Daily Times

The current pandemic of COVID 19 is still unfolding not only its own mutations but several other pandemics of inequalities too. Multi-level and multi-faceted challenges are integrated in the health systems of all countries. As a part of its commitment to the agenda 2030, achieving the Universal Health Coverage with its 16 indicators is a critical task for nearly all member countries of the UN. Pakistan in spite of many inherent constraints that also encompass its routinely underfunded health system has fortunately survived well through this global catastrophe of Coronavirus. Its health system, is or should be swiveled by leadership and governance for managing service delivery, human resources, technologies, finances etc. Most of the factors that critically influence our country’s health systems are outside the technical domain of health care systems. Too often there exists a large gap between actual needs and perceived needs not only of the target populations but also of the health care providers. This leads to a chaotic, costly and conflicting set of arrangements within the system as may be verified by inefficient coverage of healthcare, communication and coordination within the sector and with cross sectors. Illogicalities caused by hasty devolution of the provinces too are disturbing the capacity of the health systems. The health care financing, the mindset of those who run the systems and trust of the people in the system remain bigger areas of challenges and concern that require courageous exploration and oversight mechanisms.

A collective serious thinking must be started on the agenda item health. One strategic step could be that the health including mental health, sexual and reproductive health for all (meaning disabled and trans as well), be designated as a constitutional right

Denial must never be used as a substitute of diplomacy and or political correctness. Data not desires must be referred to and used for decisions. UNDP in 2020, noticed that Pakistan performed below the average for its region, being surpassed by countries such as India and Bangladesh in human development, gender development, and in human development adjusted for inequality. Their report documented huge inequalities in gender, education, health, and more as the fundamental reasons behind this low performance. A Lancet-paper in 2020 looked at the key trends in in the data relating to education, nutrition, alcohol, drugs, HIV, self-harm and several other indicators in South Asian countries including Pakistan. This research found that Pakistan is among those exceptions where mortality of younger girls (15-19 years)is higher than boys. The country is also characterized by high gender based violence, suicide rate, teen age pregnancy besides nutrition and education related discrimination among girls. According to different data sources the health work force density, hospital beds , doctors and paramedics ratio to population are much lower than the required thresholds. Our  healthcare spending for 2018 was $43, seen as 1.46% increase from 2017 when it was $42, an 8.6% increase from 2016. The World Economic Forum’s Global Gender Gap Report 2021, released on 31 March 2021 has ranked 153rd out of 156 countries on gender inequality and categorized it among the bottommost 10 countries in two of the four sub-indexes: Economic Participation and Opportunity (152nd) and Health and Survival (153rd).

The power tables are still mainly led by those who have no idea of the living conditions of disadvantaged communities and who have either never visited or never served in hostile resource deprived environments (this mention does not include carefully curated shoots for the consumption of social media). If in spite of being a modern, urban educated woman and a public health expert too my biggest nightmare in the absence of any entitlements, is to seek quality health services from my own pocket I leave it to the imagination of the readers the predicament of those millions who are living with much lesser standards ,information and more odds. The health care for trans people, people with disabilities, health service providers including doctors with disabilities, comprehensive sexual education including protection against child sexual abuse, unmet need of family planning and healthy ageing are among many of the key sidelined priorities that are sporadically dealt for ceremonial gestures only. Webinars, Apps and other technology driven activities and interventions must be used for specific and realistic purposes rather than substituting these with actual service delivery in actual spaces.

The World Health Day (WHO) celebrated on April 7 every year is aimed at spreading awareness about mental and physical health. ‘Building a fairer, healthier world’ is the theme for 2021. This day marks the founding day of the WHO and is observed by all government and non-government health organizations. The WHO has urged countries and leaders to step up and ensure equality when it comes to healthcare by ensuring that everyone has living and working conditions that are conducive to good health. Good health needs to be interpreted clearly and correctly at policy and programme echelons in countries like Pakistan where massive income and opportunity inequalities preserve poverty traps .Resultantly, the discriminations in accessing health and education would remain unharmed for several generations to come. May be it is the time to go back to the basic definition of health that describes it as not merely the absence of disease but as a state of complete physical, mental and social well-being. It gives me sorrow and trouble that this definition still needs to be unpacked, internalized and applied in actual practice by all those who are championing the health agenda and are regarded as saviors of the poor.

A collective serious thinking must be started on the agenda item health. One strategic step could be that the health including mental health, sexual and reproductive health for all (meaning disabled and trans as well), be designated as a constitutional right. More accessible health facilities, stable employment with incentives for the medical doctors, technicians and nurses at all levels , quality academia, effective health legislations and depoliticized health systems are ought to be instituted. All concerned technical aid and donor funds must review their budgeting and prepare themselves to allocate sufficient resources to disseminate health messages in local languages and build authentic community partnerships by actually working with the communities. Attention must be paid to elevate the social status of paramedics, community health workers and even the licensed medical practitioners.

The usual deceptive bureaucratic, mechanized and chasing the numbers to produce ornamental reports and presentations-style to tackle health of our people needs to be abandoned now. All current governments in the country should be organized and determined to do sustainable, empathetic and transparent investments in promoting excellent medical and allied education, building resilient health systems and ensuring the delivery of quality health services, to serve the people of Pakistan.

The write is a free thinker and founder of a non-funded independent think tank apna wallet dedicated to raise awareness about psychological-financial empowerment of all women