New health projects

The unveiling of three mega projects in health sector by the government with a total financial outlay of Rs 27.420 billion, makes one hope that things in this grossly neglected sector may at last improve. According to a Recorder Report, the focus of the projects will be on improving maternal, neonatal and child healthcare in the country, with reduction in child mortality rate and incidence of breast cancer, particularly in rural areas.
Federal Health Minister Nasir Khan, while announcing the scheme at a press conference, said the projects have been launched after a protracted consultative process with the provincial governments.
Maternal, neonatal and child healthcare constitute the main planks of the new projects, at a total cost of Rs 27 billion, while an amount of Rs 429 million will be set aside for treatment of needy women suffering from breast cancer. Five diagnostic centres, one each at Islamabad, Lahore Peshawar, Quetta and Karachi, are also planned to be established. A national rehabilitation authority for disabled persons is also being set up.
The federal government has made a "token" allocation of Rs 100 million for all these projects. What allocation each provincial government makes towards this ambitious programme remains to be seen. As health is a provincial subject, the provincial governments will have to come up with adequate allocations to make the new projects a success. Unless this is done the realisation of the millennium goals in health sector will be hard to realise.
Healthcare in Pakistan has traditionally remained a highly neglected sector, worsened by rural-urban lop-sidedness. Despite the fact that over half the population of Pakistan lives in rural areas, most of the healthcare facilities are concentrated in urban areas. For example, 85 percent of all practising doctors work in cities, which comes to a doctor-population ratio of 1:1801, as against a ratio of 1:25,829 in rural areas.
Going by the existing state of affairs, the country has signally failed to achieve the millennium goals, which the Alma-Ata declaration of 1978 had set for the 130 signatories. The major factors that have stymied the health sector in Pakistan include poor quality of the available healthcare services, a very high focus on curative rather than preventive health and medical care, access to health facilities determined by wealth and income with the rich having easy access to the best possible facilities, and above all, poor delivery of health services, and inadequate accountability.
While all these problems persist, the fact that the government, despite its strident rhetoric, is spending only 0.7 percent of GDP on health reflects the level of its commitment.
(The high percentage of GDP spent on defence and debt servicing are generally believed to be major, though unavoidable, drains.) The entry of private sector in healthcare has somewhat eased the situation, although its contribution has remained largely marginal and confined to urban areas. Meanwhile, the government's zeal to meet the numerical targets has compromised the healthcare system's quality.
Given the urgent need to promote healthcare, the government should continue to own its large asset base in health sector, as large-scale transfer of basic health services from public to private sector is bound to put such services out of reach of a vast majority of the population. There is also a need to assess the cost-effectiveness of the existing healthcare network to make it more productive.
Neglect of health sector in Pakistan costs the economy millions of lost man-hours annually in industrial and agricultural sectors, while inadequate medical facilities and infrastructure in rural areas have over-burdened hospitals in urban areas. There is therefore an urgent need to strike a balance between the two. Secondly, it often happens that a major chunk of allocation for each sector is consumed by hefty non-productive expenditure, ie perks for bureaucracy, for instance.
All such non-productive expenses should be slashed to the bare minimum, so that the benefit to the public gets proportionately enhanced. The government has done well to unveil Rs 27.420 billion health projects. It must now ensure that there is no wasteful expenditure, and that the allocated amount is spent judiciously.