By: Dr. Qazi Shahzaib Ud Din Hamza
James Patrick Moran, who used to be the Mayor of Alexandria Virginia, once said, “The future belongs to those who prepare for it”. What so ever the situation and circumstances were there for our Government and the Institutions of the state, my question is very simple but most difficult and bitter to be answered. Was Pakistan’s Health System prepared to handle a health crisis like COVID-19 pandemic? Obviously the answer is a big “NO”. As a medical graduate I want to explain and analyze the Health system of Pakistan and its loopholes too. For the preparation of something, we need awareness. Does the government, health sector and public health experts were unaware of the fact that our health system is not fully enough prepared for any health emergency? Obviously the answer is a big “YES”. But surprisingly everything about each health care system was briefly explained in Global Health Security Index in 2019.
The Global Health Security Index is an assessment of global health security capabilities in 195 countries prepared by the Johns Hopkins Centre of Health security, the Nuclear Threat Initiative (NTI) and the Economist Intelligence Unit (EIU). The report is based on a questionnaire of 140 questions, organized across 6 categories, 34 indicators, and 85 sub indicators. The six categories include Prevention, Detection & Reporting, Rapid Response, Risk Environment, Compliance with International Norms and the Health System. Health System category addresses the Sufficient and robust health system to treat the sick and protect health workers. The index said, among other things, that “no country is fully prepared for epidemics or pandemics, and every country has important gaps to address”. But it also released a health ranking according to the preparations of the countries for a pandemic. United States of America stood first, UK stood second and Netherlands the third in the list. India where COVID-19 pandemic situation is becoming worse day by day and the healthcare system almost collapsed, stood 57th in the list and Pakistan, sorry to say was at 105th ranking. When we compare the GDP expenditure of both the countries on health, the figures are disgusting and alarming also. India is dedicating only 1.3% of its GDP on health and when it comes to Pakistan, The Human Rights Commission of Pakistan (HRCP) in its annual report launched on first May 2020, said that the country is still spending less than one percent of its GDP on health services while the public sector is providing unsatisfactory quality and coverage of health services. The report said that the country’s spending on health is still less than 1 percent of its GDP, whereas the World Health Organization (WHO) recommends an allocation of about 6 percent. It also said that the unsatisfactory quality and coverage of public health services means there is high dependence on the costlier private sector, putting adequate healthcare out of reach for thousands of households. “As a result, many people are driven to consult unqualified medical practitioners, often with dire consequences,” said the report. Among developed nations, South Korea has kept its healthcare expenditure at a whopping 8.1%, Japan 10.9%, and the US at 8.5%.
It is not difficult to understand that Pakistan along with its neighbor did not pay any attention to health. The above mentioned facts clearly states that the report published by The Global Health Security Index warned everyone around the globe about health deficiencies but no one took that seriously. Moreover, we have to observe the health care system of us to know where the urgent improvements are required. Health care system of the subcontinent and specially Pakistan is the most difficult to understand. Again I want to put the facts on the table. Pakistan is ranked 122nd out of 190 countries in a World Health Organization performance report and 154th among 195 countries in terms of quality and accessibility of healthcare, according to a Lancet study. Pakistan is one of the two remaining countries in the world where poliomyelitis (polio) is still categorized as an endemic viral infection, the other one being Afghanistan. Even Nigeria has cleared itself of the polio virus. Yes, you read correctly, its “Nigeria”. Health Care system in Pakistan is divided and sub divided into hundreds of categories that we may not even know the names of all. From public sector to private, from physician to Hakeem and from a psychologist to a spiritual healer, all are included in the health system. There is not even a single effective regulatory body in the country like FDA on which everyone agrees upon. How a system with a complete shortage of doctors, nurses, paramedic staff can provide adequate health facilities to a huge population? There is little strength in health care delivery system in Pakistan like making health policies, participating in Millennium Development Goals program, initiating vertical programs and introducing Public Private Partnership for improving human resource development and infrastructure. Pakistan is improving very slowly in the health sector for the last five decades as is evident by its health indicators and above mentioned weaknesses. Therefore, the Government needs to take strong initiatives to change the current health care system.