IN the national budget, announced last June for fiscal year 2008-2009, Rs19bn was allocated for health. In GNP terms, was this the usual one per cent or thereabouts or more, like the advocated four per cent?

Further probing was definitely called for, and it was certainly worthwhile. The Rs19bn spells a 37 per cent increase in government health-sector allocations, of which Rs11.5bn is earmarked for family planning and immunisation programmes.

The deployment of Lady Health Workers, who presently number 100,000, is to be doubled. Rs7.5bn has been set aside for 111 developmental projects, of which only three are new ones, maternal and child health projects and infectious disease control programmes for malaria, TB, HIV/AIDS and hepatitis.

That said, the fact remains that all together this amount constitutes only 0.8 per cent of the federal budget, and falls grossly short of the 15 per cent recommended by WHO. Seventeen of the developmental projects mentioned above have not been allocated any funds; most are focused on the urban areas, again relegating rural areas to a subsidiary status. It is difficult to see how the health scenario will improve with this limited budget.

In the past, the role of health as an integral partner to human development appeared not to have been fully recognised; rather, its role as an `eroder` of people`s strength, vitality and resistance to disease has been prominent. This negative role remains a silent, but steady contributor to the millions of needless deaths that occur around us.

Past damaging budgetary cuts and short-sighted policies have proved to be the equivalent of shooting ourselves in the foot, with low allocations for health causing long-

term damage. Similar low allocations for education have resulted in low literacy rates, with women the worst affected. The spin-off has been uneducated families, whose lack of knowledge often renders them and their children vulnerable to disease. The near-absence in many localities of clean drinking water and sanitation facilities deprive people of the wherewithal for a healthy life. Pollution-free air is a rarity. .Around 30 per cent of the population is poverty-stricken, unable to afford even one square meal a day. The stresses and strains of modern living lead to increased mental tension, a high incidence of psychiatric problems, even suicides.

Not a pretty picture. Today`s people are functioning at sub-optimal health levels, unable to put their best foot forward.

The majority population is malnourished, physically stunted and susceptible to a host of illnesses. Relatively newer diseases, like cancer and HIV/AIDS, show increasing incidence. In addition, the country`s crumbling medicare system has to deal with the consequences of alarmingly high numbers of traffic accidents, bomb explosions and the like, all requiring emergency medical treatment.

There is, in short, a huge backlog of needs to be met. To what extent does the new health budget meet these needs? The health ministry`s plans are commendable fully staffed, equipped Basic Health Units and district hospitals are to be upgraded throughout the country. It would not be amiss to mention here that Pakistan has a substantial number of young medical graduates, who would be happy to work in rural areas if work conditions and emoluments, including rural area incentives, were satisfactory.

The LHW network is to be expanded, to facilitate improved outreach of preventive, cost-effective healthcare, a fact particularly important for vulnerable young mothers and children. Immunisation programmes for children against major communicable diseases, and for mothers-to-be against tetanus, are to be expanded. Further preventive measures include accelerated programmes for TB Control, HIV/AIDS, hepatitis, and improvement of maternal and neonatal health. Hospital-based tertiary care is to receive specific funding

Plans are to provide clean drinking water to a larger population, via filtration plants established throughout the country. This can make a dent in the currently high incidence of diarrhoeal disease but only if this facility reaches the poor.

The budget mentions increased allocations for family planning, but details are still awaited about innovative programmes. This is important particularly because of its close linkage to maternal and child health and development. High birth rates, linked often to barely adult young mothers leave women weakened, exhausted, overworked and susceptible to disease. High population growth contributes to poor health, burdens the public health system and is a significant reason for the present economic and development crisis. Inexplicably, the cost-effectiveness of the electronic media in spreading awareness about simple healthcare measures has not yet been fully explored.

The critical economic situation and the high levels of poverty are likely to push more people below the poverty line, into growing malnourishment. A major illness or a serious accident can reduce a family from middle- to lower middle-class level, or to a poor or even subsistence level existence, particularly if public health facilities cannot provide the expected care.

Given the economic crisis, and possibly forthcoming IMF conditions, budgetary cuts may be required, but they must not affect the health and social sector. Any further erosion of the health sector budget could lead to calamitous consequences. Right now, except for rapid population growth, which itself is adding to greater economic and developmental stress, human development in Pakistan is almost at a standstill.

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