Sustainable Development Goals (SDG’s) are oriented towards achieving sustainable development and SDG 3 specifically relates to health envisaging beside other diseases to reduce through prevention and treatment to one third by the year 2030 premature mortality from Non-Communicable Disease (NCD’s). Pakistan ratifies international covenants yet lags in abiding by commitments and timelines. The target for goal 8 of SGD is to achieve by 2030 full and productive employment for persons with disabilities, and equal pay for work of equal value. Goal 4 is a lesser known SDG which advocates to ensure by the year 2030 equal access to all levels of education for the vulnerable, including persons with disabilities and children in vulnerable situations.
The incidence of NCD’s along with injuries and mental health constitute the predominant portion of Burden of Disease (BoD) and NCD’s remain the major cause of morbidity and mortality in Pakistan. Disabilities arising from injuries account for around 11 percent of the BoD rising with the corresponding increase in road traffic. Economic hardships compel the rural to urban shift placing a disproportionate load on the existing civic infrastructure and public healthcare facilities of the cities. Pakistan has lost precious time and has severely compromised on health of individuals and enhanced productivity.
Perhaps due to sedentary lifestyles and unhealthy diet the incidence of NCD’s is increasing. Pakistanis ranked globally at seventh position for the prevalence of diabetes. One in four adults is hypertensive and almost twenty five per cent of the population faces cardiovascular disease and thirty per cent have critically high levels of cholesterol. Although enhanced political commitment is visible in newborn and child health in the National Vision 2016-2025 disability in children complemented with a compromised quality of life (QoL) is still a major concern adding to the years lived with disability (YLD).As per UNICEFs data for the year 2015 approximately 5,500,000 infants were born in Pakistan working to 14,900 daily yet the public healthcare system is not providing quality healthcare. Although WHO has appreciated the progress made by the province of Punjab in implementing Health reforms the province is far from achieving any success in combating NCD’s. In Universal Neonatal Hearing Screening Program, one of the four disabilities recognized by WHO, only the province of Sindh has passed comprehensive legislation.
Despite the much trumped about Official Donor Assistance (ODA) it hovers at around two percent of total health expenditure in Pakistan which is insufficient. As reported in the World Bank Country Cooperation Strategy overall outlay in the health services sector of Pakistan during the year 2009 was USD 4.853 billion comprising of 24 percent by the Government of Pakistan and donor support at six percent. The role of ODA in combating NCD’s and rehabilitation of disabled persons leaves much to be desired. The balance of health expenditure is funded by individual citizens of Pakistan from their personal resources. According to a Country Cooperation Strategy for WHO and Pakistan 2011-2017 in the year 2007 Pakistan received more than USD 2 billion in ODA. The productivity of labor remains lower as compared to regional countries in Asia and a significant cause is lack of good nutrition, stunted growth, frequent illness with the malnourished population being susceptible to disease and individuals suffering from any disease or disability working below their potential. Inculcation of a appropriate work ethos is possible only if health conditions improve.
The Center for Disease Control and Prevention lists the top causes of NCD’s as Ischemic Heart Disease eight percent, Cancer eight percent Stroke six percent and Diarrheal Diseases at six percent besides others. In numeric terms approximately 100,000 persons die each year from Cancer in Pakistan. Lung cancer is a common cause of death in Pakistan, with an estimated 6,013 deaths occurring in 2012. Tobacco use is a attributable risk factor for deaths due to cardiovascular diseases, cancers, and respiratory diseases despite Pakistan being a signatory to World Health Organisation Framework Convention on Tobacco Control.
The Global Burden of Disease 2010 data suggest that there will be about 4 million premature deaths by 2025 from NCD’ sin Pakistan with serious socioeconomic consequences. Pakistan could achieve a 20% reduction in the number of these deaths by 2025 by targeting the major risk factor of NCD. Legislation and health system interventions if galvanized can prevent NCD’s and disabilities in Pakistan.
Pakistan has an extensive network of 100,000 lady health workers (LHW’s) providing primary health care services at the doorstep for rural and urban areas seen as a panacea to health concerns despite these LHW’s being over burdened and recruited with a specific objective. A rigid mindset extols the indispensability of LHW’s whereas a parallel support cadre of technicians to cater to the rising trend in disabilities warranting early intervention and rehabilitation can be factored in the National Health Vision. This will gainfully employ the educated youth and enable technically qualified support from the grassroots to tertiary care level besides developing an exportable surplus of trained health workforce resulting in a win win situation.
Despite the threat to human development and the availability of affordable, cost-effective and feasible interventions about 50% of all deaths in Pakistan are attributable to NCD’s yet we continue to remain in denial and are not shifting policy focus to preventing premature deaths through treatment. Such an abysmal state of affairs is corroborated by the data of Pakistan Medical Association and National Health Survey 2011 where it has been estimated that 200,000 individuals die each year from coronary heart disease and annual incidence of fresh strokes are 350,000 for which timely intervention and rehabilitative services must be made available as the severity of disease increases with age. The rising prevalence of disability with its accompanying social cost calls for early intervention and rehabilitation. Our health priorities appear to take cue from the policy of donor countries to minimize the chance of any infectious disease entering their shores. Although this is a laudable goal the scope and pervasiveness of NCD’s and disability in Pakistan calls for redefining national health goals in tandem with international commitments while walking the delicate tightrope in balancing of priorities.
The writer is PhD in Rehabilitation Sciences, and has done Fellowship in Clinical & Research Neuro Rehabilitation, Department of Rehabilitation Medicine from Seoul National University Hospital, South Korea
Published in Daily Times, April 24th 2018.