Pakistan’s healthcare concerns

Pakistan Economic Survey 2013-14, while appreciating government initiative to increase total expenditure outlay on health by 29% over the preceding fiscal year, laments the inadequacy of overall healthcare facilities in the following words: ‘However, some specific gaps continued to persist largely on account of demographic, epidemiological and socio-economic factors, leaving large segments of population with inadequate healthcare access. Healthcare facilities at some parts of the country are found to be inadequate and mostly ill-equipped and the coverage also varies across the provinces. The shortage of trained health workers and the rising population pressure on public health institutions has allowed the private sector to bridge the demand/supply gaps.

While a must for the fast developing emergent economies, over-involvement of private sector in health and education sectors allows commercialism to set in. Public institutions in these two sectors should lead from the front treating private sector institutions as their equal partners. The administrative clout should remain with the government to forestall the possibility of commercial interests growing beyond a reasonable limit. Unfortunately, this has not been the case simply because of the successive governments’ peripheral interest in the development of these two vital sectors of economy. The level of government interest can well be measured by the size of expenditure allocations as percent of GDP for these two sectors. From 0.72% of nominal GDP in 2000-01, the allocation for health sector came down to 0.54% in 2009-10. The next three years were the bleakest ones which recorded, on average, a paltry allocation of 0.28%. In 2013-14, the allocation picked up to 0.4%. With this background, the hike in allocation in the last fiscal year would not seem much encouraging.

Extremely low-level allocations for health and inefficient public health institutions can take only peripheral care of the masses of a country that, besides housing a daunting percentage of people below the poverty line, is under constant demographic pressure. Public sector hospitals and clinics, ever busy in nursing elites, have neither time nor resources to offer highly subsidized medical care to the have-nots. No surprise, the majority of the poor resorts to home-made, unauthentic medical recipes. Some of them become the victims of charlatans who guarantee cure of diseases that still remain unconquered by the advanced medical science. Still some are trapped by spurious faith-healers who take advantage of the naivety of poor, uneducated people. The majority embraces death or life-time incapacity by surrendering to the Will of God. That is when faith turns out to be the biggest healer.

The silver lining in dark clouds is that a number of private medical institutions, financed by the invisible hands of philanthropists, are working day and night to provide whatever relief they can provide to the people subsisting below the poverty line. But these institutions have their own limitations in the face of sprawling cities and mounting terrorist activities.