Failures of our health sector

  • At the time of the independence, Pakistan inherited a health care system that was a heritage of British period, this system was in the shape of public health services and some curative services. It was basically designed to prevent large scale epidemic and provide medicinal services for the population in large and medium sized towns, many of which were along the lines of communication or political or strategic consequences. 

    According to the constitution of Pakistan health care is mainly the responsibility of provincial governments. The planning and formulation of health policies is dealt by federal government, the provincial government has the responsibility to ensure the proper implementation of those policies. Health care sector in Pakistan consist of private and public sector. the private sector serves nearly 70% of the population. The public sector consists of more than 10,000 health facilities ranging from Basic Health Units (BHUs) to tertiary referral center 

    Public health service delivery of Pakistan consists of 5000 basic health units, 600 rural health centers, 7500 other first-level care facilities, over 100 000 lady health workers. There are 989 hospitals at secondary level. But still, the private health care sector accounts for 70%-80% of health care delivery. 

    In the framework of health system development, there is an alarming shortage of skilled and qualified healthcare experts like human resource planners in health sector, health information experts, heath care system managers and healthcare economists. The government's ability to train the staff members is pretty limited to non-existent in the country. Unfortunately, government is unable to fully train the medical staff and is still playing with the life of people. 

    As far as the pre-service training of health experts is concerned conventional methods are being followed and there is a difference between educational objectives which are highlighted on hospital-based care instead of addressing the needs of the communities for primitive, defensive curative and rehabilitative services. Due to many institutional ad professional reasons like lack of interest from the PM&DC the attempts to establish strong rules and approaches including COME (community oriented medical education) have not been successful in medical schools. Another reason of its failure is the weak department of public health in medical schools and lack of commitment of government and heads of medical institutes 

    Pakistan ranked 149th out of 188 countries by WHO. In 2005 Pakistan spent 0.72% budget on health which has now decreased to only 0.46%. According to the World Bank, Pakistan’s per capita health spending is $36.2 which is below than the WHO’s low-income countries bench mark of 86$. the doctor to population ratio stands at 1: 997, dentist 1: 10,658 and hospital bed 1:1584. There are around 2700 health units in Punjab out of which 700 are not in working condition at all 

    Rest of them are incomplete as well, there is lack of doctors, medicines, equipment and staff. Due to the poor health facility in rural areas, people have to rush to nearby cities. Private hospitals are extremely expensive and mostly people cannot afford it. The overall quality of doctors has decreased. most of the doctors are graduates from China, Russia and Central Asian States, while the quality staff produced by local state-run medical colleges have and are leaving for greener pastures abroad. There is high population growth, uneven distribution of health professionals, deficient workforce, insufficient funding and limited access to quality health care services. Lifesaving drugs are not available in most of the small hospitals. Due to poverty and lack of awareness the lower income group of the society is compelled adopt inappropriate health seeking behaviors 

    Why has Pakistan failed to eradicate polio? 

    Pakistan is one of only three countries in the world with ongoing wild poliovirus transmission, alongside Afghanistan and Nigeria. The main reason for the failure in eradication is Environmental pollution. Polio has Fico-oral route. It seems impossible how feces get into our mouth! Have you ever thought about it? Well, Pakistan has a poor sanitation system and sewage system, the pipes are closed and jumbled up, a single drop of sewage can contaminate the whole water line! 

    Another reason which seems really small but has a great effect is the right technique of hand washing, we have not taught our kids the right technique of washing their hands after using the toilet. This way, the virus can go to their mouth through their hands. 

    There are so many myths associated to the vaccine, some people thing that it is related to birth control and it is a propaganda of family planning. Hence, they don’t give the vaccine to boys. This myth basically started because the factories of polio vaccine and birth control pills were in the same premises, people started thinking that these 2 are the same thing! Some of the people even think that this is a Yahudi propaganda, therefore, they avoid to use it and some extremist even attacked and killed polio workers while they were on duty. 

    Then come the attack on the polio teams, to some it looks like a propaganda, some power wants Pakistan to fail in the eradication of polio while the other reason could be the myth that it is a Yahudi product. 

    Illiteracy plays a major role here. some people don't know about the significance due to lack of polio but on the other hand highly educated people avoid it too but there is a risk that 1 out of 1 crore might get polio after taking the vaccination. So, they avoid it. 

    Now coming to other factors, Polio vaccine needs to be stored at less than zero degrees, but there is a lack of equipment in Pakistan which leads to the expiration of the vaccine. 

    The organization has a lack of workers so they hire people without checking their skills, some workers are not trained enough, and they do not know the right way of giving the vaccine. 

    Another reason problem that raised was, some criminal groups started dressing up like the polio team and started robbing, people got cautious and avoiding the polio team. 

    But on the bright side, in the last stage of polio eradication, Pakistan has made tremendous progress towards poliovirus transmission interruption and eradication. 

    2 years ago, transmission of the poliovirus was widespread. In less than 24 months, a reinvigorated programme has been able to first stem the tide of uncontrolled transmission and then tackle the more chronic underlying challenges that have proven obstacles to virus interruption and eradication. The number of children paralyzed by the poliovirus has dropped progressively from 306 in 2014 to 54 in 2015 to 20 in 2016 and 2 cases in 2017 so far. Eradication efforts have begun to close the immunity gaps and the programme is on track to reach the goal of interrupting the transmission of polio in Pakistan. To accomplish the eradication of the poliovirus, Pakistan Polio Eradication Programme refocussed its goal from “coverage” to “no missed children”. This paradigm shift has driven programme operations with very encouraging results. The proportion of children recorded as “missed” during campaigns and remaining unvaccinated after each campaign has declined to approximately 4% in the 2016 low transmission season! 

    The old goal to eradicate polio was 2010 but we failed to eradicate it due to some reason but the new goal is 2025 and this time we will be able to fight the wild virus and eradicate it from our beloved country!