Pakistan’s healthcare system: rising from the ashes

Everyone has a lot of complaints about the current healthcare system of Pakistan. Even rich people who can afford private care are not getting quality treatment. The public sector situation is even worse with multiple patients lying on the same bed and hospitals routinely running out of key medicines or critical medical equipment. Still, we may not be aware of the extent of the rot in the system. Every year we add 500,000 new tuberculosis cases, making Pakistan the 5^th highest burden country. Around 12 million people are living with hepatitis B and C, making us the worst affected country in the Eastern Mediterranean region. More than 250,000 children die in their first 28 days of life, making Pakistan the riskiest country for young children. More children die in Pakistan than in Afghanistan, Somalia, South Sudan, Mali and Chad. Nearly two hundred mothers die out of every thousand giving birth — one of the highest maternal mortality rates in our region. In 2022, Pakistan reported more than 3.4 million malaria cases. Pakistan had the biggest outbreak of Extremely Drug Resistant (XDR) typhoid, affecting an estimated 40,000 in two cities alone. We had the largest outbreak of HIV in young children, which was not linked to mother to child transmission. Four children out of ten are stunted. This is not an isolated issue, but countries may lose 3% of their annual GDP because of these stunted kids. Individually they will have low cognitive development, leading to a loss in economic productivity.

Just pause and think about it. We are witnessing our national demise in intellect by keeping our children hungry. We have a major problem with infectious diseases, but chronic diseases are killing us more. Neonatal disorders, ischaemic heart diseases and stroke are the main causes of premature deaths in Pakistan. Malnutrition, pollution, high systolic blood pressure and tobacco consumption are other major causes. The reasons are obvious. Pakistan is even behind Rwanda in its spending on healthcare and education — 164^th out of 188. After corruption, whatever is left is consumed by salaries. After that, the remaining resources are used primarily for clinical services with less than 20% for preventive care. A low resource country can’t provide clinical services to 220 million people if it does not invest in preventing people from getting sick in the first place.

Unfortunately, there are no quick fixes but certainly a way out of this quagmire. Here are my quick fixes. First, health should be discussed in the context of national security. A sick or unhealthy Pakistan including future generations with low IQs are a national security issue. Second, we can’t solve our health challenges until we fix our population challenge. Pakistan has a fertility rate of 3.4, which is highest in South Asia. Thirdly, we need to fix our drinking water and sanitation issues. Just by providing clean drinking water and reasonable sanitation, we could decrease more than 70% burden of infectious diseases. This is not a claim but based on pure science and historical data. Fourth, we must address malnourishment issues. Fifth, we can’t manage our health system without health intelligence. We need to have a representative and reliable disease surveillance system, which will not only tell us about impending epidemics or pandemics but also help us in effective resource utilisation. Sixth, we need to provide access to quality health care, especially to the poor. But this should not be at the cost of diverting government funds to enrich private hospitals and their owners. Seventh, we need to empower experienced health professionals to manage system. Right now, experienced professionals are sitting on the sidelines while “know it all” bureaucrats are running the show. There are many easy fixes available, but only the attention of decision makers is required.

Improving the health system does not require setting up new hospitals. Instead, we need trained professionals who know how to plan and execute health interventions at a massive scale. We need the right person for the job.

 

Published in The Express Tribune, February 13^th, 2023.

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