Similar to other sustainable development goals, Pakistan ranks very low on the global scale for health. The country ranks 57 out of 60 countries according to Global Access to Health care. The number of doctors is estimated to be 232,358. Of these 110,000 are female doctors, unfortunately about 60 per cent are not practising due to a variety of reasons. More than 40,000 practice outside the country. This means we have 130,000 practising doctors for a country of 220 million people. Well below the World Health Organisation (WHO) minimum of one doctor for every 1,000 persons.
Pakistan spends a paltry 1.1 per cent of its GDP on health. No major reform in public health has taken place other than possibly the lady health worker program. With the 18th amendment making health a provincial subject, any centralised reform has increased challenges. Every year, 150,000 students sit for the pre-medical exam but only 15,000 manage to gain admission at the 114 public and private medical colleges.
In addition to the dearth of qualified doctors and glaring urban/rural disparities, we also have the curse of spurious drugs. According to the World Health Organisation, up to 30pc of drugs in emerging markets could be spurious.
We have 130,000 practising doctors for a country of 220m, well below the WHO minimum of one doctor for every 1,000 persons
It takes a minimum of five years of medical school and one year of residency to get a doctor with basic medical skills. The bricks and mortar approach of increasing the number of medical colleges and increasing the number of doctors to meet the WHO requirement of one doctor for every 1,000 citizens is a long term solution and needs to be pursued. In the interim to solve this acute health issue, we must turn to technology and use it as a force multiplier.
The first part of the solution relies on teledensity and telephone coverage. Imagine a patient in a remote village being able to get basic diagnosis over a feature phone by calling a call centre. Imagine at the end of the call, the prescribed medicines being delivered to the remote village within 24 hours. Imagine if a patient has a smartphone then being able to get a video consultation with a local or international specialist, imagine being able to find doctors online for your needs and also being able to get an appointment. Lastly, imagine booking a home visit by a qualified doctor. All this is happening as you read this article. There are 145 health-tech start-up companies in Pakistan which are growing by the day as people become more comfortable with telemedicine.
The force multiplier comes into play because doctors can be more productive with a combination of physical visits and phone calls. In addition, the bulk of female doctors who are qualified but were not able to practice now have the opportunity to become productive again. It’s worth noting that close to 42pc of the calls received at health telecentres are related to women health issues.
On the spurious drugs front, the gold standard solution lies in putting the entire value chain of medicines being produced from the factory assembly line to the end customer on blockchain. Every strip of medicine produced must be capable of being traced back to the factory line it was produced. The value chain must be digitised so that at any time any medicine produced must be traceable. This has been accomplished in countries where laws have been passed to enforce this requirement on big pharma. Big pharma will not make the necessary investment unless regulations force them to.
In the interim, online pharmacies and large reputable pharmacies are a safer bet than the neighbourhood kiryana store for non-spurious drugs.
The last bottleneck in the health industry is the physical health records patients have to maintain. Due to the lack of the client health stack, every time a patient visits a new doctor or a new hospital he or she must carry a bulging file of old tests and prescriptions. Imagine each patient using their CNIC number as the unique identifier having a digital locker with all their medical information available. Imagine the patient walking into a consultation, providing the doctor with a public key to access blockchain information on a cloud.
All these technologies are currently available in Pakistan. Before they are scaled up, we need to first ensure that customer privacy, data security and customer complaint mechanisms are in place. Once the necessary regulations are passed, health technology can be used to leverage our existing doctor strength to provide consultations and medicines to remote parts of Pakistan. We can also access international specialists from the confines of our homes.
The writer is a technology entrepreneur
Published in Dawn, The Business and Finance Weekly, October 19th, 2020