Access the Samosa archives
Pakistan:Who votes for health?

By Dr Samrina Hashmi
April 22 2013




With elections just round the corner, almost all major parities have launched their manifestos. Nearly all political parties promise an increase in the health expenditure till the end of 2018. The PML-N wishes to increase it three-fold to 2pc of the GDP, while the PTI wishes to double it progressively. The PPP, MQM and ANP propose to increase it to 5pc of the state spending (which prompts the question of why wasn’t it done in the last five years). The truth is that in the last five years, only political postings were at the forefront.

All parties talk about preventive health and increasing health awareness through media, provision of safe drinking water and sanitation, and sewage disposal. All parties aim to eradicate polio by 2015 and intend to bring routine vaccination to 100pc by 2015 as well. Only the PPP talks about merging the subjects polio, routine vaccination, lady health workers, mother and child care, malaria and hepatitis control and family planning (FP) to create a consolidated and coordinated public health programme. This was not done in the last five years, despite its being in power. The government appointed administrators for all departments under political pressure instead of hiring the available public health doctors (some with foreign qualification) , who were later employed by WHO and Unicef.

All parties except the PML-N intend to bring population growth down to 1.6 by 2018, through consolidated family planning programmes, awareness and modern FP methods. Only the PPP talks about the functional integration of health and population welfare departments to ensure efficient service delivery. It is surprising to note that this was also not done in the last five years.

All the parties have stressed upon reducing maternal and infant mortality by 2015 and de-centralisation of health services, strengthening of Basic Health Units (BHUs), through public-private partnership, and the role of local councillors in the management of BHUs. In this regard the PPP wishes to review the People’s Primary Health Initiative (PPHI). It also wishes to improve referral systems to incorporate tertiary care alongwith integration of basic and tertiary care by improving database linkages. The PML-N also wants semi-autonomous boards comprising professionals and community to manage district government hospitals. It has suggested autonomous board for medical colleges and teaching hospitals, for better and transparent management.

All parties talk about national health insurance (NHI) schemes. The PML-N has chalked out a comprehensive plan. The NHI can be availed of at the BHU, in government hospitals or by general practitioners on concessional rates. It will be free for children under 12, on condition that they are attending school full time (to encourage education), for senior citizens and low-income families.

The PPP claims it will promote curative medicine by developing trauma, cardiac and nephrology centres at local level. The MQM also talks vaguely about it. It also talks about reforming medical education by increasing institutions, degree courses and infrastructure of existing medical colleges, but there is no reference to changing the medical curriculum to make it more suited to our needs.

The MQM talks about developing an administrative cadre in health to improve health administration at the district and provincial levels. Unfortunately, this was not implemented in these five years, although we had many officers who had been trained in healthcare management and public health following MBBS. It also talks about developing a service structure to make the health sector attractive for medics and paramedics to stay and serve in the country. It wishes to give incentives for promoting private practice in government institutes.

All these ideas have been around for years but were never implemented. There was no political will to improve the condition of public health. Our leaders were more interested in the purchase of machinery (as it involves kickbacks), posting their near and dear ones and politically affiliated doctors as heads and project directors. Most of these officers belong to a lower cadre than required for the posts and had no training in health management systems or public health. How do we believe that they will deliver this time round?

Originally published by Dawn Pakistan

Leave a Comment

Comments are closed.