NEED TO MAKE HEALTH CARE AFFORDABLE
Government alone cannot meet the need of masses
By SHABBIR H. KAZMI
Sep 24 - 30, 2007
In most of the countries around the globe providing health care facilities is the responsibility of the government. Either the government provides the services through state run hospitals or the responsibility is undertaken by social security system. Ironically, in Pakistan neither the government has the resources nor any arrangements have been made. The result is people have no option but to approach private hospitals. It is often said that the treatment at private hospitals is very expensive, almost unaffordable for the masses. However, if these hospitals were not there thousands of people would have died every year due to lack of healthcare facilities.
Federal, provincial and district governments operate hospitals and clinics throughout the country. However, the general perception is very negative. It is often alleged that these facilities have ghost doctors, paramedical staff and hospital beds are highly inadequate and medicines being supplied are spurious or expired.
Karachi is the largest city having an estimated population of 16 million. Besides, hospitals and dispensaries entities like Civil Hospital, Jinnah Postgraduate Medical Centre, National Institute of Cardiovascular Diseases have been established. In some of the hospitals specialized wards have been established with the help of the private sector. One of the glaring examples is SUIT.
Affordability of healthcare facilities is one of the key issues. Government hospitals and dispensaries often provide the service free of cost or at a nominal cost. However, the facilities are highly inadequate or of poor quality. The main reason for poor quality is availability of insufficient funds. The government may be allocating substantial funds but the largest percentage is pent on remuneration of doctors and other facilities. Relatively smaller budget is kept for the purchase of medicines and equipment.
Ideally people need different types of facilities, which include out-patient, in-patient and surgery. The largest number of visitors comes as out-patients, seeking consultancy from doctors, prescription and/or possibly medicines. If required services of diagnostic laboratory and x-ray facility also has to be used. Most of the public sector hospitals provide these facilities free of cost or at nominal cost. Therefore, the visitors to these facilities belong to middle and lower income groups. Since most of them also have low literacy rate it is easier for the paramedical staff to fleece money from them.
As regards in-patients, the facilities are inadequate in the urban areas and often completely absent in the rural areas. Hospitals have limited number of doctors and beds, equipment is hardly functional and trauma facilities are completely absent. Though, each MNA and MPA is given millions of rupees for the developmental work, it is almost impossible to find out where the amounts go.
Due to the poor quality of public sector hospitals a number of private hospitals have been established throughout the country. These hospitals mainly cater to the needs of people belonging to higher income groups and corporate employees. It is very difficult or almost impossible for the common men to bear the cost. In Karachi two private hospitals have become a big blessing for the residents.
These are Aga Khan Hospital and Liaquat National Hospital. Both the hospitals have been established with huge investment and every year substantial amount is spent on renovation, revamping and up gradation of the facilities. These hospitals have state-of-the-art equipment and some of the world renowned physicians and surgeons. However, at times the charges become pinching.
Another addition in Karachi is Tabba Heart Hospital. While Aga Khan and Liaquat have strong financial support, Tabba is the brainchild of Late Abdul Razzak Tabba. The said part is that the founder is no longer there.
Another establishment needing specific mention is Kidney Center in Karachi. It has been established by the philanthropist with the help of general public. Many walks and shows were held for fund raising.
Some of the communities have also established hospital and dispensaries for the welfare of their members. However, no one is stopped from utilizing services of these facilities. These facilities mostly operate on the basis of contribution made by each member of the community, no matter how small is the contribution.
Though, the government has been increasing budgetary allocation for the healthcare sector, it is still too small keeping in view the growing population and hike in cost.
In an attempt to ensure peace of mind to its employees the corporate sector follows two pronged strategy. Some of the companies reimburse medical expenses but the facility is limited. However, now the number of companies providing comprehensive medical coverage is on the increase.
At some of the manufacturing facilities, also having residential colonies, elaborate arrangements have been made. Some of the corporate even extend the facility to residents of the area. These include child and mother care, snakebite and eye treatment. Not only that these corporations are playing the role of "Responsible Corporate Citizen" but also contributing towards betterment of the area.
It is almost impossible for the government to finance healthcare requirement of the entire population. The way forward could be "Health Insurance". This could be achieved in two ways Individual and Group Insurance. Some of the local insurance companies have started offering this cover but clients are confined to corporate sector.
The general perception is that the cost of health insurance is high. The perception is correct to a large extent because cost is directly related to the number of persons being insured. Therefore, the cost can be reduced by popularizing the concept and making it a norm.
The society also has to play its role in a more responsible manner. If some foundations or groups manage hospitals and dispensaries all the segments of society must contribute generously to these.