Will COVID-19 change Pakistan’s pre-existing health care policies?
The uncertainty looming around the unpredictable nature of COVID-19 coupled with a lack of knowledge for its prevention and treatment have made the disease a dangerous albeit invisible foe for the entire global community. The number of confirmed cases reported in Pakistan so far hovers well above 76,000 and the virus has claimed more than 1,600 lives in the country.
Will we see changes in the pre-existing health care policies in Pakistan? This is a question on the minds of many a public health specialist in the country.
We live in a country fraught with health care disparities, where endemics like polio, hepatitis and dengue have posed major challenges. We can only begin to imagine the dire implications of this global pandemic, which exposes the fractures and gaps in our health care system. As a resource constrained country, the gaps are glaringly obvious in testing and timely detection of the disease, contact tracing, quarantine and isolation facilities, as well as availability of basic health care and provision of emergency facilities.
Pakistan spends only 2 percent of its GDP on health care as opposed to a global average of 10 percent. It fares the worst in the region in terms of various health indicators.
Additionally, Pakistan has a reactive approach to any catastrophe as compared to a proactive approach. Public health preparedness and response has historically been sporadic, as was seen in the case of the dengue outbreak. The health system therefore lacks the capacity to scale up both detection and timely interventions in the case of large-scale outbreaks.
The main focus of health policy in Pakistan over the years has been mainly the biomedical model of curative health, with a scant focus on disease outbreak and surveillance. There is need to develop a robust health policy keeping in mind the emerging threats facing the world.
Dr. Mehreen Mujtaba
Pakistan also faces the double burden of disease, and the contribution of mortality by non communicable diseases (NCDs) has outnumbered communicable diseases. These underlying co-morbidities, poverty and lack of access to water, sanitation and hygiene disproportionately affect marginalized segments of the society. With the lack of testing facilities, most people in the country cannot afford expensive detection tests, which in many cases have been found to be faulty and have given false positive or false negative results.
With Pakistan’s lack of social protection (under 2 percent of GDP) as well as health insurance facilities, this disease is expected to be devastating for the poor since they cannot afford out of pocket expenditure on lengthy hospital stays.
The COVID-19 crisis has also exposed the soft underbelly of the government to appease religious groups by failing to impose stringent and strict SOP’s for all segments of society, including mosques and seminaries.
While a majority of Muslim countries were able to shut down mosques for prayers, the government of Pakistan failed to enforce such regulations due to a fear of backlash from the country’s religious factions. It is imperative for the government to work with religious organizations and leaders but where they create problems, the writ of the state must be imposed.
In addition, there is a lack of coordination between federal and provincial governments. This cooperation between different levels of government is critical for effective service delivery and a quick response to such a crisis. Inter-sectoral coordination overcomes challenges of infectious and communicable diseases. It is a well established fact that modern health care has less of an impact on population health outcomes than do education, housing, nutrition, sanitation, economic status, human development and improvements at a governance level.
The main focus of health policy in Pakistan over the years has been mainly the biomedical model of curative health, with a scant focus on disease outbreak and surveillance. There is need to develop a robust health policy keeping in mind the emerging threats facing the world. With an expected increase in climate change related health outcomes and predictions for more pandemics and outbreaks in the future, the government must engage stakeholders to re-evaluate its health policies and make relevant evidence based changes accordingly.
With the emergence of new infectious diseases, adequate resources must be allocated to research and development in the biotechnological field.
The challenges facing Pakistan in the current crisis are stark, and any strategy that counters such an epidemic must address the underlying vulnerabilities faced by the country.
Pakistan is now at a crossroads. It is time we invest in strengthening the scientific and technological wings of the country to be able to manufacture ventilators, personal protective equipment and save our precious foreign exchequer from importing these from other countries.
The pandemic has laid bare all the gaps and big fissures in our health care system. While one cannot predict what will spur the next major pandemic and when, we can use this opportunity to better equip and prepare ourselves to tackle such events in the future in order to mitigate the loss of life and economic hardship faced by the people.
*Dr. Mehreen Mujtaba is a freelance consultant working in the areas of environment and health.