WITH reference to the three stories in the September 7 issue, Malignant malady touches very relevant aspects of maladministration in the health sector. However, it drags us through inconsequential quotes from Dr Qureshi, Dr Ahsan and Dr Khan (underscoring governance and leadership issue where ‘material resources’ being only one of them), till Dr Srichand Ochani.

Dr Ochani makes the crucial point of shifting the priority from tertiary to primary care and strengthens the preventive and promotive aspect of health delivery. The diagnosis of the malady lies in this statement. The rest remain skin (surface) manifestations.

The quote in bold says “While on paper the health care delivery set up appears to be designed quite well...”

I would like to inform the learned author that there is no ‘Health Policy’ operative in Pakistan. Those that were floated, and even adopted by the then government, have never seen the light of the day. The so-called ‘health care delivery set up’, is the same which was left by our colonial rulers.

The JPMC is still meant for the treatment of Federal Government servants, while others are allowed to be seen. Nevertheless, it is doing commendable service to the poor, against all odds. In the absence of a policy backed by a system of monitoring, nothing can be expected. The leadership one talks about needs to be at the political level. Because (if it doesn’t) the leadership at ground level, (that) comes enthusiastically, gets disillusioned and disappears.

You cannot lead without a “road map” (recently much-maligned term) which means Health Policy.

The writer argues that the private sector is more efficient and effective than the public sector. In Pakistan the private sector does not exist except for few ‘prestigious’ institutions and many ill-equipped hospitals in big cities. In terms of health delivery system in Pakistan, these few institutions are only a drop in the ocean.

The only private sector institution that is functioning and delivering is the institution of General Practitioners (Family Physicians) who cater to a large number in urban and rural areas at affordable cost. They have never been featured in the planning and development of health care.

In a frank interview (Lack of commitment is behind the mess) Dr Sher Shah focuses on lack of commitment behind the mess. But the naive interviewer asks, “Our health delivery system seems to be well designed, then why is it failing?”

I expected the secretary general of Pakistan Medical Association to educate us that presently there is no health delivery system and the old system is now breaking down.

In the hey days of Who’s slogan, “Health For All by the year 2000”, the dispensaries were renamed as BHU and Tehsil hospital as RHC, while the Civil Hospitals at district level maintained their name. It is worth recalling that currently the same old colonial health services, meant for the army and bureaucracy are operative. They were/are allowed to carry the burden of providing ‘free’ services to the poor also. There is no criteria for a medical university in Sindh, followed by another in Punjab and yet another one in the offing. Who decides and on what yardstick?

In Matters of the heart, Professor Ishaque’s ‘patriotically’ moved piece, it is suffice to quote, “Recently there was news about a young girl travelling to India for her operation” — “the Indian media made a big issue and used it to promote Indian medical expertise”. Later he concedes, “We can learn a lot from India, where perhaps treatment is provided at affordable price”. Then he advises that “special attention needs to be given to the field of paediatric cardiology and paediatric surgery to deal with the burden of CHD”.

Professor Ishaque completely missed the point in issue. This young girl operated at Bangalore brought so much goodwill between the people of India and Pakistan which could not have come at a more appropriate time. The little girl and their hosts in India have broken the myth of ‘enemy syndrome’ between India and Pakistan.

PROF S. HAROON AHMED
Karachi