Provision of Universal Health Coverage to the population is our priority-Dr. Zafar Mirza


Patient Safety and Friendly Healthcare Facilities concept will be promoted
Provision of Universal Health Coverage to the
population is our priority-Dr. Zafar Mirza
218 Health Packages being developed will
take care of 90% of the diseases

KARACHI: Dr. Zafar Mirza Advisor to the Prime Minister on Health was one of the invited guest speakers at the second plenary session of ICON 2020 organized by Indus Hospital Karachi from January 17-19, 2020. The topic of his presentation was “National Vision to achieve Universal Health Coverage”.

In his introductory remarks he commended the services being rendered by Indus Health Network and also called Prof. Abdul Bari Khan as the Edhi of Healthcare in Pakistan. During all these years, he said, we have miserably failed to provide proper healthcare to our population for various reasons. However, some people rise above self and work for the greater good of the community. It is a pleasure to know the contributions of Indus Hospital and its Health Network in providing healthcare to the community. What they are doing is unprecedented in Pakistan. There are many people who keep on contributing silently and they also achieve excellence. Some of the crisis we are facing in the field of health is manmade. Some of these diseases are preventable if someone is held responsible and they should be answerable.

Dr. Zafar Mirza advisor to the Prime Minister on Health, Ms. Saira Khowaja from Indus
Hospital, Mr. Mohammad Arshad from Sehat Sahulat Programme
and Dr. Saima
Saeed speaking at the Plenary Session during the ICON 2020 held recently.

Continuing Dr. Zafar Mirza said that we have very high prevalence of Hepatitis-C. We are still confronted with TB, Polio could not be eradicated and Pakistan is one of the two countries still struggling with this. We have high maternal mortality, infant and neonatal mortality. We use almost 95% un-necessary injections. We are also faced with population explosion with 2.5% annual growth and we have the highest fertility rate in Asia i.e. 3.6%. In next thirty years, our population will almost double if we did not control this population explosion. Universal Health Coverage is the answer to all these problems. If someone is suffering with an infectious diseases, no one is safe and protected. They are endangering the whole society.

Giving details of the proposed National Vision of Universal Health Coverage Dr. Zafar Mirza said that it ensures that everybody gets health care as per their needs. It is a mixture of public and private healthcare system. At present majority of the public is served by private sector. Cost of healthcare is going up in private sector. Those who cannot pay, State will takes care of them. We will improve quality of care. We are going to provide much more resources and we will have to take some tough decisions to provide more funding. Health Care Managers and Policy makers are confident that with tough measures we will succeed. We will have to define our priorities in health sector and we intend to prepare packages for essential health services. These includes 218 health care packages which will take care of almost 90% of the diseases. At the community level we will use Lady Health Workers. Primary health care will be available at all the Basic Health Units, Rural Health Centers and all dispensaries. The First level will be Tehsil and Taulka/District Hospitals which will provide secondary care. Then we will have tertiary care hospitals. We will go for cost effective interventions.

Almost 70% of these 218 essential services can be provided at secondary level. We can do it at primary health care level if it works. The remaining 30-40% will be then divided at four levels. Most of these will be divided at population level and it will include preventive, promotive, curative and rehabilitation. We cannot improve our public health indicators by spending on major hospitals. Sri Lanka and Iran has achieved excellent primary health care with proper planning. Common diseases should be treated in BHU level. When the elite takes the decisions in health sector, primary health care is the first casualty. We will have a National Policy of Essential Health Services. We are going to launch this scheme in Paksitan shortly and we will have a pilot project in Islamabad which will have a model health system. About 6.8 Million poor families will be covered by Health Insurance through Health Cards. All vulnerable groups will get Sehat Cards. Government has also allocated one hundred Billion rupees for Youth and the recipients will include 50% young women. We are going to promote the concept of Patient Safety and Friendly Healthcare Facilities. It is high time that we work for the society and if we fail to do so, we will not be remembered with good words, he concluded.

Ms. Saira Khowaja from Indus Hospital was the next speaker who shared the details of Primary Healthcare Programme at Indus Hospital- an integrated approach to PHC through Family Medicine. She discussed in detail the provision of maternal and child health services, community empowerment, raising awareness, promoting the concept of Psychosocial support besides Youth engagement.

She then referred to the Kiran Sitara programme which is related to young girls. In this, she said, we educate these girls. For this we work with schools and education department. It is a volunteer based programme and community activation. This is a container based facility. We have mobile vans, organize medical camps. We interact with about five thousand people in the community every month. This facility consist of a clinic, pharmacy, laboratory, immunization, treatment for TB and facility of X-ray, BCG vaccination, treatment and screening for TB, HCV, mental health, community midwifery, empowerment of women and creating awareness about diseases through health education. We have a Mobile Boat Clinic in Rajan Pur area in South Punjab. HCV screening is done at primary healthcare sites. We provide treatment facilities for depression and anxiety under mental health services. We make sure that the medication being provided to the patients are also properly used. So far we have involved one hundred forty community mental health workers and 84,186 patients were screened for depression and anxiety. We have also conducted two hundred sessions for mental health.

We also provide facilities of early safe infant circumcision. We have a Club Foot treatment programme, management of disability in children and we have established four Physical Rehabilitation Centers at Karachi, Lahore, and Muzzafar Abad. We have set up four regional blood centers and are also involved in better crop programme including provision of veterinary services. Emergency services are also being provided in the community. We have got encouraging feedback regarding empowerment of women. The number of deliveries taking place at healthcare facilities has increased. We aim at providing quality healthcare services with respect and dignity to the people. Our network includes twelve hospitals, four regional blood centers and four rehabilitation centers.

Mr. Mohammad Arshad from Sehat Sahulat Programme was the next speaker. He pointed out that they intend to cover 110 million people through local funding and State Life Insurance Corporation. We are utilizing the services of over three hundred private hospitals and the patient satisfaction level is 96%. Universal health coverage is our destination. We have supply side crisis, challenges as regards cost and quality of service which we wish to provide. We are facing challenges as regards human resource as well as technology challenges. He was of the view that we need to adopt a guarded approach. Participation of the private sector in this programme is essential.

Internal Medicine Session

In this session Dr. Taj Saber spoke about Pregnancy and Rheumatic Diseases. She pointed out that in rheumatic diseases all pregnancies are complicated. Fertility and pregnancy is rarely reduced by rheumatic diseases. Chlorophosphomide effects are disease and dose related. Pregnancy is not advisable in SLE. Pregnancy is contra indicted in certain conditions like advance heart failure and advance renal insufficiency. It is advisable to review the situation at the time of conception to have a favorable outcome. Treat hypertension. Compatibility of drugs with pregnancy and breast feeding was also discussed. She laid emphasis on planned pregnancy, careful monitoring, coordinated management to ensure successful outcome of pregnancy.

Dr. Mughees Sheerani was the next speaker who talked about seizures in pregnancy. He pointed out that two unprovoked or even one episode of seizure could be epilepsy. Sometimes the treatment has to be continued for two years and in some cases it is lifelong treatment. Just one episode of seizure can also be an epilepsy. If the seizure persists for more than five minutes it is considered status epileptics. He then talked about focal and generalized seizures. Surgery is also possible in case of focal seizures. Now more and more anti-epileptic drugs are being introduced. Many of these drugs, he said, are also used for pain management. He then referred to the first, second, third generation of anti-epilepsy drugs. As per studies 0.5% of pregnant women suffer from epilepsy and it is not a contra indication for pregnancy. Secondary epilepsy is more dangerous. Any lesion in brain can result in seizure. He then also discussed various causes of seizures in detail and also mentioned about tuberculoma which is quite common. CT MRI he said, is safe during first trimester of pregnancy. Seizure control should be better before pregnancy and it should remain so. Pre partum risk of seizures is higher and poor control is associated with worst outcome. There could be sudden unexplained death in epilepsy.

Poor compliance with drug therapy, lack of sleep can make the situation worse. Seizures do not cause any brain damage. He then talked about the teratogenicity risk of anti-epilepsy drugs and management near delivery. At the time of delivery these patients are taking extra dose of drugs. Women suffering from epilepsy should be encouraged to breast feed their babies. Those patients taking valproate, Lamotrigine should not breast feed. He emphasized on pre pregnancy counselling and use of folic acid. For management of epilepsy monotherapy should be preferred. If seizures are not altered, these patients can have pregnancy. They should also get Vitamin K. Oral contraceptives and anti-epilepsy drugs are safe and they can be taken at the same time, he added.

Diabetes and Pregnancy

Dr. Musarrat Riaz from BIDE was the next speaker who talked about diabetes and pregnancy. She pointed out that almost 84% of hyperglycemia are due to Gestational Diabetes Mellitus. One in sixteen live births suffer some form of hyperglycemia. There are about 21 million pregnancies with hyperglycemia of which just 3-4 million are detected and treated. It is related with poor outcome. Spontaneous abortion is very common if diabetes is not well controlled and even intra uterine death could occur. Its prevalence is about 3.3-8% but it may be even more. She opined that every pregnant women should be screened for diabetes. Most of them are not aware that they are suffering from diabetes. They should be screened at 24-28 weeks of gestation. One should do early screening on first antenatal visit. Big baby at 34 weeks gestation indicates diabetes. Post natal follow up, planned pregnancy are important. Insulin should be the drug of first choice in pregnancy. Patient safety remains the first priority. Use of Statins, ACEIs and ARBs are not indicated. Metformin and Insulin are good combination, Glibenclamide can also be used. There is no different among various insulin’s except the cost. One needs to increase the dose as the pregnancy advances. One also has to be careful as regards renal problems and retinopathy in these patients, she added.