2021: The year Pakistan’s health infrastructure was pushed to its limits

In a year that severely strained the country’s healthcare system with the coronavirus and dengue causing hospital bed shortages, the ruling party’s bid to provide universal healthcare was the source of joy for many but medical exam uncertainty drew the ire of future doctors.

Earlier during the year, the fourth wave of the superspreader gained traction aided by the highly transmissible Delta variant which originated in neighboring India and wreaked havoc over there causing a burial site shortage.

At home fears grew that a catastrophe similar to the one that had hit India awaited Pakistan as well and thus began the nationwide lockdowns. Despite virus related safety protocols being implemented in April the number of daily cases in the country exceeded 5,000 and the spread of Covid-19 was concentrated to its biggest cities For instance,

Karachi, the most-populous city, accounted for about 22% of all cases, Lahore, the second-largest city in the country, accounted for 19%, Islamabad, the federal capital, recorded 9% of cases, and Peshawar, the oldest city of the country, accounted for 5% of the country's total number of confirmed cases.

However, the superspreader related fears soon turned into vaccine hesitancy with the arrival of the Sinophram vaccine, which was donated by the government of China as a goodwill gesture. Myths about the inoculation drive being a human monitoring tactic and leading to possible death made the rounds. When the initial hesitancy gave way, the country’s inoculation drive saw an uptick and brought along with it fake vaccine entries.

For instance, in Lahore, the name of former prime minister Nawaz Sharif, who is currently residing in London, was used to make an entry in the National Immunization Management System (NIMS). The vaccination drive’s upsurge, currently at 67.5 million people fully vaccinated as per the National Command and Operation Center’s (NCOC) website, made citizens return to life as normal with masks long-forgotten and sometimes jostling around in mall and eatery queues to find their vaccination cards. Such was the status of normalcy that future and young doctors held protests across the country against the Pakistan Medical Council’s, National Medical and Dental College Admission Test (MDCAT) and National Licensing Exam (NLE) policies and the government’s intervention in the workings of PMC.

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With the protests ongoing but the need to carry an inoculation certificate subsiding, using insect repellent and covering up the body became paramount as dengue strengthened its vice like grip across the country. Punjab and Khyber Pakhtunkhwa (K-P), in particular, were hotspots for the mosquito-borne viral infection as reported cases stood at more than 26,000 and 10,000 respectively.

Dengue and the superspreader were not K-P’s only problems though as the province’s medical professionals refused to accept the Medical Teaching Institution (MTI) Act 2015 for the sixth year running. Former president Young Doctors Association, Dr Rizwan Kundi termed the MTI Act a disaster while talking to the Express Tribune, further stating: “Senior doctors are leaving hospitals which has not only damaged the healthcare system as poor patients are being treated by inexperienced doctors but at the same time trainee doctors have lost the opportunity to work under seasoned medical specialists and surgeons.” Kundi also grilled the Pakistan Tehreek-e-Insaf (PTI) government in K-P by stating that it had thrown money into the Sehat Sahulat Program, an initiative to provide universal healthcare, which benefited private facilities more than the government run hospitals.

The universal healthcare initiative by the ruling party which also made its way to Punjab, however, could not make it to the country’s largest province in terms of land area, Balochistan as the provincial government’s plans to launch the Balochistan Health Card, under which health insurance of Rs1 million would be provided to each resident family of the province, stalled with the change in government.

However Balochistan’s problems, despite having allocated Rs 38.5 billion for health in the 2021-22 budget, are manifold as the sole polio case of the year came from the Killa Abdullah District of the province and as per sources more than 70% of its population has not been inoculated. “Balochistan’s issues are serious as on one hand the young doctors have been on strike and on the other the government has done a poor job in providing basic medical facilities in all districts of the province,” Zia ur Rehman, an independent health expert based in the province, informed the Express Tribune.