Low Health budget amid the pandemic: a disaster in the breeding?

Throughout the course of history, Homo sapiens have faced pandemics such as Black Death, bubonic plague, and Spanish flu. while these disastrous pandemics killed millions and spread fear for ages, humans eventually survived them, proving the theory of “survival of the fittest.” However, the current pandemic, Covid-19, caused by a novel coronavirus, has put a question mark on humans’ ability to beat the microbes and survive.

Ironically, the Covid-19 has wrecked the most considerable havoc in the developed world. The last few months witnessed the collapse of the advanced health systems of developed countries like the US and the UK. Notably, Europe and North America are the worst hit with infections reaching millions and hundreds and thousands of deaths in the United States, Spain, Italy, and the United Kingdom. The pandemic highlighted the weaknesses in the best health systems, which were overburdened and reached the point of collapse.

Pakistan is a developing country and has a fragile healthcare system, which is at the cusp of the disaster. The system marred with corruption, nepotism, and incompetence is at a breaking point as the pandemic unfolds. World health organization (WHO) has warned that Pakistan has emerged as the worst-hit countries with the fastest rate of coronavirus infections in recent weeks. According to algorithms used by Imperial College of London, for predicting disease and death toll, Pakistan could face a sum of 2.29 million dead by the next January if proper lockdown and social distancing protocols are not imposed. In short, Pakistan is fleeting towards a disaster unless it changes its course in the coming days.

It is obvious to expect an increase in health budget considering the weak state of the health system and the upcoming spikes in infections and death, as predicted by the data. But the budget documents of the fiscal budget 2020-21 reveal a slightly different picture, indeed a horrific one. With a total budget outlay of Rs.7,294.9 billion (about US$ 44 billion), only Rs.25 billion has been allocated for health―a meager 0.4% of the GDP.

Although health is a provincial subject after the 18th Amendment of the constitution, a mere look at the numbers sheds light on the state of affairs and the priority given to the health sector amid the pandemic. Punjab, the most crowded province, has allocated Rs.284.2 billion for the health sector―and increase of a mere 1.86% compared to the last year. A ‘special coronavirus allocation’ of Rs.13 billion― 4.57% of the total health budget―has been earmarked. A significant chunk of the health budget (250.7 billion) will be used for running expenditures, and Rs.33 billion has been kept aside for the development schemes.

Amid a shortage of funds, PPE, ventilators, necessary medicines, and equipment, the government is facing another scarcity of human resources. A source in the health department said that “the hospitals are facing an extreme curtailment of specialized staff with dealing with the pandemic and ultimately they had to divert the existing team to Covid-19 wards.

The country is facing a financial deficit in the health sector, with a severe lack of human resources.

The budget documents of Khyber Pakhtunkhwa (KP) reveal Rs.124 billion for the health sector, which includes Rs.24.4 billion for health-related schemes, of which Rs.13.8 billion would be spent in the settled districts and Rs.10.6 billion in the merged districts. The KP government has also earmarked Rs.24 billion emergency fund to tackle the Covid-19.

The Balochistan Government allocated Rs.38 billion for the health sector―a meager 8.6% of the total budget outlay of Rs.465.528 billion.
Among all the provincial budgets, the Sindh government budget for the fiscal year 2020-21 has substantially increased the health sector’s allocation to counter the pandemic and other infectious diseases. The health department budget is raised by 16.1% to Rs.139.18 billion, compared to Rs.120 billion in the outgoing fiscal year.

Muteeb Ur Rehman, a scholar of MS economics, commenting on the health budget says that: “according to the WHO, percentage of health spending to GDP must be near about 6% while in Pakistan it is just 0.4% of GDP (Human Right Commission of Pakistan annual report). Pakistan’s health budget is not only insufficient but also poorly managed.”

He said that “the government should give attention to improve emergency medical services, training, and capacity building of staff through experience sharing of medical staff internationally, focus on the availability of essential life-saving medicines, face-masks, Personal Protective Equipment (PPE), medical equipment, and public awareness program.” He also said that there is a dire need to invest in research of vaccines to mitigate this deadly pandemic

The country is facing a financial deficit in the health sector, with a severe lack of human resources. According to the WHO standards, it is an obligation that around two doctors, a dentist, and eight nurses should be taking care of not more than 1,000 people. However, the overall healthcare scenario in Pakistan is very bleak. While the country faces an acute shortage of hospitals, the number of beds, and the number of ventilators available for patients, it is also facing a scarcity of doctors and specialized staff. According to World Bank data, only 0.7 beds, 0.98 physicians, and 0.668 nurses are available per 1000 people.

Pakistan has not witnessed the flattening of the Covid-19 curve yet. Recent protests and resignations by the health staff and doctors fighting the pandemic at the front lines, due to lack of provision of Personal Protective Equipment (PPE) by the authorities should have been an eye-opener for the policymakers and financial planners of the country. Given the warnings and predictions from international organizations regarding the future, the financial policymakers should have increased the health budget; nonetheless, some amendments are made to the low health budgets amid this deadly pandemic. It could be a perfect recipe for a disaster whose human price would have to be paid by ordinary citizens.

References: http://www.imperial.ac.uk/news/196234/covid-19-imperial-researchers-model-likely-impact/ https://data.worldbank.org/indicator/SH.MED.BEDS.ZS https://tribune.com.pk/story/2245549/punjab-sindh-budgets https://mettisglobal.news/budget-presentation-begins-in-national-assembly

Also read: Traditional Healthcare Systems; A blessing or curse

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