Moinuddin Ahmad

Since its inception 76 years ago with a nominal infrastructure base, Pakistan has faced multiple challenges, such as a rapid increase in population, poverty, lack of educational facilities, unequal distribution of resources, and an inefficient healthcare system. Among these, an inefficient health system is very persistent, with enormous consequences affecting every individual in the country. Pakistan’s health system faces multiple challenges, including inadequate financing, restricted infrastructure, brain drain, a lack of emphasis on preventative care, and unequal resource distribution. Pakistan’s healthcare system (PHS) serves over 220 million people throughout both private and governmental sectors, but currently, Pakistan's healthcare spending accounts for just 0.4% of GDP, which is much less than the 6% of the WHO-recommended allotment (GDP allocated to healthcare in low-income nations). Furthermore, low-income groups cannot access basic health care due to the difference in how this funding is distributed between rural and urban areas. Pakistan urgently needs to raise its healthcare budget to improve its facilities and solve the shortage of medical experts.

Pakistan is a developing nation that gained independence on August 14, 1947. It had no health policy at the time. Thus, it was inherited at that time from the British healthcare system. Pakistan’s healthcare system is a complex blend of public and private sectors, grappling with numerous challenges. As of 2021, the country’s population surpassed 225 million, with a gross national income per capita of around $1,506. Spending on healthcare stayed modest, at around $28.3 per person, or roughly 1.4% of GDP. With just 0.8 doctors per 1,000 people, the public sector faces several challenges, such as inadequate facilities and a severe scarcity of healthcare professionals. The unequal distribution of healthcare resources particularly impacts rural populations because they have less access to high-quality treatment. About 70% of people get their healthcare from the private sector, which frequently offers higher-quality therapy at a higher cost, resulting in significant out-of-pocket expenses.

Pakistan's healthcare system has faced several obstacles, including a paucity of qualified personnel and financial resources, inadequate governance, political meddling, and a lack of responsibility for bad performance. The Sehat-Sahulat Program and other recent initiatives aim to protect against catastrophic health expenses and provide universal health coverage (UHC); nonetheless, service delivery and accessibility continue to be significant challenges. In Pakistan, the "health system has been designed by politicians, while health professionals have implemented it on the ground level". The access and stability of the country's rural population to health services is a big challenge "because of a severe shortage of healthcare professionals and inadequate allocation of funds for the Primary Healthcare sector”. Pakistan’s health system is still under stress from the prevalence of avoidable illnesses, which include non-communicable diseases like diabetes and cardiovascular conditions, as well as communicable diseases like malaria and Tuberculosis. A lack of adequate policies hinders progress, and factors like geographic remoteness, cultural traditions, and financial restrictions all contribute to restricted access to healthcare in Pakistan, notably for women, children, marginalised communities, and rural people. Women have limited mobility, and children frequently lack vaccines and preventative care. To provide equitable healthcare access, building infrastructure in distant places, launching community-based activities, and raising awareness are necessary. Pakistani health policies are created by politicians with minimal expertise and executed by health officials. Without the involvement of specialists on the ground, positive answers may not be possible, leading to resource waste. Our country's healthcare policies prioritise curative rather than preventive measures. The Curative Healthcare Programme aims to increase patient services such as labs, ambulances, and sophisticated equipment. In contrast, the Preventive Healthcare Programme seeks to prepare the population for future ailments by promoting mental health. The industrialised countries have prioritised preventative healthcare programs, making them an excellent model.

   Male ward of a public sector hospital. (Source: Global Village Space)

In the healthcare maze, one of the most pressing issues is the brain drain of healthcare professionals. Brain drain refers to the outflow of highly talented people from one country to another, often from a developed country. According to a UNESCO report, Pakistan's highly educated professional migration rate increased by almost 60% between 1992 and 2000. Healthcare is no exception to the global trend of brain drain. Over the past five years, 2.7 million Pakistanis have left the country in search of better job possibilities, according to statistics. A Gallup-Pakistan study found that more than two-thirds of Pakistan's adult population, including physicians, want to travel overseas for better opportunities. The doctors are forced to leave Pakistan due to governmental and healthcare sector failures. Notable among them are those who have issues with the service structure, career advancement, political influence, lack of security, research funding, and low pay compared to overseas rivals. Unlike the West and the USA, where there is higher pay, better quality of life, advanced technology, no political interference, equal work chances, and professional advancement, self-interest is acceptable. Taking required remedial actions before it's too late requires comprehensive government vision and initiatives, as the saying goes, an effective Chinese technique for dealing with Taiwan's brain drain. The present administration may set a good example by reverting to brain gain. Additionally, overseas doctors are encouraged to prioritise improving healthcare in their home country. To improve healthcare facilities and services in Pakistan, everyone, including the government and the doctor community, should engage in constructive discourse.

Although Pakistan's health care system faces significant challenges, some technological and structural transformations highlight its effectiveness during the COVID-19 pandemic. These transformations include Telemedicine, which allows the patient to connect to healthcare professionals through remote platforms like “Marham" and "Sehat Kahani," and public-private partnerships appear as a viable way to close gaps, improve service delivery, and revolutionise the healthcare environment. Collaboration between the public and commercial sectors can bring together a wide range of skills, resources, and viewpoints, resulting in a more robust and effective healthcare system. Also, the Community-based programs in Pakistan promote health equity by lowering mortality and improving treatment through preventative strategies and local resources. Other areas are covered by technological advancements, including electronic health records (EHRs) and health information management systems (HIMS).

Despite these advancements, Pakistan's healthcare system offers potential for improvements. The government can provide the groundwork for equitable healthcare delivery by Promoting Healthcare Funding and spending 6% of GDP, ensuring fair rural-urban distribution, strengthening primary care, implementing preventative healthcare programs to lower the rate of preventable illnesses, enhancing governance and policy frameworks by engaging healthcare professionals in policy-making to guarantee realistic and implementable policies, improving rural healthcare by increasing healthcare infrastructure and deploy skilled personnel in underscored regions, utilizing technological innovations and integration of those advancements, addressing the brain drain crisis by an action like increased wages, career advancement, and improved working conditions, are required to retain brilliant healthcare workers.

Pakistan’s healthcare system is currently under strain, but practical adjustments and stakeholder participation may transform it into a more resilient and inclusive system. In keeping with the philosophy, the future of healthcare in Pakistan lies in harnessing innovations and solving problems via practical, human-centred solutions that cater to its growing and diverse population. Moreover, balanced collaboration among policy-makers, healthcare providers, and technology innovators would be crucial in achieving sustainable and equitable healthcare reforms in Pakistan.

Disclaimer: The views expressed in this article are solely those of the author and do not necessarily reflect the official stance of The Himalayan Research Institute Pakistan (THRIP)