Diaspora's role in promoting health care in Pakistan

Physicians of Pakistani origin living and working in the United States constitute an important part of their country's diaspora. The size of the Pakistani diaspora is now estimated at 700,000 or 0.2 per cent of the American population. Those who have moved to the United States account for 0.3 per cent of the Pakistani population. As I will take up later in this article, I and one Pakistani doctor have played active roles in getting the diaspora involved in the affairs of their country. While I established an institution based in Lahore that is now named after me, Dr Nasim Ashraf developed a close relationship with General Pervez Musharraf who gave him a position as a member of his cabinet.

Nasim Ashraf has recently self-published a book that provides a detailed account of the way Pakistani physicians under his leadership began to work together under an effective organisation called AAPNA. The acronym stands for the Association of Physicians of Pakistani descent in North America. Ashraf's book is appropriately titled Ringside, since it provides a view of the political ring that he watched from the sidelines in Pakistan. The book focuses on the role the Pakistani physicians have played in helping the country of their origin to improve the situation of health which has caused economists such as myself to worry how the country's poor performance in the sector of health is likely to affect its economic, social and political progress.

Pakistan's health system as redesigned by the 18th Amendment to the Constitution has passed on the responsibility of providing healthcare of the citizens to the provincial governments. They have not been effective in performing this role. There are a number of problems with the system. Of these, four are important: lack of finance; deep differences in coverage provided in the urban and rural areas; not enough focus on child- and mother-care; and a serious shortage of paramedics, nurses in particular. Taking the last first.

A paramedic is a healthcare professional whose main role has been to respond to emergency calls for medical help. Following the response, the affected person is transferred to a well-established medical facility such as hospitals and clinics. This system was put to test during the Covid crisis when Pakistan performed better than neighbouring India in part because the pandemic there struck difficult-to-reach slums in the highly population-dense city of Mumbai. Pakistan has only 106,000 nurses to serve a population now estimated at 240 million. As discussed below, the Burki Institute of Public Policy (BIPP) has launched a programme to increase the number of paramedics in the country, in particular in the areas around the megacity of Lahore.

The total expenditure by the federal and provincial governments combined is only 1.4 per cent of national income, most of which is spent in cities and large towns. The total expenditure on healthcare is about one-fourth of the 5 per cent recommended by the World Health Organization (WHO). The government shortfall is compensated to some extent by private sector health enterprises. Several analysts have concluded that 70 per cent of the country's large and growing populations is being served by private healthcare institutions who do their work without any involvement of the public sector.

Returning to the role played by physicians who have a large presence in the Pakistani diaspora in the United States, it should be noted that before Ashraf institionalised their Pakistani operations, several of them had funded the establishment of large modern hospital in Pakistan's major cities. The Doctors Hospital in Lahore and Al Shifa Hospital in Islamabad are good examples of these efforts. A cancer hospital in Karachi was also built by the diaspora doctors. Several Pakistani-American doctors gave up their practices in the United States and returned to work in the hospitals they and their colleagues had promoted in Pakistan's major cities. For instance, Lahore's National Hospital employs several diaspora physicians who provide major services to the visiting patients.

However, Ashraf worked to get medical care to the under-served parts and populations of the country. To achieve this objective, he established the National Commission for Human Development (NCHD) on July 22, 2002. "I was elated. I simply could not believe it was happening because of one man, General Pervez Musharraf, who was willing to spend political capital on this idea," wrote Ashraf in his book Ringside. The NCHD defined its targets, all of them ambitious, as follows: Increase literacy rate from 43 per cent of the population in 2002 to 78 per cent by 2025 with focus on female education; ensure universal primary education by enrolling all out-of-school children estimated at that time to number 15 million; reduce infant and maternal mortality rate by 30 per cent; reduce population growth rate from 2.8 per cent to 1.5 per cent. These were ambitious targets and most of them were not met. But that notwithstanding, the NCHD brought comfort and development to millions of people around the country.

I will now turn briefly to the work the BIPP is doing in improving the supply of paramedics in the country. The BIPP was initially set up as the Institute of Public Policy (IPP) at the urging of my late friend Sartaj Aziz who at that time was the Vice Chancellor of Beaconhouse National University (BNU). The funding for IPP was to be provided by the BNU. He wanted me to chair the institution by moving to Pakistan, something I was not prepared to do. While I would by an absentee chairman, the institution would be managed by a local employee. When Sartaj resigned and left Lahore for Islamabad, the BNU funding ceased. At that time the Burki family stepped in with the needed funds and decided to change the name of the institute to Burki Institute of Public Policy, the BIPP. I was about to close the institution down but was advised by my late relative AZK Sherdil to talk to Shahid Najam who had recently returned after more than two decades of service at the United Nations. Najam came to see me and surprised me by indicating that he would be happy work at BIPP without any compensation.

I would count him as a member of the Pakistani diaspora who is committed to work to raise the level of development of his native land. One recent initiative he has launched is to provide scholarship to girls from relatively poor families to study paramedic disciplines. That way the BIPP would work to relieve some of the shortages from which Pakistan's health sector suffers.