Health for all
IT is said that modern healthcare is accessible to only 15 per cent of the population of Pakistan. In other words, nearly 150 million men, women and children in this country are denied adequate medical treatment when they fall ill.
This happens more frequently than it should, given the utter neglect of preventive health and the physical environment. It translates into poor quality of life for a huge chunk of humanity and low productivity of the national economy.
In this age of despair, all is not lost. There is a way out. This was demonstrated last Friday when the Sindh Institute of Urology and Transplantation (SIUT) formally inaugurated its Primary Healthcare Centre (PHC) for the residents of Kathore on the outskirts of Karachi. This is not just another clinic to dole out charity to the poor. It is an initiative that has the potential of showing the way to policymakers to design an ideal health delivery system. Considering that the SIUT has been a tertiary health facility with a specialised approach for four decades, its move to enter the primary healthcare field now should provide food for thought.
Kathore came into the SIUT’s field of vision in 2002. That year the government planned Education City and land was allotted to various institutions. The SIUT also received some land for its Institute of Transplant Sciences and Biotechnology — a futuristic project designed to open up new frontiers of medical knowledge. A survey conducted in the area revealed the shocking absence of healthcare facilities for the million-strong community settled in 382 goths in the vicinity. The PHC is the SIUT’s response to this basic need of the people.
This move was not unusual for the SIUT, which has always had a people-friendly approach and a very close link with the community. Its growth has been need-driven. For example, it set up three satellite dialysis centres in far-flung areas of Karachi to provide dialysis at their doorstep to patients with end-stage kidney failure.
Kathore’s PHC is a project to watch — and emulate. Having proved its credentials in a very specialised field, the SIUT is now set to vindicate the suitability of its approach in the primary healthcare field as well. It is not so much the expertise that is key. It is the model. The PHC should also have an impact on the incidence of kidney diseases — in fact any disease that falls in the domain of tertiary medicine — in Kathore.
What is this model? At the inauguration, the director, Dr Adib Rizvi, described the SIUT’s philosophy simply as one that recognises healthcare as the birthright of every citizen. It logically follows from that belief that a person who is ill is entitled to healthcare. Therefore at the SIUT no one is turned back to die because he cannot afford to pay for expensive treatment. The solution? Treat him free of cost. No one is asked to provide proof of his poverty as is generally the practice in many private hospitals.
Where will funds come from? As a public-sector hospital, the SIUT’s first source of funding is the government. This, however, is far from enough to meet the needs of the growing number of patients driven there by poverty. Hence its budget needs to be supplemented by donations from the community, which has proved to be the SIUT’s best friend. Over the years, Dr Rizvi’s commitment and integrity have won him the public’s confidence.
The doctors who constitute his team have been mentored by him. They are top-ranking professionals and have imbibed his egalitarian spirit and compassionate approach to the practice of medicine. The model he has developed is like a triangle with the government, the community and the doctors constituting the three sides. At the centre is the patient whose needs are paramount.
Kathore will be a test case. It had a soft launch a fortnight ago and has already made an impact with 200 patients turning up daily. For Kathoreans the SIUT’s PHC has proved to be a “blessing”, as described by Abdul Majeed Jokhio, who lives in Goth Darsanachhana and works in a steel mill. He told me that previously anyone who fell ill had to travel 25km to a hospital in Karachi, and often several trips were needed.
Given the SIUT’s past performance and Dr Rizvi’s approach, the PHC can be expected to be different from the dysfunctional basic health units that have supposedly formed the nucleus of Pakistan’s health delivery system since the 1970s.
Like the SIUT, the PHC is also expected to follow WHO guidelines for the achievement of the health-for-all goal. This would mean no sense of exclusion or social disparity, services built around people’s needs and expectations, and an integrated and participatory approach. The SIUT’s strategy of having all services under one roof has been incorporated in the PHC, which has provisions for all basic laboratory, ultrasound and radiology tests and has simple drugs available in its pharmacy.
The SIUT has indeed pioneered a model. Can it work? That will depend on whether the provincial government can launch projects with the same mindset and commitment.