A nation in crisis – A report on the state of healthcare in Pakistan

The Islamic Republic of Pakistan was created in 1947. Since then it has faced domestic political upheavals and regional confrontations. This has had an adverse effect on the health of its population.

Population: 184.7 million (UN, 2010)

Life expectancy: 68 years (men), 68 years (women) (UN)

Let’s put these figures into context; the population of the UK is 61.9 million (UN, 2010), average life expectancy is 80.

The life expectancy of somebody who is born and lives in Pakistan is 15% less than that of somebody living in the UK.

Current healthcare provision

Pakistan does not have a free national health service. Care is provided by government run hospitals that charge a nominal fee, private run specialist hospitals, and very few hospitals run by charitable organisations. Unfortunately government run hospitals are administered by local government rather than central and hence the service provided is substandard. Most of the surveys show that utilization of Government health care services in Pakistan is low. The three most commonly cited reasons are: inaccessible facilities, lack of availability of medicines, and uncooperative staff.

If the average person falls unwell there is no structured pathway to receiving healthcare. His options are:

1. Self medicate – there is no regulation of prescription only medicines and can be bought by the patient without a doctors note.
2. Consult a chemist (dispenser) – who will issue medications.
3. See a doctors assistant – this may just be somebody who has sat with a doctor for a period of time and now feels confident to provide medical treatment.
4. Visit a local but qualified doctor – there is a charge for this which is not regulated and can be unaffordable.
5. Self refer to a government or private hospital – associated with high costs.

These are just some of the options, unfortunately due to the very low income of the average family in Pakistan, seeing a qualified and regulated medical professional is out of their grasp. There is legislation on the accreditation of doctors and nurse. The law requires that all providers for health care be registered with their respective regulatory bodies; however in practice this is rarely implemented. Legislation for accrediting institutions like hospitals and quality assurance mechanisms are absent and there is no licensing mechanism nor is any license or permission required to open or operate a health care institution.

Problems that are occurring due to these options include:

1. High levels of drug and antibiotic resistance.
2. High morbidity and mortality due to misdiagnosis and late diagnosis.
3. High morbidity and mortality due to incorrect treatment.
4. No accountability for errors that lead to morbidity and mortality.

Child health

Population under 5: 15000000
Annual number of under-5 deaths: 460000

Children in Pakistan face a variety of serious challenges ranging from malnutrition and poor access to education and health facilities to exploitation in the form of child labour. One in ten children do not survive their fifth birthday with the majority of deaths due to diarrhoea, pneumonia or vaccine-preventable diseases. Thirty per cent of children are chronically malnourished and lack safe water and household sanitation, especially in rural areas.

Low birth weight affects 25% of babies; over 35% of children under five years are stunted, 10% are underweight and over 50% are anaemic.

Pakistan has the sixth highest burden of tuberculosis in the world with an estimated incidence of 177 cases per 100 000 population per year.

Pakistan is considered a low prevalence but high risk country for HIV/AIDS, especially among injecting drug users.

Written by Dr Adnan Ali Copyright © 2011