Daily Times

There is an air of renewed hope that is palpable throughout the country. This hope is for change, for betterment; for a new Pakistan. Although this phrase is often used politically, the average Pakistani simply wants and needs advancement in the form of reforms; in education, employment, application of the rule of law, women’s rights, the economy and definitely in healthcare.

Pakistan’s healthcare sector in particular remains severely neglected and underserved. For example, besides Afghanistan and Nigeria, Pakistan is the only other country in the world with an ongoing poliovirus transmission. Moreover, new reports claim that almost 10 million people nationwide are suffering from Hepatitis C, making Pakistan the second highest hepatitis prevalent country in the world. There is a lack of facilities in rural regions, and at the same time urban areas have an extremely high patient to doctor ratio, leaving a huge portion of the population unaccommodated. Infant mortality rate continues to rise, while life expectancy for women continues to fall.

When it comes to the most basic of public health services, one of the most critical yet overlooked area is that of emergency medical services. As per the World Health Organisation (WHO) guidelines, one fully-equipped ambulance should serve a population of 100,000 people, therefore in order to cater to Karachi’s population of at least 20 million, our metropolis alone would need around 200 life saving ambulances, complete with the latest medical equipment and staffed with well-trained medical professionals. For comparison’s sake, as of last year, Delhi, a city of 22 million, has a fleet of 152 state-run ambulances, or 1 state-run ambulance per 145,000 and at least 20 percent of these vehicles have advance or basic life support equipment and capabilities.

In this regard, it is heartening to note that around 60 life-saving ambulances are presently being operated by Aman Health Care Services of the Aman Foundation. These life saving services match the most impressive of international protocols. The service was set up in 2009 by the Aman Foundation — a not-for-profit trust created with the mission of incubating scalable sustainable models that solve the most pressing issues in healthcare and education sectors of Pakistan.

Over the last decade, Pakistan has spent between just 0.5 percent and 0.8 percent of its total GDP on health, falling alarmingly short of the WHO benchmark for health expenditure, which is at least 6 percent of a country’s GDP

Using the New York Ambulance Services as a model; each vehicle is connected to a fully automated, wireless command and control centre, from where the caller is provided full medical guidance until the dispatched ambulance arrives. The ambulances are fully equipped with a cardiac monitor, defibrillator, oxygen cylinders and a medication kit of 30+ essential emergency medications among other necessary equipment. There is also a paramedic, a nurse and a driver who are all trained in the American Heart Association’s certified BLS (Basic Life Support) and/or ACLS (Advanced Cardiac Life Support).

But attaining and maintaining lifesaving ambulances such as those mentioned are very costly; they amount to almost PKR 7 million, per every vehicle each year to be exact. These vehicles and their staff work around the clock, performing 350-400 interventions daily. In the last ten years, more than one million interventions have been conducted, which is a milestone in itself. However, the organisation is only able to cater to less than half of all emergencies in Karachi, which according to some estimates cross 1000. To be able to even attempt responding to the remaining ones, the service needs to be scaled up and more lifesaving ambulances need to be added to the fleet. And all this needs to happen fast.

While some of the private sector does indeed have the resources available to an extent and is endeavouring its best to meet the demand; a country cannot leave a segment as vital as emergency health care service in the hands of private organisations, supported perhaps by a few affluent families. It is ultimately the government’s responsibility to provide basic health care to its citizens. Yet, over the last decade, Pakistan has spent between just 0.5 percent and 0.8 percent of its total GDP on health, falling alarmingly short of the WHO benchmark for health expenditure, which is at least 6 percent of a country’s GDP.

A few organisations like the Aman Foundation, with commendable track record of executing sustainable social enterprises in health care and in education are like islands of hope in the vast sea of challenges. In fact, what Aman Foundation is doing — by initiating world-class health practices for the benefit of the people of Pakistan — is easily replicable and scalable as all their initiatives have been designed to integrate with government and/or donor partnerships.

Just last year, the Government of Sindh, in a move worthy of praise, adopted the Aman Ambulance model under a public-private partnership and expanded it to the districts of Thatta and Sujawal. The Sindh Peoples Ambulance Service (SPAS) is now operational in fairly remote areas of interior Sindh — filling a part of the gap in health care provision. And while Aman has requested the government to take this ambulance service model to 4 to 6 other districts in Sindh, this needs to happen on a much larger scale, across the nation. In June this year, Aman Foundation also donated a number of ambulances to the National Institute of Cardiovascular Diseases (NICVD). The move was in sync with Aman Foundation’s strategy of integrating its services into the national network, thus vastly expanding the scale of operations.

Other organisations could take these as great examples of how public-private partnerships can work, and the provincial as well as the federal governments need to follow suit. Given the current mood of the country, this appears to be a great place to start. What better way to bring about change than to finally prioritise the basic right of every citizen — their health. So yes, if a new Pakistan would simply mean a Pakistan where no citizen is left behind; where each person can have accessible and affordable education and healthcare, then we should all be for it.

The author is a freelance writer based in Karachi

Published in Daily Times, September 16^th 2018.