Being the most neglected, the health sector is suffering from lack of funds and awareness, leaving the nation’s children in a quandary
The status of child healthcare management in Pakistan is miserable. In fact it is so bad that even a problem infested country like Bangladesh has a better child health system than ours.
The reason is very simple; less than one per cent of our national budget is allocated for the health sector of which, the share of child care is very nominal. In reality, nearly six per cent of the national income should be allocated to the health sector.
It is a known fact that only physically and mentally healthy children can make a strong nation. And accordingly, countries set their goals, first by setting a proper budget in order to meet their aims. Unfortunately our budget priorities are different. Thus unless and until there is a shift of paradigm, the already deplorable situation would further deteriorate with every passing year. Though we all believe that children are our future, nothing pragmatic has been done so far. We have to realize the importance of having healthy children in our society to ensure a bright future for the country as a whole. And this view is supported by none other than Professor Gaffar Billoo, Pakistan’s premier paediatrician.
Born 14th January, 1937, Dr Billoo has so far trained more than 150 paediatricians. As a Master Trainer of Government of Pakistan in Integrated Management of Childhood Illness (IMCI), he introduced and implemented IMCI Aga Khan Health Service, Pakistan (AKHSP) and 260 health facilities all over Pakistan.
The following are the excerpts of an interview with Dr Billoo.
Q: What is the position of child healthcare in Pakistan?
A: Hopeless. Let me give you some statistics so that you have a very clear picture. A hundred and twelve out of 1000 children born in Pakistan do not reach their fifth birthday. Eighty-five out of 1000 do not survive the first year at all. Now, if you compare this mortality rate with neighbouring countries you feel ashamed.
In India it is less than 65 per 1000; in Bangladesh it is less than 60 (better than India); in Sri Lanka less than 20 and in Iran also less than 20. In Europe and America this rate is around five per 1000.
Q: What do you think are the reasons?
A: Though paucity of funds in the health sector is the main reason, I personally feel that any increase in the allocation of budget in the health sector alone will not serve the purpose unless the similarly neglected education sector gets equal attention. Both sectors are in fact deeply inter-related. So if we want to decrease the rate of infant mortality we have to increase the rate of literacy — I mean genuine literacy. In plain words it requires the synergy from the government in these two sectors. Let me tell you that to accelerate the pace of development in any socio-economic sector especially the human resource development, these two sectors require equal attention. Unfortunately in our set of national priorities these two sectors are almost neglected.
Q: What are other factors responsible for high rate of infant mortality?
A: Lack of awareness among parents which is of course due to lack of literacy and availability of proper health services. Major infant killers are pneumonia, diarrhoea, vaccine preventable diseases and malnutrition. Eighty per cent of all deaths among children, including the death of new born in the first month are caused by these diseases. Due to lack of awareness, timely attention is not given to infants suffering from these diseases, which results in complications.
Out of five million children born every year in Pakistan, 60 to 70 per cent in the urban areas have access to primary or basic healthcare centres, whereas in rural areas this figure is less than 50 per cent. Let me again emphasize that lack of education is the main villain.
Q: What about immunization against diseases among children?
A: Expanded Programme of Immunization (EPI) was launched for the first time in 1979 with the prime objective of reducing morbidity and mortality, resulting from deadly diseases i.e. polio, diphtheria, whooping cough, tetanus, measles, tuberculosis and now Hepatitis B. Though immunization is completely free all over the country, the coverage has, instead of expanding, shrunk to only 50 per cent percent, compared to about 85 per cent in the 80s. This is in fact very alarming and requires immediate accelerations in the pace.
Q: What is the situation in the rural areas?
A: Besides the problems already discussed, in rural areas babies are also delivered by Dais, who are not trained midwives. This not-so-safe practice results in complications during delivery, leading to high infant and maternal mortality.
Q: There is a lot of concern about kidney diseases. What is it?
A: In very simple terms it is swelling or inflammation of kidney. There are two types of this disease, one is called nephrotic syndrome while other is known as nephritis. There is a vast difference between the two. They are diagnosed differently and treated in different manner. And it is very important to understand the difference.
Q: Could you please further detail the nephrotic syndrome?
A: This particular disease affects the children between two and nine years of age. The swelling below the eyes appears in the morning and during the first few days disappears by evening. After few days the swelling persists and starts spreading to other parts of the body including feet and abdomen. When the swelling persists, concerned parents rush the child to a doctor. This disease can be diagnosed by a simple urine test. Since there is a leakage of large amount of protein through urine, the body start swelling. About 90 per cent of the cases can be easily diagnosed as well as treated.
Steroids are used for the treatment. But the treatment is long and requires perseverance and patience from both patient and parents. High protein diet and restriction of salt and fluid in initial days of treatment are recommended. It also has a tendency to recur and relapse. It may take anytime between three months to three years for recovery, depending upon the case. The most important aspect of the treatment is counselling for parents which gives them the required strength and confidence so that the patient gets a supporting environment.
Regular follow up of the disease is an absolute must.
Q: And nephritis?
A: Unlike nephrotic syndrome, this disease, at times, is caused by improper and inadequate treatment of sore throat. In this disease also, the affected child may show swelling under eyes, but of a very mild nature. The most significant thing is that both patient and parents notice presence of blood in the urine known as haematuria. This can also be diagnosed by a simple urine test, which shows presence of much more blood than protein. If the disease is diagnosed in time the treatment is simple.
The patient is put on penicillin or amoxilin for ten days. The children, with continued swelling of eyes or face, may also require fluid and salt restriction for the first couple of weeks. If there is a mild kidney failure he may require protein restriction in diet. Unlike nephrotic syndrome, steroids have no place in the treatment of this disease. About 90 per cent of the patients recover in four weeks. If this disease gets complicated it may result in high blood pressure, cardiac failure, complications of brain because of high blood pressure, which can be life threatening.
Q: Is there any danger of this disease turning into cancer?
A: Not at all. There is no risk of cancer in this disease. In fact, in only ten per cent of the cases, doctors may suggest biopsy for confirmation. But then the parents must go to reputable centres who have the expertise for this test.
Being the most neglected, the health sector is suffering from lack of funds and awareness, leaving the nation’s children in a quandary 
