KARACHI, Jan 18: The federal and provincial governments' health policies have been criticized by the Pakistan Medical Association (PMA) in its annual report, released recently.

Replete with highly critical words, the PMA's report maintains that the federal health ministry and provincial health departments have no real sense of direction. It further says the federal and provincial leaderships have not shown any commitment or political will to address the health issues in the country.

"In Pakistan we produce one nurse for eight doctors and only one doctor is available to treat 2,300 people," says the report. "The government has no understanding or plans to produce adequate number of nurses and paramedical staff.

"The initiative of the federal government to produce community midwives is not well thought out and the suggested one-year midwifery training in the absence of trained tutors will not produce competent health workers."

The government and donor agencies have failed to understand that a shortcut to reduce maternal death rate does not exist, says the report. "A long-term scientific programme is required to address the issue of maternal deaths.

"The government has also failed in understanding the role of paramedical staff in th health care system. An army of paramedical staff is required to run our Basic Health Units, Rural Health Centres, Taluka Headquarter Hospitals and Tertiary Health Care System."

Criticizing the authorities' policy on medical education, the PMA's report says: "The policy of provincial governments regarding admissions to the medical colleges remains poor at its best. We are producing more female doctors, with long-term (adverse) effect on the health delivery system.

"At the same time the provincial governments have a liberal policy regarding private medical colleges in all provinces. Substandard medical education is available at a very high fee. These (private) medical colleges are producing glorified MBBS good-for-nothing doctors."

Turning to the issue of unemployment among doctors, the report states: "More than 5,000 doctors in Punjab, 3,000 in Sindh, 1,200 in Balochistan and 1,000 in the NWFP are unemployed but the government has no policy for utilization of these doctors".

The report says a system of accountability, audit, punishment and reward is required to motivate doctors. "No provincial government is ready to develop a career structure for doctors working in non-teaching units in the country."

Turning towards the issue of post-MBBS training, the PMA's report says: "Teaching hospital in the public sector, with the exception of a few departments, have no structured postgraduate training programme. A majority of the postgraduate students are working with no supervision or with minimal supervision."

No medical college in the public sector is providing training to doctors in the discipline of family medicine, says the report. "And there is no scheme to help dedicated doctors to start their practice in the community."

No step has been taken by the authorities to rid the country of quackery. "More than 600,000 quacks are playing with the lives of the poor people. They are allowed to run clinics, perform surgeries and deal with emergencies."

It is just not possible to have a good health care system in the presence of this kind of healers who are in fact responsible for the spread of diseases, says the PMA's report.

"The government has also failed in producing a drug policy to control the use of magic drugs for the treatment of cancers or sexual dysfunction. While essential drugs are not available in the market, it is full of spurious and substandard drugs.

"The government should create a system in which essential drugs are available economically the year round. The government should not be working for the vested interest groups in the pharmaceutical industry."