The PML-N had promised in its 2013 manifesto to construct one highly specialised hospital in each district of the country.
Sounds strange, on the one hand, the government promises to expand health infrastructure by opening up one highly specialised hospital each in every district of Pakistan and on the other does not increases health budget to translate its promise into action. Health sector spending during 2016-17 remained as little as 0.46 per cent of the GDP, according to the Economic Survey of Pakistan. The world average on health spending is 9.9 per cent of the GDP.
Looking at the last ten years spending pattern one finds a sharp decline from 0.54 per cent in 2006-7 to 0.23 per cent in 2010-11. But from 2014 onward an increase in budget allocation for health sector has been witnessed. Though the health spending has been ascending, it remained below the WHO benchmark of at least 6 per cent of the GDP required to provide essential and life-saving health services.
World Banks’s latest report on Pakistan’s per capita spending revealed that unlike WHO benchmark for low-income countries that are required to spend $86 per capita, Pakistan is spending $36.2.
President Pakistan Medical Association (PMA), Ashraf Nizami, said that Pakistan’s spending on health sector was less than what other neighbouring countries spend. “Afghanistan is annually spending $167 per capita, India spends $182, and Iran spends $267. He added that almost 80 per cent of the budget was spent on salaries and administrative cost and just 20 per cent was left for the masses from which the corrupt mafia was holding reign in hospital, said Nizami, took its share as well.
Today the doctor to population ratio stands at 1 for 997, and hospital bed 1 for 1,584 patients, while national health infrastructure comprises 1,201 hospitals.
General Secretary, PMA, Dr Izhar Chaudhry said the public-sector hospitals were unstaffed and under-resourced. “The world standard demands that there should be four nurses and eight paramedics with one doctor but we have 40 less support staff.”
According to the Economic Survey of Pakistan 2016-17, the government has improved the health infrastructure; however, the healthcare service is plagued by some critical issues like:
- High population growth
- Uneven distribution of professionals
- Deficient workforce
- Insufficient funding and limited access to quality healthcare services.
Pakistan has been ranked 149th among 188 countries in the first global assessment of countries progress report titled “The Global Burden of Disease,” towards the United Nations’ health-related Sustainable Development Goals.
At the federal level, the Ministry of National Health and Services (NHS) regulates and undertakes the central health functions and conducts inter-provincial coordination.
On December 31, 2016, the former Prime Minister of Pakistan Nawaz Sharif launched the Prime Minister Health Programme to ensure medical facilities for families living below the poverty line. The first initiative taken under the scheme came about on January 12, 2017, when the Prime Minister’s Health Card Scheme was introduced to provide financial support to the people earning less than Rs 200 daily. According to the scheme, each cardholder could spend Rs 50,000 for the treatment of common illness such as flu, cough, and hepatitis. For serious diseases like angioplasty, bypass, and dialysis, Rs 300,000 was set-aside for each cardholder. The scheme was launched in Narowal, and a total of 600,000 cards were given out to the poor people. However, until June 2017, only 3,901, cardholder patient contacted private hospitals for treatment.
To the health experts, this mechanism of providing financial support to the poor people fails to leave a mark because of the more significant infrastructural problems that plague Pakistan’s health care system.
In September 2016, the federal government established Health Infrastructure Development Management Company (HIDMC) to expand and facilitate the country’s health sector. Under the programme the company announced the construction of 46 hospitals across Pakistan. The prime minister announced that he wanted this project completed by the end of his tenure that is by 2018. The action was taken in this regard, however, did not match government’s ambitions. The working paper of PC-11 for the preparation of the feasibility, design and other services for 14 hospitals out of 46 in Phase 1 was issued in March 2017. The remaining 32 hospitals were to be completed in Phase 2 and Phase 3.
So far not a single land has been procured to construct the hospital.
Zero allocation in the Public-Sector Development Programme in the financial year 2016-17 indicates that the government would not succeed in completing, not even a single hospital, by 2018.
The website of HIDC, www.hidmc.com.pk is almost dysfunctional. No data beyond December 2016 is available on the site. Not a single explanation is offered about the programme. No contact numbers of those hired for the project neither their name could be found.
Federal Minister for health Sara Afzal Tarar told Truth Tracker that the government was aware of its promise and the mere announcement of the project showed the seriousness of the government. She did not give the timeline and said that much good work had been done in the health sector indicating government’s intention to improve the health sector.
Pakistan Tehreek-e-Insaaf leader, Dr Yaseem Rashid, said that the federal government had been formulating anti-poor policies in the health sector. “Even in Punjab, the PML-N government had diverted its resources allocated for the health sector in the construction of the Orange Train.” She added that instead of providing relief the government had increased medicine prices by 35 per cent.
“Of course, the government has failed to build hospitals in every district of Pakistan. They did announce building 46 hospitals countrywide, but the proposal has yet to see the light of the day,” said Dr Rashid.
Policy Research Institute of Market Economy Executive Director, Ali Salman, said that the present government had so far failed to bring about reforms that it had promised for the health sector before elections. He added that for the improvement of the health sector a focused approach by the government is required. He further said: “Health resources should be allocated on the principle of equity among the rural and poor segments of society.” Talking about hospitals in each district, he said that, “Not that I know anything about any such initiative started by the government.”
The government has failed to keep its promise of building one hospital at least in each district of the country.