Pakistan health sector remained in a disastrous position in its entire history. Pakistan’s successive governments have not given any due importance. Health policy in Pakistan received little or no space in the agenda of political parties. The media continued to report largely on health-related crises such as the spread of polio and child deaths in Thar. No serious and permanent action has been taken to control this menace.
The infant mortality rate in Pakistan is 66 per 1,000 births, compared to 38 in India and eight in Sri Lanka. Life expectancy in Pakistan for women is 67 years, as compared to 73 in Bangladesh and 78 in Thailand. The maternal mortality rate in Pakistan is 170 per 100,000 live births, in contrast to 30 in Sri Lanka and 20 in Thailand.
The indifference of Pakistan’s government to health is reflected in the fact that Pakistan spends only 0.9 percent of its GDP on health. Only two countries, the Democratic Republic of Congo and Bangladesh, have a lower ratio of GDP to health spending.
The government’s neglect is the fact that public expenditure on health accounts for a little over one-third of Pakistan’s total health expenditure.
Pakistan’s citizens rely heavily on private healthcare, which they pay primarily through their own pocket. This is in contrast to countries such as Thailand and Sri Lanka, where public expenditure accounts for most of health spending.
There is the poor health quality services provided by the government. The major role is played by the private sector in healthcare.
In Pakistan, public healthcare facilities have not been successful in creating health security for the poor. The health sector remains unattended to some extent.
There are only two countries in the world namely Nigeria and Sudan that spend less than this proportion on health. It is around 1 percent for India, 2 percent for Bangladesh and Nepal and 3 percent for China, while for most developed countries it ranges from 5 percent to 7 percent.
About 70 percent of total healthcare expenditure is spent in the private sector and almost all of this is out-of-pocket expenditure on curative care which is consultations, in-patient diagnostics care, laboratory tests and medicines.
It is worth mentioning that between 1990-2001 three countries Bangladesh, Nepal and Bhutan recorded the vast increase in public expenditure on health. There was also the maximum reduction in infant mortality rates.
The health sector is known by inefficiency and corruption. Most government-operated outlets for primary healthcare are collapsing. Quality standards are not maintained. Pakistan and India prosper on quackery and crockery.
There should be reduction in poverty and development of health as both are integrally linked with each other.
It is observed that expenditure on healthcare is more effective in reducing poverty than expenditure on poverty alleviation programmes. A major sickness of a family member particularly the primary bread earner can throw the family into poverty.
Getting the required size of pool will not be easy because paying for a future and uncertain benefit has a high opportunity cost for the poor. It is the lack of accessible healthcare and not terrorism, drones or the energy crisis that is the greatest problem facing Pakistan.
Healthcare is no doubt linked to problems of corruption and security, but there is no reason why healthcare should not be given due important priority.
Let us look at other low-income countries that have made great progress in healthcare in the last few decades. The experiences of these countries provide open lessons that should be applied in Pakistan.
Thailand and Mexico are examples of two developing countries that have made political commitments towards universal healthcare with very encouraging results. In 2001, the Thai government introduced a ‘30-baht universal coverage scheme’ that covered the entire population with a guarantee that a patient would not have to pay more than 30 baht per visit for medical care. Thailand also adopted an innovative measure to promote public accountability through the creation of the ‘Health Assembly’, a regular meeting where citizens voice feedback and complaints on the health system.
Mexico established a ‘System of Social Protection in Health’ in 2003, which includes a public health insurance scheme that has steadily expanded insurance coverage with a package of comprehensive health services to 52 million Mexicans.
Health indicators in India as a whole are deplorable; some states such as Tamil Nadu perform remarkably well. For example, Tamil Nadu’s infant mortality rate is 22 per 1,000 births and maternal mortality is 97 per 100,000 births, significantly better than many other states in India (and all provinces in Pakistan).
A distinguishing feature of Tamil Nadu is the extent to which its citizens actively lobby public officials for the provision of health and other public services.
At least two lessons may be drawn from the experiences of other countries that excel in the provision of healthcare.
Public can play a pivotal role in mobilizing public health systems to serve the needs of the population. When healthcare systems are transparent and accountable, citizen advocacy can influence government policy and healthcare governance with positive results.
In India 39 million people fall into poverty each year because of such expenditure. Efforts to tackle poverty should consider the role of health.
Those hardest hit by lack of health coverage are the poor, who suffer from higher levels of mortality and malnutrition than the rich.
There is a need for alternative financing mechanisms and instruments to achieve health-related objectives, for example health insurance.
The poor can make small, periodic contributions that could go towards meeting their healthcare needs.
India introduced a Universal Health Insurance scheme for the poor in 2003. The benefits of the scheme include reimbursement of hospitalization expenditure of up to Rs30,000 for up to five members of the family for a year and illness compensation of Rs50 per day for the period of hospitalization of the earning head of the family. It also provides for Rs1, 000 per year for transportation costs.
The transaction costs for insurance companies need to be lowered by educating people to buy insurance as a ‘group contract’.
In Pakistan, implementation of health policies devolved to the provinces in 2010 after the 18th Amendment to the Constitution.
In theory, this should create new opportunities for public engagement with provincial and local government officials for the provision of public health services.
In Sindh, for example, public health facilities are in appalling condition, plagued with staff absenteeism and shortage of essential medicines and equipment.
Democratic action is essential to ensure that the administration of public health by provincial governments is effective and equitable.
FREE HEALTHCARE FACILITIES
Prime Minister Nawaz Sharif launched a state-run health insurance program and described it as the first step towards making Pakistan a welfare state. Around 1.2 million families will get free healthcare facilities in the first phase.
Under the program, people living below the poverty line would be able to get best possible treatment at government’s expense.
About 55 percent of Pakistanis earn less than $2 a day and the government has decided to provide health insurance cover to all such people in phases and the data of the Benazir Income Support Program will be used for the purpose, according to an official.
Medical insurance usually costs Rs25, 000 per year, but the government would have to pay Rs1, 300 for each family. A family will get Rs50,000 for secondary care treatment which begins as soon as a patient is hospitalized. It includes all kind of diseases. According to our estimates, members of a family get admitted two or three times a year and Rs10,000 to Rs15,000 is spent each time.
Treatment of cancer, accidents, burns, diabetic complications, heart bypass and infection will be insured under the priority diseases category. So each family will get treatment of Rs300,000 per year and the amount will be doubled in case of emergency. The amount will be contributed by the Pakistan Baitul Maal. Under the program, special cards would be issued to families for insurance which would be activated as soon as they were issued.