The WHO has defined the healthcare holistically as, “A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”
It is quite sad to say that in Pakistan, healthcare is perceived in the narrow sense by the policy makers as just the absence of an ailment while ignoring its social and mental aspects. In a developing country like Pakistan, 40 per cent population lives below the poverty line and annual population growth rate is 2.5 per cent. As many as 150,000 HIV cases were reported only in 2018. The antibiotic resistance is on the rise while Drug Resistant Typhoid (DPT) and Hepatitis C have reached an unprecedented level. The government-led vaccination programs are not trusted by the populace.
Meanwhile, the title given to the country as the second most dangerous country for the new-borns cannot be defended. As a healthcare professional working at the district level, I have summarised major policy flaws on the part of the government, which have plagued our healthcare system eventually.
Indubitably, there is a crisis of fiscal management, which has always been a hindrance in achieving the universal healthcare coverage in Pakistan. The major portion of the meagre resources (less than one per cent) allocated to the health sector goes to increasing the incentives for the staff in the first place rather than improving infrastructure and recruiting more qualified healthcare professionals.
Despite the fact that half the people die in Pakistan of the preventable medical errors, the spending on the pre-service and in-service trainings of the staff, patient safety, digitalizing healthcare, quality medicines, extended immunization programs, waste management, availability of potable water and sanitation-all directly related to the healthcare-has remained negligible over the years.
Pharmacy services are the linchpin of the healthcare system. The services provided by the professional pharmacists in hospitals are essentially the clinical expertise in the form of reviewing the prescriptions; suggesting the best possible drug alternatives where required; dose calculations; reporting ADRs (adverse drug reactions) and, most importantly, patient counselling. In addition to this, the grave responsibility of quality medicine purchase, maintenance of proper medicine storage conditions, observing the FEFO rules and Five Rights of Drugs along with supervising the timely medicine availability and apt dispensation to the patients also lies on the shoulders of pharmacists.
Nevertheless, the pharmacy services in Pakistan are highly unappreciated and ignored at large. There is a clear dearth of registered pharmacists in the healthcare system at every level. Unfortunately, there has nothing been done to bring pharmacists at par with the other healthcare professionals in the hospitals for better service delivery.
Pharmacists have always been left outside while making policies and planning concerning the immunization, family planning and educating people about the disease transmission and prevention.
Factually, when you do not empower your qualified health professionals, the quackery steps in.
In any healthcare facility, laboratory services are rudimentary. As a matter of fact, without the error-free lab reports, a doctor cannot prescribe the right medicines, a pharmacist cannot calculate the right dose and the ultimate sufferer will be the patient.
Just like other departments, there is the paucity of professional team in pathology departments of hospitals. This negligence on the government’s end has fathered many healthcare conundrums, including drug resistance; the unnecessary usage of medicines; medical complications and errors (overdose, under dose). It has burdened our healthcare system in terms of time, money and resources.
It is a harsh reality that our political leadership, both at federal and provincial levels, is showing apathy towards the healthcare sector.
Frequent changes in the government in power are disturbing the continuity of policies. The ad-hoc based policies and excessive political interference in state’s institutions have resulted in the loss of their credibility at all levels.
Further, the patchy implementation of these policies and corruption have sown the seeds of people’s mistrust in public healthcare sector.
Our political elites must realise that these prevailing deadly diseases do not recognize rich or poor.
To achieve the universal healthcare coverage in Pakistan in line with the WHO guidelines, the concerned authorities should consider the following measures without further delay:
First, there is a dire need for coherent long term policies and multipronged approaches to achieve the well-developed public healthcare system in Pakistan. The surveyed and researched data from rural health centres to higher levels by involving all stakeholders will help to make prudent policies for healthcare reforms. Additionally, felicitous governance and the continuity of policies are preliminary for the prompt implementation by these policies through the cogent institutions. Second, the healthcare budget must be increased to two to three per cent of the GDP necessarily, with across the board accountability in funds utilisation. The adequate spending on the training of the medics and paramedics regarding medical ethics and contemporary patient safety measures must be set as a priority. Furthermore, the proper fund allocation to the public education and awareness programmes regarding population control, immunisation, sanitation and disease prevention needs the attention of the authorities at the helm of the affairs.
Third, as per the suggestions of the UNHRC report on our healthcare system, the inclusion of Article-9A (RIGHT TO HEALTH) in the constitution of Pakistan is the need of the day.
It will be a supporting step for healthcare in terms of investment. Article-25A were added to the constitution in 2010.
Lastly, the provinces must strengthen the spirit of the 18th Amendment and must prove that devolution has improved service delivery for the public.
The federal initiative of Sehat Card must also be executed prudently.
Conclusively, we cannot survive in the progressive 21 century with the same antiquated system and archaic mentality. China charms the world with a new approach by recognizing both the traditional and modern system of medicine for the full healthcare cover to its entire population. We just have to think out of the box!
The writer can be reached at [email protected].