Primary Healthcare and
Speaking at the First Convocation of University of Health Sciences Lahore held on December 18th2015, Punjab Chief Minister Mian Shahbaz Sharif also referred to the excellent primary healthcare in Islamic Republic of Iran and Cuba and wondered why we cannot achieve the same despite the fact that we have much more resources and highly competent healthcare professionals. Pakistani doctors, he said, were second to none when it comes to their professional capabilities. They occupy important positions at medical institutions all over the world where their competence, capabilities are acknowledged and appreciated. He also revealed that he had asked the health department to arrange discussion with a group of experts to discuss this issue and seek input from all the stake holders so that we can improve our healthcare set up.
No one denies the fact that Mian Shahbaz Sharif is one of the most hard working Chief Ministers in Pakistan and the province of Punjab has witnessed enormous development and progress under his leadership. He has undertaken numerous development schemes which are completed in record time because of his personal interest and monitoring. Not only that his government has also escaped any major corruption scandal so far which is indeed commendable. He seemed very serious and immensely moved at the present state of health services and genuinely feels that we need to make some meaningful interventions to improve the present state of affairs in the health sector.
As regards his question as to why we have so far failed to make any impact in healthcare despite resources and competent healthcare professionals, this question has often been asked by the health planners, health officials from time to time while speaking at doctor’s function. The answer is simple. Even the best quality seed won’t grow if the land is not fertile or is not well prepared and watered. Solution to this lies in improving primary healthcare. Unless we concentrate on improvement of primary health care and come up with some referral system, things will never improve.
Majority of the doctors after graduation settle in General Practice or Family Medicine but this specialty was recognized only a few years ago. Even at present not many medical colleges and hospitals have proper teaching and training facilities in General Practice. Those who decide to settle in general practice find it extremely difficult to adjust to the ground realities where they have to face all sort of problems, hindrances which add up to their frustrations. We have a large number of Basic Health Units but their functioning leaves much to be desired. Despite the fact that we have officials like District Health Officers and Director Health Services to monitor them but it has failed to make any difference simply because most of them seldom bother to visit these healthcare facilities. We need to look into the reasons why the services available at these Basic Health Units and Rural Health Centers are not being utilized by the public? Are there any deficiencies, if so they may be rectified? Before posting the doctors, government must make sure that these BHUs have somebasic facilities available for diagnosis and treatment of common diseases. Ensure adequate supply of drugs needed to treat these common diseases and then put in place some referral system whereby those patients who need advance care are referred to Rural Health Centers or nearby Tehsil Hospitals where they are properly entertained. They should then be followed up at the BHUs. Similarly we need to put in place a proper referral system so that only those patients who are referred by these BHUs, Rural Health Centers or other Filter Clinics established in cities come to the Tehsil and District Hospitals and those who still require specialized care are referred to the tertiary healthcare facilities. This will also go a long way in reducing the rush at major hospitals as well as teaching hospitals who will then be able to concentrate on those patients who need specialized care rather than wasting time on looking after common ailments. However, our tragedy is that we have so far even failed to compile and implement Essential Drugs List as recommended by WHO which has been implemented by a large number of countries in the world. But in Pakistan it is the corrupt health bureaucracy and corrupt elements in the medical profession and the Pharma industry that we do not have a Hospital Formulary ensuring availability of cost effective essential drugs at public healthcare facilities till today. How can we make any progress under these circumstances?
While making appointments for these Basic Health Units, these posts should be place specific for a fixed tenure of two to three years before these doctors are transferred to some other place. At present what happens is that in some cases, doctors get themselves appointed against these posts at various BHUs, some visit them a few days in a week only. Some even get leave to get training for specialization thus keep on drawing the pay without providing healthcare at the place where they are supposed to be posted. Those who wish to specialize and go for higher training should not be selected for these posts of Medical Officers which are to work at Basic Health Units and Rural Health Centers. Once these BHUs and RHC’s become fully functional, public should also be educated to avail these facilities rather than going to quacks. Public health education is also extremely important to eliminate the menace of quackery.
Once this link-up and referral system from BHUs to RHCs and Tehsil Hospitals, District Hospitals is completed, it will change the whole scenario of health services. Providing adequate diagnostic and treatment facilities including drugs, electricity, and water supply at these BHUs should also be ensured. Having accomplished that, each medical college should be asked to look after a particular adjacent area which should be their responsibility to supplement the healthcare for those areas. Most of these buildings of BHUs remain underutilized most of the time during the day. Hence some time ago the government had decided to run these BHUs with public-private partnership which is a good idea. This should be -implemented in a phased programme despite opposition and reluctance from the medical profession particularly those who are posted at these BHUs and RHCs. Government has also offered these Medical Offices lucrative package which can be further enhanced if need be depending on their performance. To evaluate their functioning, an effective monitoring system is vital. All this is not impossible if there is a will and determination on the part of the government. Our main focus has to be on primary healthcare, prevention of diseases, communicable diseases, immunization and vaccination and controlling road traffic accidents ensuring road safety. Otherwise we may go on investing billions of rupees on curative services, purchase of equipment and instruments for sate of the art healthcare facilities located in urban areas, it won’t help change the health scenario. Cuba and Islamic Republic of Iran has achieved that through giving importance to primary healthcare and we are capable and can do the same.
Tailpiece: Noting can defeat you, unless you defeat yourself.