Flaws in public healthcare

At least 400 children suffering from diarrhoea and 500 from pneumonia die daily in Pakistan due to non-provision of government health services to them, the National Coordinator of Peoples Health Movement, Dr Tanvir Ahmad has said in a press interview in Karachi. The high incidence of child mortality on account of only two diseases may be seen as tip of the iceberg.
The data works out at 27,000 deaths a month, which is a huge number by any reckoning. According to Dr Tanvir, only 20 percent of Pakistans population benefits from the public healthcare services, while the remaining 80 percent have to spend a major chunk of their household budgets on healthcare. Further, around 40 percent of the monthly income of an average household is spent on medical treatment, mainly because of the lopsided official health policy.
A major cause of the fund-starvation of Pakistans public sector health delivery system is that only 1.75 percent of the budget is earmarked for this sector, against WHOs recommendation of seven percent. Out of even this meagre allocation, only 20 percent is spent in rural areas, while the remaining 80 percent is targeted at urban areas.
As a result of the wrong health policy thrust, poor patients in both urban and rural areas often have to seek treatment at private clinics mainly run by non-qualified health practitioners such as paramedics. A large number of them also visit quacks. Another flaw in the national health policy is that it does not place sufficient emphasis on improving the primary healthcare system, as a result of which a large number of basic health units remain either non-functional or only partly functional.
This represents a great loss to low-income Pakistanis. And the new policy also does not address this problem. Secondly, Dr Tanvir has alleged large-scale mismanagement of funds in public sector healthcare system, with some of the health department officials being allegedly involved in procuring spurious or substandard drugs for supply to government hospitals. This calls for closer monitoring of the system.
According to a Unicef official, the annual per capita spending on health in Pakistan stands at only $18 which should be raised to at least 45 dollars, though even that amount will not come up to the WHO-recommended seven percent of the annual budget. As we have argued in this space earlier, most of such fatalities can be prevented through adoption of an integrated approach to mother and child healthcare, hygiene, nutrition and proper protection.
According to available data, an estimated 216,000 new-born babies die annually in Pakistan before they attain the age of one month, largely because of paucity of the health cover. This provides a measure of the problems un-addressed dimension. Pakistan has lagged behind even some of the countries in its neighbourhood in social sector indicators. According to one estimate, about one-third of the population lives in poverty in Pakistan, 70 million do not have access to healthcare, with children being the worst victims.
Viewed in the hindsight, the policy of shifting healthcare responsibility to the private sector, and the abdication by state of its traditional role of healthcare provider has proved disastrous. This has made healthcare very expensive and has put it out of the financial reach of a majority of the Pakistanis, particularly women and children.
Healthcare has unfortunately been turned into a mega business, with high-rise, posh complexes housing clinics and hospitals. The gradual withdrawal of the state from this sector has created a huge vacuum for the poor and middle-income groups. Viewed in the larger perspective, the flaws Dr Tanvir has identified exist, first, at the conceptual level of policy formulation, and secondly, at the level of policy implementation.
In fact health spending of only 1.75 percent of the annual budget against the WHO-recommended share of seven percent lies at the root of the whole problem. The second major problem is judicious spending of the allocated amount, which is clearly not the case. Thirdly, there should be a reasonable amount of parity between the health facilities available in rural and urban areas, as a majority of the population lives in the rural hinterland.
Above all, the government has not paid sufficient heed to improving primary healthcare, which remains both under-funded and understaffed. Primary healthcare, the most crucial component of the health system represents the base of the pyramid, which will have to be suitably strengthened for the whole edifice to remain stable and strong. The government should rectify the flaws Dr Tanvir has identified in the healthcare system.