Health minister is telling the truth; please listen to him

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This has not happened before. At least in the last twenty years I have not heard any senior government official publicly admitting this major flaw in the government's planning and strategy. This was very clear to us all who were dismayed by Pakistan's lackluster performance in improving the health standards in Pakistan, but it seemed decision-makers were oblivious to it.

Health Minister Syed Mustafa Kamal openly admitted two basic reasons for failure in improving health system in Pakistan. He said without controlling our population growth (highest in the region), there is a widening gap between resources and needs. Pakistan crude birth rate is more than 25 as against just 16 both for India and Bangladesh. That in simple terms means that every year the net population (live births minus deaths per year) of Pakistan increases by 5 million.

So, every resource of Pakistan needs to be increased including new hospital beds, schools and other infrastructure to provide facilities for 50 lakh newly added people every year. Currently, Pakistan has 0.7 beds for 1000 of its population while WHO minimum standard is 3 beds per 1000 population. This means currently Pakistan has a deficit of 550,000 beds to meet minimum WHO standards.

Providing hospital beds for a yearly 5 million increase in population, we need 15000 additional hospital beds every year. So, before a political leader lambasts a hospital administrator about mismanaging a big hospital, they need to answer: what are their plans to add 550,000 deficit beds and yearly need of 15000 hospital beds?

The minister is correct in saying that Pakistan needs to tackle its population challenge in order to have some grip on not only our health system, but also education, jobs creation and other governance challenges. Until now powerful prime ministers, ministers and other notables have refrained from making it a public issue because of fears of backlash from conservative circles. So, kudos to Kamal for telling a known but very hard truth!

The minister has also provided a quick solution to the current health challenge until we wait for improvement in the population crisis. He told us that by providing safe drinking water to our population we could decrease infectious diseases by 67%. I would like to correct him by saying that by just providing safe drinking water and sanitation we could decrease the infectious disease burden by 75-80%. We have historical and verified data from multiple countries which, by the above two interventions, were able to reduce infectious disease burden to the mentioned level even when there were no antibiotics or vaccines.

This also means the load on current hospital beds will be reduced significantly.

So, if a prime minister or a chief minister wants to improve hospital conditions, it will not happen by surprise visits or transferring or suspending the medical superintendents. The major challenges of health system do not originate in the health sector, but it's the failure of other departments — failure to provide safe drinking water, ensure sanitation, tackle environmental degradation and control population growth — which increases chaos in the health system.

The world has already learned that health can't be improved if we work vertically and exclusively in the health sector. 'One Health' means that human, animal and environment sectors must work collaboratively and intrinsically to have any meaningful improvement in health of the populations.

In a rare opportunity, a government minister has touched upon these two critical issues. This is an important first step and I will request him to keep talking about it even if he does not have any control over these two issues. We need people at senior level at least talking about it, and hopefully one day we will start moving in this direction.

Pakistan cannot provide clinical services for its 240 million population if we don't stop too many people from getting sick in the first place. Preventive strategies — and not hospital beds — hold the key to an effective health system.