Daily Times

Despite a respectable social image health professionals enjoy, Pakistan is in the middle of an acute health workforce shortage which is growing and will reach to 700,000 by the year 2030 – this includes a colossal deficit of 58,000 physicians including specialists.

How to overcome this shortage crisis would be a massive task for the incumbent government.Though no reliable statistics are available particularly of the female workers in the field concerning active health workers, data shows that Pakistan is one of the hard-hit countries in the world.

Pakistan is the 6th most populous country in the world, with an annual 1.2 % increase in population, high fertility rates of 3.48 births per woman and health status indicated by life expectancy for both sexes improved from 33.8 years in 1951 to 68 years in 2015.

Higher life expectancy means a higher percentage of an older population needing more and advanced healthcare.

The Health workforce crisis remains globally. The WHO estimates that by 2030 globally, there will be a shortage of 18 million health workers.

World Health Organization (WHO) has promulgated desirable doctor-population ratio as 1:1,000 and a minimum threshold of 4.45 physicians, nurses and midwives per 1,000 population as a part of its WHO Global Strategy on HRH, necessary to achieve universal health coverage.

Yet, over 44% of WHO Member States reported less than one physician per 1,000 population. Pakistan whereas has one of the lowest densities of health workers in the region and globally, with essential/skilled health professional (physicians including specialists, nurses, lady health visitors (LHVs) and midwives) density of 1.4 per 1,000 population, which is much below the indicative 4.45.

Devolution carried out in 2011 devolved health entirely to the provinces making them more autonomous, constitutionally more powerful but also promised enhanced financial share under the 7th NFC awards. It was anticipated to help alleviate the tremendous pressure on our health system by providing enhanced provincial autonomy in health care planning has instead opened a new Pandora box of problems,leading to a chaotic event with a lack of capacity, leadership and strategic direction leading to a worsening of the already bleak health care system even after a many a fold budgetary allocation increase.

Responding to this challenge Pakistan’s ministry of National Health Services Regulation & Coordination has evolved a Human Resources for Health Vision 2018-2030 in response to WHO’s call to recognize the gargantuan challenge of a global shortfall of 18 million health workers by 2030.

The vision states to “Accelerate progress towards universal health coverage, sustainable development goals and economic growth by ensuring equitable access to a quality health workforce within a resilient, responsive and strengthened health system”and with it carries various goals, objectives and strategic directions for the provinces to finalize their HRH strategic plans by 2018, establish HRH units for vertical and horizontal coordination between multiple stakeholders, strengthening of regulatory councils with new councils for allied health workers under an umbrella law which to date remain mere writings on paper with no actions so far for its implementation.

The current population of Pakistanis estimated to be218.37 million in December 2019, based on Worldometers elaboration of the latest United Nations data which is equivalent to 2.65% of the total world population requiring a minimum of 40,000 doctors, 20,000 dentists and 160,000nurses.

The health workforce is a key enabler for the attainment of universal health coverage, and for the achievement of Sustainable Development Goal (SDG) 3 – Ensure healthy lives and promote well-being for all at all ages. As is stressed in the Global Strategy on Human Resources for Health: Workforce 2030,there can be no viable national or global, health system without an adequate health workforce.

Only by achieving theappropriate healthworkforce numbers as stated in the WHO strategy for workforce would we be able to move towards achieving the commitment towards SDG’s mainly SDG 3 target specific to HRH and is important enough to merit inclusion in the universal health coverage (UHC) index (SDG3.8.1) and also as one of the thirteen core competencies for the international health regulations (IHR) index (SDG 3.d.1).

The workforce crisis is a problem without borders where even developed countries where health staff are comparably well paid and well cared for will not escape unscathed from the looming workforce crisis in healthcare.

It is estimated that by 2030 Australia will be short of 123,000 nurses, the wealthiest country on the planet America is expected to need 120,000 primary and speciality care doctors by 2030 and 1 million new nurses by the next decade 2025, the U.S. will likely face a shortage of 446,300 home health aides, 98,700 medical and lab technologists and technicians and 95,000 nursing assistants, just to name a few. Similarly, Germany would have a 300,000 shortfall of nurses in 2030, whereas Japan would need 550,000 nurses over the next decade.

While stakeholders and experts around the world ponder on best ways to address the impending crisis, it brings us to question the effectiveness of the HRH vision 2018-2030 in addressing the health workforce crisis in Pakistan where the health system is already straining under a plethora of health-related challenges.

As the health indicators and the burden of infectious diseases softens a notch, the challenge of the non-communicable disease along with the workforce crisis serves as another blow to the frail health system.

WHO data for global burden of disease shows that the communicable disease burden is on a decline but being avidly replaced by the non-communicable diseases such as diabetes, heart diseases, respiratory diseases and cancers known to be responsible for not only 15 million premature deaths in the world between 30-69 years of age but also on the rise due to global demographic shifts towards a rapidly ageing population.

This is leading to an overpopulated country with an increasingly older generation more susceptible to disease and disability, requiring increased and more frequent health care.

Pakistan has a fragmented health system, and statistics show that a health workforce crisis is on the horizon due to changing population dynamics, population boom, inequitable distribution of resources, and rising out-migration trends

Even though Pakistan is a country where healthcare is free for every citizen, but the quality of care diverts 78% of its population to resort to out of pocket spending for private health care.With only 0.42 per cent of GDP spent on health, the out of pocket spending according to National Health Accounts in the fiscal year 2015-16 was 542 billion showing a continuous upward trend from 2011-2012 315 billion, and 470 billion in 2013-2014. OOPE as % of private expenditure on health is 86.8% in Pakistan which is among the top five in Asian countries.

Despite promising and claiming behaviour of the federal and provisional government to keep health a priority Pakistan is among those countries which have a meagre budget allocation in the health sector.

Pakistan has a fragmented health system, and statistics show that a health workforce crisis is on the horizon due to changing population dynamics, population boom, inequitable distribution of resources, and rising out-migration trends.

According to World Bank’s data set in Migration and Remittances Fact book 2016, in the overall ranking, Pakistan stood third in South Asia (after India and Bangladesh) and sixth in the world (after India, Mexico, Russia, China, and Bangladesh) for human capital mobility.

Migration of a significant number of health professionals abroad is another factor contributing to the high attrition rate.

According to the Bureau of Emigration & Overseas Employment, 14,487 physicians and 2,349 nurses were registered for overseas employment mainly to the gulf countries, during 2008-2017. Only in 2017,1,632 physicians and 293 nurses were registered for overseas employment.

Trends of intellectual migration that delink great assets and cream of the country of origin are due to various pull factors such as professional advancement, better facilities to work, and improved salary structure in destination countries with a resultant of great sacrifices from the economy and society as a whole of the origin country.

Beyond doubt out of man, material and money, man has always stood out showing that a robust health workforce is the spine of any health system, and an absolute sine qua non for achieving Universal Health Coverage, National Health Vision 2025 and Sustainable Development Goals 2030. Hence the National Health Vision must be aptly adopted and reflected in letter and spirit to uplift the bleak health workforce scenario and counter the upcoming critical shortage emergency.

The writer is specialized in public health from Health Services Academy Islamabad