The World Health Organization (WHO)’s Constitution came into force on April 7, 1948 – a date which is celebrated every year as World Health Day. The focus of this year’s campaign is “Building a fairer, healthier world for everyone.” The campaign highlights the WHO’s constitutional principle, “the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.” Although achieving excellence in healthcare for all people is difficult in low-income to middle-income countries such as Pakistan, it is achievable provided the will to do so exists. Such a will is best demonstrated through a hospital’s quality policy. Healthcare institutions should devise a quality policy and use it to stay focused on all aspects of healthcare delivery, and to ensure that quality is at the core of all aspects of healthcare delivery. Principles of equity, transparency, and merit are central to the provision of quality care, and are built on a foundation of accountability.
We have examples of hospitals in our country which demonstrate that when autonomy comes with accountability, we can achieve a health delivery system which leads to building a fairer, healthier Pakistan. At our institution, we have demonstrated this in the functioning of the hospitals of the Shaukat Khanum Memorial Trust, founded with the mission to provide curative and palliative therapy irrespective of the patients’ ability to pay.
Healthcare delivery in Pakistan is mired in numerous challenges, resulting in inequitable access to quality care for the public. Healthcare is delivered by both the public and private sectors, and the quality of care varies significantly, depending on available resources, level of accountability and of course political will, which can never be discounted. Fortunately, formal mechanisms of accountability and quality standards have been put in place with the establishment of provincial healthcare commissions in our country, but we lack other formal systems of assessment of the quality of care delivery. As an example, we do not have rankings for hospitals in Pakistan based on quality of care, as is the case in the UK, for example, where the independent Care Quality Commission provides such information to the public.
Given that systems of accountability are at a nascent stage of development, hospitals desirous of obtaining quality accreditation could consider opting for international accreditation such as that of the Joint Commission International (JCI), from the US. Our institution is proud of the fact that of the current four JCI-accredited hospitals in Pakistan, two are hospitals of the Shaukat Khanum healthcare system, a feat that is all the more remarkable since these are the only charitable hospitals in the country to achieve such recognition.
On a larger scale, the government is working on health reforms to raise the standards of public hospitals by introducing autonomy with accountability. These efforts have met with some resistance but the current government has demonstrated a strong will towards achieving transparency in the public healthcare system; a system of checks and balances where good performance focused on quality care will be rewarded while holding accountable all those who fall short, so as to ensure both quality and equality in care provision. Since 2011, the healthcare system in our country has been re-aligned, with devolution of health services from the federal to the provincial level. Provincial governments have even fewer resources, but the rollout of what looks like becoming a truly effective project aiming to achieve universal health coverage in Pakistan, the Sehat Sahulat Card, is most encouraging. This programme has selected only those hospitals to become part of the programme which adhere to certain minimum quality criteria. This will be a huge leap towards bringing quality healthcare to people from all strata of our society.
On this World Health Day, the WHO has suggested that leaders should make an effort to collect reliable health data to assess inequities across population and take actions that have impact. The role of data is crucial in making informed decisions towards “building a fairer, healthier world.” Registries can play an important role in identifying relationships between factors that can lead to improved health outcomes in terms of patient safety, access to care and areas of public education. We need to invest our resources in developing registries at the national level in Pakistan. At the Shaukat Khanum Hospitals, realising the important role of data in management of cancer, our hospital-based cancer registry has been functioning since the inauguration of the Hospital in 1994, and we have supported the development of what is the country’s largest population-based cancer registry, the Punjab Cancer Registry. Data from these registries is used by the WHO to estimate cancer incidence and prevalence in Pakistan and in Afghanistan, and also informed us, for example, that nearly 30% of our patients were coming from KPK and surrounding areas. This led us to build our second hospital in Peshawar to bring curative and palliative care closer to patients of that region. Data also informs us that breast cancer continues to be the commonest cancer in women and tobacco-related oral cavity cancers are the commonest tumours in men, so we designed our cancer awareness campaigns around these types of cancers. Finally, our clinical performance dashboards, which are publicly available on our website, allow us to regularly monitor a wide array of performance indicators, so as to ensure we continue to strive towards international patient safety goals and other quality standards.
As we mark the World Health Day during the COVID-19 pandemic, the importance of equitable access to healthcare is more evident than ever, as we witness how a disease outbreak anywhere can affect everyone. Undoubtedly, the pandemic has hit already vulnerable and underprivileged communities the hardest. At the same time, it is a very testing period for healthcare systems around the world. Many in the West have been brought to a breaking point, struggling with limited personal protective equipment, lack of medical equipment and personnel needed to fight the devastation brought by COVID-19 infection. There have also been other effects on healthcare. For example, routine immunization has been negatively impacted, where thousands of children remain vulnerable to illness and death from vaccine preventable diseases. People with a host of serious illnesses other than COVID-19 have been avoiding accessing care due to fear of the pandemic. However, there is a silver lining as we have been propelled towards innovative solutions such as telemedicine clinics.
On this World Health Day, I hope that the public and private sectors together can renew their resolve to provide equitable access to quality healthcare to everyone in our country, so that we can build a more just society and a fairer, healthier world.
Dr Muhammed Aasim Yusuf, Acting Chief Executive Officer, Shaukat Khanum Memorial Trust