Sustainable Development Policy Institute (SDPI) recently conducted a citizen’s perception survey in all provinces of Pakistan to assess the state of health service provision.
A national baseline (average of responses from all provinces) of key issues related to health service delivery was prepared. It included lack of availability of public health services at the union council and community level (59 percent respondents), difficulty to access health facilities in terms of distance/time (53 percent respondents), lack of availability of medicines/supplies (47 percent respondents), lack of facilities for the patients (46 percent respondents), lack of secondary and tertiary level health facilities (40 percent respondents), and corruption/misuse of resources (38 percent respondents).Half of the respondents (44 percent) termed the health service provision as average, whereas 32 percent termed these services below average and/or very poor. Based on different focus group discussions and key informant interview, SDPI also compiled an agenda for ‘citizen centric health reforms’.
As per citizen’s perception, performance of different provinces in health sector vary a lot. According to our respondents, KP government, although needs to improve tertiary medical services, has done significantly well in terms of health service provisions at local level. On this count its performance is considerably well than other provinces. Punjab government, though needs to improve medical services at union council and community level, has done well than its competitors in providing secondary and tertiary level health facilities. Sindh’s performance in health sector is below national baseline, whereas Balochistan is way below national baseline.
In the run up to elections, it should be noted that on the day of the polls, it is not only the past performance of different governments that matter. Voters will also take promises made for the future into account
State of health service delivery in Pakistan does not show a very positive picture and this is endorsed by citizens as well. So what is it that citizens of Pakistan demand from state when it comes to their health issues. First thing first, they want a consensus of all political parties to amend the constitution to insert health as a constitutional right.
One can argue that insertion of 25-A (education as a fundamental right for children of the age from 5 to 16) has not brought any radicle change in literacy. But the counter argument is that constitutional amendment sans adequate financing and institutional mechanisms, cannot bring any miracles. That’s way citizens want an increased allocation for health. They would like to see an increase in federal health budget by 2 to 3 percent of GDP from the existing less than 1 percent. By the way two percent of GDP would be Rs 770 billion which is less than the cumulative energy circular debt of Pakistan.
Depending on which province, a one third to one half of our respondents complained of lack of availability of doctors, lady doctors, and medicines. This is partially a funding issue, partially governance issue (ghost appointments), and partially lack of capacity in public sector.
Private sector health service providers are sharing this burden but then they are unregulated. One way out suggested by our respondents is initiations of health insurance program where state does not only pay the premium for poor but also regulates the service providers to ensure quality services at affordable prices.
Regulating high prices of pharmaceuticals and medical supplies, and ensure supply of quality medicines is another aspect where citizens are expecting the government to exert its role.
According to our survey, availability of health facilities at union council and community level is still another major health related issue. Almost one quarter of our respondents in KP and more than half in other provinces complained of it. While provision of secondary and tertiary health care facilities are important, it is equally important to provide primary health facilities at union council level. It would not only save precious lives but reduce the burden on secondary and tertiary hospitals too.
Citizens are mindful of the fact that water borne diseases can be avoided through clean drinking water and well thought of sanitation plans. However, they blame lack of transparency and lack of accountability in failure/partial success of earlier schemes.
While health services are required for everyone, the importance of these services increases manifolds for senior citizens and people living with special needs. Our discussion with citizens highlighted that these two groups should be given special preference in health policies. One should be mindful of the fact that by investing in geriatric health care, policymakers would be investing in their own future in a way. At the end of our life cycle, most of us have to be senior citizens.
In the run up to elections, it should be noted that on the day of polls, it is not the past performance of different governments, but the promises made for future would also matter to the voters. The political parties should exhibit a political will to adopt a People Centric approach while strategising and prioritising their agendas for future government with the spirit of the ‘No one left behind’ mantra of SDG. The people should be at the centre of resource allocations priorities as growing population with meagre resources need affordable and quality healthcare. Health cannot be left at the mercy of the market forces.
The writer heads Sustainable Development Policy Institute. He tweets @abidsuleri
Published in Daily Times, May 24th 2018.