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Challenges to improving health care in Pakistan

A toddler receives polio drops from a mobile health clinic, at a school-turned relief camp in Tando Adam, Sanghar district, Sindh province, Pakistan UNICEF Pakistan/Warrick Page
Hamza Mazhar, a 35-year-old teacher from Pakistan’s eastern city of Lahore, says he never wants to see the inside of a government hospital again.

“My mother was taken to the hospital with an upper respiratory tract infection in February this year and doctors said she needed care in the hospital’s Intensive Care Unit (ICU),” he told IRIN.

But the doctors in charge wanted the family to pay a bribe to get into the ICU, which had plenty of spare beds. They could not afford to pay. His mother was unable to get the treatment she needed and in March she died.

Health care in Pakistan is identified as one of the country’s most corrupt sectors, according to surveys by Transparency International; general surveys suggest the majority of Pakistanis are unhappy with the health services they are offered.

This is just one of the many challenges facing Pakistan’s health system, as identified in the first ever comprehensive assessment of the sector, published in the medical journal The Lancet and launched today in Islamabad.

Entitled Health Transitions in Pakistan, the series of articles says Pakistan’s health sector lags behind 12 countries in the region with cultural, economic and geographic similarities.

Pakistan has no national health insurance system and 78 percent of the population pay health care expenses themselves. It is the only country in the world without a National Health Ministry.

The report authors say the recently elected government has a unique opportunity to push through reforms and take advantage of recent constitutional changes that devolve health care to the provinces.

The findings are not entirely negative. Progress has been made on all health indicators in the past 20 years. The rates of child deaths and maternal mortality have fallen, and the community-based Lady Health Workers programme is singled out for praise.

But improvements have been much slower coming than in other similar countries. IRIN picked out four major challenges from the health assessment.

1. Avoidably high child and maternal mortality

The assessment’s authors describe Pakistan’s progress towards meeting the Millennium Development Goals for reducing child and material mortality (4&5) as “unsatisfactory”.

Pakistan, with its population of 180 million, has more child, foetal and maternal deaths than all but two of the world’s nations.

The report calls child survival “the most devastating and large-scale public health and humanitarian crisis Pakistan faces”.

An estimated 423,000 children under-five die each year, almost half of them new-born babies. Family planning options are also limited and nearly a million women attempt unsafe abortions each year.

Simple measures like training more nurses and midwives (currently outnumbered by doctors 2:1) could save more than 200,000 women and child lives in 2015, the report’s authors say.

2. Nutrition

A lack of adequate nutrition for children contributes to the high number of child and maternal deaths. Nearly 40 percent of children under-five are underweight and more than half are affected by stunting.

Poor nutrition weakens the body’s natural defence mechanisms.

But the report also says that malnutrition affects the Pakistani economy, with estimates that it costs the country 3 percent of GDP every year, particularly through reduced productivity in young adults.

3. “Lifestyle diseases”

In Pakistan, as more widely throughout south Asia, non-communicable diseases like cancer, diabetes and heart problems have replaced communicable diseases like malaria and diarrhoea in the past two decades as the leading causes of death and morbidity.

This general trend has not been matched by an adaptation in the Pakistani health system or government policy. Poor road safety, cheap cigarettes and high-levels of obesity (one in four adults) all lead to preventable deaths.

So-called “lifestyle diseases” could cost the country nearly US$300 million in 2025, according to the report’s authors.

They say the right government action, including higher excise taxes on cigarettes, new legislation, and information campaigns could cut the premature mortality rate from cardiovascular diseases, cancers, and respiratory diseases by 20 percent by 2025.

4. Low public spending

Humanitarian crises provoked by earthquakes, flooding and conflict over the past decade have mobilized large sums of money both internationally and within the country.

But corresponding sums have not been spent on underlying health services, which have the potential to save many more lives.

Public health spending has declined from 1.5 percent of GDP in the late 1980s to less than 1 percent, according to the report - equivalent to less than 4 percent of the government budget.

That has left Pakistanis with little support for medical costs, which are responsible for more than two-thirds of major economic shocks for poor families, according to the Ministry of Social Welfare and Special Education.

Rapid population growth only makes what resources are spent on health care produce ever smaller results.


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