WHAT brings people to, or drives them away from the polls? To a great extent it is their deeply entrenched political loyalties. But what remains common among the voting masses is the basic wish to improve their quality of life.

Promises of economic uplift are all well and good but leaders often fail to realise the crucial role that healthcare plays in the country’s economy. “Good health and well-being” features third in the United Nations’ Sustainable Development Goals that we have adopted; though we fell short of achieving the targets set by the Millennium Development Goals, we should aim now to save face before 2030.

When it comes to election manifestos parties are prone to proposing radical projects and programmes to revolutionise the health sector without sorting out its fundamentals first. One of the core tenets of enhancing service delivery in healthcare is health financing.

Currently, Pakistan spends only 0.91 per cent of its gross domestic product (GDP) on health. What is more deplorable though is how this figure is cited as a benchmark of success compared to the figures of yesteryear — a dismal 0.27pc — when it comes to healthcare spending.

How do these parties intend to improve the ailing health sector when they present no concrete measures to mobilise current revenue?

Of the Rs5.36 trillion budget outlay for fiscal year 2017-18, a mere Rs384.57 billion had been allocated to the health sector. In its 2013 manifesto, the ruling PML-N had pledged to increase health expenditure to at least 2pc of GDP.

Failing to mention this in their manifesto for the 2018 elections, the PML-N again promises to somehow raise public healthcare expenditure to 2pc of GDP by 2023, if elected back into power.

Vague promises of increasing healthcare expenditure are also floated in the PPP’s recent manifesto; while the Pakistan Tehreek-i-Insaf (PTI) in both its previous manifesto and National Health Policy, vowed to bring healthcare spending to 2.6pc of GDP.

What is conspicuous by its absence in the manifestos is the mechanism to generate funds for public health. How do these parties intend to improve the ailing health sector when they present no concrete measures to mobilise current revenue?

Health indicators across the country remain horrifying. We stand at the very bottom of the pit regarding neonatal deaths. Despite this, maternal healthcare remains neglected and immunisation coverage is frightfully low.

Though provinces have autonomously conducted health surveys, a nation-wide exercise was only carried out in 2012, after which it has proved difficult to harmonise national health indicators.

In its manifesto, the PPP unveils an initiative termed “Health Care for All — Expanding, Linking-Up and Joining-in (ELAJ)”, which includes launching a Family Health Service and a Mother and Child Support Programme (MCSP).

An aspect of both these programmes is distributing swipe cards that would be used to create a database of patients, which the MCSP would follow by cash/ voucher incentives to cover antenatal and postnatal care and childhood immunisation.

PPP’s future plans seem similar in nature to PTI’s efficacious Sehat Insaf Card, which the latter in its 11-point agenda said would be distributed across the country to provide 8 million citizens with income support. However, PPP’s performance in Sindh has been far from promising.

The last available estimates for the infant mortality rate (IMR) ranged from 53.8pc in 2012-13 to scarily below 30pc as approximated by experts in 2017. As of 2013, the maternal mortality rate (MMR) in the province was 311 per 100,000 live births, second only after that of Balochistan’s at around 780 per 100,000.

All parties seem to have once again shied away from outlining any steps to regulate the burgeoning private sector in healthcare

Khyber Pakhtunkhwa fared better, under the PTI, in comparison. The MMR fell from 206 per 100,000 live births in 2012 to 183 at the present provincial government’s end of term. IMR, too, had been brought down to 58 to 22 per 1,000 live births. In the absence of their manifesto, one hopes that they stick to their Health Policy announced in 2013.

Punjab, under the PML-N, has also shown some improvements as immunisation coverage increased from 49pc to 84pc in 2018, and IMR declined from 96 in 2014 to 65 per 1,000. Unfortunately, MMR rose from 178 to 300 per 100, 000 live births in 2017. The PML-N has pledged a realistic goal of expanding immunisation coverage to 90pc, and reduce stunting and IMR by 25pc each in its manifesto “Promise 2018-2023”.

While both the PML-N and PPP manifestos have covered population growth by highlighting the importance of population control through family planning initiatives and female reproductive health interventions, the PTI has so far not let anything on regarding curbing the disquieting magnitude of population growth.

The PML-N and PPP have this time also emphasised integrating all levels of healthcare — primary, secondary and tertiary — a vital step in overcoming the gross mismanagement and substandard quality of care that frequently occurs due to a lack of cohesiveness.

All parties seem to have once again shied away from outlining any steps to regulate the burgeoning private sector in healthcare. A comprehensive health policy to tackle the public and private spheres is still non-existent but very much needed.

Most important of all, is the nutritional emergency for which all parties, apart from the PML-N — which plans to introduce a “First 100 days” strategy to reduce malnutrition and stunting— appear to be ill-equipped. It is the responsibility of the next government now to ensure it provides holistic and affordable care to its people.

Published in Dawn, The Business and Finance Weekly, July 9th, 2018