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THE ejection of Médecins Sans Frontières from Kurram Agency made headlines earlier this month. MSF, an independent medical charity and winner of the Nobel Prize in 1999, is known for its sterling contributions to medical humanitarian work in conflict-ridden parts of the world. It has often risked great dangers, as the bombings of its facilities in Yemen and Syria have shown.
MSF began its health relief work in Kurram about 14 years ago, providing both inpatient and outpatient services to children, antenatal and obstetric emergency referral services through ambulance services, besides carrying out other relief work. Importantly, it treated over 400 cases of cutaneous leishmaniasis and provided free treatment to patients of Hepatitis C who cannot afford expensive treatment.
Like many other NGOs that too are in danger of being expelled from various areas in Pakistan, MSF’s multi-strand health engagement in Kurram supported the health ministry’s efforts to achieve local health targets.
It will be harder to ensure healthcare provision in remote areas.
It is no secret that Pakistan scores poorly on all health indictors and its public health response in emergencies results from ill-resourced health systems and a lack of political will. For example, a National Nutrition Survey found that 40 per cent of the country’s population suffers from chronic malnutrition. Moreover, over 40pc children under five years of age are stunted across the country, with at least another 15pc verging on emaciation. Meanwhile, the number of Hepatitis C patients (in their millions) is said to be the highest after Egypt where 10pc to 14pc of the population is infected with the potentially lethal virus.
Because of the efforts of NGOs, local and foreign, nutrition had been back on the agenda as a key determinant of health in Pakistan, although health figures are still far from satisfactory. As far as maternal and child health is concerned, various estimates put Pakistan’s maternal mortality ratio at 276, well behind the target of 175 per 100,000 live births set for 2015.
With such statistics, it is no surprise that Pakistan has failed spectacularly to achieve the Millennium Development Goals while other countries in South Asia, such as Bangladesh and Nepal, have managed to do far better despite having lagged behind Pakistan for decades. These indicators clearly show that the provision of healthcare to the population is not a top governmental priority — this is more than evident in the low budgetary allocations for health and the declining state of our public hospitals. These indicators are the worst in poor and neglected areas. In rural and remote areas, the scarcity of hospitals and a health workforce is a perennial problem.
Pakistan has also remained under-vaccinated and with religiously-inspired militants targeting polio workers, the dream of full immunisation will remain just that — a dream. NGOs in the health sector, including MSF, have contributed hugely to improving indicators for mother and child health, nutrition, mental health services and diseases such as tuberculosis, Hepatitis C and cutaneous leishmaniasis. They have stepped in and at least partially plugged the gap left behind by the state.
It is because of this praiseworthy contribution that cancelling the MSF presence in Kurram Agency is a double blow to not only the struggling and overstretched local health systems but also to poverty-stricken patients. Moreover, the ejection of MSF will only slow down progress on overall local health targets, as it will become harder to ensure healthcare provision in remote areas. Given the extreme lethargy of the government, it is unlikely that the resources of the health facilities being managed by MSF will be given into other competent hands.
Such action to hamper the activities of NGOs genuinely working towards the welfare of local populations and to dismantle well-established health provision networks is Pakistan’s own loss, whether or not our decision makers realise it.
The need to rethink the decision to eject the organisation from Kurram Agency and to stop similar measures against other NGOs has never been more urgent. The government needs to rethink this unwise decision of not issuing a no-objection certificate to an organisation that is valued in so many parts of the world.
With healthcare on the lower rung of our official priorities and health systems in total disarray, the expulsion of health NGOs from areas where the need is most dire does not inspire confidence that Pakistan will be able to meet its development targets on health as enshrined in the Sustainable Development Goals. The policy of engagement rather than disengagement with healthcare-related NGOs can help the government meet its targets. The securitisation of health is hardly the way forward in achieving these goals.
The writer is a public health consultant and policy analyst.
Twitter: @arifazad
Published in Dawn, September 29th, 2017
