An unhealthy nation

It is becoming clear that problems that emerged following the devolution of powers that occurred post-18^th Amendment have still not been dealt with in an efficient manner. As is the case with education, which has suffered with the devolution of budgets and responsibilities, so it is with health services. By devolving money and responsibility to the provinces, none of whom were ready in terms of capacity to absorb the cash or the additional administrative burdens that go with it, there has been a loss of a ‘national vision’ in respect of shared aspirations for improving healthcare provision. Devolution has rendered the federal agencies and departments working with health, in large part, inoperative, mainly because their roles and responsibilities are now unclear. This is especially true of the Ministry of National Health Services Regulation and Coordination, which needs to review its policies across the board and reformulate a national action plan.

The body is not helped by the fact that the provinces are not as yet up to speed regarding legislative and administrative structures in respect of health. There is a wide disparity between the progress of each province in completing these key tasks. The Millennium Development Goals (MDG) have mostly been missed by Pakistan, and they are to be replaced in 2016 by Sustainable Development Goals, which are no more likely to be met than were the MDGs. There is an urgent need for the creation of a national vision document for health. Currently, there are indications that health care spending at the provincial level is actually dropping, aggregating nationally to 0.4 per cent of GDP. This has potentially catastrophic implications. The failure to have developed a national vision is also impacting on a range of international responsibilities that Pakistan has as a result of being a signatory to treaties that carry a national reporting requirement. With no cross-provincial uniformity in reporting standards, quality assurance of medicines and regulation of health professionals, Pakistan is failing in its obligations. This is a failure of vision that blinds us all.

Published in The Express Tribune, July 27^th,  2015.

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