Provision of healthcare is among the most corrupt services in the country according to the Pakistan Lancet Series, an “in depth study on the country’s healthcare system”. The study proposes substantial changes in the accountability and transparency of the health sector for improving its performance.
The Lancet, a leading medical journal published weekly from London, on Friday launched a major series on health transitions in Pakistan. The report, analysing past and present performance of the sector, calls for a unified vision for universal and equitable health access across the country.
High numbers of diseases
According to the series, an estimated 8-9 million people are infected with hepatitis-C virus, 620,000 people have tuberculosis and every year 410,000 people are infected while 59,000 die from the disease. It further revealed that 500,000 cases of malaria are detected annually and 5,000 people die of rabies every year. Poliomyelitis remains endemic despite an intense global focus on eradicating the disease.
Poor family planning and child mortality rate
Pakistan has a dismal record of reducing fertility rate although it has fallen from six births per women in 1990 to 3.6 in 2012, which is still higher compared to other South Asian countries. With nearly one million women seeking unsafe abortions annually, family planning is the most neglected component of women health issues. The most large-scale public health crisis is the child mortality rate with about 423,000 children under five dying annually, nearly half of whom are new born babies. This is compounded by the deaths of 12,000 mothers. Pakistan has the third highest number of maternal, fetal and child mortality deaths with 57 per cent of neonatal deaths occurring in the first 72 hours after birth. “A governance crisis and poor political ownership of maternal and child health have retarded progress in women and children’s health in Pakistan because no political parties have considered it a priority,” said Professor Zulfiqar Bhutta of Agha Khan University, who is a co-author of this series.
Bleak healthcare system
Public spending on health is at $9.31 per person, much less than the internationally recommended $60 per person whereas 78.08 per cent of the population pays from their pockets for healthcare. Presently 121,374 doctors are registered in Pakistan while the doctor-to-population ratio of 1:1127 is fewer than the World Health Organisation (WHO) recommended 1:1000.
Cost of non-communicable diseases
Nearly four million people aged 30 – 69 are predicted to die from cardiovascular disease, cancers, and chronic respiratory disease by 2025, with tobacco use as the prime factor behind it. Quoting surveys, the journal indicated that nearly 29 per cent of men in Pakistan smoke, as do four per cent of women. High blood pressure is also a leading risk factor for these illnesses, with an estimated 35 per cent of adults in 2008 thought to possess high blood pressure.
If unaddressed, this disease burden is predicted to cost Pakistan $296 million by 2025, with a cumulative loss of productivity due to premature death in workers amounting to $3.5 billion in the same period.
Government investment in health was recommended to increase to at least five per cent of the Gross Domestic Product (GDP) by 2025.
Dr Sania Nishtar, founder of Heartfile, and non-profit health think tank, and author of the series said, “The abolition of Ministry of Health after the 18th Amendment was clearly a setback, as we need a unified institutional framework”.
The launching ceremony of the Lancet Series was organised by Heartfile in collaboration with Agha Khan University and held at COMSTECH auditorium, Islamabad.
Published in The Express Tribune, May 18th, 2013.