Pakistan’s health care system: a tale of injustice and malpractice
Gross injustices and malpractices are the hallmarks of the private as well as the public hospital system in Pakistan where unskilled and untrained doctors are appointed with complete disregard toward meritocracy. At least two recent examples illustrate how dire things are.
Last month, nine-month-old infant Nashwa, who was left paralyzed after she was allegedly injected with the wrong dosage of potassium chloride through a drip, passed away at the Darul Sehat Hospital in Karachi. After she was administered the solution, she started having trouble breathing, at which point she was taken to the intensive care unit and CPR administered on her for 45 minutes, which resulted in irreversible brain damage.
In another recent incident, four medical officers at a government hospital in Korangi Karachi allegedly raped and murdered 26-year-old Asmat Junejo who had come to the hospital seeking treatment for toothache.
These are just a few examples of how broken the health infrastructure is in Pakistan. Any health care delivery system has three tiers; Basic Health Units (BHUs) and Rural Health Centers (RHCs) comprise the first tier. Tehsil and District Headquarter Hospitals (THQs & DHQs) comprise the second tier. Teaching hospitals are at the top tier. The irony of the situation is that while Pakistani teaching hospitals are well equipped to some extent, there are inadequate and practically non-existent medical facilities available in rural areas. At the two lower tiers, even basic medicines for common ailments are not available.
Health expenditure has historically been considered a public good as it is an economic indicator and developed countries allocate huge budgets for universal medical coverage. Unfortunately, in Pakistan, despite a proven link between economic development and a healthy society, the health care sector has always remained a low priority in both policy-making and budgetary allocation. Currently, budget allocation to the health sector as a percentage of the Gross Domestic Product (GDP) stands at a paltry 0.4%.
The vacuum created by an inadequate and unsatisfactory public sector health system has been filled by the growth of an unregulated, highly costly private sector, due to which Pakistan is among countries with the highest percentage of Out-of-Pocket expenditures on health.
Apart from being a costly alternative, the unregulated private sector is also marred by instances of gross medical negligence and malpractice.
Dr. Mehreen Mujtaba
Apart from being a costly alternative, the unregulated private sector is also marred by instances of gross medical negligence and malpractice. The death of Nashwa, the case of Asmat Junejo and scores of other cases, highlight the irregularities and malpractices in the private health care sector of Pakistan, which have unfortunately become a norm. We only sit up and take notice of such issues when they make news headlines.
In 2015, an ambitious set of 17 goals with 169 indicators, called the Sustainable Development Goals (SDGs), were announced by the global community and adopted by UN member countries including Pakistan. These goals were framed on the bedrock of human rights, justice, and inclusivity.
Goal 3, which pertains to promoting good health and wellbeing, aims to achieve universal health coverage and provide access to safe and effective health facilities, services, medicines and vaccines for all. The focus of this goal includes a commitment to end the epidemics of AIDS, tuberculosis, malaria and other communicable diseases by 2030, calling for an integrated approach across multiple goals like poverty alleviation and malnutrition. There’s an intangible nexus between poverty, overpopulation, malnutrition, and health, which defines and underlines the current predicament of the poor state of the health care system in Pakistan.
Health for all is a basic human right, the provision of which is the responsibility of the state. This translates into the fact that every citizen has a right to claim a set of institutional arrangements necessary for attaining quality standards of health care provision. By not fulling these needs, the government shows its lack of commitment and obligation toward citizens and as such fails in providing them even basic rights.
In its election manifesto, Prime Minister Imran Khan’s Pakistan Tehreek-i-Insaaf promised to revitalize and completely revamp the health care system in Pakistan. However, in the past 10 months, nothing substantial has been done to legitimize these claims. Within 10 months, the prices of essential medicines have increased by a whopping 200%.
It is imperative that the new government should prioritize the provision of adequate and quality public health goods and services that are accessible to all, especially low income, marginalized and vulnerable populations, without bias and discrimination. In order to attain meaningful outcomes, a substantial amount of the budget needs to be allocated to the health sector. Proper utilization of the National Health Insurance Programs and guarantees that they reach the underprivileged citizens in a fair and just manner will prove to be a milestone toward achieving social welfare reforms.
– Dr. Mehreen Mujtaba is a freelance consultant working in the areas of environment and health.