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Grave and terrifying

March 15, 2011

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DR Tipu Sultan, president of the Pakistan Medical Association (PMA), has described the health situation in the country as “grave, embarrassing and terrifying”. He is not exaggerating. A report titled Health of the Nation prepared by the PMA is a scathing indictment of the state of the health sector. There has been a tremendous slide and the progress made in the last decade has been literally wiped out.

Not quite. Many ‘five-star luxury’ hospitals charging fabulous fees and offering fancy treatment have come up in this period. To make room for them, institutions that were more affordable have been pulled down. This trend in the health sector symbolises the growing gap in our society between the haves and the have-nots.

In the chaos that engulfs Pakistan today, the crumbling state of the healthcare system — on which our destiny hinges — has been totally ignored. With public attention focused on our unsavoury politics, many health concerns have gone unnoticed.

Not surprisingly, our rulers fail to see the connection between politics and health, a fundamental right of the citizens. The state of their health determines their span of life, sense of well-being — both physical and mental — stamina to work and so on. These factors are basic to a nation’s productivity and therefore its national economy. As for our politics, it is influenced by our human capital, that is in turn shaped by the state of health and quality of life of the people.

These are the simple realities. One must be grateful to the PMA for recognising them and drawing attention to the crisis that grips the health sector today. The report it has prepared is a concise one (13 pages in all) but the problems identified are critical and have far-reaching consequences. The 12 recommendations at the conclusion indicate the health priorities the medical profession believes should be addressed immediately to improve matters.

They are most pertinent. For instance, the suggestion to increase the health budget to six per cent of GDP makes sense given the fall in the health allocations over the years in terms of percentage of GDP. Health receives 0.5 per cent of GDP today when it was 0.8 per cent in the 1980s. Then there is the permanent menace of under-utilisation and the cancer of corruption that do not allow a balanced and honest use of the funds allocated.

There is also the valid recommendation to improve the health delivery system in the rural areas where 64 per cent of the population now lives. It is callous to neglect this deprived and impoverished section of humanity. The government claims that there are 5,345 Basic Health Units and 572 Rural Health Centres to attend to the rural population. But the PMA’s report informs us that 2,400 of these are non-functional. It is a pity that the well-conceived programme of training health visitors, paramedics and midwives to play a basic role in primary healthcare — on the pattern of the barefoot doctors in China in the 1960s — has failed to take off due to poor implementation.

One could go on because there is so much wrong with the health sector in Pakistan today. A beginning can be made by taking up two very vital issues that should not be difficult to implement. They should not cost much either.

First is the need to shift our emphasis to preventive medicine or primary healthcare which is virtually non-existent in Pakistan. The PMA report takes note of it when it demands “clean water for every citizen” and a “scientific sewerage system” in every part of the country.

The demand for strengthening the Expanded Programme for Immunisation also falls in the same category. But preventive measures have been flawed. The PMA report says that notwithstanding 62 rounds of polio vaccination, we have failed to prevent a fresh outbreak of polio cases (13 have already been detected this year making Pakistan the leading member of the 21-strong league of ‘polio-endemic countries’ in the world).

If the government could be pushed into attending to preventive health measures the incidence of illnesses could be reduced considerably. The PMA says that infectious and childhood diseases account for 66 per cent of the burden of disease and many of these are communicable and therefore preventable.

Another area where much still needs to be done is that of health education so that people learn to take responsibility for their own health. The low literacy rate and the lack of knowledge of health issues make people vulnerable. As a result, they fail to adopt healthy lifestyles and sound dietary habits.

Health professionals and the media need to play a proactive role in educating people in the art of healthy living. They have a captive audience in the hundreds of patients and their family members who crowd the waiting rooms in doctors’ clinics. Knowledge should help eradicate problems that are self-created and preventable. How else would you describe the case of 25 million people who smoke 36 billion cigarettes in a year (the PMA’s findings) and the high consumption of gutka and paan? Do people have yet to be told about the link between tobacco and disease?

What needs to be understood is that barricades which provide security to the privileged few against terrorists cannot ward off viruses and bacteria spawned by poor sanitation. True, the toiling masses are more vulnerable to disease, but without their hard labour, the wealthy cannot subsist.

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