Walk along the bustling road opposite the Jinnah Postgraduate Medical Centre (JPMC) and you won’t miss the malnourished men lying on footpaths, waiting for a doctor to hand them a prescription for a drug they can never afford, or the mothers who clutch their young children tightly, praying for their pain to miraculously ebb away.
With Pakistan being a developing nation, the expected proportion of GDP allocation towards health sector ranges between four to six per cent. However, statistics from the Planning and Development Commission show that Pakistan has been turning a blind eye towards the welfare of its population. Statistics indicate that the percentage of GDP being allocated towards health has declined from 0.72 per cent in the fiscal year 2000-01 to 0.27 per cent in the fiscal year 2010-11. Additionally, the health sector is expected to receive a meager proportion of 0.2 per cent at Rs.7,845 million from the federal budget of 2012-2013.
Lying in a region often affected by the perils of turmoil and terrorism, the government’s priorities lie in the sectors of defence and provision of infrastructure, raising question if a crippled and ailing population, and an escalated defence budget will take Pakistan towards prosperity? Dr F Azim – a doctor associated with public provision of health – claims that the fundamental rights of the people of Pakistan are being disregarded.
“There is disparity everywhere. The difference between public and private sector hospitals is mammoth. Where should the less privileged strata of our population go? What about those who aren’t endowed with wealth? Most basic health units in rural areas are not equipped with proper facilities and on average, there is one doctor available for 1206 patients. As a result, villagers flock to public hospitals in Karachi and Hyderabad for treatment. But the fact of the matter is that they don’t benefit – they end up lying on footpaths. An average doctor’s call fee is Rs. 100. The poverty ridden can barely afford food – let alone travel to cities and pay for their treatment.” says Dr Azim.
Karachi’s troubled streets have often fallen prey to suicide attacks and target killings and its hospitals have borne the brunt of swollen case-loads comprising victims of Karachi’s violence and ailing patients from rural areas. Despite the crises, some hospitals hold sinister elements within their realms, at times exercising discrimination and prejudice towards minorities and particular racial groups or taking advantage of the lack of transparency and accountability in public provision of health.
Dr Seemin Jamali, head of Accidents and Emergencies at the Jinnah Postgraduate Medical Hospital says, “Out of the three public sector hospitals in Karachi, JPMC receives the highest case-load: firstly, because we’re situated in the heart of the city and secondly, because our hospital does not discriminate on the basis of ethnicity.”
Polio, tuberculosis, malaria, hepatitis and dengue constitute Pakistan’s major burden of disease. The World Health Organization claims that Pakistan is one of the four remaining countries with endemic polio and the sixth highest burden of tuberculosis.
Although Pakistan has come a long way since the year 1994 – during which 3000 patients were affected by the polio virus – it stands no where close to it’s neighbours, who are gearing themselves towards the path of becoming polio-free nations. The year 2011 saw the discovery of 198 polio cases in the country – from which 33 cases were from Sindh. In the year 2012, so far, 16 polio cases have been discovered from which two were from Sindh. High-risk areas in Sindh, according to WHO, include the Karachi towns of Gadap, Baldia and Gulshan-e-Iqbal.
Dr Samrina Hashmi, President of the Pakistan Medical Association, Sindh Chapter, is critical of the programmes conducted by the government for polio eradication. She claims that the government has been purchasing vaccines but reports suggest that treatments have not succeeded.
The Government of Pakistan has established a National Tuberculosis Control Programme via which 1.5 million patients have been treated and 5800 tuberculosis diagnostic centres have been set up across the country. Yet, approximately 420 000 new tuberculosis cases emerge in Pakistan every year out of which approximately 70, 000 cases are from Sindh – 14 per cent of Sindh’s cases comprise of fatalities.
Dr Azim and Dr Hashmi both believe that the focus of government-led programmes should be towards preventive, rather than curative measures.
“The authorities should focus on prevention. The National Disaster Management Authority, for example, shouldn’t limit its efforts to rehabilitation following a natural calamity. Looking at a situation logically, if you consider the floods of 2010, majority of casualties were due to unsatisfactory sanitary conditions, the spread of water borne diseases such as malaria and cholera and lack of doctors and medical personnel for treatment of ailing people,” says Dr Azim.
Adds Dr Hashmi, “So the government should focus on root causes of diseases: ensure that proper sanitation is provided; make sure that villages have adequate housing facilities; create awareness amongst villagers regarding preventive measures. Squatter settlements and close packed neighbourhoods are where diseases spread most rapidly so the government should ensure that such settlements are not constructed. If reuse of syringes and transfusion of unscreened blood is curtailed, cases of HIV/Aids and Hepatitis will automatically reduce.”
But the government of Pakistan has shown immense skill in their tactics when it came to dealing with the outbreak of Dengue Hemorrhagic Fever – first reported in Karachi in 1994. Says Dr Hashmi, “It was a commendable effort. The dengue cells in hospitals, awareness programmes in rural areas and focus on preventive measures was impressive.”
According to the Pakistan Economic Survey 2011-12, in the province of Sindh, a total of 1,547 suspected dengue cases were reported out of which 1,326 were from Karachi and 221 were from the rest of Sindh. Eighteenof these cases were fatal, 16 from Karachi and two from the rest of Sindh. The measures carried out in Sindh included coordination with agencies of the United Nations, cleanliness drives and integrated disease control by grouping together dengue, malaria and leishmaniasis.
The success of controlling dengue hemorrhagic fever from evolving into an epidemic should serve as a stimulating factor for the government, stirring them to conduct similar programs for controlling diseases and viruses that have crippled Pakistan’s population.