Dying slowly – why health reforms are the need of the hour
The major contributing factor to the current situation is Pakistan’s ineffective health governance and poor financial allocations
Health is the key indicator of an efficient and productive human capital. It has been a well-documented fact that healthy human capital is essential to achieve and sustain economic growth and development. It is also fundamental to target poverty and introduce income equality on a durable basis.
A multidimensional poverty index has put the spotlight on the importance of health when talking about poverty. Health is an important indicator for achieving economic growth, and targets eradicating poverty. Health is also a basic indicator for food security, which is essential for the existence of humans.
Developed and fast-growing economies attach a high priority to the health sector. The Prosperity Index by Legatum Institute, UK, supports the argument that countries with higher health scores are closer to prosperity and happiness.
The Prosperity Index calculates health score based on three broader indicators, including basic mental and physical health, infrastructure and preventive system.
Norway tops the list with the highest per capita investment on health of citizens. Besides, health facilities are free of cost until the age of 16. Consequently, such countries are also developing at fast speed, which shows the importance of healthy human capital for economic growth and development.
Countries with a low ranking are victims of smaller public spending, inappropriate infrastructure, and a plethora of inefficient policies and frameworks. The dilemma with policies is that they never lead to action, which is one of the major reasons for failure in these countries. The phenomenon is widespread in low developing and least developed countries. Pakistan being a low developing country is no exception. The quality of life is quite low and the health sector is one of the lowest graded sectors in Pakistan. Investment by government depicts a sorry state of affairs in the presence of high demand for health services.
Our government’s actions are not helping our health issues. Pakistan committed at the global level, with World Health Organization (WHO), that it would gradually increase taxes on cigarettes to control the use of cigarette. However, the government reduced the tax rate on cigarettes and introduced a new slab of taxes to facilitate cigarette producers.
Another example is the poor performance of the government on devolution of health services at the district level. Khyber Pakhtunkhwa (KP) government has shown good progress on this front, but other governments are for behind their targets.
The Punjab government took an innovative measure to divert the focus. Punjab has created a “District Health Authority” with maximum control of these authorities at the provincial level. The concept is good but the implementation is being done in a mysterious way.
The major contributing factor to the current situation is Pakistan’s ineffective health governance and poor financial allocations. Apart from weaknesses in public sector governance, government’s performance also remains poor if not ineffective for the enforcement of rule and regulations in private sector.
There is no doubt that some private hospitals are providing state-of-the-art medical facilities like Shaukat Khanam, Agha Khan etc. However, the poor sections of our society can only benefit from the charity services provided by these hospitals, as their commercial services are beyond their reach. The majority of private hospitals, excluding charity hospitals like Indus etc., only operate on the model of “pay for services”, which does not help matters.
Private medical teaching institutes are another source of health services and facilities. Pakistan witnessed a boom such institutes in the last few years, especially during Pakistan Peoples Party (PPP)’s rule. Currently, the private medical teaching institutes outnumber public teaching institute in Punjab, KP and Sindh. Punjab has 62 private medical universities or colleges against 28 public medical universities and colleges. In Sindh, there are 26 privately-owned medical universities against the 20 public medical universities and colleges. The facts are not different in KP; and only Balochistan has more public institutes than private.
The number of private institutes clearly depicts the role and importance of the private sector. As per the law, private institutes must fulfil the basic criteria for operating in the field, which includes provision of free of cost health services to poor sections of society.
A private sector medical institute must also have a hospital where their students can practice, and no medical institute can share a hospital with another institute. Each institute has to provide free medical services for patients without any discrimination. PMDC’s rules state “in each teaching hospital fifty percent of the beds shall operate free for accommodation and consultation, while treatment expenses including laboratory services, medicines and supplies, if any, shall be charged from the patients on a no-profit basis”.
Unfortunately, the private medical institutes are not fulfilling their obligations according to the rules. Along with other factors, weak governance and non-cooperation of private institutions are main reasons behind poor delivery in private institutes on this front.
There is no data or study to give us a clear picture of the current state of affairs. My observations above are only developed based on general interaction with private hospital staff and patients.
Pakistan cannot grow without healthy society, and this issue needs to become a priority for our government. The government should adopt a comprehensive strategy to make the health sector efficient and citizen-oriented, especially the private sector.
Pakistan committed to the WHO that it would gradually increase taxes on cigarettes to control tobacco use. However, the government reduced the tax rate on cigarettes and introduces a new slab of taxes to facilitate cigarette producers
First, the government should issue special notices to private sector institutes for compliance and give a cut-off date for inspection. It should also urge relative departments, such as the Pakistan Population Foundation, to commission a full-scale study at the national level. The governments of Punjab and KP can take the lead, as the number of private institutes is higher than public institutes. Both governments should also revise their health policies in the context of strict implementation for private institutes.
Second, civil society organisations and international development partners should also help the government devise innovative tools to engage the private sector for better health delivery.
Lastly, civil society organisations should devise ways for direct contribution to district-level health service delivery. Moreover, the civil society can also develop a framework to improve the health sector at large.
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The opinions expressed in this article are the author's own and do not necessarily reflect the viewpoint or stance of SDPI.