Americanization of health services will be a serious threat to healthcare delivery in Pakistan

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Americanization of health services
will be a serious threat to
healthcare delivery in Pakistan
We need to concentrate on improvement of
primary healthcare, strengthening of BHUs,
RHCs Secondary care besides health
education and prevention of diseases

ISLAMABAD: The Government of Pakistan intends to introduce Medical Institutions Act in Pakistan and since health is a provincial subject, it has taken initiatives to introduce and enforce it in the Province of Khyber PK and more recently a bill has also been presented in the Provincial Assembly of Punjab where the MTI Act has been referred to a select committee. There are lot of fears and resentment against this move among the healthcare professionals who are resisting it. The MTI has lot of good points but it needs to be introduced in a phased programme and after taking all the stake holders into confidence. The authorities will be well advised to immediately start holding negotiations and in depth discussions with all those who matter and are likely to be affected and refrain from pushing it through harsh measures. They must remember anything which is good for America cannot be transplanted into Pakistan without taking into account the ground realities. First we need to develop a proper health infrastructure which is extremely essential for the success of any scheme.

United States is no doubt the world’s most wealthy country with a highly materialistic society and still it does not have the best healthcare system. Millions of Americans are not able to access even primary health care. Much smaller and poor countries compared to America i.e. Cuba and Iran has much better health services. The life expectancy in Cuba is much higher than America and it is all because they gave priority to primary health care and prevention of diseases. Same is true in case of Iran and Sri Lanka is yet another success story in the region which has the best primary health care with much less infant and maternal mortality as compared to Pakistan. We need to learn lessons from these counties than looking towards America and American systems of healthcare.

What we need is to strengthen, staff and equip our Basic Health Units, Rural Health Centers, improve services being provided at secondary and tertiary care facilities at Tehsil and District Headquarter Hospitals and then introduce some sort of a referral system so that only serious, complicated, high risk cases are referred, entertained and managed at tertiary care facilities including teaching hospitals. It will also reduce rush at these healthcare facilities and improve health services.

Medical Teaching Institutions initiative can also be undertaken in a phased programme once the health infrastructure is well developed. The government must have some short term and long term plans which should be made and introduced after input from all the stake holders including the professional bodies. Any change of government should not mean change in these policies only then we can make any progress and that is only possible if we take all the stake holders along. People who live abroad are not necessarily abreast of the ground realities in Pakistan and it is also in their own interests that they should refrain from pushing any such agenda without input from the healthcare professionals who are likely to be affected by these initiatives. First try to remove their misgivings, convince them of the benefits of these plans and make necessary changes, amendments if need be to satisfy the healthcare professionals. Any scheme, health plans pushed through force are not going to work but the question remains is the team selected by government to introduce any such reforms competent and capable of delivering.

Let us not forget the fact that those who decided to come back from abroad after completing their postgraduate training and serve their own country despite hostile, uncomfortable environment has contributed a great deal during the last seventy years to improve health services than those who opted to go abroad for greener pastures, enjoyed comfortable working environment, got higher remuneration with all the facilities of life, established their life and got their families settled there. During my numerous visits to United States to attend Association of Pakistani Physicians of North America (APPNA) annual meetings,(I have no contact with them for the last many years) I often heard many of these Pakistanis complaining lack of services, healthcare facilities back home. I always asked them why do not you come back and serve your own country and set things right rather than enjoying life here in United States. Angels won’t come to put these things right. It is our own responsibility and we the Pakistanis have to do it ourselves. And surprisingly not many of these Pakistani physicians settled in North America and Europe are willing to come back and serve their own country. Some of them did come back but had to face the music. Soon they realized how difficult it was to work in Pakistan in the prevailing environment. We defamed them, humiliated them, media and disgruntled politicians launched a character assassination campaign against them hence they preferred to go back than stay here. The case of PKLI chief Prof. Dr. Saeed Akhtar the renowned liver transplant surgeon is a recent example. He was humiliated in an open court by the former Chief Justice of Pakistan, the new provincial and federal governments also joined hand to humiliate and defame him thus successfully destroying the Pakistan Kidney and Liver Transplantation Institute and Research Center at Lahore. Former Chief Minister of Punjab who provided much needed funds to ensure that the PKLI project gets completed before time was also targeted and every effort was made to humiliate him as well.

There is no dearth of competent, qualified people within the country who can suggest, plan and executive any meaningful reforms in health sector and we do not need to bring in any foreign experts to do that. We need indigenous solution to our problems and who can be better qualified to suggest that than those who have been working here and are fully conversant with the ground realities, challenges that need to be tackled. Let us not forget the most meaningful reforms in health sector introduced in early 70s during the PPP Government headed by Mr. Zulfiqar Ali Bhutto were the brain child of no foreign expert but Prof. Naseer Sheikh the then Director General of Health. It was PPP Government which brought in the concept of Basic Health Units and Rural Health Centers. Prof. Naseer Sheikh introduced Drug Registration, started Licensing of the drug manufacturers, and introduced the Drugs Act 1076 to regular the pharmaceutical trade. He also organized the Medical Teachers Convention at Lahore after which 40% doctors were promoted to the next grade among the junior doctors including general cadre doctors, introduced the post of Associate Professors. The PPP Government established new medical colleges at Karachi, Nawabshah and Larkana in Sindh, Faisalabad and Rawalpindi in Punjab. Had the PPP Government remained in office for another two three years, it was expected that they might have introduced many more reforms. Whatever the critics might say, the PPP had initiated these important measures in health sector for which they must get due credit.

During the last ten years now we see a large number of new medical and dental colleges which have been established both in the public and private sector. These colleges can be entrusted with taking care of the primary health care in the districts where they are located and also establish some referral liaison with the BHUs and RHCs in the area. In return the government can give them some facilities and incentives. In future permission to establish new medical and dental colleges should be given in those districts where no such institution is present. Those who wish to set up such institutions in these districts should get some incentives and facilities by the government. Such a scheme is workable and feasible. Government alone cannot afford to take care of the entire population as regards provision of even primary health care, immunization and other preventive measures including health education creating awareness among the public to avail these facilities once they are available.

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