Failing by Design; Pakistan’s Healthcare System

In Pakistan, transparency has not been a hallmark of the Ministry of health in response to COVID19. Public criticism has mounted about the government apathy in recognizing threats of the pandemic, a complete lack of strategy, and an unclear source of research on the ongoing crisis. People who lost their loved ones due to COVID19 do not know the difference between civil and military; they only know the pain. This led to undermining the public’s trust in health experts and science itself.

The Pakistani government is hardly alone in its strategy for deflecting attention from its poor performance, from the US to India, from Trump to Moodi, many rulers have been acting incompetent, disseminating falsehood and fear exploitation for distracting public’s attention from government deficiencies in response to the pandemic. PM Khan’s playbook is downplaying the severity of the threat since March 2020, and he has been disregarding scientific evidence that supports the critical role of social isolation and lockdown measure.

The healthcare system of Pakistan is in a complicated phase due to decentralization. However, to address the devolution of power between the federal government and provinces, the parliament of Pakistan had passed the 18th amendment bill on 20 April 2010. Taking this into account, the provincial Assemblies took active steps and passed their own healthcare bills to ensure promulgation of equity and quality to the healthcare services and improvement in access to safe medical services. After individually passing such highly aimed bills, the health indicators still lag behind in achieving set targets.

In the health financing domain, the federal government is expanding 25 billion PKR that has been doubled from the previous year’s health budget of 12 billion; still, it carries only 0.4% of GDP.  The health force indicates insufficient staff; there are approx—1:1300 doctor-patient ratios, which is lower as recommended by WHO. According to the available statistics for the delivery of medical services, there is an entire absence of programs and initiatives for non-communicable diseases at provincial and federal levels. Almost 78% of the general population pays out of their pockets for medical treatment.

Meanwhile, the statistics marked more than 2, 50,000 COVID19 positive cases with around 4500 death toll, the pandemics threw detrimental effects on healthcare.  The ongoing situation has highlighted some criticalflaws in our healthcare system that includes but not limited to a scarcity of proper diagnostic  facilities in hospitals, an insufficient workforce, and mismanagement of medical education and practices, especially in remote areas.

There lies a strong bonding between the human workforce and the patient’s safety. As we all recently witnessed, the paramedical staff and doctors are fighting this infectious disease on the front line, stepping out of their comfort zones, enduring painful experiences, and risking their lives to do everything to save our lives.

Pakistan has a pretty diverse healthcare system from tertiary care centers down the roads to primary healthcare centers, but unfortunately, they have lost their credibility at the hands of ill-administration. From posh areas of Karachi and Lahore to far-flung districts of Baluchistan, resource constraints are one of the primary barriers to quality medical services. The mal-governance, negligence, unjust, and unaccountability are the deadly poisons that restrict more allocation of local resources and wound existing ones.

According to a recent survey, in Pakistan, there exists a slight imbalance between private and public healthcare setups in terms of the burden of patients. The primary and secondary healthcare centers, especially in pre-urban and rural/remote areas, have been quite famous for the absenteeism of medical staff and doctors with an entire lack of basic medicines and diagnostic equipment.  Therefore, the mal-functioning of primary and secondary healthcare centers has ripple effects and people are forced to take their patients to the tertiary centers, which are mostly located in big cities like Karachi, Lahore, Rawalpindi, and Islamabad.

Although Pakistan has given birth to some notable, globally recognized doctors, surgeons, researchers, and physicians, without question, there were and are severe deficiencies in our healthcare systems. The WHO ranked 195 nations on the overall quality of healthcare services, and interestingly Pakistan ranked 154th, stays behind its South Asian counterparts India (145), China (47), Bangladesh (133), and Sri Lanka (71).

It is evident that the system is leaking at seams, yet politicians are immobilized by ideology, fear of being voted out of the office. The government’s poor policies in healthcare resulted in the scarcity of choices regarding effective diagnostic and medical services. Something has to change, and it has to change quickly; otherwise, if another epidemic or virus outbreak hits the country shortly, the overloaded healthcare system will cripple. The Government should have to work for us—our lives depend on it.

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Saadeqa Khan

Saadeqa Khan is the founder, CEO, & Editor-in-Chief of Scientia Pakistan. She’s a member of the Oxford Climate Journalism Network (Second Cohort) and NASW. Saadeqa is a fellow of NPF Washington, The Falling Walls Foundation, and the Science Journalism Forum. Saadeqa has won several international journalism grants and awards for her reports.