HEALTH is a crucial sector covered by all major political parties in their manifestos.
If elected to power, the parties say they will increase health spending.
The PML-N has aimed for a three-fold increase in the health budget while the PPP and the Muttahida Qaumi Movement (MQM) say they will allocate 5pc of GDP towards health. Polio eradication by 2015 and 100pc vaccination coverage are other goals.
The PPP intends to bring together polio, routine vaccination, lady health workers (LHWs), mother and child healthcare, malaria, hepatitis control and family planning under a properly managed public health programme. Currently, they work under separate departments.
A national health insurance (NHI) scheme has been proposed. The PML-N document says NHI shall initially cover the poorest segments of the population and will be free for students under 12, senior citizens and families with low income.
The PPP says it is formulating a regulatory framework for a micro-insurance health sector, anticipating that this would help it create a transparent and enabling environment for increased health insurance. It claims that the Mother and Child Support Programme is a flagship healthcare package developed by it for implementation in 2013-18.
All this appears promising but can only be evaluated in the implementation stage. The execution of these plans demands proper, honest and transparent administrative handling given the large budgetary allocations. This can only be ensured if there is no political interference in administrative affairs. But there’s hardly any party that says it will do away with political interference.
Such interference has resulted in the health sector’s poor administration, certainly in the case of Sindh, in the last five years. There were no merit-based transfers and postings. So the trickle-down effects that have a direct bearing on the lower tiers of administration at the district and taluka level had no positive impact.
According to health professional Dr Samrina Hashmi, in the last five years the PPP could have done all that it now promises. Able people were not chosen for important positions because of political considerations.
The health sector has clearly not received the serious attention it merits, despite the fact that three of the eight Millennium Development Goals, or MDGs, directly concern health. MDG-4 aims to reduce under-five mortality, MDG-5 to improve maternal health and MDG-6 to combat HIV/AIDS, malaria and other diseases.
According to the UN children’s fund, Unicef, there were improvements in the rates of infant, child and maternal mortality in Pakistan, but they still fell short of the 2015 MDG targets.
In Sindh, there is serious lack of administrative oversight in areas such as immunisation which remains below 40pc. Similarly, there is below par progress on the part of LHWs as far as antenatal care is concerned. This becomes a serious issue in rural areas.
Sindh has faced natural disasters back to back since 2010. This has affected the nutritional status of children in rural areas which were mainly hit by the super floods of 2010. Then came the torrential rains of 2011 in the lower Sindh region. These disasters led to the displacement of thousands of people.
The highest number of deaths from measles was reported last year despite tall claims that there had been 80pc immunisation coverage, as the managements of the Expanded Programme of Immunisation and the People’s Primary Healthcare Initiative (PPHI) kept wrangling over jurisdiction.
Under MDG-4, under-five mortality is to be reduced to 48 per 1,000 live births and the maternal mortality ratio (MMR) cut to less than 140 per 100,000 live births under MDG-5. Pakistan’s infant mortality is 78 per 1,000 at present and the MMR is 276 per 100,000 live births. Against the latter national average, Sindh’s rating on MMR is 314 while Punjab’s is 227 according to the Pakistan Demographic and Health Survey. These findings were reported in 2008. This shows how badly Sindh fares in the health sector.
The primary reason for the higher MMR figure is the absence of skilled birth attendants. LHWs are supposed to pay weekly visits to expecting mothers to guide them about healthcare issues. But they are mostly engaged in polio vaccination. Basic health units, otherwise supposed to offer 24 hours emergency maternal and obstetrics care, work as outpatient departments.
Affairs in the health department are managed in a casual manner, with junior officers holding important positions. The appointment of junior officers to senior posts was normal practice for the government in the days before the assemblies were dissolved and in complete disregard of court orders. Several positions are lucrative. Anyone with the right political connections can grab them easily.
Besides political influence of this sort, health programmes in the province also suffered on account of rivalries.
For instance, the health ministry was with the MQM but the health minister was heard complaining that he was not allowed to work freely. Officers were posted without his knowledge through some channels existing in the Chief Minister House.
Manifestos may be important documents that convey the goals of the party aspiring to form the next government, but it is political will that is needed to implement polices.
Healthcare conditions in Sindh are abysmal in both the urban and rural centres; the latter’s crisis is compounded by the absence of even basic facilities such as potable water.
Seen in the light of ground realities, the future of the health sector in Sindh does not appear particularly bright. Having said that we still hope that whoever forms the next government will at least ensure transparency in administrative affairs in the larger interest of the poor.
The writer is Dawn’s senior reporter in Hyderabad.