Incomparable systems, both in crisis but which provide an insight into the differences of how life is valued in developed and developing countries.
The NHS (National Health Service) was set up in the UK in 1948 with three main aims: that it meets the needs of everyone, that it be free at the point of delivery (for legitimate users) and that the provision of service is based on clinical need and not on the ability to pay. In other words, any legal citizen of the United Kingdom has access to medical facilities free of cost. The NHS does not discriminate against one’s financial standing and is bound to deliver the same level of care and treatment to all. This is the core of the provision of free healthcare by the government; that it forms part of its duty to its citizenry.
In Pakistan, following the 2011 act to devolve the Ministry of Health, the provision of healthcare was assigned at a provincial basis but still supervised at a federal level by the Ministry of National Health Services Regulation and Coordination. Tasked with creating, supervising and implementing health care policy, it is also responsible for running the newly launched Prime Minister’s National Health Insurance Scheme. The aim of the policy is to provide health insurance coverage to the poorest members of the country.
The government has set eligibility criterion but recent figures show that approximately 40% of Pakistan’s 200 million people live below the poverty line. It is still unclear on the success of the scheme to date or the future intended roll out the plan that will cover 80 million people who would presumably meet the necessary eligibility.
As of 2014, according to the World Bank, the UK healthcare expenditure was 9.6% of its GDP and which had risen from 6.7% from 1995 and compared to an average global allocation of 9.96%. In budgetary terms, healthcare in the UK was afforded 18% of the total UK budget for 2016. It has the second highest allocation after pensions.
In Pakistan, World Bank figures show that healthcare expenditure amount to just 2.6% of GDP, a figure which hasn’t changed for the last 20 years. Pakistan allocated only 0.4% of its budget to healthcare expenditure.
Even in view of the tremendous differences in resources allocated between the two, the healthcare systems in both countries are deemed to be in crisis. There are growing shortages of hospital beds, qualified doctors and staff, increasing waiting periods for patients in hospitals and a growing number of deaths directly related to these factors.
The NHS has a growing budget and yet is under pressure to reduce costs while under obligation to fulfill its core principal of delivering quality healthcare.
In numerical terms, one cannot compare the two countries (UK budget of UKP 784 billion vs approx. UKP 34 billion for Pakistan) but the key factor to study is the importance allocated to providing a workable accessible healthcare system. In the UK (as well as most other developed countries), the government asserts itself to recognize its duty to provide protection for its citizens militarily as well as physiologically. Its commitment to provide free healthcare to every single legal resident is the policy that creates its budget. This system is supported by its political system in which every resident has open access to a member of parliament to voice complaint and which technically has the potential to create policy change. Deeply embedded in culture in the West is this precious value of life and its quality.
In Pakistan for the present and foreseeable future, healthcare policy is, by most part, determined by the budget allocated to it.
As such, it becomes a self-inflicting prophecy and creates apathy towards the value of life and its quality. To be able to effectively jump up through the country’s next level of development, this is the paradigm that must shift.