ISLAMABAD: With Pakistan’s healthcare system confronted by chronic challenges of low funding, huge workforce gap, inefficient institutional alignment and governance, the need for a renewed approach towards public health has never been more critical than the present times when Covid-19 pandemic has swept through the entire world.

According to a study on ‘Shaping 21st Century Public Health in Pakistan — An Actionable Agenda for Achieving Universal Health Coverage’ published by Tabadlab, a think-tank based in Islamabad, Pakistan’s health system has “struggled to effectively and efficiently serve the needs of an ever-growing population”.

It discusses in detail the areas where the country is lacking and also suggests strategies through which this prime sector can be uplifted.

According to the study, the current population of Pakistan is over 220 million, making it the fifth most populous country in the world with an annual population growth rate of 2.05pc.

“This soaring population growth is a serious challenge with broad socioeconomic implications: 63pc of the population is younger than the age of 30, nearly one-third of the population is living in poverty (with more being pushed below the poverty line due to Covid-19), and the literacy rate hovers around 60pc. By 2050, Pakistan’s GDP per capita is projected to increase to $2,283 ($1,000 in 2015) with a corresponding population size estimated to be around 345 million.”

Says Pakistan’s health system has struggled to effectively and efficiently serve needs of an ever-growing population

It also claims that Pakistan’s disease demographic has witnessed a change and is currently facing the double burden of infectious (38pc) and lifestyle diseases (49pc). Ranked sixth amongst high-disease burden countries, 40pc of the burden of disease in Pakistan is in the form of preventable diseases and according to World Health Organisation (WHO) it is estimated that over half of all deaths can be attributed to lifestyle diseases.

Quoting media reports, the report claims that Pakistan ranks 154th out of 195 countries in terms of quality and accessibility of its healthcare, which is far behind India (145th), China (48th), Sri Lanka (71st), Bangladesh (133rd) and Bhutan (134th). Moreover, despite 60pc of the population located in rural areas, the delivery of healthcare in the country is mainly concentrated in larger cities.

“Although health regulatory commissions have been established to regulate health services across the public and private sector, the systems are weak and their work is mainly centred on licensing activity for public health facilities. Medical negligence, unethical practices and daily practicing hours of the clinics go unchecked. Public spending represents approximately 31.6pc of health expenditure, while the remaining is split between 66.7pc from private sources and 1.74pc from NGO spending and donor funds. Moreover, Pakistan currently ranks 183rd in the world for health expenditure. There is low health literacy which often results in late presentation of disease, poor adherence to treatment and little understanding of wellness and disease prevention.”

The report also states that anchoring Pakistan’s public health transformation around universal health coverage (UHC) offers a solid framework to strengthen fundamentals and shape a strong and resilient health system for Pakistan.

According to the WHO, UHC means that all people can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship.

The study suggests that strengthening Pakistan’s health system requires strategic reorganisation of healthcare delivery consistent with community needs, elevation of preventative and promotive healthcare strategies, and targeted investment in the core system components i.e. service delivery, financing, capacity enhancement, public policy and legislation, governance and leadership, etc.

According to the report, consensus building among political parties, on health, is a critical need of the moment.

Historical path dependency can be a challenging factor as it creates polarisation and has a negative impact on various correlating factors curtailing the development of healthcare as an industry with strong social responsibility.

Economic alignment between public and private providers can be a critical success factor in developing a cohesive approach.

Published in Dawn, July 22nd, 2020