The notion-“Health for all” remains elusive when it comes to Pakistan’s mixed healthcare system syndrome accompanied by worsening conditions of both law & order; declining quality & quantity of public healthcare; the dysfunction of public governance which already has reached the tipping notch; low literacy rate with low healthcare budgetary expenditures; extreme poverty; lack of skilled professionals; population explosion; insufficient healthcare commodities & last but not the least low constitutional priority accorded to the public health in the country’s basic law, have further weakened the state. Thus the provision of health facilities, which is considered to be one of the most significant indicators of country’s development, sustainability & economic progression as healthy population can live longer & more productive shedding no light to the end of tunnel. So much so that public health care of the country is at brink of decline.
Moreover, 18th constitutional amendment bill which is fundamental step towards restructuring & revamping the public healthcare system in terms of governance, management & availability has brought more the state of confusion than clarity for there is no proper decentralization which furthermore creates problems like lack of coordination & strategy for proper public healthcare implementation, inadequate financing, provinces capacity for policy making & healthcare planning, generation of healthcare information, development of human resources & international agreements. If health sector has become the provincial subject, it should have to built proper capacity, thereby, not creating Oedipus complex when federal government gets involved in provincial matters. Therefore, it is imperative to sketch a clear line of demarcation regarding roles & responsibilities between federal & federating units.
Broadly speaking, following are given some veiled facts which furthermore compounded to create hurdles for public;
Firstly, In healthcare financing domain government is expending meager of GDP, whereas, most of population pays out of their pockets for treatment.
Secondly, healthcare work force in terms of Doctor-patient ratio & Nurse-patient ratio is not upto scratching.
Thirdly, organization & service delivery dictates the absence of programs for non- communicable diseases & lack of regulatory arrangements for medicines.
Lastly, public healthcare system of Pakistan is also facing much challenges at outset to achieve millennium development goals. Infant mortality is still high which is clear indicator of that.
Moreover, all these issues backed by a large burden of population demanding scarce resources redirection, effective administrative regime & healthcare constitutional revamping.
Although, prime minister’s programme for ‘Sehat Insaf Card Scheme’ enforced in KPK apparently seems fine initiative of PTI leadership, could lead to creation of national health cover. What this programme, a sort of healthcare insurance, does is that relieves the suffering of patients who are already receiving relief at major public sector hospitals but these hospitals are unable to cope with the pressure of patients & inadequate resources & trained staff has created state of crisis at several hospitals. Therefore, comprehensive revamping is the need of hour.
Following are given some suggestions to revive the public health care.
Firstly, there should be constitutional work at both national & provincial levels that should promote meritorious, transparent, accountable & harmonious reforms. A health structure that could regulate both public & private healthcare services & packages & restructuring healthcare system locally with equality & equity of distribution.
Secondly, primary healthcare care should be focused effectively; nation wide health programs should be incorporated.
Thirdly, bridging commercial & economic space for healthcare by socializing public health financing & more allocation for healthcare GDP.
Fourthly, health work force complaints cell should be established for properly implementing the 18th amendment policy between provinces & federation. Drugs regulatory authority needs to be transparent, meritorious & strictly strong.
Lastly, E- health should be promoted in order to get supportable demand driven standards, institutionalizing the incentives, establishing disease response & surveillance mechanism & policy analysis.
All in all public healthcare sufferings are more needs effective & mechanized stewardship functioning through administrative regime, strengthened healthcare system, proper financing & coordination at all tiers of government.
The writer is a third year medical student at Gambat Institute of Medical Sciences.