Article 25 of the Universal Declaration of Human Rights 1948states: “Everyone has the right to a standard of living adequate for the health and well-being of himself and his/her family, including food, clothing, housing, and medical care.” The right to heal this the crucial one amongst human rights, though an ordinary person still lags behind in this affirmation.
Health of a population is indeed a fundamental responsibility of a government. However, broad, coordinated efforts of additional stakeholders, including the private sector, NGOs and international organisations, are some other important pillars of a country’s healthcare system.
In Pakistan, 68 percent of the total health sector allocations are directed to tertiary care, less than 10 percent goes for preventive measures and health facilities, and only 0.14 percent is for mother and child health. Despite the increased number of public sector hospitals (1,279), Basic Health Units (5,527) and Rural Health Centres (686), there is still only one doctor available to 963 persons, and one hospital bed for 1,608 persons. The maternal mortality rate at 170/100,000 is still high as compared to the other countries in the region. Infant mortality and under-five years mortality is 62 and 75 deaths per 1,000 live births, making Pakistan a dangerous place to be born in.
The country still stands at 154th position among 195 countries in terms of quality and accessibility of healthcare. The alarming population growth rate, at two percent per annum, limited primary healthcare facilities, retrograde government hospitals, and poor governance are hindrances to encourage the private sector for the provision of specialised hospital care.
The private sector plays a key, and often a harmful role, in many spheres of life, including healthcare. Private hospitals emerge as ‘clean healthcare’ and help to improve many health determinants. The private sector favours the affluent more than the weakest. Consequently, the rich are enjoying the boutique care and the poor are dying due to lack of primary medical care.
This inequitable distribution creates class disparities. These discrepancies, between and among the classes, strongly influence the state and strengthen the roots of poverty. On the one hand, the growing poverty, and on the other, prejudiced and distorted healthcare in the country affirm William Easterly’s thought provoking words, “The rich have markets, the poor have bureaucrats.”
To take advantage of this disparity, several international non-governmental organisations are running their projects in Pakistan as ‘aid bureaucrats’
To take advantage of this disparity, several international non-governmental organisations(INGOs)are running their projects in Pakistan as ‘aid bureaucrats’. These aid bureaucrats, sitting in air-conditioned rooms, try to control the temperature of those who cannot communicate whether it is hot or cold. Aid recipients either get the unwanted or not urgently needed things. Unfortunately, this aid does not meet even a favourable definition of success as it gives the entire power in the planners’ hands. For them, there is a lack of appropriate accountability to gauge how they affect ‘the economically poor’.
These aid bureaucrats work with governmental departments where corruption is already endemic. Consequently, the aid travels from one bureaucracy to other, and nothing positively changes. The aid remains like a maze.
The remaining part to suck the blood of the poor is played by an increased drug prescription, followed by an expensive cost. Pharmaceutical companies, hence, have emerged as another key stakeholder in healthcare. Unluckily, these big pharmas exist for the sole purpose to earn than to serve. For that purpose, they employ several legal and illegal tactics to increase profitability, such as involving politicians and medical personnel. They invest in biased publications to make physicians believe in their drugs. That is how they adversely affect the already vulnerable population: the poor.
The said disparities result in a society that always wishes to make some profit in any way. Creating public awareness in such a society is a real-time moon-landing show. The need is to have good governance to check ideas and actions of the powerful stakeholders. We need to have an unbiased feedback to policymakers, eliminate corruption existing in all forms, and have comprehensive planning and practical approaches to achieve the short and long term goals.
Most importantly, it is time for us to conduct deep and appropriate medical research. Scientists and academicians have a final say in drug production to interventions. Policies should guide the current findings to open, rational horizons. Such precise and indispensable measures can strengthen the ground level healthcare provision for the weakest segments of our society.
The writer is a doctoral student of Public Health with a focus on nutrition at the Medical University of Vienna.