HEALTH needs to be understood as a holistic and normative concept. ‘Holistic’ would mean covering the physical, mental and social well-being dimensions, while ‘normative’ indicates an independent and normal state of well-being, and not just the absence of disease. This is how the World Health Organisation has defined health in its constitution: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

A clear understanding of health has important implications for healthcare. The healthcare system should be so organised as to protect, promote and restore physical, mental and social health and well-being.

This was a prelude to making the real point: for such a huge and growing population as we have and with such a health crisis and such low government spending as ours, what can we expect from Pakistan’s future healthcare system? Despite a huge government health infrastructure in the country, its functioning is far below acceptable levels of access and quality vis-à-vis our burden of disease. What little we are spending as a government is not only lopsided — much less on primary healthcare than on big hospitals — but also fraught with huge inefficiencies. The commercial private health sector is into ruthless profit-making and the not-for-profit private health sector is trying to fill the gaps left by the government’s inadequate health services primarily for the have-nots and those left out.

The not-for-profit health sector in Pakistan has grown to respond to unmet healthcare needs and is driven by a passion for caring, the spirit of giving back, charity, philanthropy and in-kind support in the form of trust hospitals, telemedicine, mobile clinics, health camps and health relief operations during emergencies, which are exacerbated now due to the frequent and unexpected manifestations of climate change. This sector is huge and growing, unquantified and diverse. It operates at various levels and scales.

Right to health should underscore the ‘Health for All Collective’.

The quality of care provided by this sector is variable and the bulk of its work falls in the domain of curative care. It is aimed almost entirely at physical health, ignoring mental health and social well-being. It is generally disjointed rather than in the form of systematic integrated care consisting of preventive, promotive, curative, rehabilitative and palliative services. Most of these initiatives are aimed at improving access to care rather than improving access to quality healthcare. A general observation is also that most of these initiatives, even the big ones operating at a national level, do not have a defined package of health services. Sadly, despite the core intention to serve, these organisations and initiatives are not cooperating with each other.

I am deliberately not naming any organisations though I have visited many of them across the length and breadth of the country in the last three years. On the one hand, I have felt inspired by the service they are providing in difficult circumstances, and on the other, I have always wondered how little they know about each other and how much stronger the sector would be if there was a mechanism for cooperation between them.

I use the word ‘cooperation’ in a larger sense. Some of them admittedly are better than others and a few of them have seriously invested continuously to improve the quality of their services. But there are hardly any cross-learnings. There are best-practice models here and there but they remain isolated. I see this as a huge opportunity loss and an ironic one. Why don’t they cooperate with each other and learn? Not only this, some of them I find to be quite territorial and in competitive mode. This is a question which has made me think about a ‘Health for All Collective’ (HFAC).

How about creating a platform in Pakistan for all healthcare organisations, especially not-for-profits but not necessarily limited to them? A platform where they can share their learnings, best practices, challenges etc. A kind of ‘marketplace’ for healthcare where there are opportunities for learning and collaboration. Where every new organisation or a particular project in health doesn’t have to start from scratch and where potential partners for particular work in healthcare can be found and where basic definitions, concepts and approaches in healthcare can be standardised. Today, even primary healthcare is understood differently by different players in the field.

The right to health should underscore the HFAC. Organisations, projects and even individuals who subscribe to the importance of the idea of collectively working towards realising the right to health and add their voice to this cause can come together under the umbrella of the HFAC.

A possible vision of the HFAC can be a world where all human beings have an equal opportunity to be healthy and equal access to reliable quality healthcare according to their needs and where appropriate public health measures are in place for effectively addressing the social, economic and political determinants of health, risks to health and prevention of diseases, and a well-prepared and resilient health system to deal with health emergencies.

The mission of the HFAC will be to work towards realising this vision through creating a platform for joint action for the following: relevant policy research and advocacy; joint healthcare projects; capacity-building activities; harnessing IT/AI for qPHC and healthcare at large; and establishing a health fund to develop jointly agreed projects among partners.

‘Health for all’ is another name for UHC (universal health coverage) and it is a collective responsibility. It is too important to be left to governments alone. A Health for All Collective for those interested in delivering holistic quality healthcare to fellow citizens would be a great step and would have immense spin-offs. A great place to start this would be among not-for-profit healthcare organisations and those interested in supporting them. Readers are most welcome to provide their views on this idea.

The writer is a former health minister, currently a professor of health systems & population health at Shifa Tameer-i-Millat University.

zedefar@gmail.com

Published in Dawn, August 23rd, 2024