Every discussion on the quality chasm in the delivery of healthcare services would end with browbeating health professionals for not trying harder to keep their patients safe. In a not too distant history, this narrative had overwhelming supporters. As a result, the forest was missed for the tree. Research in due course established that “the burden of harm conveyed by the collective impact of all of our healthcare quality problem is staggering”. Studies further documented that pervasive overuse, misuse, and underuse of services was leading to the death and incapacitation of hundreds and thousands of people from non-fatal diseases and injuries. Therefore, it was concluded that if a system fails to support or prepare the healthcare professionals to provide the best to their patients, even a dedicated healthcare service provider would fail to keep patients from harm’s way.
This article makes two arguments: one, the importance of having a strong healthcare regulatory system to stem system failure. Two, to give ear to the regulating bodies because they are the people who have the advantage to see issues first-hand.
The seriousness of having a structured regulatory system in Pakistan was slow to come about, but once in place, it played its part in the development of minimum service delivery standards for the provision of need-based, resource sufficient and accessible healthcare facilities. No regulatory body, however, can be fully beneficial unless the government puts money into the health sector whereby making it a priority rather than a side issue that only gets attention in the event of an outbreak like Covid-19.
Regulatory oversight is the only way to keep the healthcare system from being penetrated by quacks and unethical healthcare practitioners. Many healthcare challenges overcome by the rest of the world to a certain extent, such as AIDS, hepatitis C, infant and maternal mortality, to name a few, have persisted in Pakistan because of the absence of quality care. It also makes healing through some spiritual experience a common practice, which at times could be as lethal as a wrong treatment.
Mass prevalence of quackery and spiritual treatment is usually the consequence of a weak social contract between the state and its citizens. A commoner is of the understanding that the peripheral treatment lent to healthcare facilities is because the state does not care about its people. Would it be wrong to say that the spiritual healers have also been committing an error of judgment by shepherding people to attend religious congregations believing the coronavirus cannot win against God in combined prayers? A large segment of the population attended to this call because of the weak ‘social contract’ and because of the human nature to have someone to trust, which is usually lent to the one capable of empathising.
Advance countries progress for three overriding reasons: one, they do not reinvent the wheel.
Two, their organisations and governments engage academia in policymaking. Three, they adopt a cross-sectoral approach to development.
As for the first reason the healthcare regulating bodies should engage with each other — within and across the country — to learn from shared experiences. This collaboration and consensus-based decision-making model has the potential to eliminate overlapped processes and find common solutions to routine challenges.
Similarly, a nexus among policymakers and academia is a sine qua non for having breakthrough medical researches and to cultivate a strong medical fraternity for a professionally and ethically run healthcare system. Unfortunately, medical education in Pakistan has been compromised with the result that few of our doctors were evicted from the Middle East on the charges of faking professional degrees. Many private medical universities have a charge sheet against them for being inefficient, ruthlessly expensive, and anachronistic.
The combination of academia and policymakers can have Pakistan make revolutionary changes to its health sector without much effort. The regulatory bodies, now operational in almost every province, have done a good amount of foundational work in terms of data collection, which could be used to make informed decisions to remove barriers to quality care.
Last but not the least, no healthcare regulation can make a difference if inter-sectoral engagement among different departments is not happening. The World Health Organization (WHO) defines inter-sectoral action as “action affecting health outcomes, undertaken outside the health sector”. For instance, quality of public transport, water, sewerage system, school curriculum, food legislation, targeted subsidies, and tax relaxations have an impact on people’s health. Any improvement in these sectors improves health indicators. According to community health studies, about 50% of diseases and 40% of deaths in Pakistan occur due to poor drinking water quality.
Healthcare commissions in Pakistan have been advising their governments to invest in socio-economic projects to reduce the burden of diseases.
Pakistan should take advantage of its healthcare regulatory framework and enable it to remove systemic failures in the delivery of healthcare services. This is not possible unless the health budget and development spending are increased. It is unfortunate that we still have a large contingent of inadequately trained clinicians and healthcare organisations unable to deliver a minimal level of quality.
Published in The Express Tribune, March 26th, 2020.