The health indicators of Pakistan have shown improvement in the last 25 years despite various social, economic, political and cross-border challenges compounded through successive natural catastrophes but still, the country lags behind in the development of the sector as compare some regional countries’ growth.
According to the Economic Survey of Pakistan, health sector allocation under Public Sector Development Programme (PSDP) for the fiscal year 2022-2023 is Rs 22,356.5 million, which is 2.8 per cent of the total development budget (Rs 800,000 million) and 0.05 per cent of GDP. There are 62 health sector projects in the PSDP 2022-23 and under which 43 projects are being sponsored through National Health Services, Regulations & Coordination (NHSR&C) with a total estimated cost of Rs 124,045.08 million.
Pakistan is presently the sixth most populous country globally, with two-thirds of its population is below the age of 30, making it among the world’s youngest nations. It is among eight countries that will account for greater than half the rise in global population by 2050.
Burden of disease
There are also reports, Pakistan is facing a double burden of disease (BoD), while the poor segments are much higher under these pressure in the country. However, many of these situations can be controlled at comparatively low-cost interventions and best practices by primary and secondary care levels. Maternal health issues, communicable diseases and under-nutrition dominate and constitute about half of the BoD. Respiratory illness and diarrhoea remained the chief killers in young children.
Our country is one of the three remaining states where polio is still endemic and furthermore, endemicity of hepatitis B and C in the general population with 7.6 per cent affected individuals; the 5th highest tuberculosis burden globally has a focal geographical area of malaria endemicity, and an established HIV concentration among high-risk groups.
Pakistan in South Asia has one of the highest prevalence of underweight children. In mothers and children similarly stunting, micronutrient deficiencies and low birth weight babies contribute to already high level of mortality. Non-communicable diseases along with injuries and mental health issues, now constitute other half of the BoD, causing far more disabilities and premature deaths among an economically productive adult age group. Of the total BoD injuries account for greater than 11 per cent, and are probable to increase with increasing road traffic, urbanisation and conflict.
Pakistan ranked 7th highest for diabetes prevalence. One in four adults over 18 years of age is hypertensive, and smoking levels are high. Rising but still underestimated burden of cancers and COPD remain a largely unaddressed area. In the society, low literacy, poverty, unemployment, gender discrimination, and huge treatment gap have led to an invisible burden of mental health problems. Because of blindness or other causes disability is also high, and services for disabled population are limited, counting provision of assist devices to enhance their quality of life.
In access to healthcare services, Pakistan has seen progress; however, despite having network of (primary, secondary and tertiary) health care system in place the gains are uneven across dissimilar service areas as out-of-pocket expenditure is still around 70 per cent. Though skilled birth attendance (SBA) has enhanced from 18 per cent in late 1990s’ to 58 per cent in 2015, but only one-third of women make the required minimum number of antenatal visits and the number decreases further for postnatal visit. Despite the reduction in polio cases because of high vertical accountability, the rates of routine immunisation remain unacceptably low at 54 per cent. Access to and affordability of essential medicines is low. There are geographical disparities in coverage between provinces, districts and rural-urban area. Evidence shows that low income groups are probable to have lower levels of health, nutrition, immunisation and family planning coverage. A mixed health system has been recorded in the country, which includes government infrastructure, parastatal health system, civil society, private sector and philanthropic contributors.
Advantages and failures
In Pakistan, a chief strength of the government’s health care system is an outreach primary health care, delivered at the community level by 100,000 Lady Health Workers (LHWs) and a growing number of Community Midwives (CMWs), and other community-based workers who have earned success and trust in the communities. Complementary, traditional and alternative system of healing in Pakistan is also quite popular. However, the health system faces challenges of vertical service delivery structures and low-performance accountability within the government, creating quality and efficiency issues.
Largely unregulated for quality care and pricing, there is also duplication of services through the private sector. Private sector although having the potential, contributes the least towards preventive and promotive health services. The public sector is poorly staffed and job satisfaction and work environment need improvement.
The overall health sector also faces an imbalance in the number, skill mix and deployment of health workforce, and insufficient resource allocation across dissimilar levels of health care. The quality of medical and allied education in order to produce a quality workforce for the health sector, both in the public and private sector needs to be looked into. A range of actions is required, acting upon the social determinants within the health and social sectors, if a wider impact is to be attained. In last I would like to mention here, despite the enormous issues facing the Pakistani public healthcare sector the experts believed that the top management of the public hospitals could play an important role in influencing employees’ attitudes and behaviours to offer quality healthcare to deserving patients.