Pakistan People’s Party (PPP), in its manifesto for Election 2013, had promised that it would increase the state’s pending on health to 5 percent of the consolidated government spending by the end of next term (the tenure of the federal and provincial governments will be over before May 20160.
In Election 2013, the PPP lost against PML-N and joined opposition benches in National Assembly. Still, it bagged enough provincial assembly’s seats in Sindh and formed the provincial government. Health sector is a provincial subject and the PPP can apply and fulfil its promises in Sindh.
Health has been low on the priority list of Pakistan governments. The federal budget for health has always hovered around one to two per cent of the total budget. The trend continued even after the 18th Amendment as health became the provincial subject. None of the provincial governments paid serious attention to the health sector or tried to increase the budget closer to the national requirement. The situation in Sindh is precarious.
Some of the major diseases, such as hepatitis and AIDS are still inflicting the people in Sindh. There are 3 million hepatitis patients in Sindh, of which 2.5 per cent have hepatitis B while 4.9 per cent suffer from hepatitis C. In Pakistan, 0.12 million people die of hepatitis in every year.
Experts believe that the steady increase in hepatitis in Sindh is caused by the lack of awareness among the masses about the disease and the inability of the government to spend on preventive measures.
Dr. Nadeem Anwar from Liaquat University of Medical and Health Sciences Jamshoro Sindh told Truth Tracker that if the government provides clean drinking water and spends on creating awareness about personal hygiene the incidents of hepatitis could decrease tremendously. The same, he said, is the case with AIDS.
Approximately 1329 cases of HIV/AIDS have been registered in 2016 in Sindh. Larkana takes the lead with 656 patients followed by Kamber Shahdadkot district with 189 and Khairpur Mir with 120 patients. Persistent negligence in the usage of unscreened and unsafe blood in transfusion remains one of the primary reasons behind the prevalence of AIDS. In 2015 Hospital Blood Transfusion Committees were formed in every hospital, but they are no longer active.
Another health issue facing Sindh is malnutrition.
According to the National Nutrition Survey conducted in 2011, the Global Acute Malnutrition rate in the province of Sindh was 17.5 per cent, and the Severely Acute Malnutrition rate was 6.6 per cent. The Chronic Malnutrition rate, which can cause stunting, was 49.8 per cent.
The World Health Organisation (WHO) guidelines say that if the Global Acute Malnutrition rate among women and children is above 15 per cent, it will be considered hitting emergency. In Tharparkar region, the Global Acute Malnutrition rate is higher, at 22.7 per cent, and the Chronic Nutrition is at 45.0 per cent.
There is evidence of a substantial increase in the health budget, but the situation on the ground remains unstable. Following is the snapshot of the budget allocated by the Sindh government since 2013.
Health Budget of Sindh
To find out if the Sindh government has been able to meet its promise of increasing the health budget for Sindh, Khurshid Shah, the leader of the opposition in the National Assembly, was asked who in turn came down hard on his government. He said that the condition of hospitals in Sindh was pathetic. Talking about his own constituency Kandhra in Sukkur, Sindh, he said only three doctors were hired against 16 posts that meant 13 posts were lying vacant. Similarly told Shah that many Basic Health Units in Sukkur were closed down due to the shortage of doctors. “This is the general situation in the entire Sindh, as people, mostly poor are deprived of health facilities,” said Shah.
Khurram Sher Zaman, Pakistan Tahreek-e-Insaf, leader, and a member of Sindh Assembly told Truth Tracker that the Sindh government lacked the will to provide basic health facilities to its people. “Most of the incubators and ventilators of Jinnah Hospitals are not functioning.” Recalling the terrible incident of the AIDS springing up in Sindh in October 2016, due to infected blood transfusion during dialysis, he said: “The incident was enough to expose the bad performance of the Sindh government in the health sector,” Zaman said.
Zaman said that it was not budgetary constraints that had kept the government from performing in the health sector; it was, he stressed the embezzlement of funds that had played havoc.
According to a government official, who does not want his name revealed, out of 204 patients treated every day in the Chandki Hospital in Larkana, Sindh, 54 have been tested HIV positive in October 2016. The labs as told by the official were supplying unscreened blood to the hospital. The investigation of the outbreak of AIDS led to the scrutiny of the blood banks and consequently 25 blood banks in Larkana and Shahdadkot were sealed.
Zaman blamed both the hospitals and the labs for malpractices. “It was the responsibility of the hospital to make sure that the blood they had been receiving was screened.” He further said that since most of the patients visiting the hospitals were uneducated; they would not have even known, said Zaman, about infected blood or whether blood should have been screened or not. “Therefore the government has committed double sin. One, by neglecting its duty to make sure that the hospitals and other health facilities such as the blood banks had been working at the optimal level and two by keeping the patients in the dark especially when they depended on the expertise of the doctors in the hospital,” Zaman lamented.
When asked as to why physicians and the administrative staff of the hospitals could indulge in such criminal activities. Zaman said, “In Sindh hiring in government department is used as a tool to extract political benefits, and health department is no exception…”
The former Executive District Officer Health, Dr. Abdur Shakoor Abbassi, confirmed Zaman’s allegations. He added that approximately six to seven thousand posts for the doctors were lying vacant in Sindh and spite of Chief Minister Sindh Murad Ali Shah’s order, he said, doctors aren’t being hired on the vacancies. The same was true with the paramedic staff he said. “There is an acute shortage of nurses in the hospitals.”
Nepotism, said Abbassi to Truth Tracker had ruined the health sector. “There is no dearth of the budget, even if the government increases the budget, it will make no difference.” It is the utilization of the budget its proper allocation that matters said Abbassi. “The government has to work on the monitoring system to plug the leakages of the health funds,” Abbassi recommended.
According to MQM, Parliamentary Leader Syed Sardar Ahmad, who had previously served as the Finance Minister Sindh, Rs 49 billion had been released last year for the health department, but the government had so far only spent Rs 32 billion.
Dr. Sana Derwaish, an expert in Family Planning and Maternal Health currently employed by the Sindh government, says that it is not about the budget. Even if the government has not been able to increase the health budget to five per cent, the very fact that the existing funds have not been fully and honestly used, shows that it is the will to improve the health sector that counts.
The Sindh government has not been able to increase the health budget to five percent in Sindh, but it has been adding to the health budget year on year basis. However, in spite of the increase, the overall condition of the health sector remains dismal and the promise has been compromised.