No shortcuts to achieving the goal of 'health for all'
By Dr Shershah Syed
KARACHI, Aug 10: A National Health Conference began in Islamabad on Tuesday. The conference has a big task in front as the country has no health policy to meet the challenges of a modern healthcare system and provide healthcare to the nation.
The participants of the conference should realize that there is no shortcut to the goal of 'Health For All 2000' and that successive governments have failed to achieve the target.
The organizers and participants of the conference should address the following issues if they want a positive outcome: According to figures quoted by international and national agencies, the population of Pakistan has soared to 141.5 million.
At least a third of the population is living below the poverty level. We have an annual fertility rate of 4.7 per cent with a life expectancy of 63 years (only) at birth. Even worse the under-five mortality rate remains high at 110 per 1,000 and infant mortality rate at 83 per 1,000.
A big proportion of our population is unable to drink clean water or enjoy the facilities of sanitation. Water-borne bacterial infection is one of the major causes of morbidity and mortality in both children and adults.
While 78 per cent of our one-year-old children are immunized against tuberculosis, only 54 per cent are immunized against measles. Hepatitis B vaccination is not available to the whole population.
Hepatitis B and C patients are increasing geometrically. It is also notable that despite more than 40 rounds of polio vaccination the country continues to report new polio cases. According to government sources, more than 78,000 people are infected with the HIV virus and there is no organized plan to fight this disease.
Two per cent of the Pakistani population is blind: 80 per cent of blindness is said to be preventable. 11 per cent of the Pakistani population suffers from diabetes with a 90 per cent chance of developing retinopathy in lifetime.
According to government figures, more than 340 per 100,000 women are dying during pregnancy because of unavailability of emergency obstetrical care to the majority of women in Pakistan. More than 80 per cent women are delivered by traditional birth attendants in sub-human conditions all over the country.
We produce one nurse for eight doctors and only one doctor is available to treat 2,300 people. The government (federal and provincial) has no plans to produce an adequate number of nurses and paramedical staff.
The initiative of the federal government to produce community midwives is not well thought out and the suggested one-year midwifery training in the absence of trained tutors will not produce competent health workers.
It will be another waste of resources like the DAI training programme in the past. The government and donor agencies have failed to understand that a shortcut to reducing maternal death does not exist.
The government has also failed to understand the role of paramedical staff in the healthcare system. An army of paramedical staff is required to run our basic health units, rural health centres, taluka headquarters and district headquarters and tertiary health care system.
No government has had a policy for the production of these professionals and neither do we have a respectable career structure for these professionals. There is a need to organize a system through which paramedics should be trained according to international standards and a career structure is required for them.
The policy of the provincial governments regarding admission to medical colleges remains poor at the best. Substandard medical education is available at a very high fee. These medical colleges are producing glorified MBBS doctors.
In a small number of medical colleges in the government sector (Balochistan, and Sindh and the NWFP especially) medical education is below standard and these medical colleges need immediate intervention to upgrade the quality of instruction.
Teaching hospitals in the public sector (with the exception of a few departments) have no structured postgraduate teaching programme. A majority of postgraduate students are working without supervision or with minimal supervision.
On the intervention of the College of Physicians and Surgeons of Pakistan, the government has been compelled to fix a stipend for doctors but hospitals are not willing to pay the fee for the obligatory training workshops and examinations.
All postgraduate training centres in the private and public sector should be made responsible to pay all workshop and examination fees of their candidates under training.
While private sector healthcare facilities are playing an important role in the health delivery system, family physicians are the backbone of the primary health care system.
The government has not utilized them in programme to prevent disease in our communities. No medical college in the public sector is providing special training to doctors who want to work as family physicians.
A majority of teaching hospitals in the private sector also have no structured programme for training, and work on the principle of self-learning. Private sector hospitals have also failed to develop a code of conduct for private healthcare facilities. There is a need to regulate and monitor them by a competent authority at the provincial level.
Private hospitals, laboratories, clinics and nursing homes should be made responsible in case of negligence on the part of hospitals and doctors. Unfortunately vested interests in government and doctors are working hand in hand against a just system in which the patients will have a right to be compensated by a negligent party.
The Pakistan Medical Association believes that a strong accountability system is required to deal with all cases of unethical medical practice in both government and private healthcare facilities.
