State of Healthcare in Pakistan
Daily Times - Tuesday, April 25, 2006
VIEW: Why Pakistanis are dying earlier — Syed Mohammad Ali
For the PMDC to become more effective, its scope must be broadened beyond mere registration of doctors and recognition of medical colleges. To this end, it may be necessary for the PMDC to become more representative of the healthcare sector rather than being dominated by government officials
Life expectancy in Pakistan, never impressive, has declined even further. Until recently, an average Pakistani had an estimated lifespan of 63 years. This has now come down to merely 60.
This is not the only bad news concerning the health situation in the country according to the Pakistan Medical Association Annual Report for 2005. Infant and maternal mortality rates also remain unacceptably high. Besides the 80 newborn babies out of every 1,000 who die within the year, 103 children under the age of five are dying annually out of every 1,000. Around 500 out of 100,000 women die during pregnancy due to lack of medical care. According to a report, issued by the East-West Centre two years ago, Pakistan is the only other country in Asia, besides Nepal, where women are not expected to live longer than men.
The low priority given to healthcare in our country becomes evident from another set of statistics. There is only one doctor for 1,900 people in Pakistan. There is just one specialist available for 14,500 people. On average, there is only one nurse to assist eight doctors. There are only 320 hospital beds available for every 100,000 people. Waterborne bacterial infections remain a major cause of death and illness in both children and adults. Despite more than 45 rounds of polio vaccination, new cases are still being reported across Pakistan.
According to official figures, there are 916 hospitals, 552 rural health centres, 906 maternity and child health centres and 5,301 basic health units and 4,600 dispensaries in Pakistan. Leaving aside the issue of how many more facilities in each category are required in view of our population, a majority of the existing facilities are unable to provide adequate care. From recruiting doctors to procuring medicines, corruption and nepotism is pervasive. Instead of addressing the growing concern about substandard medical education, all provincial governments have adopted a rather liberal policy regarding private medical colleges. On top of this, Pakistan lacks a strong regulatory system to deal with cases of medical neglect — be it in the government or private sector healthcare facilities. There is a growing number of spurious and substandard drugs. According to the World Health Organisation, Pakistan is ranked among 13 countries of the world where production of counterfeit medicines is on the rise. Yet the number of drug inspectors across the country to curb the production and supply of counterfeit medicines remains inadequate.
Public health specialists feel that the government needs to increase the health budget 10 times over. The Ministry of Health also needs to rethink how the practice of medicine can be made safer and more patient-centred. In this regard, the scope of work of the Pakistan Medical and Dental Council (PMDC) needs to be broadened to include patient protection so that a culture of accountability for medical negligence can be introduced.
The PMDC is primarily responsible for the establishment of uniform minimum standards of basic and higher qualifications in medicine and dentistry. As such it lacks the authority to deal with cases of medical negligence or take up protection of patient rights. It does not have the power to take punitive or suo motu actions. While the PMDC has finally revised its code of ethics, first developed in 1978, and cancelled the registration of some health professionals on account of medical negligence, the process is very lengthy.
According to the PMDC itself, negligence on the part of medical and dental practitioners represents only the tip of the iceberg. The PMDC lacks authority over the unregulated sector — consisting of physiotherapists, lady health workers and laboratory technicians as well as practitioners of alternative medicine. Due to the lack of an effective check on quality standards, a number of pathology laboratories and private hospitals are in business without proper equipment and facilities.
For the PMDC to become more effective, its scope must be broadened beyond mere registration of doctors and recognition of medical colleges. To this end, it may be necessary for the PMDC to become more representative of the healthcare sector rather than being dominated by government officials.
Unfortunately, the citizens remain largely unaware that patients have rights that can safeguard them against neglect. Most of them are therefore reluctant to come forward and report neglect. Leave alone the patients, even trained lawyers are unable to deal with cases of medical neglect. Some cases of severe negligence have been filed recently due to the efforts of organisations like the Network for Consumer Protection.
The case of Riaz Bibi, for example, who lost her life due to the negligence of a gynaecologist, who left an abdominal sponge in her body, did make its way to the courts. After four and a half years of proceedings and 91 court hearings, a civil judge has ordered the payment of over one million rupees in compensation to her family. An appeal for enhancement has since been filed before the Supreme Court.
To improve the overall health situation in the country, policymakers need to focus on a range of issues. Besides more investment in the sector to address the issue of quantity of available services, it is necessary to revise and update the curricula of medical colleges, curb malpractice, and improve the quality and the availability of essential medicines through more effective regulation. While the rich can still find means to secure access to quality healthcare, illness often leads the poor into crippling indebtedness. To ensure sustainable productivity, it is vital for the government to address these evident healthcare issues.
The author is a development consultant and an international fellow of the Open Society Institutes network. He can be reached at firstname.lastname@example.org