Privilege and public health

Prior dues, serious lack of funding for procuring drugs, including several life-saving drugs in KP

Well below the big breaking news of celebrity divorce and other related stories talking about the when and how of this event of great national significance, a small news caught my eye. It was about KP public hospitals having drug shortages. A recent report by Director General Health KP talked about prior dues and serious lack of funding for procuring drugs, including several life-saving drugs in the province.

Disturbed by this news, I started to look online to see if I could find out more from other news sources. What I found instead was something much more troubling. A cursory search revealed the exact same problem on a repeat cycle. There were stories, with essentially similar titles (Hepatitis patients awaiting medicine supply, May 2022; KP faces insulin shortage, Dec 2022; KP Health advisor takes action about shortage of medicines, August 2022; Pricing dispute causes shortage of critical medicines, March 2023; Funds shortage affecting patient care in KP, May 2023). And these were just in KP. Expanding to other provinces, going back another year or two, or including other search terms such as substandard medicines, would lead to dozens of other stories that were reported in just the last few years.

While the issue of drug shortage may not be new, we should recognise that our old strategies are not working, and are creating a much bigger problem for us than we anticipate. Beyond the obvious and critical issue of patient care and our ethical responsibility, there are other aspects we have to consider. Lack of medicines that are affordable and are of good quality increases the likelihood of developing complications, development of new health challenges and worsening of diseases. Poor patient care leads to significant economic burden on the patient and their families, resulting in repeated visits to the hospitals, increased out-of-pocket expenditures and the difficult choices to cut expenses in other important areas including education and food. All of this leads to depressed economic activity and tremendous personal anxiety. Beyond these, there is an important (but poorly recognised) issue of trust in the public health system. Increasingly, people are sceptical of the care that they would receive in public hospitals and they have good reasons for that scepticism. This lack of trust manifests itself in increasing demand in private hospitals which, in addition to being extraordinarily expensive, may also have their own challenges of quality of care and staff training. Ultimately, the individual and the public health system both are worse off.

So where do we go from here? The good thing is that no new wheels need to be invented here. The solutions are well known, and there is precedence from other countries as well. Strong public health system requires robust budget, but also strengthening of key pillars, including availability of quality medicines. Figuring out how to plan for procurement, utilisation and consumption is not particularly a difficult task. The harder task, however, is to recognise that strengthening the public health system ought to be a permanent priority. For many who are in positions of power, this is not a particular problem since they rarely deal with public hospitals (unless it is a photo op). But it is precisely this privilege that makes us immune to the suffering of the less fortunate.

Over the weekend, I spoke to a few people about this (and related issues). The answers were all predictable and at the core, identical. Everyone I spoke to told me that there was nothing surprising about it, and this is how it was. It is not to say that they were defending the status quo, but they had simply made peace with it. In a way, they were also right. There was nothing new about the crisis in public hospitals in KP (or other provinces). By comparison, there is something new about the most recent chapter in the private life of a Pakistani-cricketer. One person coined a new term ‘un-news’, that is the opposite of newsworthy. This to him was un-news.

I wondered if we would ever pay attention to the un-news?

Published in The Express Tribune, January 23^rd, 2024.

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