Even after over 70 years of independence, the majority of the country’s population still has no access to primary, basic and emergency healthcare. Our maternal mortality and morbidity rates are the highest among the Saarc countries. More than 200,000 newborn babies die within a month of birth every year in our country. Out of 90 million children in the country, 1.6 million or 1.7 percent children are blind. More than 44 percent of young children are stunted, while 31.5 percent are underweight. A huge number of women die due to breast and cervical cancer in the absence of screening programmes. Fifteen percent of the country’s population is hepatitis B and C positive while more than 12 percent of the population is addicted to drugs. There is no organised system to cater to the needs of and care for the elderly.
With these available numbers, health planners in the past have been influenced by vested-interest groups for making money with no regard for the well-being of patients. All previous governments concentrated on construction of huge buildings for hospitals and medical universities without proper infrastructure.
Expensive medical equipment was purchased at exhorbitant prices to benefit suppliers and government cronies. (For instance, I came across an expensive Swiss-made operating microscope lying under a plastic cover in the small town of Khuplu in Gilgit Biltistan where basic surgical instruments were not available to perform appendectomy). A multi-million dollar project for organ transplantation has been started in the absence of trained human resources without planning and vision.
An expert highlights an agenda for the new government to tackle the abysmal health sector at the grassroots level
At the same time, it seems that the provinces are in competition to build medical universities and colleges to encourage sycophants and appoint vice chancellors, deans, etc, in total violation of merit. In the private sector, medical colleges and universities are functioning as businesses and are allowed to make money in the name of medical education.
Since health planners and policy-makers ignore the abovementioned health indicators, the exploitation of masses by powerful vested-interest groups within and outside the government continues. The real health issues must be looked at on priority basis as they are tackled in countries where importance is given to the masses and health ministries work for them and not against them.
To improve our dire health situation, the following areas need government attention on an urgent basis:
CLEAN WATER AND ORGANISED SEWERAGE AND SANITATION
Thousands of years ago in Mohenjodaro, drinking water was collected from the river away from the city sewerage. Sewerage was treated with limestone although, at the time, they knew nothing about bacteria, fungus, virus and parasites.
Presently, in Pakistan only 36 percent of the population has access to clean water, while the rest of the population drinks contaminated water which causes water-borne diseases. Those who can afford it, buy bottled water. Seventy-one percent of our population uses inefficient sewerage systems in the major cities of the country so that contamination of food and drinking water due to leaking sewerage pipes is not uncommon.
The real health issues must be looked at on priority basis as as they are tackled in countries where importance is given to the masses and health ministries work for them and not against them.
During some fieldwork after the 2005 earthquake in Pakistan, I was shocked to see that the rivers — at their point of origin — were being used for disposal of sewerage. These rivers that pass through cities carry waste. No wonder renal and liver failure, as well as primary ovarian failure has become commonplace. I returned to the earthquake affected area after 10 years and saw that the damage has now become a disaster. Almost every river, fountain, canal and lake is highly contaminated from the sewerage of local communities, hotels and guest houses. No health policy will make a nation healthy as long as they are drinking dirty water and lack proper sewerage systems. The first major health initiative should be the availability of clean tap water in every part of country and construction of a sewerage and sanitation system from Kashmir to Karachi.
EDUCATION OF THE GIRL CHILD
It will not be possible to reduce maternal mortality, morbidity, neonatal deaths and population growth without the education of women. Learning from countries such as Sweden, Denmark, Norway and Holland, developing countries such as Malaysia, Bangladesh and Tunisia have invested massively in the education of the girl child. Education empowers women, who are then able to take care during pregnancy, provide a healthy environment to their children, and play an integral role in educating the male family members and the society at large. With our rural women being illiterate, it is hardly possible to end male dominance in a society where women cannot take any decisions about their bodies and lives.
BASIC HEALTH UNITS (BHU) AND RURAL HEALTH CENTRES (RHC)
BHU and RHC play a major role in preventive medicine. In Pakistan, we have a very good network of BHU and RHC but unfortunately the previous governments and their health planners have neglected these facilities. These centres can look after the immunisation of every newborn and the general population by promoting family planning and providing basic antenatal care to pregnant women. These facilities can also function as health education centres as well as provide care to the neglected elderly population.
A competent army of nurses, midwives and paramedics trained in preventive care are enough to run these centres. Sindh has produced very impressive results as far as maternal and neonatal health is concerned on a small scale — the private public health initiative (PPHI) programme. In the absence of preventive medicine, active BHUs and RHCs can tackle polio, hepatitis, blindness and other preventable diseases.
MEDICAL EDUCATION AND TRAINING PROGRAMME
Presently it seems we are producing competent doctors and nurses for foreign countries as many students of private medical colleges tend to go abroad while incompetent doctors, nurses and health workers educated in public-sector institutions remain in the country. We need a strong, competent and autonomous medical and nursing council to regulate medical and health education without political interference. Such a regulatory body should be able to address issues related to alternative medicine and quackery in our country and not work for vested-interest groups. We can only hope that the health planners in the new government will understand the importance of clean water, sewerage and sanitation systems, the role of preventive medicine, literacy among girls and regulation of medical and health education. These core health issues cannot be addressed in just a few months. It will take time, but these initiatives will pay off to develop a basic health infrastructure that is badly needed.
The writer is a former secretry general of Pakistan Medical Association
Published in Dawn, EOS, September 2nd, 2018