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18 Feb - 24 Feb , 2012
Healthcare – A Neglected Sector
Healthcare – A Neglected Sector
Although healthcare is a responsibility of the state, Pakistan has always been one of those countries that never really put the desired focus in this sector. Our country lags behind in healthcare, just as it does in education and many other significant sectors necessary for nation building. The reason is that healthcare never falls into the list of high priority tasks for the government. In a country where a government's expiry date varies, and where jamhoori governments spend four years trying to be in power, the last one planning for the next elections, it is evident why extremely significant areas like health aren't given much importance. In the last fifteen months or so, there have been countless times when healthcare has occupied the headlines in our media for all the wrong reasons, be it the multiple protests by white coats, nurses and pharmacists, or the recent unfortunate incident at the Punjab Institute of Cardiology, Lahore.
State-run hospitals and clinics are not exempt from the characteristic bureaucratic culture that almost every government institution experiences, and since medical emergencies do not follow the clock, it is a sorry affair for those at the receiving end. Last year, doctors, nurses and then later pharmacists staged separate protests demanding better service structures, special provisions and other perks. However, it is interesting to note that even though such demands are eventually met, health professionals aren't seen working with as much commitment as is expected of them. Doctors on government payrolls are either operating their own private facilities, neglecting their duties for which they are being paid hefty salaries from the public's taxes, or are so careless that mistreatment of patients take place.
Since state-run medical institutions cater to the lower-middle class and low income households, people belonging to that stratum of the society are neither too educationally sound to comprehend medical complications caused by negligence, nor have the means to pursue any kinds of legal action over it. Moreover, rarely does a check and balance system exist that can ensure that such instances do not take place. A doctor, who did not wish to be named at a government run hospital, said that medical mishaps due to the negligence of doctors had occurred many times, but they are often dusted under the carpet. Such cases are few in numbers because of which they fail to garner any attention from the authorities.
However, the PIC case has left a huge question mark about the state of healthcare in our country. The tragic incident that left over a 100 individuals dead shows the non-serious attitude of authorities over the sensitive matter of human life. The lack of proper drug regulatory body, health policies and the imbalance of the sub-professions within the healthcare sector, for example the absence of the role of a clinical pharmacist, is a reason behind this kind of carelessness.
Another predominant issue faced by the health department is the regulation of private hospitals. Since private healthcare providing institutions account for the major share of services, there is an urgent need for provincial health departments to maintain a certain level of vigilance to ensure that individuals for unethical medical practices are accounted for and held responsible. Even though provincial governments have been trying hard to enact a set of laws to regulate private hospitals and clinics, it seems that this has been met by opposition. The need for this arises from the fact that the government has received complaints from patients about private hospitals regarding mistreatment and medically prohibitive practices, such as the re-use of syringes that could result in deadly transmittable diseases. The existence of such practice in private run hospitals, in other words, healthcare-providing commercial entities cannot be negated. However, ironically, in government hospitals, where even though state-of-the-art medical facilities might not be abundantly available, such malpractice is out of the question. This is because government run institutions are not directly profiteering from the masses and are under direct funding from provincial health departments. Dr. Shaista Hassan, an RMO in the Pathology Department of Sindh Government Hospital, Liaquatabad, says, "The cost of most diagnostic tests is such that the individuals from lower-income households can afford, and despite the low cost, the service provided is as good as any other private hospital."
The recent informal warning by WHO Director General to Prime Minister Yousuf Raza Gilani in Davos, regarding the spread of diseases like HIV, polio and hepatitis is embarrassing. Despite the devolution of the Ministry of Health under the 18th Amendment in June 2011, and delegating planning and funding responsibilities to provincial health departments, certain projects were being operated such as the National Programme for Prevention and Control of Hepatitis, National AIDS Control Programme, Expanded Program on Immunization. But the situation is bleak because despite all these projects, the required outcome has not been achieved. As per an article published in a local English daily, 'Devolving Health' by Dr. Sania Nishtar, "Pakistan becomes the last remaining reservoir of polio virus transmission and is jeopardising the worldwide efforts to eradicate the disease for the second time from this planet." This clearly shows that the efforts being put in to address these problems are not enough and more needs to be done by provincial health departments who are now sole custodians of public health.
Now in the wake of recent events, the pharmaceutical sector has come under fire. The presence of an independent and just drug regulatory body is imperative in such a scenario and with calls from various health organisations such as the Pakistan Medical Association, Pharma Bureau, Pakistan Pharmaceutical Manufacturers Association, Pakistan Islamic Medical Association, it is time that the government set up an autonomous drug regulatory body that can monitor production and quality standards of medications in both local and multinational pharmaceutical companies. Although it is a fact that multinational corporations meet utmost quality standards with regards to production, local pharmaceutical companies do not, and are more focused towards profiteering because of which quality suffers. However, it cannot be negated that national pharmaceutical companies have played a part in improving the economy and bringing down the prices of most medicines by producing them locally, they must still meet international criteria for quality. Moreover, drug regulatory bodies must enact stringent laws and policies to keep a tight check on this matter. Eradicating corruption is also a necessity because drug inspectors and controllers carry the same reputation as that of custom officers in Pakistan.
In a country where one third of children have stunted growth, one third of adults older than 45 years have hypertension and where maternal and infant mortality rates are one of the highest in the world, it is crucial for the ignorant government to pay more attention towards the health needs of the populace in order to strengthen the backbone of this country. Given the state of affairs relevant authorities need to put their heads together and evolve certain policies that can improve the present condition and advance it in the coming future.


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