Health lacking sufficient funds
By Hilda Saeed
IN the national budget, announced last June for fiscal year 2008-2009, Rs19bn was allocated for health. In GNP terms, was this the usual one per cent or thereabouts or more, like the advocated four per cent?
Further probing was definitely called for, and it was certainly worthwhile. The Rs19bn spells a 37 per cent increase in government health-sector allocations, of which Rs11.5bn is earmarked for family planning and immunisation programmes.
The deployment of Lady Health Workers, who presently number 100,000, is to be doubled. Rs7.5bn has been set aside for 111 developmental projects, of which only three are new ones, maternal and child health projects and infectious disease control programmes for malaria, TB, HIV/AIDS and hepatitis.
That said, the fact remains that all together this amount constitutes only 0.8 per cent of the federal budget, and falls grossly short of the 15 per cent recommended by WHO. Seventeen of the developmental projects mentioned above have not been allocated any funds; most are focused on the urban areas, again relegating rural areas to a subsidiary status. It is difficult to see how the health scenario will improve with this limited budget.
In the past, the role of health as an integral partner to human development appeared not to have been fully recognised; rather, its role as an ‘eroder’ of people’s strength, vitality and resistance to disease has been prominent. This negative role remains a silent, but steady contributor to the millions of needless deaths that occur around us.
Past damaging budgetary cuts and short-sighted policies have proved to be the equivalent of shooting ourselves in the foot, with low allocations for health causing long-term damage. Similar low allocations for education have resulted in low literacy rates, with women the worst affected. The spin-off has been uneducated families, whose lack of knowledge often renders them and their children vulnerable to disease. The near-absence in many localities of clean drinking water and sanitation facilities deprive people of the wherewithal for a healthy life. Pollution-free air is a rarity. .Around 30 per cent of the population is poverty-stricken, unable to afford even one square meal a day. The stresses and strains of modern living lead to increased mental tension, a high incidence of psychiatric problems, even suicides.
Not a pretty picture. Today’s people are functioning at sub-optimal health levels, unable to put their best foot forward.
The majority population is malnourished, physically stunted and susceptible to a host of illnesses. Relatively newer diseases, like cancer and HIV/AIDS, show increasing incidence. In addition, the country’s crumbling medicare system has to deal with the consequences of alarmingly high numbers of traffic accidents, bomb explosions and the like, all requiring emergency medical treatment.
There is, in short, a huge backlog of needs to be met. To what extent does the new health budget meet these needs? The health ministry’s plans are commendable: fully staffed, equipped Basic Health Units and district hospitals are to be upgraded throughout the country. It would not be amiss to mention here that Pakistan has a substantial number of young medical graduates, who would be happy to work in rural areas if work conditions and emoluments, including rural area incentives, were satisfactory.
The LHW network is to be expanded, to facilitate improved outreach of preventive, cost-effective healthcare, a fact particularly important for vulnerable young mothers and children. Immunisation programmes for children against major communicable diseases, and for mothers-to-be against tetanus, are to be expanded. Further preventive measures include accelerated programmes for TB Control, HIV/AIDS, hepatitis, and improvement of maternal and neonatal health. Hospital-based tertiary care is to receive specific funding
Plans are to provide clean drinking water to a larger population, via filtration plants established throughout the country. This can make a dent in the currently high incidence of diarrhoeal disease but only if this facility reaches the poor.
The budget mentions increased allocations for family planning, but details are still awaited about innovative programmes. This is important particularly because of its close linkage to maternal and child health and development. High birth rates, linked often to barely adult young mothers leave women weakened, exhausted, overworked and susceptible to disease. High population growth contributes to poor health, burdens the public health system and is a significant reason for the present economic and development crisis. Inexplicably, the cost-effectiveness of the electronic media in spreading awareness about simple healthcare measures has not yet been fully explored.
The critical economic situation and the high levels of poverty are likely to push more people below the poverty line, into growing malnourishment. A major illness or a serious accident can reduce a family from middle- to lower middle-class level, or to a poor or even subsistence level existence, particularly if public health facilities cannot provide the expected care.
Given the economic crisis, and possibly forthcoming IMF conditions, budgetary cuts may be required, but they must not affect the health and social sector. Any further erosion of the health sector budget could lead to calamitous consequences. Right now, except for rapid population growth, which itself is adding to greater economic and developmental stress, human development in Pakistan is almost at a standstill.


A bailout for schools
By Polly Curtis
THE British government will nationalise recession-hit private schools by turning them into state-funded academies, ministers have confirmed.
Headteachers predict that some struggling fee-charging schools will seek to join the scheme to stave off closure, as more parents desert the private sector.
There are warnings, too, that thousands of pupils may seek places at already-stretched state schools this September if private schools fail.
The schools minister, Jim Knight, said the government would consider applications for academy status from fee-charging schools affected by the downturn in areas where there was demand for more school places.
Anthony Seldon, the headteacher of Wellington College, said becoming an academy would not be the “move of choice” for many private schools, but it could be their only option. Teachers’ leaders said it amounted to a “bailout” for failing private schools.
Five private schools, including two in Bristol, have already joined the academies scheme and another is to follow in September. In areas with many private schools, competition is fierce.
Under the programme, private schools in England can convert to academy status by dropping fees and entry tests, and promising to comply with the admissions code and teach the core national curriculum. They gain state funding but retain more independence around employing staff and their wider curriculum than other state schools.
Knight said: “The current economic situation might lead to a greater interest in the academies programme from independent schools. We will continue to consider applications from independent schools in areas where there is a need for additional good secondary school places, and where that independent school becoming an academy can support this goal.”
He insisted any private school joining the programme would have to adopt “fair, non-selective, admissions policies”.
Local authorities are already warning of an influx of pupils who would normally have gone to private schools. In west London, councils report record applications for state schools this year. An Audit Commission report last month revealed a surge, triggered by families wanting to take their children out of fee-paying schools, with London worst hit.
John Dunford, the general secretary of the Association of School and College Leaders, thought it likely that some schools would approach the government. “In the recession, the numbers applying to private schools will inevitably fall. Some independent schools will choose academy status rather than closure.”
Seldon said: “In some cases, it’s possible schools will want to become academies. There are benefits — above all, avoiding closing down.
Nearly 600,000 pupils attend private schools, around seven per cent of the total school-age population. Private school numbers held up in 1991, the first full year of the last recession, but then fell and took seven years to recover. They have since climbed to levels not seen since the 1960s. Over the same period, academic results in the state sector have also improved substantially, in some cases rivalling private schools.
The five private schools which have become academies say their conversions were not prompted by financial troubles, but two are in Bristol, which has among the highest concentrations of private schools in the country.
— The Guardian, London


