Unhealthy priorities

Sick and getting sicker. Punjab attains the 2nd highest position in the world in prevalence of Hepatitis C, and the race to become the most hepatitis-stricken country in the world is on with Egypt. Every change of season presents health hazards. The body needs a certain acclimatization period to adjust to weather volatility. Winter brings its own physical stresses and summer its own bodily challenges. With the onset of global warming and extreme weather conditions most countries have upped their budgets to study, research and find solutions to minimize its impact on human health. These include environmental preservation legislations, citizen awareness programs and RND efforts in developing health sector to deal with these risks. Pakistan is the 7th most risk-prone country to environmental changes in the world according to a report published by German Watch organisation. The impact of these changes have already been felt this winter as Lahore attained the status of the most smog polluted city in the world.
Smog is visible but virus is invisible. As long as smog created transport hassles and made breathing difficult the media attention made courts, politicians, and NGOs all raise a voice. However, as the blessing of God in the shape of rains befell, the smog disappeared and so did the debate on it. But what does not go away are the viruses that are not only present in the air but in the water, in the equipment that are used in hospitals and households. These invisible enemies remain largely unattended and unaddressed due to criminal negligence on the issues of health and human wellbeing in the country. The recent news that Pakistan is ranked 2nd in the world for Hepatitis C is a wake-up call. In the first six months of this year, 50,000 cases of Hepatitis C have been reported from Punjab alone. This figure itself should be enough to make most health-conscious nations declare a health emergency. However, in a country where government officials dismiss even the most bizarre occurrence of women giving birth on streets, on corridors, in toilets of hospitals, little is left to be said about matters that do not matter for those in power.
The fact that we have missed all health goals that Pakistan had signed as part of sustainable global health development plan is hardly mentioned in the assembly or in the media. Pakistan continues to lag behind not only globally but regionally as well. Infant mortality rate in Pakistan is 66 per 1,000 births, compared to 38 in India and 8 in Sri Lanka. Life expectancy in Pakistan for women is 67 years, as compared to 73 in Bangladesh and 78 in Thailand. Maternal mortality rate in Pakistan is 170 per 100,000 live births, in contrast to 30 in Sri Lanka. These are shameful statistics and in most developing countries would force government to redraw its priorities by allocating more resources and effort on this sector. However, the opposite has happened in Pakistan. The health budget as a percentage of GDP has decreased from 0.56% in 2013 to 0.46% in 2017.
Unfortunately, the problem does not end in inadequate budget allocation. The two other afflictions that infect this sector are the uneven distribution of funds within districts and the capacity to use these funds to complete projects that need to be implemented. There are 0.9 million people who suffer from Hepatitis in Punjab and majority of them are from southern Punjab, as lack of education, hygiene and contaminated water etc are promoters of this disease. Consider this contrast - for 15 cities of southern Punjab there are only seven full hospitals while in one city of central Punjab, ie, Lahore there are 15 large hospitals and medical colleges. The allocated budget for medical facilities to people of Southern Punjab is less than half of the sum allocated for the Punjab's provincial capital i-e Rs 17.75 billion. To add to this skewed distribution is the inability of the health departments to use these funds. Primary and secondary health departments of Punjab earmarked over Rs 22,000 million in the ADP 2016-17 and the finance department released Rs 14,115 million till 31st March 2017 to provide medical facilities to the patients but the health department could only spend 28 percent of these revised allocation.
Health is a provincial subject and most provinces have done some good legislations to reform the sector. The Punjab Hepatitis Ordinance, 2017, stipulates the enforcement of preventive measures (safe blood transfusions and dialysis, etc), and if enforcement of this ordinance is done in both letter and spirit it can reduce this menace that has become more dangerous than many terminal diseases. Success models like Thailand at national level and Tamil Nadu at state/provincial level are examples where with little resources a lot can be achieved. The two most important areas to work on is prevention through awareness and resource utilisation for effective treatment.
Awareness is a key to all diseases and especially Hepatitis. According to medical studies in Pakistan 90% of the patients are not even aware that they are suffering from Hepatitis or conscious of the fact that how infected water or syringes can be carriers. Thus it is crucial that local rural BHUs and lady health workers are trained to spread the message in their localities of symptoms of the disease and also dangers of infected syringes etc. Health activism is a very effective way of pressurizing the government to pay attention to this sector. In Thailand Health Assemblies are held where public is made aware of these diseases through Civil Society interventions and affected people are linked to media and social media to highlight the absence of facilities etc to create advocacy and lobbying for being granted their basic health rights.
No unhealthy and illiterate nation has ever developed historically. In Pakistan, National Security is a top priority but national security is not just about a dangerous human being trying to kill another human being, it is also about dangerous virus' killing the human body. History is replete with examples of how outbreaks of cholera, and other diseases have severely impaired a nation to progress and develop. A nation of unhealthy bodies increases the cost of medication, social subsidy, absenteeism at work and causes chronically low productivity. It is this holistic view that has made access to equal healthcare a top priority in policy making of developed nations. And it is this disregard to the health of masses that has kept many nations underdeveloped and struggling. As Dr Martin Luther King Jr says "Of all the forms of inequality, injustice in health care is the most shocking and inhumane".
(The writer is a columnist, consultant, coach, and an analyst and can be reached at andleeb.abbas1@gmail,com. She tweets at @AndleebAbbas)