter how good or bad our federal or provincial health ministries maybe they can’t provide curative services to 200 million people if they don’t stop people getting sick in the first place.

Published in The Express Tribune, September 26^th, 2019.

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